{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:46:00Z","timestamp":1790142360056,"version":"4.0.1"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T00:00:00Z","timestamp":1730764800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Milbank Quarterly"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec><jats:label\/><jats:p>\n<jats:boxed-text content-type=\"box\" position=\"anchor\"><jats:caption><jats:title>Policy Points<\/jats:title><\/jats:caption><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>This study examines exposure to out\u2010of\u2010pocket (OOP) costs related to childbirth and postpartum care for those with a Medicaid\u2010insured birth compared with those with a commercially insured birth and subsequent financial outcomes at 12 months postpartum.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>We find that Medicaid is highly protective against health care costs for childbirth and postpartum care relative to commercial insurance, particularly for birthing people with low income.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>We find persistent medical debt and worry at 12 months postpartum for Medicaid recipients who reported OOP childbirth expenses.<\/jats:p><\/jats:list-item><\/jats:list><\/jats:p><\/jats:boxed-text><\/jats:p><\/jats:sec><jats:sec><jats:title>Context<\/jats:title><jats:p>Out\u2010of\u2010pocket (OOP) costs related to childbirth and postpartum care may cause financial hardship, depending on type of insurance and income.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We estimated OOP spending on childbirth and postpartum care and financial strain 1 year after birth, comparing Medicaid\u2010insured births with commercially insured births. The Postpartum Assessment of Health Survey followed up with respondents to the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System after a 2020 birth in six states and New York City. The survey included questions on health care costs and financial well\u2010being. Our analytic sample consisted of 4,453 postpartum people, 1,544 with a Medicaid\u2010insured birth and 2,909 with a commercially insured birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>We observe significant financial hardship from childbirth that persists into the postpartum year, with significant differences by insurance and income. We find Medicaid is highly financially protective relative to commercial insurance; 81.4% of Medicaid\u2010insured births were free to the patient, compared with 15.7% of commercially insured births (<jats:italic>p<\/jats:italic> &lt; 0.001). Six of ten commercially insured births (59%) cost over $1,000 OOP. Among respondents reporting OOP costs for childbirth, we found that Medicaid enrollees are more likely to have borrowed money from friends or family to pay for childbirth (8% vs. 1%, <jats:italic>p<\/jats:italic> &lt; 0.001) and one in five had not made any payments 1 year postpartum (26% vs. 5% of commercially insured births, <jats:italic>p<\/jats:italic> &lt; 0.001). Among the commercially insured, those with incomes under 200% of the federal poverty level (FPL) fared worse financially than those above 200% FPL on a number of indicators, including debt in collection (33% vs. 13%, <jats:italic>p<\/jats:italic> &lt; 0.001) and financial worry (55% vs. 34%, <jats:italic>p<\/jats:italic> &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The cost of childbirth and postpartum health care results in significant and persistent financial hardship, particularly for families with lower income with commercial insurance. Medicaid offers greater protection for families with low income by offering reduced cost sharing for childbirth and postpartum health care, but even minimal cost sharing in Medicaid causes financial strain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1468-0009.12721","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T08:43:47Z","timestamp":1730796227000},"page":"868-895","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["When the Bough Breaks: The Financial Burden of Childbirth and Postpartum Care by Insurance Type"],"prefix":"10.1111","volume":"102","author":[{"given":"HEIDI","family":"ALLEN","sequence":"first","affiliation":[{"name":"Columbia University School of Social Work"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MANDI","family":"SPISHAK\u2010THOMAS","sequence":"additional","affiliation":[{"name":"Rutgers Center for State Health Policy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KRISTEN","family":"UNDERHILL","sequence":"additional","affiliation":[{"name":"Cornell Law School Cornell University"},{"name":"Weill Cornell Medical College Cornell University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"CHEN","family":"LIU","sequence":"additional","affiliation":[{"name":"Columbia University Mailman School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JAMIE R.","family":"DAW","sequence":"additional","affiliation":[{"name":"Columbia University Mailman School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021\u2010050552"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.whi.2021.06.008"},{"key":"e_1_2_11_4_1","unstructured":"Women who give birth incur nearly $19 000 in additional health costs including $2 854 more that they pay out of pocket. 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