Conor here: As the following piece notes, of the roughly 100 million Americans in healthcare debt, 12 percent attribute at least some of it to pregnancy or childbirth. And the family at the center of the story decided theirs was large enough at three. Elsewhere, we have further downward revisions of the US population forecast:
Oops… pic.twitter.com/RxRCQU8K9q
— Aziz Sunderji (@AzizSunderji) May 10, 2024
By Noam N. Levey, a senior correspondent at KFF Health News. He previously spent 17 years at the Los Angeles Times, the last 12 as the paper’s national health care reporter based in Washington, D.C. Originally published at KFF Health News.
Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.
The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare’s blood pressure spiked, and the baby’s heart rate dropped. “It was terrifying,” Crivilare said.
She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.
The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.
“It really felt like a full-time job some days,” Crivilare recalled. “Getting the baby down to sleep and then getting on the phone. I’d set up one payment plan, and then a new bill would come that afternoon. And I’d have to set up another one.”
Crivilare’s pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.
About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll.
These people are more likely to report they’ve had to take on extra work, change their living situation, or make other sacrifices.
Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven’t given birth recently, other KFF research conducted for this project found.
“You feel bad for the patient because you know that they want the best for their pregnancy,” said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.
“So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life,” Attwood said. “They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus.”
Best-Laid Plans
Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.
The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.
And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.
Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.
“I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield … ‘I’m never going to financially recover from this,’” she said. “‘But I want my baby to be OK.’”
For weeks, Crivilare remained in the hospital alone as covid protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, “the scariest month of my life.”
Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. “We were incredibly lucky,” Crivilare said.
When she and Rita finally came home, a stack of medical bills awaited. One was already past due.
Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.
“It was a blur of just being on the phone constantly with all the different people collecting money,” she recalled. “That was a nightmare.”
Big Bills, Big Consequences
The Crivilares’ bills weren’t unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren’t covered by insurance, researchers at the University of Michigan found.
Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.
“This forces very difficult trade-offs for families,” said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. “Even though they have insurance, they still have these very high bills.”
Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.
About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.
About half have put off buying a home or delayed their own or their children’s education.
These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.
In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. “We want … healthy children, and that starts with healthy mothers,” Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.
Tough Lessons
For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.
“No one is in the right frame of mind to deal with that when they have a new baby,” she said, noting that college graduates get such a break. “When I graduated with my college degree, it was like: ‘Hey, new adult, it’s going to take you six months to kind of figure out your life, so we’ll give you this six-month grace period before your student loans kick in and you can get a job.’”
Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare’s side job selling resources for teachers online.
But they are now back in debt, after Rita’s recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.
Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.
“It’s not for us to have another child,” she said. “I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her.”
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Nice choice of example, they used a couple who did everything right according to our archaic Rube Goldberg of a vampiric insurance and corporate health “care” system, not to mention housing system, and still got hit with bills their expensive insurance didn’t want to pay. (There is no mention in the article, but I also have to wonder if the hospital and the doctors practices were owned by private equity, the sheer greed of which can only make this situation worse.)
It isn’t entirely fair as much of this was in place for decades, but still one can only say:
Thanks Obama!!!
It’s a remarkably wondrous achievement by our political elite to have managed to conduct a presidential election where healthcare is taken completely off the table as an issue.
No politician is even faking to bother with a proposal!!!
When I saw the title I was expecting tens of thousands or even hundreds of thousands of dollars of debt. [Inflation adjusted] the amount alluded to would have been easily affordable for a middle class family from the 1960s-90s.
As much as Obamacare made things worse, the bigger problem is the continual decline in real wages and living conditions for 90 percent of the population
I’ll bet student loans are a multiplier for them (and others).
This sort of thing is so utterly normalized now as to barely be worth a story, except to tell outsiders what we Americans deal with.
My wife and I rolled the dice by changing plans to switch to a high deductible plan because her employers throws in some HSA money that we wanted to use to help pay for some dental work my wife needed, and maybe chip away at the payments for my daughters braces.
Well, a pair of annual eye appointments for each kid…bang 400 each, plus another 200 for a separate sick visit. We’re 1000 in the whole before we got a couple months into 2024.
So much for the HSA high deductible plan helping us out!
My HSA is supposed to allow me to set aside $4150 to cover out of pocket expenses. The HDHP it’s paired with promises that my max out of pocket expenses would be $2500, so I could save the rest towards retirement health expenses.
Of course, that does not include the over-$2000 in uncovered dental expenses. I have begged my employer to set up a limited FSA (they’d save money not matching my SS and Medicare! But, no.) to help me cover the expenses with pre-tax money, but they have not.
So I am likely to end the year with nothing saved towards retiree healthcare costs. At least I paid $.60 on the dollar for the out-of-pocket ripoffs.
Not being American, I was interested to read this, especially since this allegedly “third world” country has mostly free health care for those who don’t want private hospitals.
I wonder if in the future, that the working definition of being in the upper classes and the lower classes will be those that can afford to pay their medical bills – and those that cannot. Maybe under that scenario there will be a sort of black market medical service operating. The “doctors” may not have actual medical certificates and the nurses will be of a pragmatic nature while the drugs will be of an unofficial nature but for too many people, it will be the only thing on offer. Lots of injuries, illnesses and deliveries can be treated on the local level without racking up a $10,000 medical bill nor will they charge a woman $40 for getting to hold her baby just after giving birth. But I note that nobody talks about medicare for all anymore.
in the future, that the working definition of being in the upper classes and the lower classes will be those that can afford to pay their medical bills – and those that cannot.
Believe it or not, but for the generation of my grandparents, this was still the situation. Normal people could not afford a consultation with a doctor. Neither could they afford to buy medicines at the pharmacy. They managed with whatever herbal remedies, potions, poultices, and massages they knew about. People also went to the public hospital (which required a trip to the next city), but only when
a) they had a severe accident;
b) they were forcibly sent there because of some contagious disease;
c) there were free public health services, such as a vaccination campaign they wanted to take advantage of;
d) they were so severely ill they could no longer cope — basically, when they were about to die.
Back to the pre-WWII era — or even to the 19th century!
At least back then, you typically knew how much a doctor’s visit would cost ahead of time.
Plus land was cheap and you could feed your family with what you grew out back. And you can get by with an actual 6th grade education rather than just the functional reality of one.
Plus land was cheap
Not in Europe.
There was an exception to the situation I described, though: State employees. Even those at the lowest rung of the civil service hierarchy (think some junior employee of the customs or the post office) would have their health costs borne by the State — whether accident, illness, or childbirth (for female employees).
I think the conditions referenced here is limited to the USA. I don’t think any European country has yet sunk to the barbarity of no public healthcare, no affordable childcare solutions, and pricy tertiary degrees. I believe Britain is coming closer but is not nearly there yet.
I understand that; what I described was the situation in many European countries before universal healthcare systems were put in place. Health care costs then were not deliberately and purposefully extortionate, like now in the USA, but they were nevertheless simply unaffordable for a large part of the population.
Well, don’t forget, you can always go broke and get on Medicaid. Which, IMOE at least, hasn’t been totally crapifyed in blue states.
What is IMOE?
In My Own Experience. First hand knowledge.
A couple thousand in medical copays for delivering a healthy baby is nothing compared to the routine expense of daycare, dental braces and glasses, sports and activities fees, and college tuition. And what if the kid turn out to have a learning disability or a chronic health condition like diabetes? And the culture of hovering over kids for the richer half is crazy, making for what I consider to be a much more miserable childhood for the parents and kids alike.
Raising *normal* kids in the USA is so hard and so expensive these days, I do wonder why anyone does it. Or why anyone with or intending to have kids with any decent alternative options, would ever emigrate here where they don’t even have a social safety net to get help from.
I really don’t think medical costs are a major consideration compared to not being able to buy a starter home in a decent school district, daycare for two kids often eating up the take home wages of a respectable young professional salary, and one college tuitions at the likes of Columbia or WashU costing more than the take home wages of most mid career lawyers/engineers/GPs/managers.
Not only are children expensive in America, but the CO2e produced for the benefit of an American child are orders of magnitude greater than most of the world.
I am happy that Americans are not reproducing, in the same way it’s a welcome relief when a plague of locusts begins to wane in number.
But the plague of insurance rodents keeps multiplying and will never go away.
Oh don’t get me started on the insurance rodents… I’ve been fighting them off with anti-coagulants for years with no success…
I suspect we’ll just increase immigration to offset the decreased fertility rates and those newly immigrated (and their children) will see their carbon production markedly increase so that nothing really changes in the end
Well, except for the accoutrements of industrial society!
How USA has always worked, no?
When I was born in 1951, my mother spent six days in the hospital. I think that was a standard practice. My father was a steelworker, and the bills were paid by the insurance company, through his union plan. After they died, I found my mom’s discharge bill and still have it. My parents had to pay $1.54 out of pocket for my delivery. Not enough now to buy a bad hamburger.
FYI, in 1965, a McDonald’s burger was 29 cents.
How about, for comparison, steel wage rate in 1951 of about $2.50 hour? It’s quite likely adhominem’s dad had to work for less than an hour to cover the hospital expenses and still have change for a hamburger or two.
On the wage side… in Jan 1950 the minimum wage was raised to $.75. Even a minimum wage earner only had to work about 2 hours to pay that bill.
Too true.
In 1967, my parents bought a “fixer upper” house on Miami Beach. Their mortgage payment was $83 USD a month. After Dad died, Mom and youngest sister lived in that house for a few years. By the middle 1990s, when Mom sold out and moved North, her monthly taxes and fees were over $300 USD a month for basically the same house fixed up.
The promoters of the “Own Your Own Castle” scheme don’t like to mention taxes and insurance costs to the “suckers.”
A full-scale nuclear war will do the trick. I hear Nuclear Winter will ameliorate climate change and we can “kill two…with one…” The question is who will die and who will make a killing…?
You should really focus on Canada. They produce more CO2 than we do, per capita, and are even MORE intent on growth through immigration.
I agree. Had I thought through all the costs associated with raising kids, I would have seriously reconsidered having my second one. It’s kids or retirement savings at the moment.
Keeping them healthy, moving to a location with good schools but high house prices and the accompanying property taxes to pay for the schools, activities, saving for their college etc.
Its relentless.
I’m 70 years old so this all happened decades ago, but I have four children. My first one was born in a birthing center, my last three were all born at home with a lay midwife in attendance. My first birth was ok, I didn’t like the doctor very much, and it certainly didn’t bankrupt us, a good thing as we didn’t have much money. That daughter is now 45. My last three were all wonderful births, short and fairly easy, my friends around and us all laughing. I even caught my son as he was being born! They never let you do that in hospitals. And the cost was very minimal, back then. Though three of my six grandchildren were also born at home to my youngest daughter and she and her husband got away with much much smaller bills. I know home births are not for everyone, but millions of children are born at home all over the world with good outcomes. And please don’t get me wrong, I am a TOTAL believer in single payer medical insurance.
I want to clarify that the reason our first birth didn’t bankrupt us was because it WAS 45 years ago, and we lived in Hawai’i, which mandated good health insurance. Not sure how it is now. Home birth was illegal in Hawai’i, but the law was rarely enforced, but still you kind of had to go into the underground to find a lay midwife, they certainly didn’t advertise. And I think it’s 100% typical of our “betters” and overlords that they cry big, crocodile tears over our declining birth rate and then keep making healthcare more and more expensive. A big bunch of lolos!
Typical shitlib. Complex eligibility requirements, anyone? Apparently only “pregnant persons” and their babies need to be healthy.
Did you read the article? both parties are shit and there are only two to choose from. So which pile of shit will you “vote” for? The one with a D or R? They tell us it it the lesser of two stinks, but they are both shit after all
False dichotomy. Don’t participate in the system that oppresses you. Talk to your neighbors and build support networks. Everything else is fugazi
That’s exactly what I’m saying, in my crude, sarcastic way.
evil shit like this makes me so happy that america is collapsing. surely we can build something better from the ruins
What’s the problem here? Don’t take it personal, it’s strictly business.
How else can we make a living if we don’t extort people during their most vulnerable times in life by wildly inflated medical costs? Then, as an added bonus, we can relegate them to a life of debt-peonage and charge them compound interests at usurious rates on the inflated medical debt. This adds 100s of billions to our GDP after all. The US has a great business model here that generates big money, what’s not to like? It’s part of our freedom and democracy
I wonder if Health Insurance is never a political winner because insurance outrages strike unevenly in a given geographic area and hence never manufactures a voting wave? I remember when my daughter went through two heart surgeries in the 1990s and I experienced the various perfidies of the insurance system. I would talk about it to anyone who listened but I could never get them outraged much. I concluded that to them it was just anecdata. I paid bills for over 2 years stemming from the surgeries maintaining a file 2 inches thick because many a time I would get double billed and it would be up to me to call and be put on hold until I could quote the bill number and my check number that paid it. It would be interesting to know what percentage of the population overall gets ripped off by the insurance industry and how that pattern looks geographically state by state.
I don’t think it’s geographically uneven. IMO it’s experientially uneven. Most people are generally healthy, and when they do start to decline, well, they are eligible for Medicare. Most are annoyed by the high cost of insurance, but they think – erroneously- they are covered. Only two small subsets have issues:
(1) entrepreneurs, unemployed, alternate lifestylers who learn quickly that their refusal to take government or corporate employ means risking life and limb because they can’t afford insurance and;
(2) those few that have a problem, early in life, and get to see the realities… months waiting for an appointment, all kind of copays and deductibles, battles with the insurance companies routinely denying valid claims as a business model, signing paperwork at the desk accepting responsibility for any claims the insurance company denies, administrators refusing to confirm whether the doctor accepts your insurance or not, aka “That’s your responsibility…” (WTAF?) Outrageous charges for emergency procedures you weren’t capable of authorizing, outrageous charges for elective procedures you authorized, but for which nobody could quote a price beforehand…
I think if this were all a common experience like filing taxes, there would be sufficient political will to take on the profiteers… but we are more like a herd of wildebeests. We’re not terribly concerned by the few the get picked off at the edge of the pack… until that is us.
Huh? If you are an entrepreneur, you file taxes. If you try reporting all as business profit, you are asking for a big fat IRS audit. You need to report some as payroll, and that means FICA taxes and Medicare eligibility.
Medicare (original Medicare B) is generally much better than all but the blue-chippiest corporate plans. Yes, you have co-pays, which you can reduce with various additional policies. BUT you are not limited to a network. You can go to any doctor that has not opted out of Medicare. And the deductible is low. Admittedly, in some pockets of the US, a lot of doctors have opted out….
However, I agree with you on the surprise charges. I had a bilateral hip replacement with an excellent plan because ancient. Even so, I was subject to a slough of charges because NYS has what amounts to a tax (!!!!) and the insurance would not cover that. Not on the main procedure (the hospital room and operating room charges and oddly not the big surgeon charge either) but for on a boatload of other charges, like the anesthesiologist.
Yes, anesthesiologists. They are not hospital employees. So your insurance may consider the hospital “in Plan” but not your anesthesiologist. Which means no insurance coverage. After the fact, they will incredulously ask, “You didn’t know that?”.