Racial Disparities in Maternity Out-of-Pocket Costs reflect broader inequities in maternity care: JAMA

Rising out-of-pocket costs for maternal health care pose significant barriers to access and can adversely affect health care utilization and outcomes, particularly among marginalized racial and ethnic groups. The disparities in maternal health outcomes within the U.S. are stark, with Black and Hispanic birthing individuals facing higher severe morbidity rates and lower quality of care compared to their White counterparts. Despite the Affordable Care Act's provisions for certain prenatal services becoming exempt from cost-sharing, many necessary services remain subject to out-of-pocket expenses, resulting in financial burdens for birthing individuals.

Racial Disparities in Out-of-Pocket Costs

Recent analyses of data for those with commercial insurance reveal that birthing individuals incurred an average out-of-pocket expenditure of approximately $3,070 during maternity episodes, with higher deductibles exacerbating these costs. Importantly, racial and ethnic differences in spending were pronounced: Black birthing individuals experienced the highest overall out-of-pocket costs, and their expenditures on prenatal care were significantly greater than their White peers — by 74.4%. Hispanic individuals incurred costs that were 51.2% higher than those of White individuals. Notably, while out-of-pocket spending was elevated during delivery, the differences by race and ethnicity were most pronounced in the prenatal period.

Impact of Income Disparities

Income disparities also play a critical role, as out-of-pocket costs for maternity care can represent a significant percentage of median household income, thereby leading to financial strain. While higher deductibles contributed substantially to overall spending, coinsurance was identified as a primary driver of racial disparities in costs, highlighting the need for policy interventions aimed at modifying insurance benefit designs.

Policy Recommendations and Future Research

Addressing these disparities may involve policy measures such as lowering deductibles and coinsurance requirements or eliminating cost-sharing for maternity care altogether—an approach already proposed in certain legislation, supported by stakeholders like BCBSMA. Future research should explore the implications of out-of-pocket spending on racial and ethnic disparities in overall health outcomes and care utilization. It is also crucial to investigate contributory factors such as provider pricing negotiations and the nature of care received to comprehensively understand the landscape of maternal health costs and disparities. Thus, reducing the financial burden of maternity care, particularly for Black and Hispanic populations, is imperative for achieving equitable health outcomes.

Key Points

- Rising out-of-pocket costs for maternal health care significantly impede access and utilization of services, particularly impacting marginalized racial and ethnic groups, which can result in adverse health outcomes.

- Stark disparities exist in maternal health outcomes in the U.S., where Black and Hispanic birthing individuals experience higher severe morbidity rates and lower quality of care compared to White individuals.

- Analysis shows that birthing individuals with commercial insurance face an average out-of-pocket expenditure of approximately $3,070 during maternity episodes, with racial and ethnic spending disparities evident—Black individuals incur 74.4% higher costs on prenatal care compared to White counterparts, while Hispanic individuals face costs that are 51.2% greater.

- Income disparities significantly affect maternity care expenses; out-of-pocket costs can consume a large portion of median household income, contributing to financial strain, and highlighting the urgency for policy interventions in insurance benefit designs.

- Suggested policy measures to alleviate financial burdens include lowering deductibles and coinsurance requirements for maternity care or entirely eliminating cost-sharing, as endorsed by various stakeholders, which could promote equitable care access.

- Future research should focus on the effects of out-of-pocket spending on racial and ethnic disparities in health outcomes and care utilization, as well as factors like provider pricing negotiations, to fully understand the dynamics of maternal health costs and inequities.

Reference –

Rebecca A. Gourevitch et al. (2025). Racial And Ethnic Differences In Out-Of-Pocket Spending For Maternity Care. *JAMA Health Forum*, 6. https://doi.org/10.1001/jamahealthforum.2024.5565