America might finally make childbirth free

Vox

a day ago

is a policy correspondent for Vox covering social policy. She focuses on housing, schools, homelessness, child care, and abortion rights, and has been reporting on these issues for more than a decade.
As politicians grapple with declining birth rates, the financial burden of giving birth in America — where privately insured families face out-of-pocket costs of nearly $3,000 on average — has captured widespread attention. Last month, when news broke that the Trump administration was considering $5,000 baby bonuses for new parents, comedian Taylor Tomlinson captured the national frustration: 'That's like spritzing a volcano with a water gun.' A recent viral TikTok showing one mother's $44,000 hospital bill shocked viewers worldwide, underscoring the uniquely brutal pressures facing American families.
Now, a rare bipartisan solution could directly address at least the problem of expensive childbirth. The Supporting Healthy Moms and Babies Act, introduced in the Senate last week, would require private insurance companies to fully cover all childbirth-related expenses — from prenatal care and ultrasounds to delivery, postpartum care, and mental health treatment — without any co-pays or deductibles. (Medicaid, which insures roughly 41 percent of American births, already covers these costs.)
The bill was introduced by Republican Sens. Cindy Hyde-Smith (MS) and Josh Hawley (MO), and Democratic Sens. Tim Kaine (VA) and Kirsten Gillibrand (NY). A companion bipartisan version is expected in the House soon, with Democratic Rep. Jared Golden (ME) among the forthcoming cosponsors.
Perhaps most striking are the bill's endorsees: organizations that typically find themselves on opposite sides of reproductive health debates. Supporters include the American College of Obstetricians and Gynecologists, the American Medical Association, and the Association of Maternal and Child Health Programs, alongside prominent anti-abortion groups including Americans United for Life, Susan B. Anthony Pro-Life America, Students for Life, and Live Action.
While the White House has not yet weighed in, Vice President JD Vance championed the idea during his Senate tenure. He publicly called the free childbirth proposal 'interesting' in January 2023, and his office had been preparing bipartisan legislation on the issue last year before being tapped to join the Trump campaign. Notably, Vance's former Senate staffer Robert Orr, who led the childbirth bill initiative, now works for Hawley.
Some abortion rights advocacy groups, too, have expressed approval. Kimberly Inez McGuire, executive director at Unite for Reproductive & Gender Equity, told me her organization 'proudly supports' the bill. Dorianne Mason, the director of health equity at the National Women's Law Center, said they are 'encouraged' to see the bipartisan effort. A spokesperson for Planned Parenthood Action Fund said the group is still reviewing the bill but 'generally supports legislation to make the cost of maternal health care and parenting more affordable.' Reproductive Freedom For All declined to comment.
While questions remain about whether eliminating childbirth costs would actually boost birth rates or reduce abortions — as various supporters hope — there's little doubt it would provide crucial relief to families who have already chosen to have children. The unlikely alliance behind the bill traces back to an unexpected source: a journalist's challenge to the anti-abortion movement.
How the free childbirth bill would work
The Affordable Care Act already requires insurers to cover essential health benefits, like birth control and cancer screenings, at no cost to patients. This new bill would expand the list of essential health benefits to include prenatal, birth, and postpartum care, and require these services also to be free.
The costs would be paid by insurance companies and modest increases in premiums for the 178 million people primarily covered by private plans. On average, premiums would go up by approximately $30 annually, according to an analysis from the Niskanen Center think tank.Lawson Mansell, the Niskanen policy analyst who ran the cost modeling, told me he thinks this proposal is the simplest way, on an administrative level, to make birth free. The trade-off, though, is instability: employer-sponsored coverage can disappear just when families need it most, since people often lose their jobs during pregnancy.
The bill started with a challenge to the anti-abortion movement
The bill to cover childbirth costs under private health insurance has an unusual origin story compared to most pieces of legislation in Washington, DC, and reflects evolving factions within the anti-abortion movement.
In early July 2022, shortly after the Supreme Court overturned Roe v. Wade, Elizabeth Bruenig, a staff writer at the Atlantic, published a piece urging the anti-abortion movement to take up the cause of making birth free.
'It's time the pro-life movement chose life,' Bruenig, who identifies as pro-life but opposes criminal bans on abortion, wrote. She recommended expanding Medicare to cover the costs, just as Medicare was expanded to cover dialysis and kidney transplants in the early 1970s. Her article cited examples of staggering medical bills, such as one couple charged $10,000 for delivering in Texas and another $24,000 in Indiana.
The piece made waves within an anti-abortion movement that was grasping for its next move after the Supreme Court struck down Roe.
'She was really challenging the pro-lifers on this issue, and we found the idea super interesting,' said Kristen Day, the executive director of Democrats for Life of America.
Catherine Glenn Foster, then the president and CEO of Americans United for Life, responded a week after publication, praising Bruenig's piece and adding, 'Making birth free should be table stakes as a political matter. I'll work to advance this.'
Democrats for Life and Americans United for Life teamed up, and in January 2023 the two organizations released a white paper, fleshing out the 'Make Birth Free' policy in more detail. The authors thanked Bruenig in the acknowledgements for pushing them to take on the idea, and it was this white paper that caught the eye of Vance in the Senate.
John Mize, who succeeded Glenn Foster as CEO of Americans United for Life in January 2024, said the Bruenig article arrived at exactly the right moment. He acknowledges his movement 'missed the mark' by being so singularly focused on banning abortion for so many years. 'I think there's been a little bit of paradigm shift in some of the movement — not by all, by any means — but certainly by some parts' to better support women and families. He pointed to the Blueprint for Life coalition which launched in June 2024 to promote more holistic family policies, and he noted that some anti-abortion groups are newly advocating for policies like expanding the Child Tax Credit and paid family leave.
Still, many leading anti-abortion advocates and lawmakers have been leading the push to cut federal spending on programs like child care, food assistance, and maternal health care. The Heritage Foundation called the original proposal to make childbirth costs free an 'unjust wealth transfer' and others protested the risk of more 'socialism' in health care as too great.
When Bruenig's piece was originally published, she faced fierce pushback from the left. Critics felt the article was insensitive, implicitly endorsing the Supreme Court's decision to overturn Roe, and offering 'fanfic' for a right-wing movement historically opposed to a robust welfare state. Political science professor Scott Lemieux called the piece 'cringe' and 'embarrassing' and 'deluded.' Others said she was pitching 'forced birth but make it free.' The left-wing backlash ultimately prompted Bruenig to quit Twitter.
Bruenig says she never expected much uptake on the idea, but is encouraged by recent changes. 'For the last 10 years or more I have contended that the best way to deal with abortion is on the demand side, by creating a welfare system that gives people an honest choice,' she told me. 'There's been, for better or worse, a shift in the way Republicans are thinking about these kinds of things...and in the center, and I'm very impressed to see some uptake on the idea.'She says she's not surprised there was criticism, but was writing for 'people who are persuadable when it comes to what the pro-life movement should be about.' She added that she embraces the 'pro-life' label despite opposing abortion bans because 'I don't think the pro-ban people should get to decide what counts as pro-life policy or philosophy.'
The political road ahead
Bill supporters are cautiously hopeful about the road ahead for the legislation.
The timing reflects converging forces that have created an unusual window for bipartisan family policy. President Donald Trump's election, combined with growing concerns about declining birth rates, has coincided with a shift among some conservatives toward more proactive family policies. Meanwhile, Democrats see an opportunity to advance maternal health goals.
The legislation also benefits from political cover on both sides. Republicans can champion it as pro-family policy that potentially reduces abortions, while Democrats can support it as expanding health care access. Crucially, because it doesn't require new government spending but instead redistributes costs through the existing private insurance system, it sidesteps typical fights over federal budget increases.
But challenges remain. The upcoming reconciliation process will test whether Republicans prioritize fiscal restraint or family policy when forced to choose. And while Vance previously supported the free birth idea, the administration faces pressure from fiscal conservatives who view any insurance mandates as market interference.
Not all conservatives will be thrilled at the idea of tinkering with the Affordable Care Act or facing accusations of supporting socialized medicine. Bill supporters hope the momentum for pronatalist policies might help to combat those kinds of criticisms, though other conservatives have pointed to falling birth rates in places with single-payer health care, too.Still, the legislation has attracted support from heavyweight conservative intellectuals. Yuval Levin, the director of social, cultural, and constitutional studies at the American Enterprise Institute, wrote a policy brief earlier this year urging Congress to embrace making childbirth free, even if it doesn't affect birth rates. 'Substantively and symbolically, bringing the out-of-pocket health care costs of childbirth to zero is an ambitious but achievable starting point for the next generation of pro-family policies,' he wrote.Patrick Brown, a family policy analyst at the conservative Ethics and Public Policy Center tells me he thinks it's 'the right instinct' to share the costs of parenting more broadly across society, though he hopes it does not 'distract from more broad-based efforts to help parents' such as a larger Child Tax Credit.
Mize, of Americans United for Life, has been in 'the planning phases' of working with the White House on family policy. He thinks once the reconciliation bill is done, Republicans and Democrats could either retreat to their camps ahead of the midterms or decide to work together on achievable wins. 'You could see level-headed people say, 'Hey, this is one opportunity for us to put a feather in our cap and say that we're working on a bipartisan basis with our constituents,'' he said.A Senate staffer working on the bill, who requested anonymity to more candidly discuss their plans, said their intention is to move the bill through normal order and attach it to a must-pass legislative package. Both Hawley and Kaine sit on the Senate HELP committee, which holds jurisdiction over the bill.
Rep. Golden, who is working on preparing the House version, said they're hoping to introduce their bill within the next week or two.'While some debates over what that should look like can be complicated or contentious, this idea is simple and powerful: Pregnancy and childbirth are normal parts of family life,' he told Vox. 'So, insurance companies should treat it like the routine care it is and cover the cost, not stick people with huge medical bills. That's the kind of simple, commonsense reform that anyone can get behind. '