New research published in the journal Obstetrics and Gynecology last week emphasized the extreme financial risk of being pregnant and giving birth in the U.S. “Pregnancy and delivery are associated with increased risk of catastrophic health expenditures in the delivery year,” the researchers wrote, defining catastrophic health expenditures as spending more than 10% of annual family income on out-of-pocket health costs. The costs tended to be most exorbitant for people with low incomes.
To investigate the financial risk involved in pregnancy and birth, researchers at Mount Sinai performed a retrospective, cross-sectional study using U.S. Department of Health and Human Services’ Medical Expenditure Panel Survey data from 2008 to 2016. They compared the medical spending and employment status of 4,056 birth parents with the same records of 7,996 reproductive-aged women who were not pregnant in a given year.
The study found that 9.2% of birth parents experienced catastrophic health expenditures in their delivery years, compared with 6.8% of those who hadn’t delivered children in a given year. With premiums included, those numbers rose to 21.3% and 18.4% respectively. Birth parents with low incomes had the greatest odds of catastrophic health expenditures; 18.8% of families with incomes at less than 138% of the federal poverty level had catastrophic health expenditures in the year they gave birth. That number rose to 29.8% when premiums were included.
“Pregnancy and delivery are critical periods of time with high health care utilization. Our study demonstrates that this health care utilization can be a financial burden for expectant parents,” study author Jessica A. Peterson, MD, maternal-fetal medicine Fellow in Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, said in a press release. “This burden primarily affects those at lower incomes.”
Researchers noted that the risk of significant spending for birth parents did not noticeably decrease with the implementation of the Affordable Care Act (ACA). In fact, birth parents on private insurance had higher risks of catastrophic health expenditures. “Medicaid and public coverage were more protective from high out-of-pocket costs than private insurance, particularly among low-income families,” the researchers said.
The ACA, also known as Obamacare, was signed into law in March 2010. The objective was to provide affordable health insurance for people in the U.S., including coverage for medical, dental, and vision services that they otherwise would not have been able to access. In 2021, 31 million people were enrolled in coverage related to the ACA, making this the highest total on record, according to the Office of Health Policy. The act has faced significant problems over the years, though, including monthly premiums rising significantly. Many agree that the act requires improvement and reform.
The Obstetrics and Gynecology study also found that parents who had just had children were more likely to be unemployed, with 52.6% of birth parents reporting unemployment for at least part of the year compared with 46.6% of the people who hadn’t given birth. This, of course, can then affect insurance coverage. “Given the association between pregnancy, delivery, and catastrophic health expenditure—as well as the protective effects of public insurance—it is imperative that we create policies that not only ensure insurance coverage for pregnant people, but also make it affordable,” Dr. Peterson said.
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