Although many countries offer free or low-cost health coverage to all pregnant women, in the United States, expectant mothers are frequently uninsured or underinsured. As of 2010, private health plans paid for only half of U.S. births because of maternity care exclusions, high premiums and routine rejections of pregnancy as a "pre-existing condition." If you encounter financial barriers to necessary health care for you and your baby, you are not alone in either the problems you face or the solutions you and your child deserve.
Affordable maternity care coverage safeguards mothers’ and babies’ lives and health. Many pregnancy-related injuries and deaths in the U.S. are preventable. They arise from a lack of insurance and proper, prompt health care access, not an absence of modern health facilities. One million women annually give birth without prenatal care. Not having prenatal care increases the death rate for babies fivefold and triples the rate of low birth weight babies.
Inadequate prenatal care, if any, helps explain why U.S. women risk death from pregnancy complications more than women in 40 other nations. 1.7 million women per year--one-third of all who deliver in the United States--have pregnancy complications that can be debilitating even when not fatal. Women and babies who are minorities and poor disproportionately suffer from all these threats to life and health.
Human Rights at Stake
The access to maternity care that affordable coverage permits is a matter of long-established universal human rights. A 2010 Amnesty International report found that the U.S. failure to ensure maternity care access for all violated the rights to life, the highest attainable standard of health, and freedom from racial and sex discrimination.
Private Market Alternatives
If you already have a commercial health insurance policy, or are applying for one, read through its details carefully to see exactly what services it covers and excludes. If you cannot obtain or afford insurance coverage for your pregnancy, move on quickly to other options so you can reduce any delays in your prenatal care.
Discount health care programs appeal to many underinsured or uninsured people. The Consumer Health Alliance, the trade association for these programs, stresses that they are not health insurance plans. For a monthly fee, they give you access to health providers who offer lower prices. These programs do not usually exclude people with pre-existing conditions, including pregnancy.
In 2014, federally mandated health care changes will ban most private health plans' rejections of pregnancy as a pre-existing condition and their designations of maternity and newborn care as optional rather than essential. Between 2010 and 2014, people rejected by commercial insurers might be eligible for the Pre-Existing Condition Insurance Plan, or PCIP that health reform brings to every state. You need not be low-income to qualify.
Medicaid and the Children's Health Insurance Program, or CHIP, are government-funded health insurance plans. Medicaid is for lower-income people, is free or has low premiums and co-payments, and does not exclude for pre-existing conditions. Children, pregnant women and people with disabilities are most likely to qualify. Medicaid pays for 42 percent of U.S. births, and now covers services at freestanding birth centers as well as hospitals.
CHIP is a low-cost plan for children whose families do not qualify for Medicaid but cannot afford private health insurance. In many states it covers pregnant women. Some states offer Medicaid or CHIP to immigrant pregnant women and children legally residing in the U.S. Undocumented immigrants can receive Medicaid solely for emergency treatment.
Ask your health care providers about installment or sliding-scale payments. Look for free or reduced-cost care in the online directories of the American Association of Birth Centers, National Association of Community Health Centers, National Association of Free Clinics and National Healthy Start Association. Contact the Maternal Child Health Bureau's prenatal care line at 1-800-311-BABY/2229 (English) or 1-800-504-7081 (Spanish). It is illegal for a hospital to turn away a woman in active labor, whatever her financial situation.