When insurance is a privilege
My parents *almost* didn’t have maternity coverage with their first pregnancy. If they hadn’t, it would have ruined them financially, and there’s a chance our family would have been in poverty, at least temporarily. There’s also a chance my sister wouldn’t have survived her birth.
But they had insurance, so that alternative reality never happened.
Technically, my mom wasn’t eligible for my dad’s company maternity coverage, because she was already pregnant when he started work. (That, btw, was because her Dalkon Shield had failed her, along with enough other women that it became the largest class action medical lawsuit of its era.) But someone advocated on their behalf and the coverage was approved.
It turns out it was needed. Badly.
My mom went into labor at 28 weeks. While she was in labor they discovered she was carrying twins (her suspicion all along but her doctors didn’t believe her). Both babies were born and immediately put on the highest level of life support — back in 1973, this was the edge of viability and if my sisters hadn’t been born in Manhattan, where they had the newest technology and procedures, they likely both would have died. Frances did die after a day of intensive care. Katherine spent the next 3 months hospitalized with round-the-clock care. She survived unscathed and is healthy today with a healthy, born-full-term kid of her own.
The experience was traumatic and horrible, but it could have been so much worse. The cost of all of this care would have easily plunged my parents into debt it would take decades to climb out of, or forced them into bankruptcy right at the start of their adult lives.
If I go back to the beginning of this scenario and imagine that they hadn’t bent the rules to give my parents the health insurance they needed, it is so easy to imagine how differently things could have gone.
This was back in 1973, but these days the out-of-pocket cost of a NICU bed in New York City if you don’t have insurance is at least $10,000 to $20,000 a day. Obviously, if you have twins you have to double that. This is how people end up with million dollar medical bills.
This would have caused massive stress (on top of the stress of most likely losing two babies). And stress gets into the body and can make you sick. It can also make you higher risk for preterm birth. Which means this whole scenario was likely to repeat in their next pregnancy (which resulted in me). Except this time they would have even fewer resources to deal with unexpected expenses, because they would already be broke and in debt. And as it turned out, although I was born full term, I also came with my fair share of unplanned medical expenses in my first couple years. And the hole would deepen.
Disparities in access to insurance widen disparities in wealth and cascade into disparities in health. If you start pregnancy healthy and with a proper safety net, you have both a better chance of a healthy pregnancy, and more resilience and resources if the unexpected or unthinkable happens. Countries that make big investments in universal coverage are doing this in large part because of this reality. Lack of insurance stunts any possibility of prosperity for those unlucky enough to need it when it isn’t there. That sets off a cascade effect that puts an ever increasing drag on families, communities, and our whole economy.
We need to agree to pay for all people’s maternity and newborn care as a society and a country, rather than relegating this to those fortunate and wealthy enough to have insurance coverage. It’s not just the right thing to do, it’s the only sustainable thing to do and it’s necessary if we are ever going to have a hope of ending disparities.
This issue is one of many reasons I’m participating in the March for Moms on the National Mall on Mother’s Day. We will be visiting legislators the Friday before (May 12). Please join us in DC or in your own community.
