The Best Things in Life Are Free?

A new bill seeks to give parents a little more predictability via good, old-fashioned actuarial cross-subsidization

According to 36 U.S. Code § 116, the last Monday in May is set aside to “pay tribute to individuals who have made the ultimate sacrifice in service to the United States and their families” and “for the the people of the United States to observe Memorial Day by praying, according to their individual religious faith, for permanent peace.” So there’s your assignment for Monday. But for now, if it’s Friday, it’s Family Matters.

• Love Don’t Cost a Thing: And neither will childbirth?

• America Is Not “Pro-Natal”: Quick look at new Yahoo/YouGov survey

• It’s Me, Hi: The Wall Street Journal, The Hill

• Parting Shots

Love Don’t Cost a Thing

In July 2022, The Atlantic’s Elizabeth Bruenig tried to provoke the pro-life movement into some light socialism:

“Rather than tee up an exhausting, decades-long legal battle over whether crisis pregnancy centers (the modern anti-abortion movement’s preferred delivery method for services, money, and goods for women in need) ought to receive state funds and under what conditions, agree that pregnancy, childbirth, and postpartum care should all be free, and demand that the federal government make it so.”

Pregnancy resource centers are, and will continue to be, the backbone of the pro-life movement. In the two years after the Dobbs decision, over a dozen states that protected the unborn through new legislation also directed state dollars to these centers, and hopefully more will continue to do so. But Bruenig’s call to “make birth free” caught the attention of Catherine Glenn Foster (then-President of Americans United for Life) and Kristen Day (executive director of Democrats for Life), who wrote a white paper and COMPACT article making the case that pro-lifers should seek to make the cost of every childbirth in America zero for parents.

Stock photo via Flickr

That idea, in turn, drew the attention of then-Senator J.D. Vance of Ohio, who tweeted:

“We sent over $100b to Ukraine in the last year. For half that, we could make birth free in this country, end the surprise billings that devastate families with newborns, and possibly save the lives of a lot of new moms.”

As the Washington Post’s

Jeff Stein

reported last year, Sen. Vance's team was working on bipartisan legislation to turn that idea into reality until certain events last summer intervened. Now, the baton has been passed to Senators Cindy Hyde-Smith (R-Miss.), Kristen Gillibrand (D-N.Y.), Josh Hawley (R-Mo.), and Tim Kaine (D-Va.), who introduced the “Supporting Healthy Moms and Babies Act” this week. It would require private health insurers to cover prenatal, childbirth, neonatal, perinatal, or postpartum health care with no cost-sharing (that is, deductibles, coinsurance, copayments, or similar charges.) For parents on private health insurance plans (about 52 percent of all that give birth), that would make birth free.¹

The way the senators have gone about designing the policy is a smart tweak to existing insurance regulations, rather than a stab at establishing an ersatz Medicare for Babies, as Bruenig alluded to in her essay. At a fundamental level, the bill seeks to more fully socialize the cost of bearing children within the U.S.’ current health insurance structure. It’s been carefully tailored to explicitly change the actuarial tradeoff for insurers without injecting too much radical change or complexity. “Make birth free” does not mean, of course, that doctors or hospitals wouldn’t be compensated; just that who pays for those bills would change. In a very real sense, this is pro-life Republicans officially making their peace with some of the regulatory powers embedded within the Affordable Care Act. Instead of the costs related to childbirth and postpartum care being concentrated on the shoulders of individual families, these will be wrapped into insurance premium hikes — asking everyone in the plan to pay a little bit more to give parents a little more predictability and stability.

The overall policy idea has undoubtedly been overhyped by some of its supporters. Writing in First Things, Kenneth Claycraft suggested that “no concrete proposal will do more to facilitate [boosting birth rates] than to make birth free.” Yet of course, many European have free pre-, peri-, and post-natal care through their socialized health systems and have birth rates even lower than ours here.² And some pro-life voices have championed the policy as being a response to the post-Dobbs challenges facing the movement to protect unborn life, offering it as a compassionate response to the needs of low-income women facing an unplanned pregnancy.

But 41% of American moms already had free birth last year, paid for by Medicaid (in Louisiana, nearly two-thirds of births are paid for by Medicaid, and it pays for over half of births in Mississippi, New Mexico, and Oklahoma.)³ Pregnant women generally have higher income limits to qualify for Medicaid (though increasing them is a good idea for states on lower rungs); the likelihood that a low-income woman facing an unplanned pregnancy would choose abortion due to the cost of childbirth itself, rather than the next year, or five, or eighteen years of raising a child, seems unlikely.

But once we look past the hyperbole, conservatives who want to dip their toe in the water of proactive pro-family policy can find a lot to like with the Hyde-Smith bill. The correct way to think about the Supporting Healthy Moms and Babies Act is that it is intended to cross-subsidize parents’ expenses and boost their financial stability (and, as

Leah Libresco Sargeant

and I wrote in 2023, minimize the unpredictability of too many hospital birth bills.) The average out-of-pocket expense for a normal birth is around $2,800 (though it can rise with complications or NICU stays). According to the Niskanen Center’s Lawson Mansell, the overall impact on insurance premiums across-the-board will hardly be felt, particularly against the backdrop of already-increasing insurance premiums. “Any rise in premiums resulting from covering out-of-pocket pregnancy costs is likely to be modest,” he estimates, comprising (at most) an increase in the range of one percent.⁴

Indeed, as the dean of conservative family policy scholars, Allan Carlson, wrote for Family Studies, the precedent for a universalist, pro-family focus on maternal health and mortality was set by 1921’s Sheppard-Towner Act, which funded the precusor to today's maternal home visiting efforts. And as AEI’s

Yuval Levin

wrote in a policy brief earlier this year, the strongest case for the proposal is not on pro-life, or even pro-natal grounds:

“[W]hether or not it affects birth rates, this policy would express a national commitment to children and parents that could hardly be more important. It would also provide for an unusual convergence between some pro-life Republicans and some progressive Democrats—and thus exemplify how family policy generally might draw together strange bedfellows and assuage polarization.”

Of course the Supporting Healthy Moms and Babies Act is not a replacement for expanding the Child Tax Credit, giving new parents upfront assistance upon childbirth, better urban design is, more flexible work arrangements, or the rest of the policy ideas that make up a pro-family agenda. It is essentially, an act of horizontal equity, asking the childless (or those who have already had or have yet to have children) to pay a little bit more to give new parents a little more piece of mind. As such, it’s a thoughtful, modest, worthwhile step towards building a public policy that places families’ needs first.

America is Not “Pro-Natal”

I’ll have more to say on a fascinating Yahoo/YouGov poll around pro-natal policies soon, hopefully next week, but for now, two charts that suggest the unpopularity (or, at least, lack of popularity) of explicitly ‘pro-natal’ policies at this current moment in time:

It’s Me, Hi

For the Wall Street Journal, I argued that the push to include “Success Sequence” legislation in public school curricula is a welcome opportunity to talk to students about what “success” really consists of:

“Republican legislators are aiming to reorient public education toward students’ long-term flourishing. Last month Tennessee Gov. Bill Lee signed a bill amending the state’s family-life curricula to include discussion of marriage, family structure and the importance of work. Lawmakers in Ohio and Alabama are considering similar legislation. Other states would be wise to follow suit.”

For The Hill, I used our 2023 report to illustrate why the Child Tax Credit deserves to be included in whatever ‘One, Big, Beautiful’ legislative product ends up making it to the President’s desk:

“Among moms with just some college education or only a high school diploma, their preferences were dramatically different: 38 percent wanted to be working full-time. Another 30 percent wanted to be working part-time and nearly as many, 28 percent, wanted to be at home with their kids…the tax code’s main provision that supports working families however they choose to arrange their work-life balance should be a priority for the coalition that wants to be widely seen as the pro-parent party.”

For the Washington Examiner, Zach Halaschak asked my opinion of the new Trump (neé MAGA) Accounts included in the Republican tax bill:

“I am heartened to see an expansion in the child tax credit as part of the bill, but I’d encourage Republicans to swap out accounts that won’t benefit anyone for at least 18 years in favor of upfront assistance to new parents — a bigger impact move, and one that will have more political upside.”

At Family Studies, Grant Bailey links to last week’s Family Matters in his writeup of the Johnston-Jones-Pope paper on divorce and child outcomes, as does Glenn T. Stanton at Focus on the Family’s Daily Citizen.

Parting Shots

• Kate Wells reports that physical abortion clinics are closing due to rising operational costs and expanasions of tele health, even in blue states (NPR)

• Senators Cindy Hyde-Smith (R-Miss.) and James Lankford (R-Okla.), will re-introduce the Reproductive Empowerment and Support Through Optimal Restoration (RESTORE) Act, which seeks to direct more federal funding and resources into exploring the root causes of both male and female infertility. (Daily Signal)

• My EPPC colleague

  Clare Morell
  proposed some AI principles to the White House AI Action Plan, including restricting the use of AI tools to users over 18.

• Leah Libresco Sargeant
  writes about the energies behind the Make America Healthy Again movement, and why they are ill-served by a push to expand public funding for in vitro fertilization (National Review)

• I am incredibly jealous of

  Charles Fain Lehman
  for writing this piece before I could — “Temptation as a Public Policy Problem” is worth The Dispatch subscription

• “America has a porn problem, but acknowledging it also means admitting that Christian conservatives have been right. So America will likely continue to have a porn problem,” writes my EPPC colleague Nathanael Blake (The Federalist)

• Delaware became the 12th state to pass a law allowing for physician-assisted suicide (Spotlight Delaware)

• Michigan lawmakers are debating a bill that would allow parents to claim an unborn child as a dependent for tax purposes starting at 10 weeks’ gestation

• A new editorial by Northwestern’s Katie Watson argues that “abortion and IVF are comparable practices because both are family-building medical interventions; therefore, support for IVF access ought to lead to support for abortion access.” (JAMA)

• Jess Grose argues that the pro-natalist energies behind some of the ideas being discussed in D.C. distract from other policies that could meaningfully support families (New York Times)

• Rachel Cohen continues her reporting on the child care landscape, rightly pointing out that despite BBB’s push for requiring “high-quality” child care, the evidence base is actually quite meager (Vox)

• Josh McCabe offers a solid, well-informed rundown of the family-related provisions in the “One, Big, Beautiful Bill” (Family Studies)

• Jason Furman calls the ongoing legislative effort a “tremendously expensive effort to make the tax code less efficient, less fair and more complicated” (New York Times)

• “South Korea’s infants and toddlers are entering day care institutions at a younger age and spending more time there,” per a new report from the country’s Education Ministry (Strait Times)

• Elaine Maag, C. Eugene Steuerle, and Margot Crandall-Hollick offer policymakers a guide in how to “Use the Tax Code to Better Serve Children” (Tax Policy Center)

Comments and criticism both welcome, albeit not quite equally; send me a postcard, drop me a line, and then sign up for more content and analysis from EPPC scholars.

1. While most employer-offered health plans must comply with the ACA’s regulations, a handful remain “grandfathered” and remain exempt from providing essential health benefits (and other aspects of the law) — as of 2019, about 13% of workers were enrolled in a grandfathered plan. (The bill even would apply to ERISA (self-funded) plans, often considered politically untouchable!)

2. I thank a regular Family Matters reader, who will remain anonymous to preserve their professional reputation, for flagging that the nation of Japan is also considering making childbirth free in their public insurance system, though the country already does provide a 出産育児一時金 (shussan ikuji ichijikin; literally “lump-sum childbirth and childcare allowance”) of ¥420,000 (roughly $3,000) to help cover the costs associated with childbirth.

3. Another, smaller share of women had free birth through generous health plans; approximately one in ten workers on employer-provided insurance are enrolled in plans that require no annual deductibles or additional cost-sharing.

4. Mansell is more copacetic than I to the concern about misaligned incentives; hospitals who know that parents no longer face any cost-sharing constraints could be more likely to steer them to services with higher reimbursement rates, such as needless tests on the low end to, potentially, unnecessary c-sections or other higher-profit interventions.