No-cost birth is a bipartisan idea, but is it a good one? | Abby McCloskey

He is not alone. A bicameral, bipartisan group in Congress is working to make free birth a reality for all Americans.

Childbearing in America isn’t cheap. For most families, the costs start accumulating right away, with prenatal appointments, ultrasounds and blood tests. One in 5 pregnant women will also need miscarriage treatment.

Then there’s the birth itself. Childbirth is the most common reason for hospitalization in the U.S. For families with private health insurance, the average cost of birth hovers around $3,000. If a newborn requires care in the neonatal intensive care unit or if a family has a high-deductible health plan, the costs can easily climb above $10,000. Then tack on more costs for postpartum appointments and newborn pediatric visits.

The American middle class feels this burden the most. For families with income low enough to qualify for Medicaid, hospitalized childbirth is free, along with prenatal and postpartum care. And Medicaid covers 40% of births. Looking abroad at America’s peer countries, the average out-of-pocket cost of childbirth is zero.

All this forms the backdrop to the “Supporting Healthy Moms and Babies Act,” which was introduced in the U.S. Senate last year, with companion legislation in the House. It seeks to bring the out-of-pocket costs for maternity care to zero, including prenatal, childbirth, neonatal and postpartum expenses. These would be treated as essential services, and insurance premiums would be slightly increased to cover them.

This sounds good on its face. Who doesn’t love “free” things? But just because something is expensive doesn’t mean the government should pay for it.

Free birth unites a broad coalition across the political spectrum, with advocates ranging from Democratic Sen. Kirsten Gillibrand of New York to Republican Sen. Josh Hawley of Missouri. This is the case even though the political left and right have deep disagreements about the future of family policy. A free-birth policy builds on the patch of common ground that healthy babies and mothers are plainly and clearly a social good.

But free birth is not without costs — because nothing, of course, is actually free. Requiring insurers to cover childbirth will result in higher healthcare premiums and perhaps higher prices charged by hospitals, who will know that patients won’t bear the direct burden.

If the government helps to offset the cost of birth, it will raise questions about why it does not invest in other family-friendly benefits instead. A free-birth policy would not target the most cash-strapped Americans — who are already covered by Medicaid — but the middle class and the wealthy.

Free birth for millionaires and billionaires? I’m not sure that’s the highest and best use of our deficit-financed spending. If the goal is broad financial relief for middle class families as opposed to structural change, that’s more efficiently done through tax cuts.

Nor is free birth going to bump up our falling fertility rate. Simply look across the pond, where free birth and other family-friendly support is already the norm, and yet European fertility rates are below our already sub-replacement one.

To mitigate costs while making birth a more predictable expense, a compromise could be an out-of-pocket cap on birth-related expenses. The government could set a ceiling of, say, $2,200 for maternity care, above which the costs would be borne by the insurance company or subsidized by the government. The $2,200 number is the size of the current Child Tax Credit, which if applied against the costs of birth, would essentially make it free.

I know that this sounds less jazzy than “free birth.” But it would address the biggest problem — unpredictably high costs — while being less expensive for taxpayers.

Making birth free won’t budge our nation’s baby bust, but I’m glad it is on the table for debate. Whether you’re the vice president or a family on Medicaid or somewhere in between, birth shouldn’t break the bank.