Health Care for Women is Underpaid

Cast off the shackles of yesterday

Oh hi everyone, it’s been awhile. I’ve been working on a big project that’s going to be published in the next week or so, but in the meantime, I have a little appetizer for you (if you can call a 3,000 word story an appetizer.) I received a grant from the USC Annenberg Center for Health Journalism to do a few stories and ran across this one in the course of my reporting:

Why Maternity Care is Underpaid

I was talking to a bunch of women in Alabama about their birthing experiences, and many women in Birmingham kept talking about a hospital called Princeton that was everything they’d dreamed of for maternity care. Though in the U.S., Black women have high rates of maternal mortality and morbidity, high c-section rates, and high obstetric trauma, the labor and delivery ward at Princeton had great outcomes. It had midwives. It had groups of women coming together to talk about their birthing experience. And then, in October 2023, it closed.

It’s one of hundreds of maternity wards to close in recent years, and though news stories you might read blame low birth rates, there’s really something else going on. In short — maternity care is severely under compensated, and so doctors and hospitals can’t afford to keep doing it unless they have high volume units processing lots of women and not really giving them the care they want. The compensation is especially bad for women on Medicaid, which a lot of women are, since Medicaid covers pregnant women up to a higher income bracket than non-pregnant women. About 41% of U.S. births are covered by Medicaid.

Consider this: a doctor who cares for an Alabama Medicaid patient for ALL of her prenatal visits, her labor and delivery, and her postpartum visit — we’re talking about nine months of care here — would get $1,690 for all that time. A doctor who does a two hour hip replacement gets $1,617. Does that seem fair?

One controversial reason for the low rates of compensation, some doctors argue, is something called the RUC. (Warning: do not say the RUC is the reason for low compensation unless you want to have the American Medical Association argue with you for dozens upon dozens of emails. They do not agree.) The RUC is basically a committee of doctors that meets a bunch of times every year to set values for different procedures that doctors perform. Medicare and Medicaid then use those values to help set rates.

A number of academic studies over the years have suggested that the RUC sets values lower for procedures for women (that not coincidentally are also often performed by women) than for men. (For a cool paper on this, check out Double Discrimination, the Pay Gap in Gynecologic Surgery, and Its Association With Quality of Care.) There are other reasons care for women doesn’t pay well, including abysmal Medicaid compensation rates and insurance monopolies. But it all adds up to doctors and hospitals realizing that it’s not very profitable to do one of the things that you’d think would be the most important for our society—bringing a baby into the world.

Why Maternity Care is Underpaid

I also sat down for interviews with the CEO of Lyft (in person), the CEO of Chanel (virtually), and wrote a story about why I don’t like the term Forever Home for home-buying.

Lyft’s CEO on Layoffs, Leading With Purpose and the Future of Ride-Sharing

Why Chanel CEO Leena Nair Is Leading With Compassion

Stop Looking for Your Forever Home

Books to Fall Asleep To

This was a random one, but I listened to The Quiet World: Saving Alaska's Wilderness Kingdom, 1879-1960 by Douglas Brinkley. It’s basically about all the people that tried to keep Alaska wild and free of development, which includes some famous people and also some randoms.