During the last couple years that I’ve been writing this blog, there’s been a big increase in the number of readers who include the line, “I don’t have health insurance,” somewhere in their emails. Whether they’re asking about prenatal care, pain management, pregnancy complications or pre-pregnancy planning, their lack of insurance weighs heavily on their minds. I’ve had readers wonder whether they should have children at all or continue a pregnancy since they don’t have insurance. One reader was considering a home birth because she couldn’t afford a hospital and doctor. She hoped a midwife would be more affordable. She didn’t qualify for state medical insurance because she earned too much money, but couldn’t afford private health insurance. She was between a rock and a hard place. She was American. I had déjà vu.
Recently, I had lunch with a doctor-friend who wanted to know what I thought about all the recent attention home births are getting. He worries women are taking big risks by delivering outside of hospitals. I said I didn’t think the numbers were much greater than they’d always been (about 1% of births are outside the hospital) but understood women’s concerns about medical interventions, high C-section rates and expensive hospital bills. I also understand how scary it is to know you can’t afford traditional care. Sure, most states cover pregnant women through state or public insurance, but that sometimes means limited choices about the type of care they receive.
More than 20-years ago when I was finishing nursing school, my husband lost his job. We had a one-year-old. I worked part time from home as a medical transcriber and went to school full time. I worked long hours at the county hospital where we cared for countless patients who had no health insurance and very few resources. I was seven months pregnant when suddenly, we had no insurance. My husband quickly found another job but, of course, the pregnancy was a pre-existing condition. They’d cover the baby once she was born, but not me.
We calculated what it would cost to deliver at the hospital and were blown away. I was healthy, had already delivered one baby vaginally and had every reason to believe this one would be born without complications, too. And still, the cost for an overnight hospital stay, no pain medication or epidural and hopefully, no surgery, was so far out of our financial means that it came down to a choice: pay the hospital or pay for nursing school. I decided to investigate other options.
I found a lay midwife with a good reputation who delivered in her office – sort of a combination clinic/master bedroom. Certified nurse midwives didn’t do home deliveries in my state back then. Since I was already nearing my due date, she was willing to pro-rate my prenatal care and accept monthly payments. An epidural was not an option and if I developed complications, I’d have to go to the hospital and deal with expenses later. I took the chance and delivered a healthy girl in her office three days after graduating from nursing school.
20 years later, my husband and I struggle to pay for our children’s college tuition along with private health insurance policies. Once again, our employers don’t provide health insurance and we pay huge premiums to keep our family covered. Pre-existing conditions mean going without insurance (especially for me) could be disastrous. It’s a struggle to afford both college and health care. We all (college kids included) work hard. For our family, it’s education and health care, not education or health care. Not every family is so fortunate.
Why are health care and education in the richest country in the world a luxury? Doing without either means sacrificing our future. Why do so many families have to choose between food or doctors, hospital or school? There’s so much squabbling these days about national health care. This is America. Can’t we figure this out?