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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Baby Boom 2014
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Like any young couple with a growing family, Brandon and I have been discerning and having monthly conversations about when we should have our next child. Recently, the following statement actually came out of my mouth, “Well, Obama’s health care reform will kick-in in 2014 and then we will be able to get maternity care on our insurance plan. Maybe we’ll just have to wait until then.”
Wow. As soon as I said it I was just so disgusted by the kind of system we have that would make it so hard to have kids. Our family planning is going to be based on when a law goes into effect? No way. I refuse to be bullied by the insurance industry into letting it dictate our reproductive planning.
Our mailbox has been bursting at the seams with medical bills the last few months. When I stop to think about all the money we have spent on medical needs in the last year it seriously makes me sick. Granted, Lina is absolutely worth all the bills (those chubby cheeks are so irresistible,) but it doesn’t make the amount of money that is moving from our savings account to the hospital’s or doctors’ or Blue Cross Blue Shield’s pocket any less obscene.
When we got pregnant and found out our medical insurance didn’t cover maternity care, we definitely panicked at first, but eventually figured it out. We talked to the hospital before we had Lina and, if we paid in full before the birth, they would give us a major discount. Done. Our doctor was very kind and gave us a bit of a discount as well. It was going to be a lot of money but we were navigating the waters and saving a little here and there. Additionally, our medical insurance covered Lina from the second she was born so we thought we were in the clear.
But then we got a bill from the hospital for Lina and all her expenses. We called the insurance company and understood they were still trying to work it out. Then we received a note on the bill saying that it had been processed by insurance, but we had to meet the deductible first. Ugh.
We know how important it is to have health insurance, and have never gone one day without it. We have been paying Blue Cross Blue Shield faithfully for years, and are prompt at sending them a check the first of every month. And what did they do? Not cover one cent of my pregnancy — no OB appointments, no ultrasounds, no lab work, no labor and delivery, no postpartum checkups. Not even one single thing for Lina; not her lab work, shots, etc.
To be fair, this is exactly what the insurance told us they would cover. It’s in the contract — the deductibles and the no maternity coverage. So maybe we shouldn’t have been so blindsided. But what gets me is that we live in a system that can leave a family so stranded for such an ordinary event. We know insurance is important in case something catastrophic happens and I’m thankful for that security. But all we did was have a baby — the most natural thing in the world, the natural fruit of marriage. In the last 9 months, less than $2,000 has come out of Blue Cross Blue Shield’s pocket for all of us combined while we have paid over $15,000 for little Lina.
We are wiped out. After all the tallying, we actually would have come out ahead if we hadn’t paid for health insurance over the last 9 months because then we would at least have kept the money we’ve been spending on monthly premiums. People who believe health care reform and insurance reform is only going to help slackers or those who aren’t responsible for their family’s health, well, that’s really not true.
We didn’t go on a crazy spending spree. We didn’t buy top of the line baby gear. We didn’t vacation off the Mediterranean coast all summer. We had a baby. Should it really cost this much? Should we live in a system where having a baby causes a family to go broke — not because of the cost of diapers or carseats or school and college, but solely because of the cost of having that baby? (I know my frustration should also be aimed at the medical industry and the rising costs in this field.)
This is a serious pro-life issue. There are so many people that are so vocal about being pro-life but I hear very few talking about actually supporting women who are open to new life and having babies. They should be breaking down the doors of insurance companies making them cover pregnancies. They should be lobbying the medical industry for lowering how much it costs to have a baby. The way both of these industries are set up, they work in support of profits, not life. No insurance company or group or individual is working toward pro-life goals if they make supporting new life so hard.
The coming of a new life into the world should not have to wait for 2014. The planning for new life should be in God’s hands, not Blue Cross Blue Shield’s hands (or any other insurance company) And I shouldn’t find myself praying that the healthcare reform isn’t repealed so that insurance companies will be forced to provide maternity coverage.
What are we going to do if I get pregnant again? We flat out don’t have the money to pay for it.
God only knows when we will have our next child, but I’ll be darned if I let Blue Cross Blue Shield dictate it.
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God bless you and your family.
Move to Canada & apply for citizenship and/or landed immigrant status. The only health care you’ll have to pay for ever (and that’s only in certain provinces) are dental, optical, and alternative therapies like chiropractic. Even then, if it’s a dental emergency, certain things are covered.
I’ve grown up in a country that believes in access to health care as a fundamental human right. I can’t imagine why someone would want to live in a country that doesn’t.
BTW: yes, I understand that packing up and moving to a new country & applying for citizenship, etc. is not an easy procedure, and that it’s definitely not an option for most people. I’m just making a point.
There are some really great things about your country, and there are some really terrible things, and making people pay to get medical care is one of those really terrible things. Kinda seems like a human rights issue to me.
Vanessa,
1. Congratulations on you beautiful baby, God bless you.
2. It may seem obvious, but why don’t you upgrade you insurance now to include maternity care and a lower deductible. I understand your frustration, (I’ve been there myself ) but it seems you picked a cheap plan without reading it first. Not really their fault ( I did this too). The best thing to do would be to learn from ones mistake . In my case I got better plan. Also looking for a job with better benefits would work as well.
3 I work in health care and the reason it costs so much are many . First, the wonderful technology that makes it safer also costs a lot in research and development. Having a child while natural is fraught with many possible dangers . Personally I like the comfort having my wife and newborn in a place that’s ready for the worst ( that costs money). Ob/gyn’s are some of the most sued Dr.’s . It costs them $200,000 just to pay for malpractice ins. They in turn pass the cost onto the patient. Unfortunately it’s so hard and expensive for them to practice, that I know many who have quit practicing ob altogether.
I know your a big believer in Obama care, but it will never live up to the hype and promise. I don’t know about you, but I’ve never seen a government agency ever run efficiently, or within budget. I’m not sure what the answer tot this really is, but I d
Sorry hit submit by accident
I do agree with you that something needs to be done to help the unimsured or partially insured.
You know what they say, watch what you wish for you just may get it
Take care and God bless you and your family
Jairo
I think what’s wrong with the US health care system is that people are profiting from misfortune of others. Yes, doctors & medical staff need to be paid. And paid well, because they provide an important service, and work stressful jobs. But medical care should not be a business. It should be free for everyone.
Taxpayer-funded health care provides for everyone equally. I don’t wait any longer to see a doctor her in Canada than most people in the US. Know what my costs were for giving birth to my child in a hospital? $0. Know how much my dad’s knee replacement cost? $0.
Canadians don’t pay much higher taxes than Americans, and our economy is actually doing better than yours right now. Our medicare system has not crippled our economy.
Sorry, I just get sick of the American rhetoric/load-of-crap-idea that runs around about how privatized health care is the only way to provide efficient & effective health care to everyone in your country.
Jairo –
2. I think the issue is that they are not going through an employer for their health care. They have to buy private health care through BCBS. Maternity coverage is not required (and not available) through private coverage. It is only available through employer backed plans. The options for private plans are not many. After I was laid off, I researched private plans and was amazed at how expensive and dissimilar they were to employer backed plans.
3. One of the issues they are having is with BCBS. Any of their direct interactions with health care providers seems to be great. The hospital gave them a discount for paying ahead and out-of-pocket and their OB/GYN even gave them a discount. It appears they have only encountered difficulties when dealing with BCBS.
I’m not sure you read or understood this post of the previous post about their health care.
When I was pregnant with my second child we were in an insurance quandry. COBRA would have cost over $800/mo and private ins wasn’t any better. My husband’s job at the time would only cover him. So I went on Medicaid for 5 months for the last trimester, delivery of the baby and the 2 months post partum, until my husband’s summer job kicked in and we had ins again. It was the only time I’ve ever used Medicaid.
Ben I hear what you are saying . And your right the plans don’t offer many options it’s a real pain. Part of problem is that these companies are not allowed to cOmpete across state lines. My sister in law asked her mother in California to say she lived there ( she lived in another state) so she could get a Plan that was cheaper and more comprehensive .if the company had been allowed to sell I’m her state she wouldn’t have had to do that. Christy, while the Canadian system may work for you there are many other canadiens who complain about the wait time to see a doctor. It’s also like comparing apples and oranges. Canada has much smaller population comared to the US. The US has had government run health care for native Americans on their reservations for many years now. Just ask them how happy they are. The rates of infant mortality on Indian reservations are on par with many 3rd world countries. It’s a shame. I understand the frustration I’ve had to pay for health care myself i know how expensive it can be. I’m not sure what the answer is I just don’t see government take over as a smart answer. The problem is that we have people who believe in an all or none solution . When the answer is probably somewhere in the middle. Perhaps partial plans for people that work but have to buy their own insurance and tax incentives for doctors and hospitals who take care of uninsured or underinsured people for little or no money .
J
@Mary Ann – I didn’t know it was possible for just a married mom and baby to go on Medicaid. I actually know several people who haven’t married so they could have Medicaid cover childbirth. Vanessa should look into the way the law works re Medicaid in Texas. If she has paid her taxes all along, she should feel absolutely no guilt about doing this. That’s what it’s there for.
@Jairo – I am a US citizen, but most of my relatives are Canadian. Although they have gripes here and there, I have never once heard one of them say they wished they had our health care system. Mostly they are incredulous that a great, rich country like ours puts up with it. A couple of years ago, Canada made some minor changes in administration, and now their waiting times are actually shorter than they are in the US for many tests.
And there are so many other models out there besides Canada’s – Germany, Switzerland, Taiwan, Japan – many of whihc have private sector involvement. Every single one of them uses a smaller percentage of GDP for health care, covers a vastly higher percentage of people (usually 99%) and has better health outcomes for most illnesses. I’m not sure what the answer is for the US, but I’m willing to give Obamacare a chance because what we have now certainly isn’t working.
Vanessa is right; it is a pro-life issue. She’s also a better mom than I am if she can already contemplate having another kid while she has an infant ;-)
Even though it is interstate commerce, which constitutionally belongs to the Feds, insurance companies and states fought for it to remain in the hands of each state. That doesn’t make much sense to me. Misrepresentation on an application is grounds for all claims to be denied and policy cancelled.
In addition to Native Americans, the military health care system is another example of government-run care in the U.S. As a former military dependent, I miss going out to the Base Clinic.
Things need to change and the health care reform law is the only real push to change anything I’ve seen recently.
I absolutely agree that the cost of hospital birth is outrageous. The idea that it can put so much financial stress on a family planning to have a baby, during a pregnancy, and then with a newborn, horrifies me. Perhaps if doctors and hospitals did not treat a natural event such as a childbirth like a huge medical issue, the cost would lower, but that’s a whole different can of worms. ;)
Yes, it seems weird that insurance and healthcare costs can influence our reproduction schedule, but money is a limited resource, and we make all life choices within certain constraints. It also doesn’t stop only at ‘when’ to have a baby. It influences our prenatal care and birth choices (i.e., midwife and out of hospital births are typically less but often paid out of pocket as they are not covered or barely covered by out of network plans).
That all being said, these are facts, like others have commented. For example, my husband and I were discussing another baby and when we realized my surgery at the beginning of the year had already hit our maximum… I’m due in December before the end of the calendar year. Sad? Maybe. Would it have changed if we had another baby? Definitely not. I prefer to look at it as some careful planning used to our advantage.
Jairo:
The issue on your native reservations isn’t with government funded health care. It’s a social concern. We have the same problems on many reserves here in Canada. High infant mortality, high rates of diabetes & alcohol & drug abuse. The problem is systematic & has very little to do with who pays their health care bills.
susan:
We do have a bit of a two-tiered system in some provinces. In some places, you can go to a pay clinic to get an MRI done faster, etc. I don’t agree with this in any way of course, because it enables the rich to get faster access to care. which goes against the purpose of our health care system. there are, in fact, some people in this country who think privatization will solve any problems the system has. But it’s a pretty small minority, and most of those people have money to pay for whatever they want.
You are right though, most canadians do not look at the US system with envy. Most of us look at the american system & are disgusted with it.
We’re not the only ones with a public health care system. Many other developed countries have even better public health care systems than ours!
Gb
I worked at a VA hospital once . The Place I was at was great, but we’ve all heard the horrors of some of our VA hospitals. The Indian health service is horrible .
Susan I agree that there are probably some aspects of the health system of those countries we could look into, again the population of all those countries probably still doesn’t equal ours. Medicare and social security are a disaster economically. Besides our military our government can’t run any agency efficently or within budget. England is another country who’s health care is a disaster. We recently had relative from england visit . One has emphysema from years of smoking . He’s always sick because they only approve one medication for him. It’s unbelievable, here in the US he would be on at least 3 if not more that would help him and let him enjoy a more active life. Believe me the last thing I would want is to have t he government limit my choices to treatments. All these countries with gov health care do it to one extent or another. I know that ins com
Thank you for sharing your story with us. Sad the ‘hoops’ the insurance and medical system force you to jump through for maternity care. Sad. We as a country as so behind in mother-child care vs rest of world. Hopefully we see the right way and straighten up soon.
I’m having a home birth, and our insurance won’t cover one red cent of it (even though they _would_ cover a hospital birth). The grand total will come to $2400. Research your options, and see if there might be a reasonable, safe alternative to going to the hospital in your area (midwives are illegal in some states) should you get pregnant again. Good luck!
Jairo – I was referring to DOD hospitals, not VA facilities. Someone please do correct me if I’m wrong, but I’m pretty sure the two systems are completely separate.
Thank you so much for this blog post. My husband and I are in a similar situation. We are graduating and looking for new jobs this year. I am scared to get pregnant and then lose my insurance. Perhaps we will apply for some positions in Canada. I do not think we should have to wait until 2014 either!
Aside from the usual “Come to Canada!” statements (our experience with our first child was great and its covered in our moderate taxes), I think that Vanessa touched on an important issue: pro-life advocacy seems to be focused only on those inside the womb. What about once they’re out? We do need to collectively support mothers beyond telling them what to do with their unborn. I honestly believe that a significant amount of abortions would be reduced if mothers-to-be felt they had support for birthing and beyond.
We have the government we allowed. Now, if you do have a baby, make sure your husband doesn’t leave unless you have a very good-paying job. America gets very, very tough on single mothers, whether they’ve been abandoned, divorced or widowed. Over the past 30 years or so, America has taken an increasingly punitive stand against motherhood. Make sure that you are able to be a full-time mother while also working full-time at a good job, and in all your leisure time, it is essential to participate in all school and church-related activities, and get back home to be a sweet, attentive wife. You are often required to be in two places at once, doing the impossible, but consider the actual consequences of failure in America. Do NOT allow failure; if you should fall into poverty, America’s policies now allow state social service agencies to take “indefinite custody” of the children of those whose parents fall into poverty, on the wildly vague grounds of “failure to adequately provide.” They might or might not, and if they do, there is also a little provision written into the 1996 welfare “reform” laws that ended the right of parents to legally contest the decision to take their children. Now, enough of that. With July 4 just around the corner, remember to practice all those patriotic songs about American freedom and justice.
Jairo, just curious: Why do you write that Social Security and Medicare “are a disaster”? Social Security has proved to be a near-perfect program, stunningly effectively in protecting the elderly while protecting all of the middle class. Medicare has problems because to date, the government has failed to rein in the wild profiteering of the medical establishment. This will have to be done. Social Security remains solvent for a number of reasons, including the declining life expectancy among low-income Americans — and so many Americans are now permanently low-income. Think back just a few years: Republicans were declaring that the Social Security surplus was massive, “far more than will be needed by retiring Boomers,” and we should therefore allow them to “borrow” that money. People said “No.” They waited a few years, then completely spun around and claimed that since Social Security is “going broke,” we might as well allow them to “borrow” from the surplus, “for more immediate needs.” The bottom line is that every tactic is being tried to convince the American people that they might as well let the right wing take all of our money. If it did run short, no problem. Do you know that since the Reagan admin., the US has actually lost TRILLIONS of dollars to massive tax cuts/handouts to the rich/corporations? This continues to be done on the threat that it is absolute vital to job creation. After some 30 years of handouts, we have a fraction of the jobs, at deteriorating wages. Instead of using taxpayer dollars to cover the costs of building factories and offices outside of the US, exporting our jobs, as we’ve been doing since Reagan, use that same money to shore up Social Security/Medicare.
BCBS covered maternity in my state on the individual side until Obama became president. Then with the passage of Obamacare they scaled back on covering pregnancies due to over regulation of government. The more government regulation = more scaled back benefits from BCBS and other companies in order to try and stay in business. Which is only about 2-3%. Relatively low compared to other industries.
2-3% profit that is. That’s super low, insurance companies are not evil. It’s just the media only portrays the negative aspects of then but never the positive help they bring to families every day. Like mine.
“They should be breaking down the doors of insurance companies making them cover pregnancies. They should be lobbying the medical industry for lowering how much it costs to have a baby.”
Here’s the problem: those two things are mutually incompatible.
Either medicine is paid for by third parties, or it’s affordable. You can’t have both. Turning it over to the government just means that you no longer even have the leverage of telling BCBS that you’re going to stop paying them if they don’t get reasonable.
In prior years, I’d have suggested an HSA and a high-deductible plan…low monthly premiums, you control the costs, and it protects you against catastrophe. You’d certainly have been better off this time around. But those are about to become illegal.
I just can’t bring myself to understand ObamaCare cheerleaders, knowing that in less than 3 years my wife is going to be forced to choose between her health and her immortal soul, when it becomes a felony to treat her chronic condition with anything except birth control pills.
Matt – I’m sure not what source you’re getting your information, but the last paragraph is not compatible with anything I’ve read from legit sources.
I’ve learned not to trust the pundits on either end of the spectrum on this issue because they make up most of what they spew.
The health care law does not create a single-payer system (e.g. turn over to the government); it adds various regulations onto the current health insurance industry and creates state-level marketplaces to make it easier to determine what plans are out there for people.
Can you cite where birth control pills are mandated in the new law? The closest thing I’ve read is a physician’s board overseeing aspects of Medicare, which is a practically single-payer government system already, so I assume you’re not referring to this.
I’m surprised that you mentioned leveraging BCBS by telling them you’re not going to pay for them. They’re not going to cover anything that isn’t legally mandated because their competition won’t either. Other commenters have mentioned how there are low profit-margins already with health care insurance companies so no company is going to do more than required. The only reason maternity is covered (in states that don’t mandate it) by group plans is a Federal law (ERISA) that requires coverage on group plans offered by employers with more than 15 employees.
I don’t think Mrs. Kraft’s quote is mutually incompatible. Her point is it shouldn’t cost so much for families to have a baby. Whether that is handled through insurance or lowered health care costs or a combination of the two, that’s all possible.
If health care providers were able to assist with pregnancy and delivery in a way that gave access to urgent care only if needed at a lower price, that would reduce the pricing for everyone. If insurance companies were charged less, they wouldn’t be so keen on excluding it.
When there are complications in pregnancy, insurance covers it. The newborn has to be covered from birth without proof of insurability. Why won’t they help to ensure the pregnancy doesn’t have complications and that the baby is born healthy?
Some folks have mentioned birthing centers as an alternative. Why couldn’t hospitals co-operate one? A birthing center adjacent (next building, next wing, whatever) to a traditional L&D ward. For the normal, no complications, cases, they head over there, midwives or some equivalent assists. If there are any signs of needing urgent care due to emerging complications for mother or child, they’re already very close. To me, this answers the health providers objections that they need to get paid fairly, etc (true) while giving a lower-cost solution to delivery without jeopardizing the availability of urgent care.
“Can you cite where birth control pills are mandated in the new law?”
They’re not…by name. But any treatment which isn’t accepted by them as the most cost-effective for the given ailment (polycystic ovarian syndrome, in my wife’s case…treatable in most patients with really inexpensive birth-control pills) may not be paid for with government funds. Which I suppose is fine…if the government wants to refuse to pay for anything except birth control pills, then I’d be fine with continuing to pay for my wife’s medical care myself. Except that, beginning in 2014, it is a felony for a doctor to provide any treatment which isn’t on the “comparative effectiveness panel” approved list, whether or not the government is being asked to pay for it.
So. Birth control pills, or no treatment at all.
As for making childbirth less expensive, your idea is a great one. Too bad it’ll never be seriously tried, because there’s no incentive to try it. Everyone has to have insurance or be punished. Every insurance plan will have to cover all expenses of childbirth, or be punished. So who, exactly, is going to care about how much it costs to deliver a baby?
Even fewer people than care about that today. And today’s number isn’t nearly enough to get things like that done.
Matt,
Again, can you cite the law?
The Comparative Effectiveness Panel is a 15-member advisory panel created by HHS through the economic stimulus effort to oversee research on the comparative effectiveness of various treatments, without regard to cost nor with any mandate forcing doctors to use it.
Regarding my birthing center idea:
I think there is a great incentive to try it–if insurance companies are required to cover maternity and a less expensive but as effective course of action is available, why wouldn’t they try it? Just a personal opinion, but I’d venture that the health care industry would be most opposed as they would have the most to lose in such a situation.
Friends in the military (another single-payer government system) who were pregnant were commonly referred to military midwives if their pregnancies weren’t high-risk and everything appeared to be normal. It saves everyone money (except the doctor/clinic taking in less).
Gage-
Have you seen in the law where it specifically says the 15 – member panel created by HHS is “to oversee research on the comparative effectiveness of various treatments, without regard to cost nor with any mandate forcing doctors to use it.”
What I take from that is 15 bureaucrats deciding the basis of medical research. So they ultimately decide what treatments should be allowed and not allowed. Kind of scary have a panel of 15 bureaucrats deciding our healthcare options. I hope I get a waiver.
Greg,
Public Law 111-5 (American Recovery and Reinvestment Act of 2009, aka the Stimulus law that created the HHS panel).
Sec. 804:
(g) RULES OF CONSTRUCTION.—
(1) COVERAGE.—Nothing in this section shall be construed
to permit the Council to mandate coverage, reimbursement,
or other policies for any public or private payer.
(2) REPORTS AND RECOMMENDATIONS.—None of the reports
submitted under this section or recommendations made by the
Council shall be construed as mandates or clinical guidelines
for payment, coverage, or treatment.
PDF: http://www.gpo.gov/fdsys/pkg/PLAW-111publ5/pdf/PLAW-111publ5.pdf
Public Law 111-148 (Patient Protection and Affordable Care Act, aka the Health Care Reform law) does two things – it eliminates the above panel upon the effectiveness and creates the Patient-Centered Outcomes Research Institute as an independent organization to, basically, do what the above government panel was made to do.
Subtitle D establishes it: http://www.pcori.org/images/PCORI_EstablishingLeg.pdf
It creates Sec. 1181 of the Social Security Act and includes as Sec. 1181(e)(8)(A)(iv):
[The organization's research reports shall] (iv) not be construed as mandates for practice
guidelines, coverage recommendations, payment, or policy recommendations.
More info on this organization can be found on this website: http://www.pcori.org/home.html
All of this research is already being done. The primary difference is putting some coordination in place to not duplicate effort.
Well we all know research isn’t cheap. And the Gov’t is broke. Sooo… That won’t get us very far.
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