Jessica Hurley owed nearly $38,000 — close to a quarter of her family’s income — in medical costs, the difficult delivery of her twin boys and the babies' weekslong NICU stays. “I just felt like this isn’t fair,” she said. “I’m going to have to file bankruptcy.”

The Hurleys’ income was too high to qualify for Medicaid in Illinois, where they live, but their insurance plan had a high out-of-pocket maximum of $28,500. That put them in a vulnerable category of middle-class families: those who earn too much for Medicaid but can’t afford to access insurance plans that sufficiently cover costly births. In the last few years, this group has been left behind by major health care reforms.