Families covered by private, employer-provided insurance plans are paying higher and higher out-of-pocket costs for the delivery of their newborn, a new study found, despite the reforms enacted by the Affordable Care Act.
The study, published Monday in Health Affairs, looked at insurance claims made by over 650,000 women on employer-sponsored plans across the country who delivered their children at the hospital. The claims covered maternity care before, during, and up to three months after delivery. They were fully adjudicated, according to lead author Michelle Moniz, meaning they had been paid off by the insurance plan, the patient, or some combination of both. While the study didn’t look at women on other types of insurance, Moniz noted that employer-provided plans cover up to 50 per cent of all deliveries performed annually.
In 2008, Moniz and her team found, the average out-of-pocket cost for a delivery was $US3,069 ($4,425). But by 2015, the average had jumped up to $US4,569 ($6,588).
“$US4,500 ($6,488) is not a small amount. Few of my patients have that kind of money readily available for an unexpected healthcare expense,” Moniz, a practicing OB-GYN and researcher at the University of Michigan, told Gizmodo via email. “Moreover, these costs are incurred at a time when patients are already thinking about how they are going to buy a car seat, a crib; how they’ll afford childcare costs.”
Over that same time period, the actual net costs of maternity care haven’t changed by much. And the Affordable Care Act, which mostly came into effect in 2014, banned insurance plans from not covering maternity care at all, as well as mandated that certain preventive services for prenatal patients, such as Pap smears, be covered free of charge. The team also found evidence that the ACA may have lowered out-of-pocket costs somewhat for lower-income patients by outlawing especially shady insurance plans post-2014. But the ACA hasn’t stopped insurers in general from shifting the costs of many services to patients. These shifts have largely come in the form of higher deductibles, meaning that patients have to pay more money upfront into their medical care before the insurer will step in.
The current study doesn’t provide more recent data on the out of pocket costs of maternity care. But given that everyone is paying more for their medical care, it’s likely things have only gotten worse. A survey last February, for instance, found that as many as 45 per cent of working-age adults are now underinsured, with high annual out-of-pocket costs and deductibles. This increase in underinsurance has been highest among people with private, employer-provided plans. And the staggering prices women and their families are being forced to pay for childbirth could be especially harmful to new mums and their newborns.
“I worry that the costs we observed might mean that some patients don’t get recommended maternity services, which can lead to adverse birth outcomes for mum and baby,” Moniz said.
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Some Democratic presidential candidates have highlighted the financial plight faced by many mothers’ high deductibles in calling for a universal, Medicare-for-all system that they and some experts have argued will be more cost-effective and save lives, while still being able to eliminate nearly all forms of cost-sharing, including deductibles.
But at the very least, Moniz hopes that her team’s data will persuade state and federal elected officials to start taking action to restrict or eliminate out-of-pocket costs for maternity care.
“Policies that require insurance plans to cover maternity care ‘at first dollar,’ without patient cost-sharing, would go a long way towards reducing financial burdens on families,” she said. “Such policies might make it easier for all women to get recommended maternity services and help ensure that every baby and every family gets off to the best start.”