In recent years, the cost of giving birth in America has skyrocketed — even for women who have employer health insurance.

A major study of employer provided health insurance women found that the average new mom paid $4,500 out of pocket to give birth in 2015, the most recent data for the year was available.

“I don’t know a lot of patients who have this kind of funding lying around,” said Michelle Moniz, an assistant professor in obstetrics and gynecology at the University of Michigan and the study’s lead author.

Moniz, a practicing physician, added: “These expenses are coming at a time when most of my patients are thinking of everything else on their  baby list — a crib, a car seat, everything they need to keep their newborn safe — and they aren’t expecting a bill like this.”

The cost of one birth — a woman’s most common reason to be treated in her lifetime in itself — is now more than the typical woman makes in a month. According to the US, the average full-time worker in America makes just over $41,000 annually, or about $3,400 a month. Department of Labor.

And the more than 650,000 women in the study, reported in many ways this week in the academic journal Health Affairs, reflect a best-case scenario: they are in large employer sponsored health insurance plans, usually more comprehensive than plans offered by small businesses or bought separately.

 These plans cover about half of U.S. births.

In the study period, Moniz and her co-authors observed that the average billed expense for birth remained relatively constant over the seven years. What shifted was the increasing portion charged by patients: the average deductible payout rose from just over $1,500 to almost $2,500, while the standard coinsurance (a percentage compensated by the covered patient after reaching their deductible) decreased by around $300.

“I was completely surprised that the phenomenon of having to pay something out of pocket for maternity care was almost universal,” said Moniz. “98% of people had some out-of-pocket cost by the end of the study.”

The research addresses a common misconception that raising a newborn was made cheaper by the Affordable Care Act, which required compensation for maternity benefits.

“For people who talk about the ACA, there seems to be this misconception that ‘Oh, maternity’s covered,'” Moniz said. In fact, while large employers are required to provide maternity care coverage, that coverage can include significant payments from the patients. That concerns Moniz, especially as the maternal mortality rate is increasing in the U.S.

“Our hope is that policymakers take note now and change the situation,” she said. “We want every family to get off to the best start in life, and this is an irremediable barrier.”

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What is the Affordable Health Care Act?

The Patient Protection and Affordable Care Act, also the Affordable Care Act or colloquially known as Obamacare, is a United States federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010.

Does the Affordable Health Care Act cover maternity?

While large employers are required to provide maternity-care coverage, that coverage can include significant payments from the patients. That concerns Moniz, especially as the maternal mortality rate is increasing in the U.S.