punchline of an old joke - Only thing in the house that’s paid for and it leaks
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Years ago spouse and I were in the US and got chatting to a visibly pregnant waitress. Yeah, she had two jobs, was still working the second waitressing job to save the $5K she needed to have the kid in the hospital. We were seriously taken aback, the concept was entirely foreign. Then she explained that she was only taking a couple weeks off work, because no work=no pay.
Contrast that to Canada. Hospital delivery of any sort =0. Or at home with a midwife, also 0.
One year off of work, with paid gov’t benefits for a good part of that. Some employers top up the gov’t benefits to make your pay 90% when you’re on maternity leave. And now, fathers can tag in and take off some portion of that year leave. You can see why I was taken aback to find out about the US system.
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Which brings up Medicaid, which paid for 42% of childbirths in 2020 according to Births Financed by Medicaid | KFF
Interesting state-by-state map there.
And you can add a couple of zeroes to that if your kid is pre-term
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And then afterwards you can pay around $2k or more a month for infant daycare!
If you can’t feed your baby (yeah, yeah)
Then don’t have a baby (yeah, yeah)
And don’t think maybe (yeah, yeah)
If you can’t feed your baby (yeah, yeah)
$10 per day daycare is being introduced across Canada.
Is this the case you’re talking about?
[I think] You’re talking about a case from 32 years ago where the plaintiff’s own lawyer thinks that Alito’s views were being misrepresented.
First, prenatal care IS mandated to be free under Obamacare.
Second, I acknowledged that delivery isn’t free in my post… just covered as an EHB.
Third, it sounds like both of those articles are exaggerating the numbers. Both studies include only mothers with private insurance whereas Medicaid and TriCare combined cover around half of all births, and nearly all low-income mothers. I think delivery is free under Medicaid & TriCare Prime and $25 per day of hospitalization under TriCare Select.
Further, the second includes all medical care for 12 months prior to delivery… citing that, as an example, the expense of treating a broken leg that occurs at any point in the 12 months prior to delivery is included in their cost of “labor and delivery”.
That said, I certainly don’t dispute that if you have a high deductible plan, the out-of-pocket cost can be high. Particularly if you don’t have an HSA to help with the deductible. They don’t mention the impact of HSAs. If I’m presented with a bill for $4,500 from the hospital and I use my HSA to cover $4,000 of the bill and pay the other $500 from savings, is my out-of-pocket $4,500 or $500?
What if I don’t actually pay the full $4,500 and the hospital eats some or all of the cost? How is that counted?
Anyway, like I said, I acknowledged in my initial post that it I wasn’t claiming it was free for everyone, just mandated to be covered by insurance.
IFYP; highest permitted OOP Max in 2022 is $8,700.
Yeah, daycare can be expensive, although Head Start and Early Head Start are free for low-income families. $2K a month would be considerably higher than the national average of $216 per week, but it is certainly possible to pay that much.
I do think that we could do more to help with that. An obvious start would be to retroactively index the DCFSA and CDCTC to inflation.
If DCFSA had been indexed to the CPI it would today be $12,826 instead of $5,000.
If the CDCTC had been indexed to the CPI it would today be $4,817 / $9,634 instead of $3,000 for the first kid and $6,000 for two or more kids. (They temporarily bumped that in 2021 due to Covid, but in 2022 it’s back down to $3,000 / $6,000.)
Now by “retroactively” I don’t mean change 2021 & earlier tax calculations - that’s too complicated. But starting in 2022, treat it as if it had been indexed to inflation going back to 1986 (DCFSA) when they put it in (or 2001 when they set the current level of the CDCTC)
Retroactively indexing the $2,000 CTC to the CPI would make it today worth $2,269. (That one’s much newer.) Weirdly, the refundable portion of the CTC (the ACTC) is indexed to inflation and in 2022 increased from $1,400 to $1,500. But the full CTC is not indexed to inflation. Whose brilliant idea was that??? (CTC was also temporarily bumped in 2021 due to Covid, but back down to $2,000 for 2022.)
There’s more we could do, but those are obvious places to start that should be fairly non-controversial. And you know, go ahead & round to the nearest fifty or hundred if you feel so inclined. I just compared January - January CPI numbers and did NOT round, but I don’t particularly object to rounding. And I’m not married to the CPI either. In fact CPI-W might be more appropriate. I just mainly object to there being zero inflation adjustment at all.
Oh and for reference:
CTC = Child Tax Credit
ACTC = Additional Child Tax Credit
DCFSA = Dependent Care Flexible Spending Account
CDCTC = Child and Dependent Care Tax Credit
you realize that people who are poor don’t have a lot of money, right? Not even in HSAs and 401Ks.
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Interesting data in this Gallup poll. Definitely touches on a lot of the nuance around this issue. Interesting at the very end of the article when they dive into why a woman is getting abortion that only 45% of Americans think abortion should be legal even in the first trimester for normal healthy pregnancies where the only reason the abortion is being performed is the mother doesn’t want the baby. To me that is fundamentally what the argument here is about as overwhelming majorities support abortion in cases of rape, incest, mother’s health being in danger, and the baby having a major genetic defect.
I certainly wouldn’t think people on Medicaid would, no.
If income is too high to qualify for Medicaid, even while pregnant (which often has a higher income threshold than it not pregnant) then a silver plan the Obamacare exchange is a good choice because of the CSRs.
Probably the people in the worst boat in terms of paying for a delivery while being somewhat low-income are the ones who have employer-sponsored coverage deemed “affordable” and it has a high deductible. But IIRC “affordable” means it has to cost less than 9% of income. That’s going to put most of the next income tier that are too high-income for Medicaid into PTC / CSR eligibility.
Yes, in theory you could have a woman whose income is 201% of FPL* whose employer offers a high deductible plan that just barely meets ACA guidelines but who also pays most of the premium, thus making it “affordable” to her. That’s sort of a perfect storm of factors making it as unaffordable as possible. But probably most employers who pick up that much of the premium are also picking more generous plans. They’d certainly be better serving their employees to do so. And if they’re not picking up enough of the premium then the plan is “unaffordable” and you can go on an ACA plan instead and qualify for both PTC and CSRs.
*This seems to vary quite a bit. I checked several states, both ones that expanded Medicaid and ones that did not. They all have different numbers and in some states it doesn’t matter if you’re pregnant or not, but most of the ones I checked seem to be near 200% of FPL. California was 213% of FPL, Ohio is 200% and Texas has a table where the amount for a pregnant woman in a household of 1 (I didn’t check every possible family size) worked out to slightly over 198% of FPL. I checked a few others too. Surprisingly (to me) Oregon was lowest of the ones I checked at slightly over 180% for a HH of 1.
And in normal countries that are as wealthy as the US, no woman has to carefully research her insurance options, save money, and generally worry about how to pay to have a kid.
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I haven’t read the article, I just looked at the map. But I thought it was just states that will outlaw abortion immediately upon Roe going away, and not a projection of who might pass what legislation in the next 3 years, or whatever.
Personally, I expect Kansas will outlaw abortion, but doesn’t happen to have a law already in the works to do so.
Yeah, true, I’ll grant you that. It’s certainly complicated. That said, I know my ob-gyn offers assistance in figuring this all out as the office is plastered with signs. I’m not sure how common that is, but it seems like I’ve seen similar in the offices of past on-gyns too .
Maybe I’m reading too much into the word “likely” but that would seem (to me) to imply some level of projection.
Hmm, I may be wrong. Here’s a better link:
If Roe v. Wade Falls: Travel Distance for People Seeking Abortion | Guttmacher Institute
IANAConstitutionalL but that seems like it would fly in the face of the SCOTUS’s interpretation of the 10th Amendment, assuming that this draft decision is adopted. (Which from what I’m reading, due to the leak, is now more likely than before the leak happened.)