By Mira Ptacin
This past year, I found myself in a bittersweet predicament: I was pregnant, but I was uninsured. It is a common paradox for working- and middle-class women: not poor enough to qualify for state-funded health insurance, not rich enough to purchase your own. Unless you are lucky enough to have family to help cover your expenses, or an employer who treats you as an employee rather than an independent contractor, you’re screwed. Without insurance, prenatal care and delivery can range from about $9,000 to over $250,000, depending on where you live, whether it’s a vaginal delivery or a caesarian, whether or not your pregnancy has complications. In Maine, where I live, the state median household income is approximately $52,000 and dropping—if you are part of a two-person family and together make more than $2,500 per month, government assistance is not an option. That’s $30,000, before you pay your bills, even if you cannot afford to purchase your own health insurance, even if growing a child and need adequate care.
Six months ago, my husband and I migrated from Brooklyn, New York, to a tiny island just off the coast of Portland, Maine. Nearly ten years prior, before we met, Andrew and I had both moved to New York to pursue our careers. I aimed to become a professional writer and felt like the Big Apple was where I needed to be. For Andrew, a structural engineer, his job in Manhattan was more than a great job—it was a life accomplishment, a prize. We took our careers and ourselves very seriously. We wanted to make our parents proud. We were both eyeball-deep in our jobs when we met and fell in love. Our courtship was complicated (to say the least) but we were, as they say, meant to be.
When we got married, we continued stoking our careers as we’d been doing all along. With our combined salaries, we made enough to put a little bit in savings and maybe go out to eat at a nice restaurant every once in a while. Through Andrew’s work, we had health insurance and even a modest retirement fund. We moved to Park Slope, a nice spot in Brooklyn, right by a big park and tall trees. With financial security and some material comfort, we thought we had it pretty good, but in reality, we were unhealthy. Our spirits became comatose because our lives revolved around our careers; aspects of our marriage felt businesslike, our home life like a flowchart: Which bills were paid? led to How can we earn more? Whose take-home work is more urgent? determined Who will walk the dogs and make dinner? We were so busy that we rarely saw one another, we fought all the time, and in time, the threat of divorce slipped into our arguments. I soon realized that for every good thing about the city (the career opportunities, the cultural diversity, the art, the food), there was also a dark side (the relentless urgency, the class divide, the cost of living, the competition, the grind). Many New Yorkers are able to ignore or deal with the negatives, but we could not.
So, about a year ago, we threw a dart at the calendar and vowed that no matter what, come June 22nd, we’d be in a moving van with our two dogs and our belongings, driving over the BQE, away from Brooklyn, to Maine, a state whose motto is “The Way Life Should Be,” where we’d breathe fresh air and live like a team. Instead of devoting ourselves entirely to our careers, we’d stoke the fire of our little family.
It was a risk: we were well educated and hard working and had some local connections, but didn’t have firm plans for employment or housing. We took a leap, confident that we could make it work. We shifted gears, purchased cheap health insurance for “catastrophic” what-ifs. We adjusted our expectations about careers and professional development, and did anything we could to get some traction. Soon we had job leads, and were confident that at least one of those leads would result in a job with benefits. But after a few weeks, we quickly learned that those jobs were sparse. Desperate, Andrew found a job doing manual labor on an alpaca farm, and I snagged a gig ghostwriting for a progressive blog covering Maine state politics, a subject that I knew next to nothing about. At one point Andrew was washing dishes at a local restaurant and working for a two-bit construction crew. He couldn’t seem to find work for which he was qualified; it was easy for him to find lesser-paying jobs for which he was over-qualified. It wasn’t exactly what we dreamed about, but we were moving in the right direction. Anyways, we’d already gotten over the biggest hurdle: we’d made it to Maine, “Vacationland,” and we were together. The rest was details.
Insurers can and very often do deny coverage to uninsured moms-to-be by defining pregnancy as a preexisting medical condition.
Eventually, I was offered an adjunct position as a writing instructor at my alma mater. It was job without healthcare benefits, but otherwise a dream job, one for which I was perfectly tailored, and it for me. After a few weeks, Andrew decided to make a go of it as a freelance structural engineer and slowly began finding clients. We found a sensible rental on a small island. A routine emerged that was what we wanted: work, paychecks, a hike together every morning, catching the sunset after dinner. We were finding balance, rebuilding a healthy marriage, and we were happy.
Then, one morning in October, ten weeks after moving to Maine, I woke up feeling awfully nauseous. A chemical stick revealed that the life of our little family was about to change. We were overjoyed.
But not insured.
I am now thirty-three years old. As I write this, I’m nearly seven months pregnant with our little baby boy, whom we call “In-utero Theo.” While Theo was not an accident, up until this year, I’d always been ambivalent about having children of my own. Andrew and I had lost a baby when I’d gotten pregnant a few years earlier, and thinking about having a child made me scared that my body was abnormal, that if I got pregnant again it would fail me again, and that I’d have to go through the terrible ordeal of losing a child once more. But then, this year I started feeling some new urges—primal ones—complicated pangs coming from my body and not my ego. Looking back, I think these feelings were my body’s way of telling me that it needed to do the most natural thing in the world: reproduce.
This was also when I realized that I was over myself—I was less interested in focusing all my ambition on my career. I became inspired by the idea of taking all the good things and lessons I’d learned from my life and putting them into a new person, a little human who might help contribute something really, really good to this world. A peacemaker. A person who might improve things, rather than use things. I realized that I might actually make a really good mommy, and raise a really good human.
After a doctor confirmed I was pregnant and projected my due date, I began prepping. The 15-minute visit alone cost $70 dollars; I needed health insurance.
We looked into purchasing private insurance. Andrew could get insurance for himself as a small business owner and I could be included in his plan as his wife, but the pregnancy wouldn’t be covered. I found this stunning, but it is common: insurers can and very often do deny coverage to uninsured moms-to-be by defining pregnancy as a preexisting medical condition. This meant that my husband and I both would have to purchase our own separate insurance, which, we learned, would cost up to $275 dollars a month each and did not include copays at the obstetrician’s office or significant deductibles ($2,000, or more). To some people, $550 every month isn’t much to stress about, but we could not afford these plans. After rent, utilities and groceries, we had almost nothing left. Covering the premiums wasn’t just difficult, it was impossible.
Considering all this, and with a spreadsheet demonstrating our unexceptional income and expenses, I was confident that I qualified for Medicaid. Not Andrew, just me and the child I was growing. Of course Theo would get adequate prenatal care. First of all, I was pregnant. I figured that Medicaid qualifications would be less stringent for unborn babies—how could anyone deny healthcare to an unborn child? If politicians wanted to deny birth control coverage or the option of abortion for unwanted or unsupportable pregnancies, surely they would be there to support women who do reproduce, even if they can’t afford healthcare. Right?
Of the 41 million Americans without health insurance, more than 800,000 are pregnant women. Of these uninsured pregnant women, 57 percent receive no medical care for themselves or their babies until the fourth month of pregnancy, or later. Twelve out of every 100 births come early, before the end of the ninth month. One out of every ten newborns is low birth-weight, and thus at an increased risk of disease or deformity for the rest of his or her life.
There is no moral victory in abandoning the most vulnerable members of our society, sacrificing them on the altar of a reactionary and antisocial opposition to universal health care: the financial costs of sick and high-risk babies belong to all of us in the form of increased medical costs that are absorbed by hospitals and, eventually, passed along to customers, or taxpayers, or both.
When I explained my personal healthcare injustice to my father, he was unsympathetic. “Be careful, Mira,” he said. “It is what it is, and you might be acting a bit-self entitled.”
To me, the moral is clear: pregnant mothers should have the right to adequate prenatal care to ensure that they, and their developing babies, stay healthy through pregnancy and birth. All of us are better off when that is the case. All of us are worse off when that is not the case.
I sent in my Medicaid application and waited. Weeks were punctuated with a doctor’s appointment here and there; a sonogram, blood tests, an ultrasound. Medical bills quickly began piling up—$300, $400, $600—with more prenatal appointments approaching. I wasn’t worried, though, because once Medicaid kicked in, these bills would be retroactively covered. Eventually, a thin letter came in the mail from the Maine Department of Health and Human Services, and after decoding its abstruse, bureaucratic mumbo-jumbo, I learned I hadn’t qualified for assistance and my application had been denied.
We were above the income limits for Medicaid eligibility. We didn’t make enough to afford private insurance and we made too much to get public insurance. It’s more than the middle-class squeeze. It’s a kick in the teeth (or the uterus) for women like me. We were doing our best, we had the best jobs we could find. What more could we do?
I immediately called the department—but my explanation was greeted with a dry, breathy laugh, followed by, “Just because you’re pregnant doesn’t mean you get healthcare.”
I immediately called the department—surely they must have looked over the fact that I was carrying an unborn child who needed medical care, and couldn’t afford to purchase health insurance—but my explanation was greeted with a dry, breathy laugh, followed by, “Just because you’re pregnant doesn’t mean you get healthcare.”
If the United States truly prides itself on family values, why is it nearly impossible for so many of us to care for our family, starting with the most basic care of all?
Eventually, I gave up on Medicaid. The rules were the rules, not intended for individuals with specific and complex circumstances. Eventually, our only option was to purchase private insurance and eat the premiums, the co-pays, and the deductibles. We started using our credit card, which we had avoided until now. We reluctantly accepted money from our parents to make up the difference—even though I know we are lucky to have this safety net, having to use it rankled. When I explained my personal healthcare injustice to my father, he was unsympathetic. “Be careful, Mira,” he said. “It is what it is, and you might be acting a bit-self entitled.”
He was right. We are lucky. We fell through the cracks, but we have a safety net. I don’t like that my parents are supporting us. They don’t help us just because they have the money, but because I’m their child. That makes sense. That’s the kind of parent I want to be. But what if we didn’t have a safety net?
Our economic system requires workers at many different levels—some people are CEOs, some people sell insurance, some people make and serve food, and some people clean toilets. Not everyone can pay equally to support our military, or our roads, or to help guard our clean air and water—yet we recognized that these things are appropriately thought of as part of “the commons”—when these fundamental elements are in place, society works better, for everyone. Just as we all benefit from these resources, we all benefit from healthy babies that have the best chance to become future contributors to society. Why should being rich or having a certain type of job be a prerequisite for health care security? Why should everyone else have to live in fear of what could happen and whether we can afford it?
I find this whole situation preposterous. It goes beyond the middle-class squeeze: it’s disrespectful to women. A woman’s reproductive options are dangled over her head: access to contraception is threatened; abortion rights are constantly under attack. When a woman gets pregnant, unless she is wealthy or covered by private insurance, there is little help for her to raise children without going into debt. And the medical bills start piling up before she even start pushing.
Yes, we are all deeply entitled to health care, not only but especially when pregnant.
Opponents of universal health care sometimes argue that our current system encourages competition and rewards the best doctors for developing the best treatments. In fact, it wastes money, delivers substandard results, and mostly exists to enrich pharmaceutical, insurance, and health-care conglomerates. All of our allies in Western Europe, Canada, Japan, and Australia have universal healthcare. The United States ranks 34th on the list of countries ranked according to infant mortality rates, behind Cuba, Croatia, and Greece. We rank 40th in life expectancy. Our mediocre health care system comes with an astronomical price tag—we spend roughly 50 percent more on our health care, as a percentage of GDP, than comparable industrialized nations. And surely, even those who use up-by-the bootstraps rationale to argue against supporting society’s most vulnerable must admit that babies in utero cannot be responsible for their financial situations. The system is broken, like a caved-in roof, and it’s the working- and middle-class citizens that are struggling in vain to stay dry, or even keep their heads above water.
Theo is due to enter this world on June 24th, one year and two days after Andrew and I left New York. The nine months of pregnancy are packed with preparation: eating healthy, sleeping enough, choosing schools, day cares, kid-proofing the kitchen, educating myself, working up until my delivery date and pinching pennies, doing our part to ensure that, given our resources and wits, Theo is born into comfort and safety. But how much can we truly protect him from when we cannot guarantee that we can see a pediatrician. Once Theo is born, he will stay on my plan and we will continue to pay with the money we don’t have. All we can expect is that we will continue to hustle. All I can hope for is that I can hide my fears and my stresses from my forthcoming son, and that these fears and stresses don’t detract from the attention I hope to give him. I want to raise him right. I want him to grow into a solid, loving, healthy, stable human being. I don’t want my financial impossibilities to get in the way of the development of the most important qualities of a human being.
When I was a little kid, my brother and sister and I had a game we played on car rides called “I Want.” The game was unsophisticated and fantastic: whoever pointed at an object (a Dairy Queen, a playground, a shiny sports car) and yelled “I Want!” first, got it. It was greedy and immature, and once my parents understood the gist of our make-believe game, they rolled their eyes and banned us from playing it. Looking back, I can’t imagine this game did anything good for my development other than helping me recognize the things I desired, as if any kid needs help with that. Perhaps it tainted me with a bit of self-entitlement. Maybe it gave me drive and ambition. Now, as an adult, when I see something I not only want, but I think I deserve, I wonder if I’m being ridiculous, like I was when I played that stupid car game. A roof over our head, food on our table, a loving relationship, basic healthcare, fresh air and clean water, a safe neighborhood…am I being greedy? Or are these desires actually basic, fundamental human needs, things to which all of us are actually entitled? I believe in the latter: that Yes, we are all deeply entitled to health care, not only but especially when pregnant. And I believe that anyone might believe otherwise is a symptom of how incredibly tangled and twisted our culture has become with regard to individualism, bootstraps, and the role of work, luck, and money in our normal lives. Equal access to healthcare is not something I want for me or just a few. It’s what I believe is a basic fundamental right for everyone who started their life inside a woman, no matter where they are in their lives today.
Mira Ptacin is an author living in Maine. She teaches the writing program at the Salt Institute for Documentary Studies and is founder of Freerange Nonfiction Reading Series & Storytelling Collective. She recently completed a memoir about the uterus and the American Dream. For more of her work, please visit miraptacin.com or follow her on Twitter: @miraptacin