My sister was on welfare and had a kid around the same time as me. Hers was covered completely by Medicaid.

Mine, because I had a job and health insurance, cost me $20,000. Didn’t finish paying for the kid until her 2nd birthday.

Have I personally avoided going to the hospital? Absofuckinglutely. Unless I’m in immediate danger of dying I’ll figure it out myself. I’ve superglued more than one nasty cut that probably needed stitches, entirely possible I’ve ignored more than one concussion. Is it smart? Unequivocally and resoundingly not. Do I do it anyway so I can pay my rent? Yep.

I can answer this: my son was born in 1990. We were extremely poor.

We had midwives help us out as best they could, to the tune of about $3200 at the time. The birth got complicated due to a variety of health factors, and both my son and wife almost died (not because of the midwives). Luckily the midwives had a direct line to Georgetown Hospital, and the cesarean was done there. The total hospital bill was $58,000, or $138k in today's money, although hospital costs have rose much higher vs inflation, so maybe it would be in the $200k range now. She was in the ICU for a week, hospital for another week, our son for about 3 weeks.

My wife job didn't have health insurance, because it wasn't required back then. Because she was gone a week, her job fired her for an unexcused absence. Oddly enough, this made her unemployed and Washington DC had some law (or rule or something) that immediately dropped the hospital bills because of her unemployment. In the end, we had to pay $15k to about two dozen practices who individually sued us, which took 7 years to pay off and a lot of court visits and wage garnishments. It financially ruined us, pretty much. Both suffered a lot afterwards because we just couldn't afford minimal care. It was hellish. I can't imagine how much worse it would be today. We got evicted from our apartment, and lived in government housing for six years.

So, yeah. Don't have a baby in America unless you can guarantee it will be healthy and you have a lot of money. Most of my friends don't have kids, they simply can't afford it and look at it like the previous generation looked at concepts like summer homes and yachts. Nice luxuries, but way out of affordabilty.

Ah... In short.. Insurance covers a portion of it and whatever insurance doesn't pay, I just... Simply don't pay it. It goes to collections and they spam call me and I don't answer my phone. Suddenly they give up and after 7 years, it's gone. Is it right? I don't know. I definitely haven't devoted half of my paycheck to medical bills though.

Simply.

They don’t pay the hospital bills.

Do people ever avoid hospital visits

At least in my experience, we’ll generally be able to go to the hospital

Do hospitals put people on a payment plan

Generally, I’ve just seen the debt transferred to a debt collection agency afterwards, since there’s no money for them to take. They’ll harass you, and it affects your credit score, but they can’t send you to jail

If you are poor enough you can qualify for Medicaid (MediCal in California) which is a sort of limited health insurance. This is life saving for poorer families and most of the time completely covers birth costs. After birth in some states they even offer follow up plans from nurses for assistance with food and meal plans for babies and toddlers.

Even if you don't qualify you can apply for financial aid which I believe is required to be offered in every public hospital even to people whether citizens or not. If not you can just take on the debt and not pay, which destroys your credit score but after long enough you might be offered a favorable financing or a discount... Only after being harassed by collections for months if not years.

Source: not American but I've worked with American healthcare workers interpreting for Spanish.

They send the infant to debtors prison to begin working off the $70,000 hospital bill. They don't have to pay the infant minimum wage though, and they charge them for room and board and meals, so by the time they're 18 they are actually indebted to the hospital an average of 1.4 million dollars, which they will then begin working off as adults earning minimum wage.

American hospitals cannot legally refuse to treat you even if they know you can't pay/don't have insurance. So worst case scenario is you go and have whatever done and they bill you and you don't pay and it's a write off for the hospital.

Often times, if you can't pay they will offer a reduced amount to at least get something out of you if they know they won't get anything otherwise.

Was poor, had a baby at 20. $6,000 hospital bill we paid in monthly installments of like $100

Paid off my kid being born when she was like 6 or 7 lol. Kind of like a car

Some people give birth in their own homes like in medival times. I know people who have done it. In my opinion people shouldn't be having kids if society is so broken you have to do stuff like this but to each their own.

Vaginally

As a poor Florida resident who grew up and has known several people giving birth in poverty; if you're lucky you qualify for WIC (women, infants, and children) which is essentially food stamps/ welfare for pregnant women and mothers. That covers food. If you qualify for WIC then you're also eligible for Medicaid which is the US' version of free* healthcare for people in poverty. That will cover pre and post natal care for the mother and baby. The baby is usually covered until they're ~6. Unless you're still poor by then, in which case it usually covers the child to adulthood or until their parents no longer qualify for Medicaid. Note that none of this covers diapers, clothes, or other necessities for the infant. Just food and drs visits. If you're poor, but on the [benefits cliff](https://www.ncsl.org/human-services/introduction-to-benefits-cliffs-and-public-assistance-programs#:~:text=Benefits%20cliffs%20(the%20%E2%80%9Ccliff%20effect,a%20small%20increase%20in%20earnings.) you can get fucked lol. Murica

Mine were born at home with a midwife who did sliding scale pricing (charged based on your income). Only available to low risk women who lived close to the hospital though.

If you are quite poor, Medicaid will cover pregnancy and hospital birth expenses, even if you don't otherwise qualify. I know someone who did that and said the nurse yelled at her because she wasn't married.

Bankruptcy.

Debt. Massive amounts of debt.

My son was premature and racked up 14 days in the NICU. The hospital (which is 'legally a charity' billed $250,000.00. We were low-income with no employer-provided medical insurance, so the state Medicare provider got to pay a reduced rate of that.

My first kid was born at 27 weeks, and would have ended up costing us 3mill if they weren't on Medicaid due to being born so early. My second kid we were living in Canada (due to my job) and basically only cost us to park at the hospital.

Growing up in the US and living in Canada for a while, I genuinely don't understand why Universal Healthcare isn't fought for more. I know it's talked about but holy fuck, it's so much better in Canada.

To comment on OP's actual question, I have no idea how people do it.

Once there's a kid in the equation then it's pretty easy to get on state paid insurance. It's even easier now with so called Obamacare in the equation (Affordable Care Act). If you qualify, then you'll have free neonatal care, free gyno visits, and free delivery and hospital services. It's not great insurance, like you'll be at the community hospital and not some swanky private birthing center, but it's not bad either. Medi-Cal, the California state insurance is actually pretty good for child care and birthing services. They pay for hearing aids too, which only 3% of private insurances pay for. So medical care when you're poor and have a kid is decent in the States. Now that there's Obamacare it's decent even without a kid. Where it falls short is if you're under-insured as a middle class citizen, and it's pretty easy to be uninsured, even with expensive plans.

Question to Americans, is it a secret way to make poor people not have children?