This brief was updated on July 11, 2025 to include the latest KFF polling data.

For many years, KFF polling has found that the high cost of health care is a burden on U.S. families, and that health care costs factor into decisions about insurance coverage and care seeking. These costs and the prospect of unexpected medical bills also rank as the top financial worries for adults and their families. This data note summarizes recent KFF polling on the public’s experiences with health care costs. Main takeaways include:

• Just under half of U.S. adults say it is difficult to afford health care costs, and one in four say they or a family member in their household had problems paying for health care in the past 12 months. Black and Hispanic adults, those with lower incomes, and the uninsured are particularly likely to report problems affording health care in the past year.
• The cost of health care can lead some to put off needed care. About one-third (36%) of adults say that in the past 12 months they have skipped or postponed getting health care they needed because of the cost. Notably three in four (75%) uninsured adults under age 65 say they went without needed care because of the cost.
• The cost of prescription drugs prevents some people from filling prescriptions. About one in five adults (21%) say they have not filled a prescription because of the cost while a similar share (23%) say they have instead opted for over-the-counter alternatives. About one in seven adults say they have cut pills in half or skipped doses of medicine in the last year because of the cost. A third of all adults say they have taken at least one of these cost saving measures in the past year, including larger shares of women and those with lower incomes.
• Health care debt is a burden for a large share of Americans. In 2022, about four in ten adults (41%) reported having debt due to medical or dental bills including debts owed to credit cards, collections agencies, family and friends, banks, and other lenders to pay for their health care costs, with disproportionate shares of Black and Hispanic adults, women, parents, those with low incomes, and uninsured adults saying they have health care debt.
• Those who are covered by health insurance are not immune to the burden of health care costs. Almost four in ten insured adults under the age of 65 (38%) worry about affording their monthly health insurance premium and large shares of adults with employer-sponsored insurance (ESI) and those with Marketplace coverage rate their insurance as “fair” or “poor” when it comes to their monthly premium and to out-of-pocket costs to see a doctor.
• Notable shares of adults say they are worried about affording medical costs such as the cost of health care services (including out-of-pocket costs not covered by insurance, such as co-pays and deductibles) or unexpected bills. About six in ten adults say they are either “very” or “somewhat worried” about being able to afford the cost of health care services (62%) or unexpected medical bills (61%) for themselves and their families.

Difficulty Affording Medical Costs

Many U.S. adults have trouble affording health care costs. While lower income and uninsured adults are the most likely to report this, those with health insurance and those with higher incomes are not immune to the high cost of medical care. Just under half of U.S. adults say that it is very or somewhat difficult for them to afford their health care costs (44%). Uninsured adults under age 65 are much more likely to say affording health care costs is difficult (82%) compared to those with health insurance coverage (42%). Additionally, a slight majority of Hispanic adults (55%) and half of Black adults (49%) report difficulty affording health care costs compared to about four in ten White adults (39%). Adults in households with annual incomes under $40,000 are more likely than adults in households with higher incomes to say it is difficult to afford their health care costs. (Source: KFF Health Tracking Poll: May 2025)

When asked specifically about problems paying for health care in the past year, about one in four (23%) adults say they or a family member in their household had problems paying for care, including three in ten Hispanic adults (33%) and Black adults (30%). Over half (55%) of uninsured adults under age 65 say they or a family member in their household had problems paying for health care, compared to just one in five (22%) insured adults. (Source: KFF Health Tracking Poll: May 2025)

The cost of care can also lead some adults to skip or delay seeking services, with one-third (36%) of adults saying that they have skipped or postponed getting needed health care in the past 12 months because of the cost. Women are more likely than men to say they have skipped or postponed getting health care they needed because of the cost (38% vs. 32%). Adults ages 65 and older, most of whom are eligible for health care coverage through Medicare, are much less likely than younger age groups to say they have not gotten health care they needed because of cost.

Three-quarters of uninsured adults say they have skipped or postponed getting the health care they needed due to cost. Having health insurance, however, does not offer ironclad protection as about four in ten adults with insurance (37%) still report not getting health care they needed due to cost. (Source: KFF Health Tracking Poll: May 2025)

Skipping care due to costs can have notable health impacts. Nearly two in ten adults (18%) report that their health got worse because they skipped or delayed getting care. Among adults under age 65, those who are uninsured are twice as likely as those with health coverage to say that their health worsened due to skipped or postponed care (42% vs. 20%). About four times as many adults under age 65 (23%) say their health got worse after skipping or postponing care as adults ages 65 and older (6%), most of whom have Medicare coverage. (Source: KFF Health Tracking Poll: May 2025)

A 2022 KFF report found that people who already have debt due to medical or dental care are disproportionately likely to put off or skip medical care. Half (51%) of adults currently experiencing debt due to medical or dental bills say in the past year, cost has been a probititor to getting the medical test or treatment that was recommended by a doctor. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Prescription Drug Costs

The high cost of prescription drugs also leads some people to cut back on their medications in various ways. About one in four adults (23%) say in the past 12 months they have taken an over-the-counter drug instead of getting a prescription filled because of cost concerns and about one in five (21%) say they have not filled a prescription due to the cost. Additionally, about one in seven adults (15%) say that in the past 12 months they have cut pills in half or skipped doses of medicine due to cost.

One-third of the public (33%) say they have taken any of these cost saving measures in the past 12 months. Four in ten women (39%) say they have taken any of these prescription medication measures compared to one-quarter (26%) of men. Additionally, just under half of Hispanic adults (46%) say they’ve either taken an over-the-counter drug, skipped doses, or not filled prescriptions because of the cost, compared to three in ten (29%) White adults who say the same. Similarly, larger shares those with lower incomes report having taken a cost-saving measure in the last year compared to those with higher incomes (41% of those with a household income of less than $40,000 a year vs. 29% of those with an income of $40,000 or more). (Source: KFF Health Tracking Poll: May 2025)

Notably, adults with chronic conditions, who tend to have higher health care and medication needs, can often face challenges affording prescriptions. In KFF’s 2023 Survey of Consumer Experiences with Health Insurance, insured adult with a chronic condition were twice as likely as those without a chronic condition to say they had delayed or gone without prescription drugs due to the cost (18% vs. 9%).

Health Insurance Cost Ratings

Health insurance provides some financial protection, but premiums and out-of-pocket costs can still present a financial burden for many individuals. Overall, most insured adults rate their health insurance as “excellent” or “good” when it comes to the amount they have to pay out-of-pocket for their prescriptions (61%), the amount they have to pay out-of-pocket to see a doctor (53%), and the amount they pay monthly for insurance (54%). However, at least three in ten rate their insurance as “fair” or “poor” on each of these metrics, and affordability ratings vary depending on the type of coverage people have.

Adults who have private insurance through employer-sponsored insurance or Marketplace coverage are more likely than those with Medicare or Medicaid to rate their insurance negatively when it comes to their monthly premium, the amount they have to pay out of pocket to see a doctor, and their prescription co-pays. About one in four adults with Medicare give negative ratings to the amount they have to pay each month for insurance and to their out-of-pocket prescription costs, while about one in five give their insurance a negative rating when it comes to their out-of-pocket costs to see a doctor.

Medicaid enrollees are less likely than those with other coverage types to give their insurance negative ratings on these affordability measures (Medicaid does not charge monthly premiums in most states, and copays for covered services, where applied, are required to be nominal). (Source: KFF Survey of Consumer Experiences with Health Insurance)

Health Care Debt

In June 2022, KFF released an analysis of the KFF Health Care Debt Survey, a companion report to the investigative journalism project on health care debt conducted by KFF Health News and NPR, Diagnosis Debt. This project found that health care debt is a wide-reaching problem in the United States and that 41% of U.S. adults currently have some type of debt due to medical or dental bills from their own or someone else’s care, including about a quarter of adults (24%) who say they have medical or dental bills that are past due or that they are unable to pay, and one in five (21%) who have bills they are paying off over time directly to a provider. One in six (17%) report debt owed to a bank, collection agency, or other lender from loans taken out to pay for medical or dental bills, while similar shares say they have health care debt from bills they put on a credit card and are paying off over time (17%). One in ten report debt owed to a family member or friend from money they borrowed to pay off medical or dental bills.

While four in ten U.S. adults have some type of health care debt, disproportionate shares of lower income adults, the uninsured, Black and Hispanic adults, women, and parents report current debt due to medical or dental bills.

Vulnerabilities and Worries About Health Care and Long-Term Care Costs

KFF’s May 2025 Health Tracking Poll shows the cost of health care services and unexpected medical bills are at the top of the list of people’s financial worries, with about six in ten saying they are at least somewhat worried about affording the cost of health care services (62%) or unexpected medical bills (61%) for themselves and their families. These are larger than the shares who say they worry about affording housing costs (51%), transportation expenses (50%), utilities (49%), and food (48%) for their families.

Notably, eight in ten uninsured adults under age 65 say they are worried about affording the cost of health care services or unexpected medical bills (82% and 80%, respectively). About four in ten (38%) insured adults under the age of 65 say they are worried about affording their monthly health insurance premium. (Source: KFF Health Tracking Poll: May 2025)

Many U.S. adults may be one unexpected medical bill from falling into debt. About half of U.S. adults say they would not be able to pay an unexpected medical bill that came to $500 out of pocket. This includes one in five (19%) who would not be able to pay it at all, 5% who would borrow the money from a bank, payday lender, friends or family to cover the cost, and one in five (21%) who would incur credit card debt in order to pay the bill. Women, those with lower household incomes, Black and Hispanic adults are more likely than their counterparts to say they would be unable to afford this type of bill. (Source: KFF Health Care Debt Survey: Feb.-Mar. 2022)

Among older adults, the costs of long-term care and support services are also a concern. Almost six in ten (57%) adults 65 and older say they are at least “somewhat anxious” about affording the cost of a nursing home or assisted living facility if they needed it, and half say they feel anxious about being able to afford support services such as paid nurses or aides. These concerns also loom large among those between the ages of 50 and 64, with more than seven in ten saying they feel anxious about affording residential care (73%) and care from paid nurses or aides (72%) if they were to need these services. See The Affordability of Long-Term Care and Support Services: Findings from a KFF Survey for a deeper dive into concerns about the affordability of nursing homes and support services.

In this article in the Journal of Health Politics, Policy and Law, KFF’s Tricia Neuman, Jeannie Fuglesten Biniek and Juliette Cubanski examine three isssues facing Medicare’s future: privatization, affordability and spending/financing.

They write that as Medicare approaches its 60th anniversary, it almost goes without saying that the program is both popular and successful. Medicare provides health insurance coverage to 67 million older adults and people with disabilities. Medicare is viewed favorably by Democrats, Republicans, and independents. Medicare has also helped to extend life expectancy and, in conjunction with the Civil Rights Act of 1964, narrow disparities in care. It is a vital source of revenue for hospitals, physicians and other health care providers, and health insurers, and it is an essential component of health and retirement security in the United States. These are among the reasons why Medicare is often considered a third rail in politics.

The authors also note that Medicare also faces challenges stemming from the growing role of private plans, demographic shifts, and rising health care costs. They examine these challenges by focusing on three fundamental questions: What are the implications of the transformation taking place such that private insurers are playing a more dominant role in providing Medicare benefits? What changes may be important for addressing the gaps in covered benefits and related affordability challenges? And how can Medicare be sustained to finance care for current and future generations?

OB-GYNs provide a range of care for women throughout their lifespan, including diagnosis and treatment of gynecological conditions such as endometriosis, polycystic ovary syndrome, and cervical cancer; contraceptive care; prenatal and postpartum care; and menopause management. Access to care depends on several factors, including the availability of providers and, for people with insurance, whether the provider is in their plan’s network. When there are few providers in an area, local providers are not taking new patients, or a patient needs to see a provider who is not in their plan’s network, their ability to get care, how long they have to wait for an appointment, and potentially how much they have to pay out-of-pocket can all be impacted.

This brief examines the supply of OB-GYNs in the U.S. and the share of OB-GYNs participating in the provider networks of Qualified Health Plans (QHPs) offered in the individual market in the federal and state Affordable Care Act (ACA) Marketplaces in 2021. This analysis uses multiple data sources; see the Methods section for details. While many more women are covered by employer-sponsored health plans than ACA Marketplace plans, there is no publicly available data to analyze the networks for employer plans.

Key Takeaways

• There were 38 practicing OB-GYNs per 100,000 women in the United States, with higher ratios in metro counties (41) than in rural counties (13) in 2021-2022. 38 practicing OB-GYNs per 100,000 women is equivalent to one OB-GYN per about 2,600 women.
• Nearly half (48%) of counties did not have any practicing OB-GYNs and 7% of women lived in a county with no OB-GYN. The share of women with no OB-GYN in their county was substantially higher in rural counties than in metro counties (58% vs. 3%).
• In 2021, enrollees in ACA Marketplace plans had in-network access to 55% of practicing OB-GYNs in their area on average. By comparison, Marketplace enrollees had in-network access to 43% of primary care physicians.
• Marketplace enrollees in metro counties, on average, had in-network access to 53% of the OB-GYNs near their home compared to 70% in rural counties. However, as noted above, there are relatively few OB-GYNs practicing in rural counties.
• On average, Marketplace enrollees in counties with the highest shares of people of color had in-network access to 43% of area OB-GYNs while those in counties with the lowest shares of people of color had in-network access to 69%.

OB-GYN Workforce

OB-GYNs play an important role in ensuring women have access to comprehensive health care. There are many factors that can create barriers to accessing obstetric and gynecological care, including the size of the OB-GYN workforce and the ratio of OB-GYNs to patients. Although there is no established “adequacy” ratio of OB-GYNs to patients, OB-GYN shortages could be considered in the context of longer appointment wait times and increased travel distances, among others. The U.S. Department of Health and Human Services projects a shortage of 7,980 OB-GYNs by 2037 based on the supply of OB-GYNs in the workforce and the demand for OB-GYNs (based on the population of adolescent girls and women).

According to KFF analysis of the HRSA Area Health Resource Files for 2021-2022, there were 38 OB-GYNs per 100,000 women ages 15-64 (hereafter collectively referred to as “women”) in the United States, with wide variation by county (Figure 1). The workforce data analyzed here is from the year that Roe v. Wade was overturned (and the year before), so that decision’s specific impacts on the OB-GYN workforce are largely not reflected in this data.

In 2021-2022, nearly half (48%) of U.S. counties did not have any OB-GYNs, and 7% of women lived in a county with no OB-GYN. Three-quarters (74%) of all counties had fewer than five OB-GYNs, and 17% of women lived in a county with fewer than five OB-GYNs.

The number of OB-GYNs per 100,000 women was higher than the national average in 28 of the top 30 Core-Based Statistical Areas (CBSAs) with the largest number of women (Figure 2). Among these 30 CBSAs, the CBSAs with the highest ratios were San Francisco-Oakland-Berkeley, CA; Baltimore-Columbia-Towson, MD; and Portland-Vancouver-Hillsboro, OR-WA, with 61, 53, and 53 OB-GYNs per 100,000 women, respectively. The CBSAs with the lowest ratios were Columbus, OH; Los Angeles-Long Beach-Anaheim, CA; and Virginia Beach-Norfolk-Newport News, VA-NC, with 39, 38, and 33 OB-GYNs per 100,000 women, respectively.

CBSA is the umbrella term for Metropolitan and Micropolitan Statistical Areas as defined by the Office of Management and Budget (OMB). CBSAs consist of the county or counties or equivalent entities associated with at least one urban core (urbanized area or urban cluster) of at least 10,000 population, plus adjacent counties having a high degree of social and economic integration with the core as measured through commuting ties with the counties containing the core.

County Classification Differences in Provider Availability

In 2021-2022, eight in ten (79%) rural counties had no OB-GYNs and nearly six in ten (58%) women in rural counties lived in a county without an OB-GYN (Table 1). There were approximately three times more OB-GYNs per 100,000 women in metro counties (42) than in rural counties (13).

County classifications are based on USDA’s 2013 Rural-Urban Continuum Codes and KFF categorized these classifications into metro counties, small urban counties, and rural counties. See the Methods section for more details. Using this taxonomy, 85% of women lived in metro counties, 11% lived in small urban counties, and 4% lived in rural counties.

Race/Ethnicity Differences in Provider Availability

Counties with an above-average share of White non-Hispanic people had almost half the number of OB-GYNs per 100,000 women as counties with an above-average share of Black non-Hispanic people (24 vs. 46). There were 41 OB-GYNs per 100,000 women in counties with an above-average share of Hispanic people of any race. On average, about 58% of the U.S. population was White non-Hispanic, 12% was Black non-Hispanic, and 19% was Hispanic (any race) during that timeframe.

Other Implications

Provider shortages can also play a role in hospital and clinic staffing. For example, one study found that more than 35% of counties are considered “maternity care deserts,” meaning that there is no access to birthing hospitals, birth centers offering obstetric care, or obstetric providers. Maternity care deserts affected maternity care for more than 2.3 million women of reproductive age in 2022, resulting in poorer health outcomes, less prenatal care, and higher rates of pre-term births. Additionally, another study found that the share of hospitals in the U.S. without obstetric services increased from approximately 35% in 2010 to 42% in 2022, with even higher percentages for rural hospitals. Studies have identified that workforce challenges are one of the primary reasons for labor and delivery units closing in rural hospitals.

Although it is not clear how, precisely, OB-GYN workforce shortages impact the use of obstetric and gynecological care, the overall disparities in maternal and infant health for women of color are well-documented. While increased attention to these disparities has contributed to a range of federal and state efforts to reduce disparities in maternal and infant health, it is unclear how, or if, these efforts will continue in a political landscape characterized by rolling back efforts aimed at identifying and addressing disparities in historically marginalized groups and eliminating agencies and committees that lead these efforts. Additionally, state abortion bans and restrictions may exacerbate poor maternal and infant health outcomes, especially for people of color.

Additionally, it is reported that 1.2 million reproductive-age women live in a county without a single health center offering the full range of contraceptive methods, referred to as a “contraceptive desert.” A 2023 KFF survey of OB-GYNs following the overturning of Roe v. Wade found that just three in ten (29%) OB-GYNs provide all contraceptive methods, and that share is substantially lower in states that had banned abortion (13%). Although most OB-GYNs do not provide abortion services, abortion bans could also exacerbate provider shortages in some areas and impact access to other types of care that OB-GYNs provide.

OB-GYN Provider Networks in Marketplace Plans

The breadth of provider networks in the Affordable Care Act (ACA) Marketplaces has been the subject of significant policy interest. As insurers seek to offer lower-premium plans, one mechanism for controlling costs is to limit their physician networks to providers with lower payment rates. While the Centers for Medicare and Medicaid Services (CMS) establishes minimum standards for the adequacy of physicians, including OB-GYNs, in Marketplace plan networks, insurers retain considerable flexibility in how they design networks.

While many more women are covered by employer-sponsored health plans than ACA Marketplace plans, there is no publicly-available data to analyze the networks for employer plans.

The 2023 KFF Survey of Consumer Experiences with Health Insurance found that 24% of adult women with Marketplace coverage said that in the past year, a particular doctor (not specific to obstetric or gynecological care) or hospital they needed was not covered by their insurance. Among women Marketplace enrollees who experienced this problem, 32% said that needed care was delayed, and 42% said they ended up paying more out of pocket for care than expected as a result of problems they had with their health insurance.

This section analyzes OB-GYN provider networks of Qualified Health Plans (QHPs) offered in the individual health insurance Marketplaces in 2021. (At the time of analysis, 2021 was the most recent data available for calculating the total number of active OB-GYNs. See the Methods section for more details.) In total, 12 million consumers selected a plan for the 2021 plan year, roughly 55% of whom were women. Due to missing or incomplete demographic data for some states, this analysis presents data for Marketplace enrollees of all genders.

On average, Marketplace enrollees had in-network access to more than half (55%) of the practicing OB-GYNs near their homes in 2021 (Figure 3). By comparison, Marketplace enrollees had in-network access to 43% of primary care physicians and 37% of psychiatrists near their homes. One-quarter of enrollees were enrolled in plans with fewer than 34% of the local OB-GYNs in-network, while another quarter were in plans with at least 78% of local OB-GYNs in-network.

Geographic Differences in Marketplace Provider Networks

While metro counties had more practicing OB-GYNs overall, smaller shares of them participated in Marketplace plan networks compared to OB-GYNs in small urban and rural counties (Figure 4). Eighty-eight percent of Marketplace enrollees lived in a metro county. Marketplace enrollees in metro counties, on average, had access to 53% of the OB-GYNs within five to ten miles of their county through their plan networks, with one-quarter enrolled in a plan whose network included no more than 33% of local OB-GYNs.

Marketplace enrollees in rural counties (e.g., Knox County, ME; Anderson County, TX; Macon County, NC), on average, had access to 70% of OB-GYNs in their local area (within 30 miles) through their plan networks. The higher OB-GYN participation rates in these counties, however, should be considered in the context of the small number of OB-GYNs practicing in these areas. For example, 98% of rural counties had fewer than five practicing OB-GYNs. It is possible that not all of these providers are accepting new patients, and an enrollee’s choice may be even more limited than the number of OB-GYNs who participate in the plan network. (See the OB-GYN Workforce section for county classification definitions.)

The 30 counties with the highest enrollment in the Marketplaces in 2021 collectively represented 34% of all Marketplace enrollees and 21% of the U.S. population. Most of them are urban and some are home to large cities (e.g., Seattle in King County, WA). On average, Marketplace enrollees in almost all of these counties were in plans that included fewer than half of local OB-GYNs, though there was significant variation across these 30 counties (Figure 5). For example, Marketplace enrollees in Cook County, IL (Chicago) had access to fewer than two in ten (20%) OB-GYNs in their area on average. In contrast, enrollees in Gwinette County, GA (outside Atlanta) had in-network access to seven in ten (71%) practicing OB-GYNs on average.

Race/Ethnicity Differences in Marketplace Provider Networks

On average, Marketplace enrollees living in counties with a higher share of people of color were in networks that included a smaller share of OB-GYNs than counties with a smaller share of people of color (Figure 6). The quarter of Marketplace enrollees living in the counties with the highest share of people of color had access to 43% of OB-GYNs in-network, on average, compared to 69% in counties with the smallest share of people of color. These differences may reflect the higher concentrations of these people of color in large metro counties, where plans typically had narrower provider networks. ‘People of color’ include those who identify as Hispanic (of any race), multi-racial (Hispanic or non-Hispanic), or a race other than White (Hispanic or non-Hispanic).

Numbers of Practicing and In-Network OB-GYNs

The share of providers participating in a network is just one component of access and may not always gauge how well enrollees are served. High network participation rates matter little if there are few local providers to begin with. For example, in 2021, about one-quarter (23%) of Marketplace enrollees lived in a county with fewer than 25 practicing OB-GYNs in the local area (Figure 7). One in ten (10%) Marketplace enrollees had fewer than 10 practicing OB-GYNs in the local area, and 4% lived in a county with fewer than five OB-GYNs in the area (0% of Marketplace enrollees lived in a county with no local OB-GYNs). Sixty-three percent of Marketplace enrollees live in a county with 25 or more practicing OB-GYNs.

When it comes to network breadth, more than one-third (36%) of Marketplace enrollees were in a plan that included fewer than 25 local OB-GYNs, either because there weren’t 25 OB-GYNs in the market, or because available OB-GYNs were not included in the network. Nearly two in ten (18%) were in a plan that included fewer than ten OB-GYNs and one in ten (10%) were in a plan that had fewer than five local OB-GYNs (including 1% who were in a plan with no OB-GYNs). Thirty-five percent of Marketplace enrollees were in a plan with 25 or more OB-GYNs.

Although this OB-GYN network analysis is just among ACA Marketplace plans, employer-sponsored plans, which cover more people than Marketplace plans, also have provider networks. While many employers describe their plan’s provider networks as “very broad” or “somewhat broad,” nearly 1-in-5 (18%) firms with 5,000 or more workers characterize their plan as “somewhat narrow” or “very narrow.” The extent to which provider networks reduce the availability of OB-GYN services for those with employer coverage, and for which enrollees, remains unclear.

Methods

OB-GYN Workforce Analysis:

Information on the OB-GYN workforce is available in HRSA Area Health Resource File (AHRF) for 2021-2022. Data on the OB-GYN workforce is derived from the American Medical Association Physician Masterfiles. Data on the share of the population that is Black non-Hispanic, White non-Hispanic, or Hispanic is based on the 2010 Census Redistricting Data. Data on the share of the population that is foreign-born or that has limited English proficiency is based on the American Community Survey 2016-2020.

County classifications are based on USDA’s 2013 Rural-Urban Continuum Codes, which was the version in use for the 2021-2022 AHRF. This analysis defines metro counties as those in metro areas with any size population; small urban counties as those with a population of 20,000 or more, adjacent or not adjacent to a metro area or that have a population of 2,500-19,999 adjacent to a metro area; and rural counties as those with populations of 2,500-19,999 not adjacent to a metro area or that have a population of less than 2,500, adjacent or not adjacent to a metro area.

It should be noted that clinicians other than OB-GYNs, such as nurse practitioners, physician assistants, and midwives, also provide obstetric and gynecological care and are included in this dataset. However, the dataset does not indicate the specific field in which they practice, so we are unable to include them in this analysis. Doulas, who provide non-clinical support to pregnant and postpartum people, are not generally included in the dataset and so are also not represented in this analysis.

Provider Network Analysis:

This analysis of ACA Marketplace plan networks uses similar methodology as a 2024 KFF analysis. In total, 12 million enrollees selected or were automatically re-enrolled in a plan on either HealthCare.gov (8.3 million) or a state-based Marketplace (3.8 million) during open enrollment for the 2021 plan year. Approximately 55% of enrollees were female and 45% were male. Gender counts for some state-based Marketplaces are incomplete due to unknown or missing gender data; therefore, the data presented in this analysis is representative of Marketplace enrollees of all genders. This analysis estimates the share of OB-GYNs included in individual Marketplace plans in 2021. The data include only physicians (which includes OB-GYNs) and not other providers of obstetric and gynecological care.

Information on plan provider directories was compiled by Ideon through an API with insurers as well as other data including the National Plan and Provider Enumeration System (NPPES). Data for carriers not participating in the Ideon API were supplemented with carriers’ public filings.

Local OB-GYNs are defined as those who practice within the same county as an enrollee or are within the distance thresholds specified as part of CMS’s network adequacy standards for HealthCare.gov plans. See mileage thresholds in Table 1 here for defining “local” areas.  While the mileage standards in network adequacy regulations are based on the proximity to plan enrollees, this analysis measures the distance from the population-weighted center of the county. County classifications (e.g., rural, small urban, metro) were derived from the data source and approach listed in the OB-GYN Workforce Analysis methods section above.

To estimate the total number of OB-GYNs who are in active practice, we relied on Medicare Data on Provider Practice and Specialty (MD-PPAS), a federal database of physicians who submitted at least one Medicare Part B claim in 2021 and therefore saw at least one Medicare patient in the year. Virtually all OB-GYNs participate in Medicare, with only about 1% formally opting out altogether. In total, 34,945 OB-GYNs were included in MD-PPAS in 2021.

Although MD-PPAS provides a list of physicians known to be working, one concern is that a disproportionate share of OB-GYNs may not have treated a Medicare patient in 2021. To assess the representativeness of OB-GYNs in MD-PPAS compared to other physician types, we examined the share of individual providers by specialty in the National Plan and Provider Enumeration System, a federal registry that assigns health care providers unique National Provider Identifiers (but that is not intended to serve as a census of the active health care workforce), who also filed a Medicare Part B claim in MD-PPAS. On average, 61% of OB-GYNs filed a Part B claim—a rate comparable to adult primary care physicians (57%) and all designated physician specialties (58%).

A central challenge in analyzing provider networks is determining the size of the physician workforce. While the vast majority of physicians engaged in active practice accept Medicare, some physicians may be inadvertently missed, including those in closed-network HMOs serving exclusively commercial populations or those specializing in services not typically used by Medicare enrollees. Telehealth providers whose addresses are not within the local market are also excluded. Further, this analysis only considers individual-level physicians enumerated in the plan directory. In some cases, plans may include group health practices in their networks and not individually list providers.

Conversely, this analysis may exaggerate the breadth of provider networks. “Phantom providers,” or physicians who are listed in the plan directory but no longer accept the plan, may artificially increase the breadth of some plans.

Click here to read the full methodology, scope, and limitations of this analysis.

In this July 1 column for The New York Times Opinion section, KFF Executive Vice President for Health Policy Larry Levitt explains how the budget reconciliation bill passed by the Senate on July 1 is effectively a partial repeal of the Affordable Care Act (ACA) and, if signed into law, the resulting reductions in Medicaid and ACA Marketplace coverage would make it “the biggest rollback in federal support for health coverage ever.”