Big Medicine is about to make pregnancy more expensive

The American Medical Association is overhauling the way doctors bill for pregnancy care. Anyone who cares about families should be alarmed.

The AMA says the new model promotes accuracy and modern care. Nice slogan. For millions of American families already struggling with rising costs, it looks more like an unelected lobbying organization has found a way to make having children even more expensive.

Policymakers cannot allow the AMA to blow up the current system at the expense of families.

Starting January 1, 2027, the long-standing global maternity payment will be replaced with a more complicated system that bills pregnancy, labor, delivery, and postpartum care in pieces. Instead of treating pregnancy as a single episode of care, the new structure lets providers bill separately for visits and services.

But pregnancy is not a menu where mothers pick one item from column A and one from column B. It is a coordinated journey that should be managed as a whole. A bundled payment system rewards providers for delivering care efficiently and effectively. An unbundled framework rewards the accumulation of billable moments.

For many couples, the question is no longer whether they want children. It is whether they can afford them. Now one of the most expensive moments in family life could become even more expensive.

The AMA controls the billing codes — those five-digit numbers patients see on medical receipts. The codes tell insurance companies what providers did so they can get paid. Moving pregnancy from one bundled code to many separate codes pushes maternity care toward a fee-for-service model. That model incentivizes more services and more fees.

Federal watchdogs have warned for years that fragmented billing creates openings for abuse. The Department of Health and Human Services Office of Inspector General investigates billing practices and often identifies coding and billing integrity problems.

In one audit, the inspector general found that Medicare made up to $17.8 million in potentially improper payments tied to complicated coding and other billing problems in opioid treatment programs. Different specialty. Same lesson. When payment systems get sliced up or loosely controlled, waste, fraud, and abuse follow.

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Pregnant women and their families get stuck with the bill. Patient advocates already warn that the new system could mean higher out-of-pocket costs.

Policymakers moved toward bundled payments for maternity care because the model had the potential to lower costs and improve quality. Bundling can discourage unnecessary cesarean sections, which cost significantly more than vaginal births, carry greater risks for mothers and babies, and require longer recovery times.

When payment incentives reward more services rather than better outcomes, families can face higher medical bills, extra recovery time, more follow-up visits, and increased child-care costs.

The policy question is not whether every provider will abuse the system. It is whether Washington should allow a system that makes abuse easier and family life more expensive.

This billing-code change is landing at exactly the wrong moment. The United States recorded its lowest fertility rate ever in 2024. If conservative policymakers are serious about family formation, they should not tolerate the AMA worsening one of the most expensive and stressful experiences in American life.

As the father of a large family, I know firsthand that having children in America is not for the faint of heart. Every new baby is a blessing. Every parent also knows the bills come fast.

Policymakers cannot allow the AMA to blow up the current system at the expense of families. American families will notice when the bills multiply and the care journey is less coordinated. We cannot allow another elite institution to call this progress while ordinary Americans pay more for the privilege of bringing a child into the world and pursuing the American dream.