Shortly after her two-year-old son’s monster truck birthday party in April, Kaitlyn received an unexpected call from a debt collection agency about an unpaid bill for his birth – over two years later. Since then, Kaitlyn and her husband Luke have had a third child, a daughter who was less than a month old at the time of the call. At the same time, they were going through the hospital bills and realized they needed to come up with over $10,000 to pay off the bills.
It was probably scenarios like this that Republican vice presidential candidate JD Vance had in mind when he said at an event last year that “something has gone terribly wrong with American health care, especially for new mothers” – and expressed a desire to find political solutions to make free births possible.
The story of a family
Kaitlyn and Luke, whose names have been changed to protect their privacy, are both in their early 30s and live on a property in Wilmington, Ohio, with their three children that they plan to manage — chickens, garden and goats. They married in their early 20s. Luke began an electrician’s apprenticeship, which typically takes four to five years; Kaitlyn started in a mission organization. After having children, she worked part-time at a bakery before getting her real estate license. This gave her more flexibility and allowed her to work toward the longer-term goal of managing rental properties, which the couple hopes to use as a sort of mission to help people without housing security. Luke now works full-time as a licensed electrician.
For most of their marriage, their combined income was around $50,000, which meant the $9,000 bill for the birth of their son in 2022 was pretty high. “I handled the financial aid thing,” Kaitlyn says, recalling spending hours in a postnatal fog on paperwork and the required documentation. “I sent all my stuff over… And I thought it was done because I got something (in the mail) that said zero dollars, and I was like, ‘Oh, okay, they must have forgiven it.'”
The bills stopped coming, as did other forms of communication. “They didn’t send an email or anything. They sent it to a collection agency and didn’t tell me,” Kaitlyn told me. “It was really stressful. I have to take care of this one, and now I have another one (bill from the birth of her third child).” She takes a deep breath before adding with a mixture of hope and irony, “It’s OK. It’s great.”
The costs of birth
The average cost of childbirth in the U.S. is $19,000, with $3,000 being the average amount a mother with large group employer insurance pays out of pocket. The day I spoke to Kaitlyn, she opened her mailbox to find a bill for her last birth in March of this year. The total cost was over $40,000; after insurance, she still owed about $7,000.
It’s worth noting that she had “good insurance” through her husband’s employer – and that she had a natural birth. “Easy birth, no epidural, no pain medication, no interventions,” says Kaitlyn.
The cost of giving birth can vary significantly from woman to woman, depending on location and services, potential complications and procedures, and type of insurance. For example, I also had a baby in 2022 in a hospital not far from the one where Kaitlyn gave birth. I also have private insurance through my husband’s work. But unlike Kaitlyn’s uneventful birth, my pregnancy and birth involved complications and a medically necessary induction of labor. However, when I looked at the cost breakdown for this birth, it was significantly lower than Kaitlyn’s:
Billed by provider $12,874.80
Plan Discount -$6,888.80
Allowed by Plan $5,986.00
Paid Plan – $4,986.00
What you pay: $1000 (deductible)
There may be good reasons for these differences, but those of us who receive these bills don’t understand the logic.
In addition, 42% of all births in the United States are covered by Medicaid at no cost to the mother. This is due in part to state expansions of the program, which many pro-lifers have advocated for after Dobbs as a necessary component of support for pregnant women. While I think this support is incredibly important, the benefits cliff and marriage penalty associated with Medicaid mean that lower-income mothers receive free care, while married women like Kaitlyn—whose median income puts them perhaps just above the eligibility threshold—are left to pay thousands of dollars to give birth. In other words, while nearly half of American mothers receive full reimbursement for pregnancy and childbirth costs, the other half are caught in the middle of America’s health care wars, left to guess at what the costs might be. A more universal approach, where all mothers could trust that the cost of perinatal, birth, and newborn care is fair and straightforward, would be ideal, and is not without precedent in American history.
The administrative costs of birth
In addition to the financial burden of giving birth, there are also administrative costs—a “time tax,” as Annie Lowrey calls it. At a recent playdate with her friend, who also recently had her third child, Kaitlyn and another mother held their babies and complained about the time they spend on the phone with hospitals and insurance companies. (To complicate matters, Kaitlyn’s friend has two insurance companies, a primary and a secondary, which helps her husband’s employer save money and reduce the cost of care. But it’s confusing.) Four months after giving birth, this mother still has no clear idea what her bill will be.
This back and forth leads to absurdities that seem like a parody: one representative says one thing, the other contradicts it; suddenly there is urgency, then a call for patience.
“There are so many discrepancies, and what my insurance tells me and what the hospital tells me are two completely different numbers,” Kaitlyn explained.
And this “time burden” comes at a time when baby care is demanding and physical recovery is a priority; time is precious and seems especially scarce. Kaitlyn’s two-year-old son is struggling to adjust to a new baby at home, and it’s a shame that Kaitlyn has to choose between spending 45 minutes on the phone with the insurance company or 45 minutes on the phone with her toddler when the baby is sleeping. When she makes the call, there’s a good chance there will be a loud toddler in the background and a less-than-patient employee on the other end of the line.
Kaitlyn is considering whether it’s worth applying for financial assistance from the hospital. She doesn’t think she’ll qualify for it now that her income has increased. She’s also pretty sure she won’t go to her six-week check-up. “Honestly, I probably won’t because I’m fine,” she says. “I just don’t have the time.”
“Free births”
Although family policymakers disagree about the best approach (you can find differing views on “avoiding births” here and here), one thing is clear: the uncertainty about the costs associated with childbirth causes great stress, and much time and energy is spent trying to understand, manage and pay for these costs.
When Kaitlyn thinks about her recent birth experience, she is grateful. “We just want to raise as many children as the Lord gives us,” she tells me. But her memories of giving birth include intrusive financial stress. She remembers lying in the adjustable hospital bed, her newborn safely delivered, and repeatedly asking hospital staff if they were OK. secure that their insurance would cover an additional night’s stay.
I was so worried about the bill. I thought to myself, “I don’t want to stay longer than I’m supposed to because I’m going to get a huge bill and the insurance isn’t going to cover it.”
Kaitlyn pauses before adding thoughtfully, “That’s not really what you should be worrying about at this point.”
And frankly, Congress wouldn’t have to do much to change that.
Amber Lapp is a research associate at the Institute for Family Studies and co-investigator of the Love and Marriage in Middle America Project, a qualitative research investigation into how white, working-class young adults form families and think about marriage.
