Having a Baby on Obamacare

For those who lack high-quality employer-provided health insurance, every little cost can add up.

When friends discover that I am pregnant, their first reaction is to say, “Congratulations!” Their second is to ask, “Are you going to find out the sex? Apparently you can now, with a simple test, at as early as 12 weeks!”

The honest answer is, “It depends how much that costs.”

When my husband and I conceived our first child, who is now three, we didn’t have to concern ourselves with the nitty-gritty of the price of individual tests. My husband was was a corporate lawyer at a Manhattan firm with a view of the Statue of Liberty out of his office window. I worked in development at a half-century-old non-profit. Both of us enjoyed benefit packages that included health insurance.

My first ob-gyn doctor was a businesslike Russian on Manhattan’s Upper East Side affiliated with Lenox Hill Hospital (of Beyonce and Blue Ivy fame). She didn’t ask me if I was interested in tests; she proceeded on the assumption that I wanted the best informed, most monitored pregnancy the money of my insurance company could buy. She piled on the screenings and the sonograms.

Later in my pregnancy, I switched to the Park Slope Midwives. There everything was calmer, more low-tech. I wondered how many bills my original doctor racked up on my behalf demonstrating that everything going on in and around my uterus was perfectly normal, but it didn’t affect me too much. After all, I wasn’t the one paying the price.

Nearly four years later, my husband’s and my situation is quite different, and prices will affect us a great deal.

We have both struck out on our own: Two years ago, to become a full-time freelance writer and editor, in my case, and one year ago, to pursue a different and far less lucrative career passion, in his. Though we were afraid of trying to make these new career paths work in New York City and raise a child at the same time, we were bolstered by our faith in each other, the savings we had managed to accumulate over 10 years of frugal living, and the idea that neither of us wanted to wake up at age 45 and wonder why we felt unfulfilled. And, perhaps most importantly, we were bolstered by Obamacare.

The Affordable Care Act was not designed with already privileged people like my husband and me in mind. It was intended to help millions of Americans with less access to insurance and fewer choices, and those success stories are the ones that really matter. It is also true, though, that my husband could not have left corporate law without the ACA unless I had gone back to office work. At least one of us would have had to remain unhappily employed in the private sector so as to provide health insurance for the family. Thanks to the New York state exchanges, and with minimal difficulties, we were able to take professional risks and still procure coverage of all three of us that was accepted by our various doctors, including the Park Slope Midwives and our daughters’s pediatrician.

Overall her coverage—through Healthfirst Amerigroup—is at least as good as it was before. Ours is not.

In signing up for a “Standard Bronze” level family plan via Oscar, my husband and I knew we were taking something of a risk. As the little explainer on my phone’s Oscar app informs me, “You pay for covered services up to your $3000 deductible. After that, you pay: 50% primary care; 50% specialist; 50% urgent care; 50% emergency.” For that, my husband and I owe $705 a month, of which we pay $472, since we are helped by the fact that our income last year was so low that we qualified for a government subsidy. We pay an additional $45 a month for our daughter.

That I’m fervently grateful to shell out only (“only”) $500 a month for what amounts to bare-bones care for us and good coverage for our daughter is a testament to the enduring dysfunction of the for-profit health-insurance system, but never mind that, because now I have more specific things to worry about. How much will it cost us for me to carry a baby to term and deliver it? What if something goes wrong with the pregnancy, or with me? Will we have to make hard choices this time, choices about whether to remain in the dark on matters more serious than whether the fetus seems to be male or female, because of the out-of-control cost of tests?

The baby is due on March 15, 2016. Beware the Ides of March, when the baby arrives and the bills do too.