Making Childbirth Free Would Backfire, Pass Mothers’ Right To Save Instead

Coauthored with McKenzie Richards.

In the United States, childbirth costs anywhere from a few thousand to more than a hundred thousand dollars, leaving many young families in medical debt immediately upon welcoming a child into the world. Yet well-intentioned federal proposals to reverse falling birth rates with “free childbirth” will worsen long-term health outcomes of mothers and children, while ballooning the cost of healthcare for everyone. There is a better way: Mothers’ Right to Save.

In June 2025, the House introduced a bill to “make childbirth free” by prohibiting private insurers’ cost-sharing for prenatal, labor and delivery, and postpartum care. Under this bill, families with private insurance would not have to pay anything out of pocket for the costs associated with childbirth. State-level versions modeled after the federal version will likely arise in the coming year.

Despite popular appeals to leverage “free” childbirth to improve birth rates, these plans still will not result in overall reduced costs. Insurance companies would simply shift the costs to everyone in the form of higher premiums and deductibles. So, the patient might not get a bill right after the birth, but everyone would be forced to pay higher rates for decades to come to make it appear free. Ironically, the greatest economic burden would fall on families since they comprise the largest demographic that pays for health insurance.

Beyond economic concerns, mothers could expect a significant increase in cesarean sections, which can be riskier and lead to worse long-term health outcomes for both mother and infant.

Though necessary in some circumstances, the World Health Organization indicates that C-section rates exceeding 10 percent do not improve overall maternal mortality or morbidity. Yet one-third of all babies in the U.S. are already born by C-section, and that number is increasing. This is partly because private insurance pays significantly more for C-sections than vaginal births. Removing cost-sharing entirely could financially incentivize needless interventions and, therefore, lead to an increase in C-sections.

In San Diego, the price of a vaginal birth can be as high as $50,000 at Sharp Hospital, while Scripps Hospital, just a few miles away, charges $11,000 for the same services. Believe it not, for a C-section rate, the disparity becomes even more jarring: Sharp charges a staggering $117,000, compared to Scripps’ price of $35,000. Massive price differences are compounded by a crucial distinction in care: Scripps has a C-section rate of 23 percent (below the national standard), while Sharp’s rate is significantly higher at 29 percent. More C-sections mean more money for Sharp Hospital.

Just walking through different hospital doors in the same city to have your baby could mean a $80,000 price difference and a higher likelihood of undergoing a major surgery. Similar trends are seen consistently across neighboring hospitals throughout the United States.

There’s no doubt that giving birth is too expensive. But well-intentioned efforts to make childbirth “free” obscure true costs and may actually lead to unnecessary interventions. Policymakers and legislators should look to solutions that tackle the heart of the problem: a dysfunctional healthcare market.

A patient on private insurance might not be directly impacted by where services are received, because once their insurance deductible is met, the patient pays the same out-of-pocket amount regardless of location. But in the San Diego example, insurance companies still “pay” the $80,000 differential, which means denying services to other patients or pushing costs elsewhere. More denials mean providers will bill more to cover overhead costs. It generates an upward spiral of costs.

By contrast, in a market without middlemen, mothers would simply go to providers offering better quality of services, lower prices, or both. Changes in demand would pressure nearby facilities to dramatically lower costs and improve quality so they could compete.

To introduce competition in the market, states should establish “Patients’ Right to Save” style programs that encourage patients to find less expensive care. If a mother finds a delivery option that works for her at a better price, the insurance company would reward her with a portion of the savings. A mother choosing care at the more affordable Scripps Hospital in San Diego would receive a portion of the $24,000 – $80,000 in savings from the insurance company as a reward for lowering costs.

Insurance companies could give the mothers cash. Even better, they could invest in the new child by putting the savings into an investment account intended for future childcare or education costs, such as a 529, HSA, or the new “Trump Accounts” for newborns.

Arizona, Maine, Oklahoma, and Virginia already have a Right to Save style program for their residents, and about a dozen states have one for their public employees. Legislators should pilot an innovative “Mothers’ Right to Save” program for maternal health services. Rewarding mothers for saving money empowers parents, drives down costs, and invests in children.