Billed At Birth: Maternal Healthcare

This Valentine’s Day, we’re showing some love for moms and other folks who have given birth by talking about one of the most important but least-discussed aspects of our current healthcare system: maternal healthcare. We’ll be sharing your stories about the good, the bad, and the ridiculously expensive, celebrating resilience, and getting fired up to change what it looks like to have a baby in this country! Since neither Ben nor Gillian have given birth, we brought in a Momspert: our guest is Claire in Kansas City, a Registered Dietician and mother of two.

Disclaimer: We’re calling this “maternal” healthcare because that’s the term the majority of our listeners will recognize, but we recognize that not everyone who has a uterus is a woman, and not everyone who gives birth is a mom. Trans-men and non-binary folks have babies, and they can face even more challenging obstacles to accessing pre-natal and birthing care because they are already working with an extra layer of misunderstanding and discrimination.


Show Notes

BIRTH STORIES

We asked our members for stories about giving birth in America, and our good friend Rebecca Wood, a long-time single payer activist, shared this with us:

I went to the emergency room. My blood pressure was 190/110. I was diagnosed with severe preeclampsia and hospitalized. I spent the next few days sitting in the dark (light made my brutal headache worse) while daily bloodwork documented my slow deterioration. Meds were given. The peri-natalogist explained to me we were defusing a bomb. We needed to keep me pregnant until the very last minute I could to where it wouldn’t harm me or the baby. I would be hospitalized until I had my baby. It could be days or, hopefully, it would be a month or so. After a few days, on Wednesday, the OB-GYN explained to me that I wasn’t crashing fast enough for insurance to want to pay for me to be hospitalized and that I would have to go home on Friday. Horrified, I asked the peri-natalogist about it. She said that she had done this dance with preeclampsia hundreds of times and there was no way it was safe for me to be home. But, my OB-GYN insisted insurance said that I had to go home. Thursday night, my kidneys failed. … It was very clear now that I only had a matter of days until I delivered. I got to stay hospitalized.I think about how lucky I was my kidneys failed when they did. Otherwise, I would have gone home for the weekend.  By Monday, Charlie and I were both dying because I developed HELLP syndrome over the weekend. On the Friday my kidneys failed, when it was clear Charlie was coming in a matter of days, I got a NICU consult. During the NICU consult, a neonatalogist came in my room, handed me a piece of paper with Charlie survival odds based on gestational age and weight. He asked if I had any questions. I had none because, it was all so surreal and overwhelming, I had no idea what to ask. The whole visit lasted two minutes and I was charge close to $400. My insurance wouldn’t pay it because it wasn’t my doctor. Charlie’s insurance wouldn’t pay it because she wasn’t born yet. I think about all this a lot and it angers me. I think about how I was in the nation’s capital and this was considered “good” health care with “good” insurance and I’m furious. If this is what it was like for me, what chance do mothers with lesser privilege have? 

Throughout the 20th century, maternal mortality rates have dropped rapidly due to improved living conditions, safer surgical procedures, etc. But in the late 1990s, the maternal mortality ratio (maternal deaths per 100,000 births) began to rise again.

In 2018, U.S. maternal mortality ratio = 17.4 per 100k births, highest in any comparable “developed” country. Of course, in countries with national healthcare, those numbers are far lower:

  • Canada: 8.6
  • UK: 6.5
  • Norway, the Netherlands, New Zealand: all under 3

As far back as we have data, a drastic disparity in maternal mortality has existed between Black mothers and white mothers, and it has gotten worse with time – since 70s, Black mothers have been 3-4 times more likely to die than white mothers. In 2018, maternal mortality for Black mothers was 37.1/100k births versus 14.1 for white mothers.

Similar disparities among other racial/ethnic groups – for Native American women, maternal mortality is 29.7 

These disparities persist even among Black mothers even when you control for factors like income, college education, and insurance status. Single Payer healthcare would not eliminate all the layers of racism, inequity and bias that lead to these disparities, but it’s a piece of the puzzle.

  • Access to home care/postpartum care after delivery varies widely in the U.S., but is guaranteed in other countries. Federal law requires that Medicaid cover mothers for 60 days postpartum, but after that it may only be available through special pathways, and not at all in non-expansion states. This is significant because data shows that 52% of all maternal deaths occur postpartum. 
  • Studies based on OECD data show that the U.S. has an overall shortage of maternity care providers (midwifes and OBGYNs) compared to other developed countries.
  • Unlike other high-income countries, the U.S. does not guarantee paid leave after childbirth

Claire shares the story of the birth of her second child, when she had new insurance in a new state. Trying to be a good healthcare “consumer” she even called around to all the hospitals to ask about costs to give birth. She ended up being billed for everything throughout the pregnancy, including basic preventative bloodwork. She had to call the doctor, the lab and the insurance company to find out why she was being billed, and she finally learned that the Trump Administration changed the definition of preventative care, and this routine bloodwork was no longer considered preventative, so she got billed. She also paid $300 a month for injections to prevent premature labor, not covered by her insurance.

After the baby was born in February, they got one bill for Claire’s care, and a separate bill for room and board for her newborn daughter. A tiny baby who slept in her room and only ate breastmilk! The internet is full of similar stories from new parents who received ridiculous charges, like this one for $39.95 to hold the baby after he was born.

Viral 2016 Reddit post made the rounds: mother charged $39.35 for “skin to skin after c-sec(tion)”

The 2019 story of Lauren Bard adds another twist – how your EMPLOYER can screw you over with the costs of childbirth. Lauren’s daughter was born 3 months prematurely, and when she got home she got a bill that ended “AMOUNT DUE: $898,984.57

Lauren’s employer, like most employers, requires you to enroll your newborn in your insurance plan within 31 days of birth for childbirth to be covered. Lauren wasn’t aware of the requirement, had  and spent much of those 31 days in the emergency room for her own complications from childbirth, and also in the NICU where her daughter was given a 50/50 chance to survive and was there for over 100 days. Only a week after missing that 31 day window did the hospital alert her that her $1 million bill was not being covered.

Here’s the kicker: Lauren is an emergency room nurse, and her employer who refused to cover her baby’s care was Dignity Health, the 5th largest healthcare system in the country! After multiple internal appeals, they still refused to cover her care. 

Only when ProPublica began writing a story on the situation, did Dignity Health agree to cover her – alerted by their “media team.” 

POLICY SOLUTIONS

Of course, the ultimate solution is a Medicare for All program that covers all pregnancies, births and postpartum care. Everybody in, nobody out, literally from cradle to grave. Until we get there, here are a couple of potential solutions that would bring some justice into birthing care:

  • The Black Maternal Health Caucus’Momnibus” bill (initially introduced in March 2020, re-introduced 2021) is focused on addressing the racial inequities in maternal health. This bill has bipartisan support and has a chance of passing. So far the caucus has passed one of their proposed 12 pieces of legislation, the Protecting Moms who Served Act. 

Follow and Support the Pod!

You can listen to Medicare for All on Apple PodcastsGoogle Podcasts, or visit our website here.

Please donate to the Healthcare-NOW Education Fund to support the podcast!

Resources:

Episode of America Dissected where Rep. Lauren Underwood discusses the “Momnibus” bill and the Black Maternal Health Caucus

US: Include Maternal Health in Climate Change Action | Human Rights Watch 

Medicaid Postpartum Coverage Extension Tracker | KFF.

Maternal Mortality Maternity Care US Compared 10 Other Countries | Commonwealth Fund

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