By Ralph Riviello, MD, MS

Recently I saw a pregnant woman I will call Lillian, a 22-year-old who brought her two children with her to the ER. Lillian has a fulltime job whose health insurance doesn’t cover pregnancy. She can’t afford to cover herself and her family on the individual market, and she makes too much money to qualify for Medicaid. Lillian came to the ER because she wants to make sure her baby is okay. A friend with better insurance advised her that she should have an ultrasound.

But because Lillian told the registration clerk about abdominal pain, we had to put her through other work-ups like a complete pelvic exam, cultures, and blood tests, on top of the only test she wanted. The hospital spent at least $1,000 on Lillian, which drives up the price of care for everyone.

I discharged Lillian with worry. I know that she will have a difficult time finding standard prenatal care. Without that help, she and her baby are at much higher risk for complications, like low birth weight, that can turn into tragedy. Or Lillian’s health might suffer. I am embarrassed by how many women die in childbirth in the U.S. -- at 15.1 maternal deaths per 100,000 live births, our rate is higher than most developed nations