High Childbirth Costs Burden Lower-Income Families with Commercial Insurance

A recent study from Columbia University’s Mailman School of Public Health reveals the substantial financial strain that childbirth costs impose on lower-income families, especially those with commercial insurance. Published in the Milbank Quarterly, the study surveyed 4,453 postpartum individuals across the United States and found that families with commercial insurance face significantly higher financial hardship from childbirth-related expenses. In contrast, Medicaid provides greater financial protection, often sparing lower-income families from out-of-pocket expenses entirely.

Financial Burdens Associated with Childbirth

The study, conducted in six states and New York City, found that more than half of respondents with commercial insurance incurred over $1,000 in out-of-pocket costs for childbirth. Nearly 40% reported concerns about paying their healthcare bills. Among families earning less than $60,000 annually, financial strain was particularly acute: close to half still owed money for childbirth costs, 16% had yet to make any payments, and 20% had medical debt in collections. In contrast, 80% of families with Medicaid-covered births reported no out-of-pocket costs. However, for those with even minor out-of-pocket expenses, some accumulated debt over the year following childbirth.

Policy Proposals to Ease Financial Strain

Medicaid’s ability to protect families from financial hardship during the postpartum period highlights the program’s role in reducing medical debt among low-income families. The researchers, Jamie Daw, PhD, and Heidi Allen, PhD, suggest that eliminating all cost-sharing requirements for pregnant and postpartum individuals under Medicaid and the Children’s Health Insurance Program (CHIP) could further shield vulnerable families. For those on commercial insurance, proposed measures include allowing low-income families to access supplemental Medicaid coverage, exempting certain pregnancy and postpartum services from cost-sharing, and enacting state-level policies to reduce medical debt.

Implications for Early Child Health and Development

Childbirth-related financial demands come at a challenging time for families, who may also face unpaid family leave, childcare expenses, and other new costs. According to Daw, assistant professor of Health Policy and Management at Columbia, policies that improve the affordability of childbirth may also be seen as investments in early childhood health. Families facing high medical debt may struggle to provide essential resources, like healthy food, housing, and childcare. Reducing the cost burden of childbirth, Daw suggests, could help support a healthier start for children by allowing families to direct resources toward their care rather than toward debt repayment.

This study highlights the often-overlooked consequences of high medical costs associated with childbirth in the United States and points to actionable policy solutions to alleviate financial hardship among lower-income families.