As Out-of-Pocket Costs Rise, Momentum Grows for Legislation to Eliminate Cost Sharing for Full Spectrum of Pregnancy Care
Massachusetts residents testified on Tuesday in support of a bill to ensure that cost is not a barrier to the full spectrum of pregnancy care
BOSTON (May 3, 2021) – With more than 1.7 million people in Massachusetts on high deductible health plans, residents are facing exorbitant out-of-pocket costs for the full spectrum of pregnancy care. To combat these growing costs, Reproductive Equity Now is advocating for An Act Ensuring Access to Full Spectrum Pregnancy Care (H.1137, S.646), legislation to require insurance plans to cover the full cost of pregnancy-related care—including prenatal care, labor and delivery, miscarriage management, and postpartum care—without cost-sharing.
Yesterday, the Joint Committee on Financial Services held a hearing on several health insurance bills, including An Act Ensuring Access to Full Spectrum Pregnancy Care. Massachusetts residents testified to share their experiences navigating these exorbitant—and often unexpected—costs and what full spectrum pregnancy care would mean to them:
Katie Forde, West Roxbury resident: “The care for my high-risk Monochorionic/diamniotic (mono/di) twin pregnancy became so expensive that I actually received an email from my then-employer right after giving birth—while sitting in the NICU—asking when they could remove me from their health insurance. In total, it took us three years to pay the $6,000 in out-of-pocket medical bills for that one pregnancy. The moment the doctor surprised us with two heartbeats we were overjoyed, but our economic outlook radically changed. Women and families should not have to risk bankruptcy to have a child.”
Karen Aguilar, East Boston resident: “This year, I will be 38 years old, and I am genuinely struggling to decide whether to have a child or not. My work as a Bilingual Special Education teacher in public schools is a vital public service, but everyday I teach other parents’ children while knowing I simply cannot afford to have a child of my own. It is preposterous that a public school teacher cannot afford to give birth in this state, even with insurance. Like many, I am now forced to wrestle with an impossible choice: either have the child I’ve always wanted and risk financial insecurity due to out-of-pocket medical costs, or be financially stable but give up on my dream of having a child of my own.”
Dr. Shiva Niakan, OB-GYN and Hatfield resident: “I was fortunate to have an uncomplicated birth that required only a one night stay in the hospital, so I was surprised when I was left with a bill for $3,000. In my practice as an OB-GYN, many of the patients I care for require much more complex care for their pregnancies. I want my patients to receive the best care possible—not be forced to choose between skipping their prenatal or postpartum appointments or going into medical debt to obtain the care they deserve.”
Melissa Donahue, Ware resident: “I was fully insured at the time of my pregnancy, but my care still cost me $10,000 out-of-pocket with insurance. My child is now four and a half years old and I am still paying off that pregnancy. I had hoped to have more children by now, but that is financially untenable for me and my family. I often think about the quality of life that those $10,000 could have afforded my child and myself: that’s $10,000 of quality child care, preventative health care to ensure that I am able to continue caring for my child, and the absence of a baby sibling for my child to grow up with and to love.”
Katie Adamek, Medford resident: “When I gave birth to my daughter in December 2020, my insurance covered all of my prenatal care, so I had no idea that my birth itself would be subject to our family’s $5,000 deductible. I wound up receiving a bill for $3,000 that I only recently paid off—just after my daughter’s second birthday. This was frustrating and an additional expense my family should not have had to take on, especially when we were concurrently paying $2,200/month for child care. As someone who has had a cesarean section and three miscarriages that were all fully covered by my insurance, I know that not having a financial burden from an unthinkable situation can make it just a little bit easier to cope, and that can make all the difference in the world.”
Claire Teylouni, Director of Government Affairs, Reproductive Equity Now: “Massachusetts responded to Dobbs in force, with comprehensive legislation that included a mandate for insurers to cover abortion without cost sharing. Now, we must go further in eliminating cost sharing for all pregnancy-related care because for too long, we’ve simply accepted that pregnancy has to break the bank. It doesn’t have to be that way. It’s time to center and support the needs of pregnant people and families by making all pregnancy care more accessible.”
In July 2022, following the Dobbs decision, Massachusetts took bold steps to eliminate cost-sharing for abortion and abortion-related care. However, people on high deductible plans still face exorbitant out-of-pocket costs for the full spectrum of pregnancy care. Now, Massachusetts must take further steps and enact this legislation that would require health insurance plans to cover all pregnancy care—including prenatal care, childbirth, and postpartum care.
The number of Massachusetts residents on high deductible plans has grown from 14 percent to 43 percent of the private commercial insurance market in under 10 years. According to a CHIA analysis, requiring coverage for the full spectrum of pregnancy care by fully insured health plans would result in an average annual increase to the typical member’s monthly health insurance premium of $2.09 per member per month.
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