News Release

Having a Baby = Higher Odds of Medical Debt


A new study in the Journal of General Internal Medicine found that having a baby in the last 12 months is associated with an increased chance of being in medical debt by nearly 50 percent. Medical debt, which affects one-fifth of American adults, may “disproportionately burden postpartum women,” the authors wrote, “due to pregnancy-related medical costs.”

The study’s authors advocate for states to extend pregnancy-related Medicaid coverage to one year. (Federal law currently requires that states provide Medicaid coverage for 60 days postpartum.) Extending coverage could “substantively reduce the number of uninsured women” and thus reduce medical debt.

    Sundaram is an internal medicine resident at Cambridge Health Alliance at Harvard Medical School. 

The team looked at a cross section of parents who had babies in the previous 12 months, including uninsured people, people on Medicaid, and people with private insurance. For uninsured people, birth can cost tens of thousands of dollars. “The uninsured are bearing a lot of the burden,” Sundaram said. But “even people with private insurance, which should cover the majority of costs, still end up being affected by medical debt. Private insurance is not sufficient to eliminate the odds of medical debt for this group. Even after adjusting for insurance and socioeconomic status and insurance status, women who have a baby are across the board 50 percent more likely to go into debt.

“We strongly feel that the way to reduce those costs for all is to implement universal coverage to ease the burden of medical debt.

“We [also] found that women with comorbidities were more affected by medical debt. Women with asthma who had had a birth within the last 12 months were more affected. Especially in states that are affected by the recent Dobbs decision [curtailing abortion rights], if they have other medical conditions and financial burden, they run into the risk of not being able to afford medical care for comorbidities to have this child.” Patients with comorbidities are also more likely to have high-risk pregnancies, which cost more.

The 2021 American Recovery Act gave states the ability to extend postpartum Medicaid coverage from 60 days up to a year. “This study shows that the uninsured are more prone to medical debt, so extending coverage to a full year is important for this population,” Sundaram said. “But even people with Medicaid coverage, at 60 days they start getting costs added on.” To reduce medical debt in this population, the study’s authors recommend both reducing the numbers of uninsured and reducing surprise costs associated with Medicaid. “In Massachusetts, we have legislation in the pipeline to extend coverage.” Sundaram hopes that other states will follow suit.