Busted Halo

Vanessa Gonzalez Kraft tries to balance her traditional Mexican-American cultural heritage and Catholic identity, personified by her grandmother La Lupe, with her roles as a young wife and mother.

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January 25th, 2011

An Uninsured Pregnancy (Health Care Part 1)


uninsuredpregnancy-flash2An uninsured pregnancy. Definitely not a boat expectant parents want to find themselves in. The common perception when you hear those two words together is that the mother must be poor, young, and uneducated. Wrong. This describes me and many other women I have met.

How did my husband and I find ourselves in this predicament? After Olivia was born, we decided I would be a stay-at-home-mom and we went down to a single income. We had the option of paying for insurance under Brandon’s new employer but it was just too expensive. We couldn’t afford it. We decided to find an individual plan and did a lot of research. We made sure the individual plan we found paid for well-visits and vaccines for Olivia, as well as eye, dental, etc. This individual plan, when compared to the employer insurance we were trying to substitute, looked identical but for half the price. Awesome. Until I got pregnant. I went to my first OBGYN appointment to confirm the pregnancy and to my total shock they returned my insurance card to me and told me that they don’t cover maternity care.

So while I do have health insurance, they do not pay for prenatal care, prenatal lab tests, labor and delivery, or postpartum care, unless there is a complication. In order for my insurance to pay for anything associated with the new baby, one of us has to be dying. I know; it doesn’t make sense to me either.

When I got home from my appointment Brandon and I immediately jumped on the computer to start researching and pulled out the insurance policies. Yup, sure enough. No maternity care. Man, did we feel stupid for such an oversight.

After more research, we realized that there was no way to have maternity care unless we paid for Brandon’s employer plan which would have taken 1/3 of Brandon’s paycheck. Texas and many other states do not require insurance companies to provide maternity coverage unless it is an employer plan that employs over 15 people. Because there is no law forcing insurance companies to cover pregnant women on an individual plan, they don’t do it. That means there is no possible way to buy insurance to cover maternity care if you are a woman who is self-employed, employed by a small business, has some kind of non-traditional job like an artist or musician, or works part-time and is not eligible for an employer plan. Or (like us) cannot afford the employer plan and has to find a less expensive alternative. This is a lot of women.

We realized our current situation was not simply us being careless but rather the health care system in place giving no support to pregnant women unless they fall into the aforementioned parameters.

In case you’ve never had to pay any hospital bills, they are very expensive. After Olivia was born we put all the bills together from prenatal care, labor, delivery, and postpartum and realized that if we hadn’t had insurance, we would be paying roughly the same amount it would cost to buy a new, compact car.

At this point, we started asking a bunch of people we knew in the medical field if they knew of any way we could get help paying the hospital bills that would soon be hounding us. The only answer – the government. The only way that we were going to get subsidized maternity care was either through Medicaid or CHIP. There was no way for us to qualify for Medicaid. Not even close. CHIP, while we were hopeful, didn’t work out either.

We even decided we would just suck it up and pay for Brandon’s employer plan, somehow dealing with the extreme decrease in income, but their open enrollment wasn’t going to happen in time for the baby’s birth. We’ve hit dead end after dead end.

There is truly something wrong with a health care system that does not make it easier to care for a pregnancy. I (and a lot of women in the same boat) am educated and responsible. We have health insurance, life insurance, home insurance, car insurance. We pay taxes, we vote, we are good citizens. I have never had to depend on the government to help me pay for anything and yet the only place we could turn to for help is the government — the only ones willing to help pregnant women with no insurance.

This has seriously shaped our view of President Obama’s health care reform. In looking for ways to help us pay hospital bills, we found out that some of the health care reform went into effect on January 1st of this year. Our hearts leapt because part of the reform is that insurance companies are required to include maternity care in all individual plans. Could we be that lucky? Would our insurance be forced to start providing maternity care just one month before the baby comes? Nope, that part doesn’t kick in until 2014. Ugh.

You might be wondering what the heck we are going to do. Well, we’re going to try to get through labor and delivery as inexpensively as possible. No IVs, no drugs for the pain, or anything else we can get away with refusing until it is absolutely needed. Of course if I need something we will gladly give in and take it regardless of how much it will cost but we’re going to do our best to keep costs down and hope that it’s enough.

So, do we need health care reform? Yes. More families than you would imagine need it. And not just nameless families. Our family.

Stay tuned: in my next post I’ll be writing about the reforms that are already scheduled to go into effect and the Church’s response.

The Author : Vanessa Gonzalez Kraft
Vanessa, a Notre Dame grad, loves the Catholic Worker Movement, Catholic education, and overbearing Mexican mothers, which she may or may not be. She lives in Austin with her husband and five daughters and is a freelance writer. You can find Vanessa at v.kraft.im or follow Vanessa on Twitter @laluped.
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Please note that the editorial staff reserves the right to not post comments it deems to be inappropriate and/or malicious in nature, as well as edit comments for length, clarity and fairness.
  • James Henry

    I think if Catholics want universal health care for all, they should start with there own institutions. My son was born in a Catholic hospital and it was far from free. The rule should be “if you tithe and support your church financially, you should be able to walk into a Catholic hospital no questions asked.”

  • Susan

    Second what Greg said. I work for a very small company – less than 10 employees. By working through an insurance broker, we were able to find a much better deal. The broker also helps us find the best deal in terms of coverage vs. cost. Unfortunately, health care is a moving target, so our insurance company and plan has changed every single year, which is a pain with paperwork and prescriptions, but it’s worth it to get more bang for your buck and sometimes only single digit percentage increases in premiums. (Many years it is double digit, which is why fewer employers are offering insurance.)

  • Greg

    Working in the insurance field i would recommend the author and any one else moving off of group insurance to consult with an agent. If they are good, they would of advised you ahead of time that individual insurance would not cover maternity. So you could of planned ahead of time.

    Also, being in the industry i have seen gov’t regulations directly cause insurance premiums to rise and plans to becoming less comprehensive.

    If we had less gov’t regulation, someone in TX would be allowed to buy and individual plans here in KY with maternity coverage.

  • Ashley

    My MIL works as a medical biller and if there is one thing I’ve learned from her it is to pay cash! Most hospitals offer a cash discount and some, like the Catholic hospital she works for, offer financial assistance.

  • Laura Mitchell

    A lot of people who don’t work in health care don’t realize that a lot of employer provided health insurance does not cover anything related to pregnancy. The author is, unfortunately, the rule when it comes this. Not the exception.

  • Kathryn

    We faced a gap in insurance between when I finished up teaching at a Catholic school (June) and my husband was to start teaching at a Catholic school (August). Religious Institutions are not required to offer COBRA and mine did not, so we had to purchase temporary insurance which did not cover maternity costs (it would cover miscarriage or ectopic pregnancies). I was 8 weeks pregnant before my husband’s insurance kicked in. Sadly, I miscarried two weeks later, but was thankful it happened on my husband’s insurance. It was so frustrating for me that the Catholic Church lobbies for health care, yet my Catholic employer did not offer COBRA, because it did not have to. It is incredibly expensive, but it is an option for many. (The school does offer it now after years of complaints.)

    This was just a small taste of what others, like you face all the time.

    And, I second what other folks say — having had two births, one at the hospital and one at a birth center, the birth center is far more affordable. Just make sure you can get her on an insurance plan so any costs following her birth (NICU, etc.) are covered.

  • Susan

    @Matt – I get what you’re saying, but things have really changed in US health care delivery/payment in the last decade or two. We already have insurance companies dictating what medical treatment we are allowed to receive – and then only to the people who are lucky enough to have insurance.

    According to a couple of studies that were done in the past couple of years, Canada now has a shorter waiting period for most tests than the US does. I don’t think the same is true for surgical procedures, but their outcomes are actually better five years down the road for people who have been diagnosed with the same thing as someone in the US.

    And I know people who have gone overseas for medical treatment because it was better and cheaper than getting it here even though they paid the entire thing out of pocket.

    Look at the current stats – we now pay far more per capita for health care than any other country, yet we have a much lower percentage of people covered than ever single first world country. Add to that the fact that our health care outcomes are close to the bottom – often the bottom – of first world countries for many illnesses and procedures, even after controlling for things like lifestyle habits (smoking, exercise, diet, etc.)

    I, too, used to think our health care and health care delivery system was one of the best until I started looking at stat after stat, study after study done by different people of various stripes – medical researchers, public health researchers, economists, sociologists – reaffirming the fact that our system is great in research (which is very important, I know), but not so good in much of anything else.

  • Brendan

    This sounds like a seriously difficult situation.

    One thing that you might consider is looking at going with a birthing center or a home birth.

    My wife and I payed out of pocket for all three of our children who were born while we were in Texas because my wife wanted to have a homebirth with a midwife and this wasn’t covered by our insurance from my work. However, working with a midwife is _much_ cheaper than a hospital birth. The entire package (which included all prenatal visits and the birth itself with two midwives in attendence) was about $3k. Having given birth to our first two in hospitals in California (via insurance) we both felt that the homebirth experience was far superior.

  • Matt

    It’s not about the “unworthy other”. It’s about not letting the state dictate what medical treatment people are allowed to receive. It’s about ensuring that women in danger of breast cancer don’t have to wait so long for a mammogram that by the time they know they have cancer, it’s progressed too far to save their lives. It’s about making sure that doctors can afford to pay their medical school loans and the ever-increasing liability insurance premiums that government appears to have no interest whatsoever in alleviating. (Good luck getting medical treatment in the future, if they can’t.)

    Mostly, though, it’s about the fact that not _everything_ in life needs to be politicized.

  • Susan

    Your post completely depresses me, but it does not surprise me. What does continue to surprise me is that pretty much everyone knows someone who has faced a situation like this, yet they still do not want universal care. This is not something, like many other social services, that happens to some “unworthy other,” but something that happens to loads of everyday people every day. My family is extremely comfortable, yet we know we are one layoff away from not having health care coverage.

    Why should coverage be tied to a job, especially in this economy? Often when families have health care issues is exactly the time that it is difficult to work full-time. And many people who are finding work in this economy are underemployed and have jobs without insurance.

    I agree with the reader above that there are many things that insurance covers that cost a lot and go beyond the basics. However, it doesnt’ have to be an all or nothing proposition. As Christians, I think we should advocate a certain basic level of coverage for everyone (and, yes, this would include maternity care, hardly an exotic need). Insurance companies and employers could compete by offering supplemental policies. If company A wants to lure certain employees, they could offer the supplemental, but the everyday hourly worker would still have the basics covered.

    One of the problem is that when we say “universal coverage” in the USA, people automatically assume nationalized medicine. That is just one of many ways to obtain universal coverage. There are many models out there. I highly recommend the book “The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care.” by T.R. Reid. It is a very positive book that looks at the pros and cons of universal health care as provided by a number of countries. There’s so much we could easily learn from other countries!

    Well, now that my sermon is over, on to deal with your immediate problem at hand. I also second people’s advice to look at home births and/or midwives. It may be scary proposition, but I know several women who have done it without a hitch, and it is a whole lot cheaper than a hospital. Most felt they got better care too.

  • Michael

    As an expectant Canadian father, I cannot imagine the stress and the bills that you are staring down – impending parenthood is enough for anyone. I cannot even imagine having to shop around for a hospital for my child’s birth (in my city, you just go to the one that your doctor works from or the one with the best facilities). Our system isn’t perfect, but none of this is an issue and we see this as a great injustice.

    That aside, glad that others have ideas. Such a generous and supportive group. Keep ’em coming!

  • mary

    With my second child I had no insurance, because the employer insurance for my husband was too expensive and individual plans were WAY too expensive. Luckily we did qualify at that time for Medicaid.
    But the hospital also offered plans to help those who couldn’t cover the cost of their care. They allowed former patients to work off the cost of their care offering whatever work they could provide. Some people worked folding towels, some did landscaping, some offered computer services, etc. It was very innovative and they were lauded for this program. The hospital did not recoup the total cost of the medical care provided, but they expected that. Their plan allowed the hospital to recoup some of the cost while allowing the people to give back to the hospital in whatever way they could.

  • Sue

    While I’m certainly sympathetic to the author’s plight (we too added up all of the bills after delivery and thought YIKES!) the one issue I have is that the implication of said coverage under Obamacare will be “free” or “affordable”. Even the coverage that HAS kicked in before 2014 – let’s take the “Parents can cover grown children up to age 25” still will cost a parent upwards of $4500 per year (no small change, especially for an aging parent with hopes of retirement).

    We were lucky – we live in CO where small businesses (my husband is a business of one) can carry insurance with maternity coverage, but it was DOUBLE what we now pay now that I’m too old for more kids (we dumped the maternity coverage and got different insurance).

    In my opinion, the missed boat in this whole healthcare debacle was not opening up insurance policies across state lines. This way, the author could have purchased insurance in CO (or wherever maternity coverage was offered to individuals) and someone like me could opt for lower rates in another state with a “bare bones” plan. My friends in NJ pay out the nose (whether they want to or not) because of the long list of insurance mandates (including IVF, some plastic surgeries, massage therapy, etc) dictated by the state. I don’t think that adding more mandates is the answer – and it certainly wouldn’t make insurance any cheaper.

    God bless you with your pregnancy and delivery. Once you’re holding that beautiful baby, all of this money stress will no longer matter. :)

  • Gage Blackwood

    Matt — I agree that insurance shouldn’t cover typical, everyday events. The reality, though, is that the medical complex and the insurance industry have jointly developed a co-dependent relationship.

    In all the various medical matters I’ve had done, the doctors all charged one price, which by contract, was reduced to what the insurance company would agree to pay (after my deductible, co-insurance, etc). The best I’ve been able to do is get the doctors to agree to have me pay what they’d get from the insurance company (including what would have been my deductible and co-insurance) and giving me an extra 10% off if I put it all onto a credit card instead of making payments to them.

    Having a baby (not c-section or anything besides natural birth), or something “normal”, shouldn’t cost $10,000 or $15,000. When costs are reasonable, insurance can go back to what it is supposed to be–a tool to spread catastrophic risk among many.

  • D. Thorp

    We worked out a deal with the hospital and dr to pay cash. It ended up being less than all those copays and premiums a month. Don’t give up; cash is easier than insurance to deal with. Congratulations on your new little one!

  • Jennifer Moeller

    Call a midwife and have a home birth!

  • Ellen Donnelly

    My recollection is that most employer-based policies only cover pregnancy if you’re insured before becoming pregnant. As you’ve sadly discovered, one must read insurance policies very carefully.

    Best wishes for a healthy pregnancy and delivery.

  • Liz Monticello

    Hi Vanesa,

    Check out the Ausin Area Birthing Center. Cheaper than a hospital delivery and an awesome facility.

  • Matt

    The first reform we need is to get over the collective delusion that “insurance” is supposed to cover the eminently predictable.

    Talk to your doctor about it. Not general-purpose “people in medicine”…your actual doctor, to whom you’ll owe the actual money. Chances are your doctor has some ideas about how to keep the costs contained…especially once he knows that you’re actually planning on paying his bills yourself. (It’s a lot easier to insist on a bunch of unnecessary and expensive stuff when the huge bill will go to a faceless corporation you probably already hate anyway, than it is when the bill will go to the nice pregnant lady sitting right in front of you.)

  • Marie

    Hi Vanessa,

    My heart goes out to you. I work in health care and it can be so difficult dealing with the insurance companies. I’ll say a prayer for you and your family.

    If you’re comfortable with the idea, you might want to consider a home birth. As a former childbirth educator, I always tell women (if they’re low-risk) to birth where they’re most comfortable and for a lot of us, that will be in our own home. My only child was born in my bedroom and it was a great experience. And the cost effectiveness? While my insurance eventually paid my midwife back, we had to pay out of pocket first and it was well under $2000 for all the prenatal care, the birth, and the postnatal care.

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