Since the U.S. Supreme Court overturned Roe v. Wade in June, there has been talk in the pro-life movement about what comes next.
Much of the political focus has turned to state legislatures as the new battleground for abortion restrictions.
But discussion among pro-life groups in the U.S. has also stressed the importance of creating a more supportive climate for parents and new babies, with suggestions including government support of pregnancy resource centers, initiatives to ensure paid parental leave, and efforts to make the adoption process easier.
Last week, Americans United for Life and Democrats for Life of America released a jointly authored white paper entitled Make Birth Free: A Vision for Congress to Empower American Mothers, Families, and Communities.
The paper argues that women, babies, and society as a whole all suffer as a result of the high costs associated with childbirth in the United States, costs which far exceed those of other developed nations.
It says a federal policy to make childbirth free would discourage abortion and encourage rising birth rates.
The Pillar spoke with Tom Shakely, Chief Engagement Officer at Americans United for Life, about the policy proposal. That interview is below. It has been edited for length and clarity.
Why are you proposing free birth? What role does this initiative play in the pro-life movement at this particular time in the United States?
We created our "Make Birth Free" proposal to start a conversation in Congress about what can and should be done in this post-Roe era to deliver truly life-affirming healthcare to all American mothers, families, and communities. We want to foster a brighter future.
Leaders from across the American and international pro-life movements recently signed "Building a Post-Roe Future," a public statement calling for federal and state governments to take action to eliminate the economic and social pressures that make abortion the norm for too many and discourage childbirth for too many.
In the statement, pro-life leaders call for "accessible and affordable healthcare for parents and children" including "expanding Medicaid funding for prenatal care, delivery, and postpartum expenses to reduce the financial barriers to welcoming a new child."
Americans United for Life and Democrats for Life of America came together with "Make Birth Free: A Vision for Congress to Empower American Mothers, Families, and Communities" as a way to implement the sort of vision America's pro-life leaders outlined in "Building a Post-Roe Future."
We know we need to do more, and we believe that marginal policy changes or tinkering around the edges will not meaningfully improve the American healthcare experience for mothers and families.
What is the cost of birth in the U.S.? How does that cost affect women, babies, and society?
Childbirth is the number one reason for hospitalization in the United States, and maternity care in the United States is uniquely expensive. In "Make Birth Free," we write:
"A recent study by the American Academy of Pediatrics found that between 2016 and 2019, one in six privately insured moms were on the hook for more than $5,000 in out-of-pocket expenses. Costs are even higher for families whose babies need to be treated in the neonatal intensive care unit (NICU), and one in eleven of those families paid more than $10,000 out-of-pocket for the birth of their baby.
"Mothers in the United States face staggering medical bills for labor and delivery. According to Elizabeth Bruenig’s reporting in The Atlantic, 'a hospital in Texas charged one couple north of $10,000 for labor and delivery, with some $3,000 paid out of pocket in the run- up to the due date, and another $1,500 charged after the birth; in Indiana, a high-risk delivery this year totaled more than $24,000; in Colorado last year, a hospital sent a mother a $14,000 bill for her uncomplicated hospital delivery without so much as an epidural, $5,000 of which she was forced to pay out of pocket.'"
Addressing these costs, containing them, and providing robust healthcare is essential and there is precedent for how to do this successfully. Mothers and fathers should not be wary about having a child. Mothers and fathers should never face the prospect of unforeseeable five-figure bills or experience crippling medical debt. Mothers and fathers should be free to focus on their future as they welcome their child into the world and free to invest in their family's future.
What exactly are you proposing, policy-wise? What benefits are you hoping to reap from this?
Making birth free simply means eliminating direct costs to mothers and families. There are many ways to make birth free, and we offer a few policy proposals to members of Congress to take this vision and make it law.
We are proposing that Congress exempt prenatal and birth-related expenses from deductibles and co-pays in all Affordable Care Act-compliant public and private insurance, much as preventative care is under the existing healthcare system. ACA-compliant plans, for perspective, presently make contraceptives co-pay free, but not prenatal care like ultrasounds.
Exempting prenatal and birth-related expenses from deductibles and co-pays would also have the effect of ensuring, not unlike property taxes with respect to public education, that all Americans on public and private insurance are in some sense working together to strengthen and grow American families.
We are also proposing that we build upon Medicare and Medicaid policy precedents to ensure that we truly make birth free for all Americans, including comprehensive prenatal, childbirth, and postpartum care. We would eliminate the existing reimbursement disparity between C-section and vaginal births, and create financial incentives for mothers to work with midwives and doulas, or if they desire to choose home-birth or birthing centers. We also propose that states extend Medicaid's postpartum coverage cut-off from 60 days to a minimum of one year after birth.
The average cost of childbirth and the approximately 3.6 million annual births in the United States, a basic program to Make Birth Free would cost about $68 billion. Crucially, only $39.5 billion of that amount would be new spending, due to existing Medicare and Medicaid spending that already makes birth free for roughly 40% of all births.
Since we released Make Birth Free last week, we've seen other proposals to make this vision a reality, from Matt Bruenig's Medicare Pregnancy Program to Patrick T. Brown and Leah Lebresco Sargent's proposals to create a "baby bonus" and generally make birth more affordable. While we believe making birth free should be as simple and straightforward as possible—in order to eliminate administrative burdens and government bloat—we applaud any approach that leads to making birth free to all mothers.
Financial concerns are one of the leading causes preventing men and women from creating the families they say they want. The economic conditions that discourage men and women from starting families or from having another child create social realities that threaten America’s future.
A five-year RAND health insurance experiment found that it matters to mothers whether it's free to have a baby. They found that women had 29% more children when childbirth was free, compared to those assigned to a deductible-based healthcare plan. Think about the astounding social and economic ramifications for 29% growth in babies and in American families.
Making birth free is an investment not in the private good of some but rather an investment in the public good of the American family as a generator of America's future.
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What would you tell Republicans who are wary of this being one more government-funded program?
In this post-Roe era, when abortion activists are in some ways more aggressive than ever, Congress must act boldly to ensure that childbirth is no longer more expensive than abortion. It's that simple.
In fact, Republicans pioneered the publicly-funded program we cite as precedent in our Make Birth Free white paper: nearly 50 years ago, President Nixon oversaw an expansion of Medicare to provide public healthcare to all Americans experiencing kidney failure, to ensure that no one in such a condition would be financially ruined or left to face their condition alone.
This Medicare expansion has delivered excellent healthcare to those experiencing kidney failure and it has also contained costs associated with this treatment. We cite many other healthcare precedents.
For nearly 50 years, Roe v. Wade taught Americans not only to accept abortion as a part of our way of life, but in many ways to celebrate it as a supposed means of empowerment. In reversing Roe, the U.S. Supreme Court nonetheless failed to repudiate abortion. Instead, the Court delivered an opinion in Dobbs that effectively accepted a radical notion: that is, the view that the U.S. Constitution is compatible with abortion.
We remain at least another generation away from the possibility of truly abolishing abortion, but there are many pro-life and affirmative and substantive—rather than reactive and merely rhetorical—actions we can take to foster the sort of pro-life culture that will be life-giving for our nation. We must not accept a status quo where the federal or state governments publicly fund abortion or contraception, but refuse to support conception, pregnancy, and childbirth.
Congressional Republicans joined Democrats last year with very little substantive public debate to allocate more than $100 billion to finance the war in Ukraine. The additional spending we are proposing to make birth free to all mothers represents less than half of what we spent in Ukraine last year. As worthy as the cause of Ukraine may be, we believe American mothers are our greatest allies in the cultural and demographic war to foster a stronger future.
Abortion activists treat pregnancy as if it were a disease, but being pregnant is one of the most beautiful and wondrous experiences a mother can have in this life. The act of childbirth, and the pre-natal and post-natal care essential to it, should be natural for every Republican lawmaker to support.
What would you tell Democrats who are concerned that women will be left without the resources they need after birth?
We understand the desire to always do better and more. In addition to making pregnancy and childbirth itself free to mothers, we believe and propose that Congress should implement a monthly maternal stipend, equivalent to a Social Security monthly payment, for the first two years of a child's life. We envision this stipend coming with no strings attached, so that families are able to use the money however they wish to address their growing family's needs.
Do you think this is a realistic proposal? Can it get bipartisan Congressional approval?
There's nothing more realistic, pragmatic, or prudential than investing in our future by making birth free. We must continue to invest in America's future, where we are in the deepest and most profound sense invested in the future of our families, our children, and our communities.
The Washington establishment routinely comes together to fund all sorts of far costlier and far less obviously worthwhile national programs. We say we believe in America. We say we're pro-woman. We say we're pro-family. We can come together to make birth free.
There is energy and momentum behind making birth free. We are already dialoguing with members of Congress on both sides of the aisle about making birth free. While we know it can take years for good policy to go from vision to implementation, we also know that American families deserve this sort of public investment today.