(WOMENSENEWS)—When Ashleigh M., a black woman living in Houston, became pregnant with her third child she thought her preferred provider organization, or PPO, health care insurance would cover all of the costs of her maternity care with her doctor of choice.
She was mistaken.
“We have a PPO, a.k.a. ‘good insurance,’ but every time I would go they would say we owed a couple hundred bucks and there are a lot of obstetric visits during pregnancy,” said Ashleigh, who asked not to use her full name to protect her privacy.
When she and her husband turned to their employer-sponsored insurance company for information about their out-of-pocket expenses, they say they were directed to a number of people who told them conflicting things. All in all, they paid over $4,000 out of pocket for prenatal care and the delivery of their child.
Ashleigh later learned that things may have been different if she had chosen to receive care from a provider preferred by her insurance company. “But I didn’t do that because I wanted to stay with the same doctor that knew my history. I literally paid for the choice to go with the doctor I really wanted.”
Not all are as fortunate as Ashleigh. Plenty of women cannot afford to pay out of pocket for the maternity care of their choice. Shouldn’t women be able to choose what kind of maternity care they receive, regardless of their income or health insurance status?
Black women in particular are less likely to benefit from the high-quality, personalized care that they need to have healthy pregnancies and safe deliveries. They are more likely to lack insurance coverage, have lower incomes than other groups of women and lack wealth that provides financial stability.
This pervasive financial insecurity limits health options for many women and may contribute to disparate maternal health outcomes: Black women in the United States are three to four times more likely to die from pregnancy-related causes than their white counterparts.
Even though the Affordable Care Act (ACA) has increased insurance coverage in the U.S., solutions to the problem of disparate access to care and maternal health outcomes are few and far between.
One Solution
What could help women like Ashleigh, who have private health care insurance coverage that still leaves them on the hook for hundreds or thousands of dollars? An effort recently proposed in the United Kingdom might be something to consider.
In late February, the U.K.’s National Health Service (NHS) National Maternity Review proposed offering pregnant women “birth budgets” of about $4,300 that they could use to access private sector care, promoting continuity of care and expanding women’s options.
It’s true that the system of care in the U.K. is different from that of the U.S., but the problem of rising maternal mortality here at home and persistent racial disparities in maternal and infant health outcomes requires immediate action.
What if expanding financial access to care could reduce maternal death and pregnancy-related morbidity among black women?
Under health care reform, new health plans and those in the health insurance marketplace must cover maternal health care, but women like Ashleigh are still paying out of pocket. Health insurance policies that were created or purchased before ACA’s enactment on March 23, 2010, also known as grandfathered plans, are not even required to cover pregnancy and childbirth.
Medicaid or Medicare is the only real safety net for accessing care in the U.S., but that is its own ball of wax. For privately insured women, maternity care could present a real financial burden. But, everyone deserves to build the families they want without unfair financial hardship.
Additional funds of $4,300 or even more provided to women exclusively for maternity care and related services could make up for ongoing gaps in health insurance coverage.
The amount of money provided would depend on the woman’s unique health and financial status. For example, someone who has a high-risk pregnancy and delivers via Cesarean section would likely need to use more funds than someone with a low-risk pregnancy who has a vaginal birth.
Beyond the cost of prenatal care, labor and delivery, pregnant women have expenses that may be above and beyond what they usually spend on self-care. Maternity clothes, nursing bras and supplies including health-related items needed to relieve discomfort are added expenses during and after pregnancy that aren’t necessarily covered by health insurance companies or even accounted for in measures of how expensive motherhood in the U.S. can be.
The Right Direction
Certainly, there are many factors that contribute to maternal health outcomes and money isn’t the entire answer. Still, it could be a step in the right direction.
As maternal mortality in the U.S. continues to rise and racial disparities persist, every option that can turn the tide must be explored. There’s too much at stake to not take action.
U.S. policymakers have to be willing to explore every possible solution, even when it comes from overseas. Birth budgets just might be a foreign import that could work for privately-insured women who need extra help. Fortunately, there are already a few mechanisms in place for implementation of a birth budget program in the U.S.
First, the health insurance marketplace could serve as a portal for pregnant women to sign up to receive supplemental funds for maternity-related expenses both during pregnancy and after. Another possibility is to grant pregnant women access to an account that operates like a flexible spending account, where money is set aside for expecting and new mothers to spend on their unique maternity needs.
A birth budget program should be explored for its potential to improve access to maternity care, especially as it relates to the possible impact on maternal mortality and morbidity among black women.
These supplemental funds could help pregnant women receive more personalized, quality care that meets their unique needs. The NHS is trying to do just that for women in the U.K.
“Safe care is personalized care,” Baroness Julia Cumberlege, chair of the NHS National Maternity Review, wrote in the February proposal. That sentiment should hold in the United States as well.
This article is published in collaboration with Strong Families’ Mamas Day campaign, which recognizes that mamahood is not one size fits all. Learn more at MamasDay.org.
