My Medicaid Babies

How my family got here

I can’t stop thinking about this chart from the Center on Budget and Policy Priorities.

If I had it my way, there would have been a million dollars in my savings account before I got pregnant. A statistic that was oft-quoted in my mid-twenties social circle held that a baby cost $10,000 to raise in the first year. I didn’t have that kind of money for one, two, much less eighteen years. The sensible thing to do was to find financial stability, save money, then have kids. Of course this very sensible plan didn’t take into account that there was a divorce in my future, then a move back to my hometown to start over, alone, then a second marriage. A million dollars? By the time that happened, I would have run out of time to even try.

What did happen was this: at my yearly physical, a pregnancy test came back positive. I’d barely been married a year. I was working as a receptionist and renting an apartment from slumlords that didn’t care that our bedroom wall bowed out from the weight of rain every time there was a storm. My salary was $39,500 a year. Mr. Running Balance wasn’t on my health insurance because he was in school instead of working and we couldn’t quite stretch to make the premium. The surprise sent me into a panic. We talked, decided to have the baby. I panicked again.

I don’t remember being told to apply for Medicaid for pregnant women, but my OBGYN must have been the one who encouraged me to do it. It didn’t sit right with me, for reasons that I can now identify as classism. I did a lot of research first, including typing into a search bar, “Is Medicaid good insurance?” At the time, I felt insanely lucky to have a job that offered me somewhat affordable health insurance. My premium was $95 a month and it only cost me $40 to see a doctor. Surely it must be superior in some way, for all the time I spent in pursuit of it?

Somewhere deep on the second or third page of search results, a financial columnist said yes. Medicaid, if you qualify, is good healthcare. Take it and run. I was still suspicious, but my new doctor, who took my private insurance at a suburban location, took Medicaid at a bigger practice downtown. It was busier, and not as nice. The waiting room wasn’t full of leather couches and perfectly mismatched velvet pillows. But it was the same doctor, so presumably the same level of care.

I don’t want to go crazy with praise. Applying and getting enrolled was a part-time job whose duties included collecting copious documentation about my residency, income, and pregnancy status, not to mention finding fax machines at my office that I could use once everyone left for the day. It was a huge victory when I got an approval letter in the mail. Four days after that, I got a denial letter with no explantation. It took more phone calls, more web searches, more faxes, but three weeks later, I got another approval letter along with an enrollment packet. By that time I’d spent $200 in copays and received a $14,000 bill for uncovered genetic testing that I didn’t ask for. (My pregnancy was considered high risk, but my private insurer didn’t cover the test for anyone under the age of 34.)

My state also had an insurance premium payment program that was recommended to me. A separate agency, a separate application process, separate forms to fax from my office after hours. I kept paying for private insurance through my employer and Medicaid became my secondary coverage. At some point, some public policy maker realized that if private insurance paid for the majority of someone’s healthcare, it would still be cheaper to reimburse patients for their deductibles and have Medicaid just cover the copays. I faxed my paystubs once a month to the program and got a direct deposit reimbursement for my $95 premium.

There was one additional high stakes nightmare paperwork issue to get through before I gave birth. While the doctor’s office took the Medicaid plan I’d selected (there were five to choose from) the hospital where my doctor delivered didn’t. I had to sign a very scary form acknowledging that we were on the wrong plan and would have to put down a $3,000 deposit if we wanted to be admitted to the hospital to give birth. There were almost exactly enough business days left to be able to change plans. I left the office eight months pregnant crying openly in the elevator and wondering what would happen if I went into labor without any money. I was on short-term disability pay at 80% of my salary—which I was immensely grateful for—and we had nothing in savings. We got the ID cards for our new plan on January 28. The baby was born the first week of February.

Once I defeated the paperwork, every $40 office visit, every $40 ultrasound, every $20 blood draw, the one ER visit when I started having contractions after a fender bender, none of it cost me anything. The $3,000 deposit? No one asked about it. Even when I had to stop working because I was on bed rest, I never had to worry about how I was going to pay to keep myself or my baby healthy.

I lost my Medicaid coverage shortly after my son was born, since I was no longer pregnant. He, however, was automatically covered by Medicaid for a year. All of his primary care was covered, all his immunizations. We automatically qualified for WIC, which helped us buy formula, fresh produce, Cheerios, and peanut butter. When it was time to renew his coverage after that first year, we still qualified based on our income. His referral to a developmental pediatrician was covered, his Autism diagnosis was covered, any therapy he needed. It didn’t cost us anything.

I felt ashamed of having a Medicaid baby for a long time. When I got pregnant again, I did a much deeper web search and found out that almost half of all births in the country are from mothers covered by Medicaid. I didn’t feel ashamed after that. 

Thinking of it now, I think that’s something to feel proud of as a country, that we take care of families at a vulnerable point in their lives and help them. Because it’s public policy, I know that the choice to do that isn’t based on feelings, but a cost benefit analysis. A spreadsheet that says x dollars in saves y dollars down the line. Even though it could arguably be better—it could be easier to apply, to qualify, someone could talk more about how much it helps people—it’s scary to me that this might go away. It’s heartbreaking to think about other women struggling to pay for a breast pump or a gestational diabetes test. I’m so thankful that I had that help, because my family wouldn’t be here without it.

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Elsewhere:
5 Calls - Protect Medicaid Funding
Set your location. Call your reps.

keds_economist on TikTok - “If [tax cuts] were gonna solve some problem […] they should have done it a few trillion dollars ago.”

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Housekeeping: In a year where I’m really trying to focus on my values, I’ve decided to migrate away from Substack. I’m guessing you know why, but if not, you can read Anil Dash from last November or Ryan Broderick from last January. I don’t have paid subscriptions on, so it should be easy. I just wanted to make a public commitment to this so that I have to sit down and do it before my next post.