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January 20, 2015

Navigating the Rise of High-Deductible Health Insurance: Childbirth in the Bronze Age

Author Affiliations
  • 1Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
  • 2Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • 3Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis
JAMA. 2015;313(3):245-246. doi:10.1001/jama.2014.16085

Death and taxes might be life’s only certainties, but birth and deductibles are poised to become their equivalent in the private US health system. Childbirth is the most frequent reason for hospitalization in the United States,1 and high-deductible health plans (HDHPs)—combined with their high out-of-pocket cost “bronze” counterparts in state health exchanges—will soon become the most common insurance arrangements for expectant mothers.2 Although the Affordable Care Act (ACA) mandates that health insurers cover birth hospitalizations, it does not limit cost sharing except through relatively high annual out-of-pocket maximums.3 Thus, childbirth-related cost sharing may increase markedly for US families in the coming years. This Viewpoint discusses potential implications of the increasing financial burden of childbirth and offers policy suggestions.

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