Pregnancy Proves the Flaw in the Argument That “Healthy People Don’t Need Coverage”
By Rachel Madley, PhD
December 2, 2025
As debates over health care costs continue, a familiar argument has resurfaced: that healthy people don’t need comprehensive insurance coverage. Avik Roy recently argued in the Washington Post that healthy enrollees are subsidizing sicker ones in the ACA marketplace. But pregnancy and childbirth show why this frame doesn’t hold. People having children are overwhelmingly young and healthy, yet they still face extremely high out-of-pocket (OOP) costs, even with insurance.
They would face even higher costs under some of the reforms proposed by groups including the Republican Study Committee, which proposed removing the requirement for insurance plans to cover essential health benefits, which include maternity and childbirth services. This would likely restore the trends that existed prior to the ACA when only 12% of individual plans covered maternity services. Reforms like these are moving in the wrong direction in a health insurance system that already puts too large a cost burden on patients.
The Peterson-KFF Health System Tracker found that, “On average, the health costs associated with pregnancy, childbirth, and post-partum care amount to $20,416, including $2,743 in out-of-pocket expenses, for women enrolled in employer plans.” In addition to those costs, they reported that “the medical costs associated with toddlers in their first two years of life average $16,575, with $1,511 paid out-of-pocket.” And many families pay more. In a widely shared Reddit thread, dozens of women reported paying $7,000–$10,000 out of pocket. These are costs for women with insurance plans required to cover maternity and childbirth care.
These out-of-pocket costs have real consequences. New mothers are two times more likely to have medical debt than young women who did not recently give birth, according to the Peterson-KFF Health System Tracker. Evidence also suggests that these high out-of-pocket costs affect a person’s decision whether to have a child or not. A PBS survey that asked participants their thoughts on improving health care, one of one participant said that the best way to make them more confident about having children “would be universal health care, guaranteed maternal and paternal leave, and subsidized child care”.
Having given birth less than a year ago, I have felt the stress of these high out-of-pocket costs. I paid over $3,000 out-of-pocket just for care during pregnancy and childbirth, and I have what I consider “good” insurance. I switched health insurance plans in the middle of pregnancy and met my out-of-pocket maximum of $3,000 in just five months after paying for my prenatal care and delivery services. I also paid bills out-of-pocket for my daughter’s care once she was born, which added to the cost.
We know that adequate prenatal and maternity care reduces complications for mothers and babies and prevents costly medical emergencies like severe preeclampsia. Ensuring that this care is covered is essential to safe pregnancies, healthy births, and lower overall health spending. Rolling back maternity coverage would undermine all of that.
Instead of reviving proposals to let insurers drop maternity and newborn care, policymakers should focus on a far more impactful fix: eliminating out-of-pocket costs for pregnancy, childbirth, and newborn services. Families should not face thousands of dollars in bills for a medically necessary and universally relevant health event.
And we can afford it. Recent Health Care un-covered analyses found tha…
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