The cost of childbirth and postpartum health care results in significant, ongoing financial hardship, particularly for lower-income families with commercial insurance, according to a new Milbank Quarterly study. Researchers Heidi L. Allen, PhD, of the Columbia University School of Social Work, Jamie Daw, PhD, of the Columbia University Mailman School of Public Health, and colleagues surveyed people with Medicaid or commercial insurance about a year after they gave birth and found: Over half of respondents with commercially insured births spent more than $1,000 out of pocket on childbirth and nearly 40% reported being somewhat or very worried about paying health care bills Lower income people (with annual incomes of less than about $60,000) with commercially insured births reported particularly high financial strain: nearly half still owed money for childbirth costs, 16% had not made any payments yet, and 1 in 5 had medical debt in collections. Overall, Medicaid was financially protective for birthing families relative to private insurance because only 20% had any out-of-pocket spending on childbirth or health care in the postpartum year. However, any cost-sharing was associated with outstanding medical debt. The authors propose several policy solutions, including eliminating all cost-sharing for pregnant and postpartum people in Medicaid and allowing lower-income birthing people with private insurance to apply for supplemental Medicaid coverage. (fb)

A trip home to help with Appalachian mountain relief work in the wake of Hurricane Helene brought lessons on trust and community for Morgan McDonald, Milbank’s National Director of Population Health and Health Equity Leadership. In a new View from Here, Dr. McDonald reflects on what she witnessed through the lens of her years in public health — and what it means for people in government. Preparing for emergency scenarios takes dedicated and ongoing federal, state, and local funding, as well as attention to building relationships that are put to the test during a pandemic or in a flood recovery, McDonald says. (fb)