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

Mira Ptacin’s memoir, Poor Your Soul, was released in 2016. Her work has appeared in NPR, New York Magazine, McSweeney’s Internet Tendency, The National Book Foundation, The Morning News, Tin House, The Rumpus, and more. She teaches memoir writing to women at the Maine Correctional Center and lives on Peaks Island, Maine, with her husband, Andrew; son, Theo; daughter, Simone; and their two dogs, Huckleberry and Maybe.

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35 Comments on “Is a Baby a Luxury?

  1. I’m sorry but no one forced you to quit your job and give up health insurance.

    Yes I want national health care too but I find your choice to be argument to be incredibly weak and self-serving. The only people who put you and your husband in this spot are you and him.

    Part of being a parent is teaching your children how to live in the world that exists not the world you wish existed.

    I hope you or your husband find something stable fast for the sake of your future son.

  2. You made the choice to have a child – that was YOUR decision. You now cry out for care for pregnant women bc it is the right thing to do. Well the right thing to do was not get pregnant before you are ready. I wanted kids earlier than I had them but I waited until we were stable.

    Honestly you are no different than a pregnant teenager in HS – irrational about consequences, making due with help from parents. At least a teenager has their lack of life experience to blame.

    Newsflash, raising the kid is even more expensive. Where is that bag of cash coming from?

  3. Theo deserves better; you and your husband deserve better… I write this from the ‘safety nest’ of Europe, where I did not have to worry about such things. If you are pregnant here, you only focus on a healthy baby and delivery; you do not have to worry about falling through any cracks. Where I live (Germany) everyone is required to have health insurance; below a certain income level (below 65000 Euro annually), one pays instead a percentage of gross income. It is not a perfect system, but it has always served every medical need we’ve had. It is not a wasteful system (doctors do not overprescribe the newest medications), and everyone has a right to coverage, no matter what.

    Some years ago the state of California had some sort of medical (perhaps Medicaid affiliated) plan for expectant mothers whose income level was too high for traditional Medicaid but too low to make private insurance affordable. I can’t say if it still exists, but I can only hope something like it is still out there. I believe there are a number of religious-affiliated hospitals and organizations that will also provide assistance and support (including negotiating medical fees); I suspect you’ve already looked into all options, but here’s hoping there might be another option or at least system of support waiting in the wings.

    What I wish for Theo and you, for your new family, is a system that understands. Much, much support from this side of the Atlantic — Anna

  4. I completely support a single payer universal health care system and I sympathize with the problems the author has in obtaining insurance. However, does anyone really feel much sympathy for the decisions that led her to her predicament? Her and her husband are both college educated and I’m sure were aware of the health care system before they packed their bags. At 23, I would have more empathy, but not a mature women in her 30s. My questions/thoughts;

    1. There are other places in the country that are less stressful than New York, where you can find engineering jobs or jobs with benefits. It may not be an island in Maine or off the coast of Oregon, but whimsy isn’t always convenient or rewarded.
    2. She was planning a family. Didn’t she think of this problem beforehand? I’m not sure my thoughts would go – quit job with benefits, move to nowhere land, have baby, expect the baby to be paid for by state/insurance co…
    3. Did she really think it was fair to expect an insurance company to pay for her immediate needs when she hadn’t been paying into the system?
    4. Did she ever give two thoughts to those poor uninsured women, before she herself faced the problem, became indignent, and wrote an essay on Guernica?

    I have a minor pre-existing heath care condition and there is no way I could ever leave the corporate system with the current health care system. It stinks and it’s why I’ve worked hard to get people to support Obamacare or a universal health care system. I read this essay and it just seems like a hipster who faces reality for the first time. I don’t get a sense that she ever thought about this before it directly affected her life. I might be being too judge-y though…..

  5. While prenatal and infant care I important, and should be a tight and not a privilege, the idea that infant care is going to build a stronger society on its own is limited. How can we expect to build healthy children who have sick parents? A healthy community is one in which all it’s members are healthy.

  6. As I’m sure you know, the heath care expenses don’t stop when you stop being pregnant. Kids cost a LOT, health-wise. My 11-month-old has been to the pediatrician no fewer than seven times just in the last six months for a variety of “normal” winter illnesses.

    While I sympathize with your predicament and also feel strongly that babies and young children should not be the casualties of an individualistic, “up-by-the-bootstraps rationale,” I cannot help but wonder if you anticipated any of this before becoming pregnant (i.e., researching Medicaid cutoffs, etc.). As you rightly point out, “babies in utero cannot be responsible for their [parents] financial situations” — but the flip side of that is that their parents are. Or do you expect that someone else should be…?

  7. Strange view. You put yourself in a position to be without health insurance, and were surprised when someone didn’t offer to give it to you because you changed your mind?

  8. In response to your comment, Paul: you must be thinking of someone else. My husband does not come “from money.” He comes from a typical middle-class, small-town family made up of hard-working people.

    I find it somewhat disappointing that that’s your only response–an inaccurate, accusatory one at that–to an article about the fact that there are 800,000 uninsured pregnant women in our country.

  9. To me, the moral is clear: pregnant mothers should have the right to adequate prenatal care…

    No. That is a highly desirable social good. But, since it involves accessing other people’s time, treasure and talents, it cannot be a right.

  10. Even as a supporter of single payer government funded healthcare, willingly moving from two great jobs with insurance to go live a luxury life in Vacationland, then complaining about your lack of insurance makes you sound like a GOP anti-healthcare anecdote.

  11. Just a friendly reminder from your Guernica editors: this is a moderated space, and while we encourage readers to engage in lively (and respectful) discussion and debate about the pieces we publish, neither cursing nor personal attacks will be approved.

    Thanks very much,
    Your Comments Editor

  12. Mira, you are one of so many patients we used to see at the OB/GYN practice where I worked. Working hard (as a freelance writer and faculty member!) with a partner spearheading an entrepreneurial business and living the American Dream — yet trapped because of policy changes that are needed (many are law but not yet regulation because of timelines in the law).

    The world of health insurance seems dedicated to leaving patients uninsured, even when you want to pay for coverage. Facing the end of your rope, you explored Medicaid, to see that wasn’t an option either.

    I know has an insurance finder and it looks like four plans surfaced for Portland, Maine eff 6/1 with maternity coverage for you and your family at anywhere from $1500-$4000/month – often with high deductibles. I know some of it means tax incentives for small businesses. (One option here:

    This gap in the insurance marketplace hits pregnant patients, those with mental health issues, and others that most need coverage to be healthy in the community (thus making all of us healthy!). As more health insurance exchanges and other options open up in the years ahead, the future Miras (inserting a lengthy list of patients from the practice right now in addition to your name) won’t face this struggle and those many millions in the US above the federal poverty line but below an affordability metric for having the income to support a monthly premium of several thousand dollars will have an option to buy insurance through more affordable means.

  13. some of the comments on this thread make me sad. at the end of the day, do we really believe that if someone gets pregnant or sick in our country they should not have access to good, affordable health care? isn’t this something we should want all our friends, neighbors, family members, and fellow Americans to have?

  14. I think most of the comments agree that everyone should have access to affordable heath-care. The problem with this article is that it’s tone-deaf, reeks of privilege, and the snarky comments show that it hasn’t garnered much sympathy. No one is going to sympathize with a white lady who leaves her nice Park Slope apartment with her engineer boyfriend to go off to “vacationland,” knowing they are incurring substantial risks by not paying for healthcare while simultaneously planning a baby. Most people don’t have that privilege – a highly specialized job skill set, family members to fall back on, etc… She’s had this realization that many women in this country don’t have health care because she, a middle-class women, is now faced with some hefty hospital bills. We need to want to change the system and not just when it effects us. I agree with the message, I just didn’t like the delivery.

  15. While some commenters are focusing on the writer’s personal choices, I think we’re missing the bigger point here: “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.”

    We need to focus on what’s really at stake–the health and wellbeing of our youngest and most valuable resource–our children. Regardless of whether the author chose to have her baby, the socioeconomic status of her husband, or if she has her Master’s Degree, the most important takeaway from this article is that we have a deeply flawed system, and we need to work together to change it.

  16. As a society, we must all watch out for one another regardless of circumstance. We should not dictate who can procreate. We should love and care for each other while striving for better social reform, as caring citizens of this planet.

  17. Whatever education and (perceived) privilege the writer has, which somehow seem to be emboldening people to attack her, are actually irrelevant here. Healthcare should not be a privilege, and that’s the point. The author has posited some important questions, ones that deserve answers: “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?”

  18. Bravo, Mira Ptacin for having the courage to write such a brilliant, articulate and essential article. It’s only HUMANE that all citizens of this country have access to basic health coverage.

    I’m a bit shocked by the total lack of empathy and intelligence by those who left the first few comments. So are people who have it together financially the only ones allowed to have children? Well guess what folks: life happens. Children come into this world whether our lives are economically stable enough to raise them or not. Having a family should not be a luxury. But our country has lost touch with the values that once made it a great nation, and it’s the disgusting lack of compassion and common sense from individuals who posted above that have helped get us to this sad place. Shame on you.

  19. I disagree that you’re deeply entitled to healthcare. From the point of view of a Maine taxpayer, you’ve never paid into the community, yet you expect them to pay tens of thousands of dollars worth of care for you, and you won’t even pay for insurance.

    You ought to prevail on your husband to get a higher-paying job. It’s a little retrograde, but it is his duty. If you really want Medicaid divorce him and file as a single mother (or move to Massachusetts) If you insist on having free medical care, sit in the emergency room and give a fake social security number… or ask for charitable aid at your nearest religious hospital.

  20. Mira–I am sorry to see that people are attacking you personally for your choices. Your situation captures so much of what is wrong with life in America right now. It seems that in order to have the stability of jobs and health insurance, one has to live in a place like New York where the cost of living and the stress levels are high. I like that you use your predicament to challenge those who wish to eradicate abortion–when clearly some women need abortions simply because they can’t afford to have babies. At the other extreme, you have the people who commented here that you shouldn’t have gotten pregnant without having a solid financial plan in place. Life doesn’t always work that way, and it is in society’s interest to look after infants and children. I wrote a blog post called “Is Having Kids a Hobby Some Parents Can’t Afford?” about the cost of child care that explores some of the same territory as your article: You may already know this, but midwives often deliver babies for a set price that includes all the prenatal appointments, and you are far less likely to have unnecessary and expensive interventions. Birth centers have lower operating costs than hospitals, partly because they send moms home within hours of delivery. Best of luck to you!

  21. I found the story well written and heartfelt. It wasn’t until I read the comments did I see Mira as a foolish hipster. I see see the point of view from the commentators, and the importance of universal healthcare, and the importance of “good” decisions in our lives. But what moves me most is the actions these people took despite their advantages. Poor people tend to follow bliss despite the outcome because they have not much else to lose, but this couple with what appears to be an insight into the sickly structured power structure of success, chose not to sacrifice their bliss. I don’t think she made her decisions lightly or uninformed, she did them humanly.

  22. The writer obviously wants to convince us of the need for comprehensive medical coverage. However, her arguments appear to be based almost entirely on self-pity and her recent realisation that babies are expensive.

    The author is in serious financial trouble. She has a prestigious but low-paid job as an adjunct. Her husband is a freelance engineer in an economically depressed state. They’re struggling financially and are encountering the financial stress of parenthood. I think that most parents would have a certain amount of sympathy for their position.

    On the other hand, neither the husband or her husband appears to have done any planning whatsoever. They moved to a depressed state without jobs or the skills which would be needed to support a family. The writer wanted to have a baby, but didn’t do any financial planning (e.g., does the family qualify for medicaid, can we afford the medical consultations and treatment).

    When we change from children to adults, the expectations on us change as well. Part of the expectations and responsibilities of adults include planning, self-reliance, independence and so on. Yet as soon as the writer became pregnant, she regressed. Suddenly the government is responsible for paying her medical bills. When the government declined, her parents were expected to do so. I don’t think the writer quite understands the expectations society has of adults, even though she appreciates the freedoms.

    I’m desperately sorry for the child. The parents’ marriage was already uncertain and may not withstand the financial and personal stresses that a child brings into a family. I really hope that the child is healthy and happy. My sympathy for the parents is much more restrained. They chose their jobs, their financial circumstances and their location. Now they have to accept and manage within the consequences of those choices.

  23. I think the short answer to the question posed in the title of this well-written piece is: yes, unfortunately. As many of the commenters have pointed out, the bills don’t stop once pregnancy ends, and not just for healthcare. It’s sad that modern society has evolved to this point where the decision to procreate now must involve the question of affordability, but that’s where we are.

    I think it’s easy to pick apart the author’s personal choices — Monday morning quarterbacking is, after all, one of America’s favorite pastimes — but what’s missing from this piece is how much research about options beyond Medicaid was done. Few Americans are aware that most major, second- and third-tier cities host at least one (but usually multiple) HRSA health clinics and community health centers. Sometimes these are operated through local health departments, area charities, academic hospitals, federal programs, or a mixed bag of all four. Community clinics usually offer varied payment plans, discounted fees, and in some cases, free care. Depending on your community, many community hospitals and academic medical centers also have developed strategies for dealing with un- and under-insured patients — but it’s sometimes hard to figure out which are the “safety net” hospitals or providers, and in some places it’s dependent on individual physicians and other care providers who advocate for patients in need. Many alternative providers — like midwives or doulas — also work with patients in situations like this one, or are at least aware of resources to help.

    One of the main takeaways from this piece is that American healthcare truly requires the patient to be her own advocate. Like many other things in the US, one can’t assume that things will be automatically taken care of — you have to ask questions, be assertive. We’re free to make our own decisions and create our own paths — even to “Vacationland” — but the dark side of that freedom is that we have to fashion our own solutions when things go awry.

  24. Unfortunately, it appears as if many of the readers who are choosing to comment are getting caught up in the personal aspects of Mira’s story that doesn’t resonate for them. I find this unfortunate to say the least. I am personally offended by people who choose to work at jobs that take advantage of our environment and our communities and leave us depleted – many of which are corporations. I don’t get why people would be drawn to such work. With that said, the people who do this kind of work are no less worthy of good healthcare. Why do we continue to make this issue about who is “worthy” and who isn’t? We all make choices and I am grateful for people like Mira and her family who have the courage to step off of the “me, me, me” treadmill and do their best trying to find what sustains them. We need more people who do this.

  25. Mira, I’m so glad you wrote this article. I could have written it myself as I had the exact same experience, nearly word for word, and it’s an experience that deserves illumination. The commenters who suggest that your situation is somehow your fault are surely missing the forest for the trees. But you know what, maybe they’re right. Maybe all of us should wait to have babies until we’re “stable.” (Nevermind that steady jobs increasingly come without any health insurance.) Maybe if we boycott childbearing until there’s negative population growth that impacts the economy, then those in power might take notice of us. Then maybe they would be forced to adopt the family friendly policies of our more progressive neighbors in Canada, Europe, and beyond, as an incentive. Sadly, there’s no monetary profit for anyone when you or I find ourselves in stable marriages, with jobs we love that make our communities a better place, pregnant, and without insurance. So, we continue to be invisible, without a voice, without help. And there’s no profit in offering us accessible affordable insurance or care, otherwise, they would be doing it. And that’s what really counts, right? Profit. The love of money. Not healthy, productive families. That would be crazy!

  26. Paul, she might not have explicitly mentioned it, but she did mention that she and her husband had a safety net as part of her acknowledgement of her fortuitousness. I do not think the lack of total disclosure detracts from her valid points.

  27. Why aren’t women united in fighting for pregnancy care and health insurance? I am shocked when I see infographics like this:

    Thank you to Mira for being brave and honest in sharing her experience, which seems to be the first step in addressing this problem in our society.

    I am surprised to see comments from people who think Mira doesn’t deserve health insurance because she is a writer and professor. Our system is broken!

  28. Mira, you write of something near to my heart and of an experience very similar to one I myself endured. When I got pregnant sooner than I thought I would be able to after a miscarriage, I did so without insurance, and was astonished to find my options nil. I made too much money in severance from my contract job (which had ended the day before I discovered I was pregnant) to qualify for WIC or Medicaid. I was too pregnant to get insurance, even if I could afford it. our solution was different; my husband joined the Army.

    but the very real concern so many of your commenters seem to pass over with no more than a sliding, snarky personal attack is how the high-pressure stress of jobs that *do* earn enough to afford premium maternity insurance is destructive for family structures and the health & happiness outcomes for children. and for so many families, those jobs are simply not attainable or available. for every freelance writer or happy entrepreneur or adjunct instructor, there are dozens of women working minimum wage jobs with not only no health care, but no paid maternity leave.

    not all of us can strategic-plan a biological imperative, and even if we all could, what sort of society would that be? do we really want a world in which only the beautiful, rich, and good at spreadsheets can have children? even our own president was conceived without forethought or financial planning. the care taken in conception has no correlation with the value of a human’s life — and the hubris in thinking that any of us has the wisdom to foretell whose life is worthwhile is so enormous it very well might crush us.

    no, we all deserve health care, and we all deserve good prenatal and maternal care. it should be a basic human right. it should not be a privilege belonging only to those with good credit scores. you, Mira, should have not only the right to health care, but you also should have the right to choices that improve your happiness. the lack of human empathy among so many of these commenters saddens me.

  29. One of my best friends is undocumented and both her pregnancies have been covered completely by emergency medicaid. Although I am grateful for her coverage and think she should have it, I find it troubling that it is easier and far more common for undocumented mothers to obtain free pre and postnatal medicaid than American citizens. I wish you and your family the best, Mira.

  30. I love the tone of all natural disdain when you call the pregnancy test a “chemical stick.”

    Pregnancy tests don’t have chemicals on them. The only chemicals involved come from you. The sticks have an antibody on them that bind with the chemicals in your urine.

    You clearly know as much about science as you do about health care and basic planning.

  31. Wait, you were actively trying to have a baby, and you didn’t research beforehand about health insurance? And now you complain that you should be able to buy insurance really cheaply, and have it cover your pre-and post-natal care? Surely you know that once the house burns down, it’s too late to buy insurance? I support single payer health insurance, if only to prevent wannabe free-loaders like yourself from wanting something for nothing.

  32. Jennifer,
    First, that was needlessly snarky. Second, pregnancy tests work because the hCG hormone binds to an antibody *attached to a pigment indicator*, which is a chemical. There’s no need to pick on Mira’s science knowledge.

  33. Leah, most indicators use pigment molecules, which is different from a compound. So unless the author would write “I drank a glass of chemical water” when she just means water, then my point stands.

    More broadly, I think it’s annoying when people use the word “chemical” as a pejorative, despite the fact that chemicals are what make us work.

    For me that detail emphasizes her whole feeling-over-fact approach to the essay which is so frustrating. Her being socially irresponsible is none of my business (and irrelevant to this whole issue), so I’m in no position to make that the center of my complaint. I wanted to comment on a hard, verifiable fact. That one point, to me, does a great job of showing what a lazy thinker the writer must be.

  34. The Sanity Inspector:

    “But, since it involves accessing other people’s time, treasure and talents, it cannot be a right.”

    Actually, it only really involves accessing other people’s treasure. The talents and time are paid for by the treasure and no one is enslaved to provide them.

    If you acquire treasure in a society that enables you to acquire and keep that treasure, are you not under some obligation to maintain that society and pay it back for the favors of civilization? People can only accumulate wealth without violence in a society that has law enforcement and courts. And the vast majority of modern wealth can only be accumulated in a society that has a military, public health, public education, public roads, clean air, clean water, collective investments into the accumulation and distribution of knowledge and innovation,collective investments into the discouragement of violence through the care and improvement of the impoverished. The evolving social contract in which the very concept of “rights” as well as all modern concepts of treasure evolved has included the concept of collective duty to prevent illness, starvation, exposure, and wasted potential longer than it has included the concept of rights.

    I don’t agree with this author’s choices, and I don’t like the way she reported her article and sentimentalized her privileged example and experience without fully and respectfully putting it in the larger context of those lacking her resources and safety net. It is a rhetorical disservice to her point and to the people who truly depend on her point being made. But it does not disprove her point, and your stark focus on the value of “treasure” highlights her points innate validity despite the lack of perspective in her writing. We have a right to life, liberty and the pursuit of happiness. Property is not on that list. If we accumulate property with the help of the whole, we must contribute to the health of the whole. If you want to live in a society where you are allowed to continuously horde treasure and you want the rest of us to contribute to preventing a malnourished, uneducated, unhealthy youth from attacking you and stealing your treasure and punishing him if he does, you better damn well also contribute to making sure innocent youth don’t get pushed into that state. Since your hording of treasure disproportionately puts demand pressure on the ability of the poor and the ill to survive, your contribution better damn well be made in the form of progressive taxation. And if all mathematical and empirical analysis determines that the single most efficient way to make these preventative measures is universal health care, do not think you can cloak your desire to profit and horde even more treasure on the back of an exploitative and inefficient system in whiny injured protests involving the lack of society’s right to tax your treasure, even once the even more fake protests about family values fade away.

    Back to the flaws of this article: it’s also bad reporting to not include, in this entire discussion, an analysis of how her situation might or might not be different if she had waited a year or two to get pregnant: I am under the impression that the kind of crappy catastrophic individually insurance she purchased, which does not cover pregnancy, will not even be legal come Jan. 1 and insurers in Maine will *have* to provide an affordable plan to self-employed pregnant women. Not elaborating on that this year of all years is just bad policy writing.

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