By Julie Steenhuysen

(Reuters Health) – In spite of protections baked into the Affordable Care Act, women who have health insurance through their employer may pay thousands of dollars out of pocket to have a baby in the United States, researchers reported this week.

Although the Affordable Care Act requires large, company-based health plans to cover maternity services, these plans are free to pass along some of those costs to women in the form of copayments and deductibles.

As a result, the estimated average cost of having a baby for women with health insurance through their employer rose to $4,569 in 2015, up from $3,069 in 2008, according to a report in the journal Health Affairs.

“We found that between 2008 to 2015, 98% of women had some out-of-pocket costs for maternity care. This was a universal phenomenon,” coauthor Dr. Michelle Moniz, of the University of Michigan’s Institute of Healthcare Policy, said in a telephone interview with Reuters Health. “These are really big financial burdens for people.”

The study included a national sample of 657,061 women enrolled in 84,178 employer-sponsored plans who had been hospitalized for childbirth from 2008 to 2015.

The team analyzed costs for all healthcare services used before and after delivery that could play a role in the success and health of the woman and her child.

Estimated out-of-pocket costs for cesarean sections were higher than for vaginal births, with average out-of-pocket spending rising from $3,364 in 2008 to $5,161 in 2015. That compared with an estimated average cost of $2,910 in 2008 for vaginal births, a figure that rose to $4,314 in 2015.

“This paper provides new data on out-of-pocket spending for maternity care under employer-sponsored insurance, which is the leading form of coverage for reproductive age women,” Usha Ranji, associate director for women’s health policy at the Henry J. Kaiser Family Foundation (KFF), said in an email to Reuters Health.

She said the increase tracks with data from the KFF Employer Health Benefits Survey, which shows that nationally, 82% of covered workers have an annual deductible, and deductible levels have been rising.

Ranji said the average annual deductible among covered workers with a deductible increased 100% over the past decade.

“Having a baby is the most common reason for hospitalization in the U.S., and even with private insurance, women could face significant out-of-pocket costs when they have a baby,” she said.

A limitation of the study is that it used standardized costs, which reflect allowed payments, and not actual charges or payments.

Even so, Moniz said the findings are concerning because cost is one reason many women might defer or skip needed care, which leads to poor outcomes for mother and baby.

Already, the United States has the highest rate of pregnancy-related deaths in the developed world, with some 700 women dying each year from pregnancy complications, according to the Centers for Disease Control and Prevention.

The study is the first to quantify maternity costs in the post-ACA era, Moniz said, and it raises concerns that in spite of long-stated goals, U.S. policy still does not provide adequate coverage for maternity care.

“These are essential services to ensure every baby gets a healthy start in life and that families do well,” she said.

SOURCE: Health Affairs, online January 6, 2020.