The number of U.S. newborns requiring intensive care is on the rise—and parents, like Eric and Stacey Brown, are shouldering a larger share of the financial burden for the life-saving, yet expensive care, provided in neonatal intensive care units (NICUs), Christina Caron reports for the New York Times.

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The cost of triplets born at 28 weeks

In September 2017, Stacey Brown was transported via air ambulance to the Woman's Hospital of Texas in Houston. At the time, she was 28 weeks and five days pregnant and doctors had decided she required an unplanned cesarean section to deliver her triplets prematurely, Caron reports.

The triplets stayed in the NICU for two months, and during that stay they racked up more than $4 million in medical expenses.

Stacey Brown's job as a teacher at a public school provided them with insurance through Blue Cross Blue Shield Texas, which shouldered most of the medical bills, Caron reports. But the family still faced thousands of dollars in out-of-pocket costs, and quickly hit their plan's $13,000 out-of-pocket maximum for in-network providers, Caron reports.

But the medical costs were only one factor: Stacey's husband, Eric, drove roughly 6,000 miles to and from Woman's Hospital during the two months the triplets were in the NICU, increasing the family's transportation costs.

Eventually, Stacey Brown quit her job, a move that made her children eligible for Medicaid, Caron reports. The coverage applied to medical care provided up to three months before the triplets  were born—but it didn't go back far enough to cover the month of their birth.

"Yes, your life is always turned upside down when you have a child," Eric Brown said. "But with us, it was with the snap of a finger and a minute and a half we essentially doubled the size of our family and cut our income in half."

More babies need the NICU

Unfortunately, the Browns' story is not unique in America today, as more babies are born preterm and end up in the NICU, and families' out-of-pocket health care costs are rising, Caron reports.

In 2018, the number of preterm births—those delivered before 37 weeks—increased for the fourth consecutive year, according to the National Center for Health Statistics. The number of babies admitted to the NICU also has risen, even among babies who are full-term and born at a regular weight, according to a 2015 study published in JAMA.

As the Brown's learned, NICU stays can be costly. A number of families have their NICU bills covered by Medicaid under the Social Security Administration's Supplemental Security Income (SSI) program, which provides benefits for adults and children with disabilities as well as babies born under three pounds, Caron reports. But those with private insurance can be on the hook for thousands of dollars, depending on their coverage plans.

According to Sara Rosenbaum, a professor of health law at George Washington University, the private insurance market has decreased so much over the past few decades that "nothing can guarantee that these families are protected."

Nonmedical costs like transportation, food, and child care can add up for families as well, Caron reports. And during this time, families often have less income because they're either not working or are working fewer hours in order to care for their newborns, Caron reports.

For the Browns, there is a light at the end of the tunnel: Between their private insurance, Medicaid insurance, and some additional help from the Browns' community, the family expects to have all of their bills paid by the end of the year.

As for the triplets, Eric Brown said they're healthy and "absolutely wonderful" (Caron, New York Times, 2/11).