US citizen: should my Filipina wife give birth abroad (in the Philippines) or in the US?

Question

I am a US citizen but I live abroad as a permanent resident in the Philippines. I've been married to a Filipina since early 2016. We've decided to move back to the US since my income in the Philippines is too low to cover our living expenses and my savings have been virtually exhausted.

However, my wife is currently two months pregnant. Right now she's in the middle of waiting for her medical report to come back (it'll be another 2 months for TB sputum analysis) so we can proceed with her visa appointment. If all goes as planned, we hope to be in the US by December, and she would presumably give birth in January. Note: because of my low income and savings, I am planning to rely on my proof of SSS credits to file the I-864W. However, while researching to ask this question, I just read something online at Immihelp that says only my work while we are married can be counted towards this waiver. Is that right?

Anyway, my back to my main question:

I am hoping that someone can give me advice on whether it would be best to proceed with our plans to come back to the US by December and give birth in January. We would probably move back to the state of Georgia, if I can get my old job back, or to Tennessee otherwise.

Would my wife be able to use Obamacare, Emergency Medicare, or other services for her labor if we go back to the US (probably Tennessee/Georgia)? Our goal is to pay the least amount possible while still giving birth in a respectable hospital. In the Philippines they have a nice Hospital called St. Luke's, which is about 10 times cheaper than hospitals in the US, but they will turn you away if you don't have enough money, so that would be a bit concerning if there were any complications and we weren't able to save up enough by then.

Answer 1

I don't know about the Philippines; I can only speak about the health insurance situation in the US.

When she enters the US with her immigrant visa, she immediately becomes a US permanent resident. As a permanent resident, she can purchase a private insurance plan through her state's health insurance exchange (Obamacare marketplace). You, as a citizen, can too. Both of you will get a Special Enrollment Period since you just moved to the US, so you guys can sign up even if it is outside of Open Enrollment.

Medicaid is usually available to low-income pregnant women; however, new immigrants are generally not eligible for the first 5 years. Some states allow Medicaid to pregnant women even to new immigrants in the first 5 years, but neither Georgia nor Tennessee is among them. Emergency Medicaid can cover low-income people regardless of immigration status, but it is only for emergency treatment, so it might cover the actual delivery, but not pre-natal care. Tennessee (but not Georgia) has an "unborn child" option in its CHIP (Children's Health Insurance Program), which can cover pre-natal care even if the mother doesn't have insurance.

You can't get Medicaid either, because neither Georgia nor Tennessee covers non-disabled childless adults in their Medicaid.

Note that both of you will be subject to a penalty for any months of 2018 after you return to the US where you do not have health insurance (unless it's unaffordable, or your income is below 138% of poverty level, since Georgia and Tennessee are non-Medicaid-expansion states). So both of you should probably have health insurance if your income is above 138% of poverty level, probably from the exchange.

Another question is whether you and/or your wife would qualify for the subsidy (premium tax credit) if you buy a plan from the exchange. Generally, you guys would qualify for the subsidy if the household income is between 100% and 400% of poverty level. In the case of your wife, she might qualify for the subsidy even if the household income is below 100% of the poverty level, as there is an exception for people who can't get Medicaid due only to their immigration status, which she is (since otherwise low-income pregnant women would qualify in those states).