Republicans in Congress are working to repeal and replace the Affordable Care Act (ACA), which boasts among its achievements the fact that insurance companies must now cover all costs for all maternity care. In contrast, conservatives shimmied their answer to the current law, the American Health Care Act (AHCA), through the House last month — and, in its current form, it would obliterate that benefit. Now, it's up to the Senate to rework the AHCA into legislation that can pass there, too. If they're successful, and coverage for care before, during, and after birth is curtailed, families across the nation could be left scrambling financially, and therefore considering birth alternatives. So, will home births increase if the ACA is nixed, and is that dangerous?
Under the ACA, more commonly known as Obamacare, maternity care is covered as one of 10 "essential health benefits." Not only does this guarantee that insurers on the private market will fully cover all care associated with pregnancy and having a baby in every plan, but the law also makes it illegal for any insurer to raise premiums simply because a woman is pregnant. The version of the AHCA that passed the House and is now being doctored by an all-male group of senators, though, introduces a new, regressive reality: According to a report from the Center for American Progress, it could tack on an extra $17,320 just for a pregnancy. That's a mind-boggling 425 percent increase.
The insurers wouldn't legally be allowed to out-and-out deny a woman coverage, but it may not matter. This has the potential to make the coverage too expensive for many to afford. After all, the United States is already the most expensive place in the world to give birth, according to the BBC, with total costs averaging between $30,000 for a vaginal delivery and $50,000 for a C-section. If insurers were permitted to abdicate their responsibility to cover significant portions of these costs — or if they once again began charging astronomical premiums to do so — some women and families trying to figure out how to bring their children into the world would likely have to think of a plan B.
In fact, one of the main reasons why women do opt for home births is to curb their expenses, as an "average uncomplicated vaginal birth costs about 60% less in a home than in a hospital," according to the American Pregnancy Association. There are other benefits of going the at-home route, which is generally done under the supervision of a midwife or sometimes a doctor, too: the ability to move around freely, share the experience with family and friends, and avoid medical interventions like a C-section or epidural. There's a major requirement, though: Women must have a healthy, low-risk pregnancy in order for a home birth to be a safe option.
According to the Mayo Clinic, there are some women who would be better off giving birth in a hospital. This group includes those who have already had a C-section; are dealing with any chronic medical condition; are less than 37 weeks or more than 41 weeks pregnant; and more. For these women, feeling forced to have a home birth because a hospital stay is financially out of reach could prove incredibly, and unnecessarily, dangerous.
There are no data that project whether home births will increase if the AHCA passes the Senate with the damaging slashing of this "essential health benefit" still in place. But, considering the financial burden it could impose, it does not seem like a particularly outlandish possibility.