BALTIMORE. I'm Pregnant. What Would Happen If I Couldn't Afford Health Care? (NPR Shots)

By Dr. Leana Wen

On Christmas Day, I found out that I was pregnant. It was the best present I could have hoped for. My husband and I have wanted to start a family for years, and we could not wait to share the news with our loved ones.

But my initial exhilaration quickly turned to anxiety. As a physician, I knew many of the things that could go wrong. I wanted to do everything I could do to have a healthy baby.

I found an obstetrician and made an appointment for my first prenatal visit. I was so relieved when I saw the baby's heartbeat on the ultrasound. My blood was drawn to check for anemia and thyroid problems. I had the rest of my recommended first trimester tests, including a Pap smear and testing for HIV and sexually-transmitted infections.

The appointment also provided other valuable information. I talked to my doctor and his nurse practitioner about combating morning sickness and eating nutritious meals. I don't smoke, but if I did (as 1 in 10 pregnant women do), they would have counseled on why and how to quit. My providers asked additional questions to assess for domestic violence, a concern for up to 1 in 6 pregnant women.

Even though I'm a relatively healthy 34-year-old, I have several medical conditions that call for more frequent monitoring. My doctor recommended that I return every two weeks for a physical exam and ultrasound. Closer to delivery, I should plan to see him every week.

I didn't hesitate to follow my doctor's recommendations. I have excellent health insurance with no copay for doctor's visits and a minimal cost for tests.

But what would I have done if I didn't have insurance?

One obstetrician visit would cost $150. With an ultrasound each time, it would be $400. A Pap smear would cost $53. One set of blood tests would add another $300. All told, my prenatal care with all visits and tests included would be over $10,000. This is not counting labor and delivery, which in my area is estimated to be up to $30,000 for a vaginal birth and $50,000 for a cesarean section.

Facing these astronomical costs, would I be forced to pick and choose care based on my ability to pay, rather than the best available medical evidence? What services would I forgo, and with what consequences?

These are not hypothetical questions.

The Republican proposal to replace the Affordable Care Act would drastically cut Medicaid, which provides health coverage for women, children, seniors, and individuals with disabilities. In Baltimore, where I serve as the health commissioner, the majority of pregnant women are insured through Medicaid. Thousands of low-income women could lose coverage and have to pay out-of-pocket for services; others who have insurance may only be able to afford bare-minimum plans that don't cover needed services. Read more.