I like the sentiment of the call to “Make Birth Free!” but at the Institute for Family Studies, Patrick Brown and I are the wet blankets pointing out this proposal wouldn’t help the most vulnerable mothers. For the poorest moms, birth is already free, at least in theory, but there are other gaps to close.
Expanding coverage isn’t enough if mothers can’t access the help they’re eligible for. Temporary Aid for Needy Families (TANF) is a well intentioned program that reaches only 23% of families eligible for aid. America has a pattern of funding benefits but underfunding administration, leaving those in need waiting months or years for aid. Expanding Medicaid’s promises should go hand-in-hand with expanding administrative staff and training for patient advocates who can help women navigate enrolling and who will help fight surprise or misleading hospital bills.
Bad bureaucracy is a regressive tax on the poorest and most vulnerable, who are least able to take the time to fight back or to have the confidence to threaten to sue a doctor in small claims court if erroneous bills are not corrected (as Leah did).
Inside the hospital, mothers need advocates, too. Doulas advocate for mothers during labor, standing up for women who might be ignored or taken advantage of during their most vulnerable moments. Organizations that pair Black doulas with Black mothers offer a particularly critical form of support. Just like a patient advocate contesting a bill, doulas work to get mothers what they’re entitled to on paper: lifesaving, compassionate care. Including doula fees in the “preventive care” covered by insurance would help women have safer, easier, and more humane labors.
And check out this companion piece by Allan C. Carlson on the history of making birth free.