It's Time to Ease the Financial and Administrative Costs of Childbirth

Shortly after her two-year-old son’s monster-truck-themed birthday party in April, Kaitlyn received an unexpected call from a collection agency about an unpaid bill for his birth—over two years after the fact. Since that time, Kaitlyn and her husband Luke had a third child, a daughter less than a month old at the time of the call. They were simultaneously sorting through those hospital bills, realizing that they would need to come up with over $10,000 to settle accounts.  

It was presumably 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 in American healthcare, especially for young mothers”—and expressed a desire to find policy solutions to make birth free.  

One Family’s Story

Kaitlyn and Luke, whose names have been changed to protect their privacy, are both in their early 30s and live in Wilmington, Ohio, with their three children on land they hope to homestead—chickens, a garden, and goats. They married in their early 20s. Luke started out in an electrical apprenticeship, which is typically a four-to-five-year process; Kaitlyn started out in a missions organization. After having kids, she worked part-time in a bakery before getting her real estate license. This gave her more flexibility and allowed her to work on the longer-term goal of managing rental properties, which the couple would like to use as a ministry of sorts to help the housing-insecure. Luke now works full-time as a licensed electrician. 

For most of their married life, their joint income has hovered around $50K, which meant that the $9,000 bill for their son’s birth in 2022 was quite hefty. "I did the financial assistance thing,” Kaitlyn says, recalling how she, in a postpartum haze, spent hours on paperwork and the required documentation. “I sent all my stuff over…. And I thought it was taken care of, 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 collections, and they didn’t tell me,” Kaitlyn told me. “It’s been really stressful. I need to deal with that one, and now I’ve got another [bill from the birth of her third child].” She takes a sharp breath before adding with a mix of hope and irony, “It’s fine. It’s great.” 

The Cost of Birth

The average cost of childbirth in the United States is $19,000, with $3000 being the average amount that a mother with large-group employer insurance pays out of pocket. On the day that I spoke with Kaitlyn, she opened the mailbox to find a bill for her most recent 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 this is with “good insurance” through her husband’s employer—and that she had a natural birth. “Easy delivery, no epidural, no pain meds, no interventions,” Kaitlyn says. 

The price tag for childbirth can vary considerably woman-to-woman, depending on location and services, possible complications and interventions, 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, too, have private insurance through my husband’s work. But unlike Kaitlyn’s low-key delivery, my pregnancy and delivery were fraught with complications and a medically-necessary induction. Yet when I reviewed my claim cost breakdown for that birth, it was remarkably less than Kaitlyn’s: 

Billed by provider $12,874.80

Plan discount -$6,888.80

Allowed by plan $5,986.00

Plan paid -$4,986.00

What you pay $1000 (copay)

Perhaps there are good reasons for the differences, but the logic is lost on those of us who receive these bills. 

Additionally, 42% of all births in the U.S. are covered by Medicaid at no cost to the mother. This is due in part to state expansions of the program, something many pro-lifers advocated for after Dobbs as one necessary component of support for pregnant women. While I think this support is incredibly important, the benefits cliff and marriage penalty associated with Medicaid means that a mother with a lower income gets free care, while married women like Kaitlyn—whose moderate income may put them just above the eligibility threshold—might pay thousands of dollars to give birth. In other words, while close to half of American mothers are able to get pregnancy and birth-related costs totally covered, the other half is caught in the middle of America’s healthcare wars, left guessing at possible costs. A more universal approach in which all mothers could count on perinatal, childbirth, and neonatal healthcare costs to be fair and straightforward would be ideal, and not without precedent in American history. 

The Administrative Cost of Birth                                  

Beyond the financial burden of birth, there is an administrative cost—a “time tax,” as Annie Lowrey puts it. At a recent play date with her friend who also recently had her third child, Kaitlyn and another mom held their babies, as they commiserated about the time they spend on the phone with hospitals and insurance companies. (To make matters more complicated, Kaitlyn’s friend uses two insurance companies, a primary one and a secondary payer, which helps her husband’s employer save money and lower the cost of care. But it’s confusing.) Four months after birth, this mom still doesn’t have a good sense of what her bill will be. 

This runaround leads to the kind of absurdities that seem like a spoof; one representative saying one thing, the other contradicting; sudden urgency, then urging 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 tax” comes at a moment when baby care is demanding and physical recovery a priority; time is precious and feels especially scarce. Kaitlyn’s two-year-old son has been struggling with the transition to a new baby at home, and it’s a shame that if the baby is napping, Kaitlyn must choose between spending 45 minutes on the phone with insurance or 45 minutes with her toddler. If she makes the phone call, there’s a good chance there will be a noisy toddler in the background and a less-than-patient representative on the other end of the line. 

Kaitlyn is weighing whether it’s worth the time it will take to apply for hospital financial assistance; she doesn’t think they will qualify now that their income has increased. She’s also pretty sure that she will not be going to her six-week follow-up visit. “Honestly, I’m probably not going to because I feel okay,” she says. “I just don’t have time.” 

"Make Birth Free"

While family policy experts have their disagreements about the best approach (see here and here for differing perspectives on “make-birth-free”), one thing is clear: there is a lot of stress caused by uncertainty about childbirth-related bills, and a lot of time and energy spent trying to understand, adjust, and pay them. 

When Kaitlyn thinks about her most recent birth experience, she is grateful. “We just want to raise as many kids as the Lord gives us,” she tells me. But her memories of birth include  intrusive financial stress. She recalls lying in the adjustable hospital bed, her newborn safely delivered, and repeatedly asking hospital staff if they were sure that her insurance would cover another night’s stay. 

I was so worried because of the bill. I was like, ‘I don’t want to stay longer than I’m supposed to because then I’m going to get a huge bill and insurance isn’t going to cover that.

Kaitlyn pauses before adding reflectively, “Which is not really what you should be worrying about at that time.” 

And honestly, it would not take a lot for Congress to change that.

Amber Lapp is a Research Fellow at the Institute for Family Studies and co-investigator of the Love and Marriage in Middle America Project, a qualitative research inquiry into how white, working-class young adults form families and think about marriage.