When a baby is born to a surrogate mother in the United States, it is immediately entitled to US citizenship. That right to citizenship is guaranteed by the 14th Amendment. But who pays that cost of surrogacy procedures and the resulting “anchor baby’s” benefits as a US citizen? Forbes takes a look in a recent article on the cost of surrogacy.

Forbes reports that roughly one out of every 12 newborns in the United States can be classified as a so-called ‘anchor baby.’ That term includes children were born to pregnant ‘birth tourists’ who come to the US legally to take advantage of the citizens law. That’s an estimated total of 36,000 new American babies a year.

cost of surrogacy noteIn the U.S., “birth tourism” is a flourishing business. Pregnant women fly to clinics in the US, stay at special hotels and pay sometimes extraordinarily high costs for “concierge services” designed to facilitate the birth of their children. In most cases of surrogacy, the parents soon return home with their baby while the surrogate mother stays behind. But the baby continues to enjoy US citizenship, which is a phenomenal benefit in countries like China or Mexico. The surrogacy baby can travel and live almost worldwide without issue. The larger benefit to the family is that the child is eligible to claim U.S. social welfare, be educated at much lower cost and obtain certain medical benefits for life if the family remains in the US.

Various court challenges have tried to block this practice. For example, in 2015 the State of Texas stopped giving birth certificates to parents who could not produce U.S.-issued documents for themselves. What was more, Texas refused to recognize the Mexican Consulate-issued matrícula consular as an identity paper as it had previously.

But such state efforts to frustrate birth tourism have run up against the prohibition of the 14th Amendment to the effect that, “No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States …”

Canadian officials have wrestled with the same issue, with the rise of birth tourism for both surrogacy and non-surrogacy cases. Like similar past US efforts, at least one online petition to the House of Commons in June has called on the federal government to stop granting citizenship to newborns unless one of the parents is a Canadian citizen or a permanent resident. The petition needed 500 votes to be considered by the House of Commons, but gathered more than 8ooo signatures to date.

Surrogacy (in this case an American woman having a child for foreigners who are unable to give birth) could become a highly explosive problem. Unlike in the U.S. where surrogacy is banned in New York but legal in California for example, Canada as a whole is becoming a magnet for surrogacy for the following reasons: excellent in vitro fertilization clinics, legal equality of access to health care regardless of sexual orientation or marital status, obscure and vague laws on the subject and the low Canadian dollar.

While from a health and human rights perspective it may not be desirable to limit a surrogate’s access to prenatal care, the question is who is going to pay for such care? The Forbes article poses the question, if a surrogate is bearing a child for non-residents, shouldn’t her medical costs be charged back to the non-resident commissioning parents? Should prenatal medical services in such cases be offered for a fee to be paid by foreign clients? Alternatively, should commissioning parents be required to make a charitable contribution to a local hospital or children’s medical center in order to gain access to medical care for their surrogate?

The issue of the cost of surrogacy and the fertility tourism is becoming paramount in Canada. National Health Care was always one reason why Canada had grown as a popular surrogacy destination,, but is now losing its luster. Canadian mothers are longer assured of free medical are, and neither are the babies once they are born. In the US where insurance if privatized, the question may be whether babies born through surrogacy can qualify for health insurance. The answer may be changed depending on the future of Obama Care, but something that will effect the cost of surrogacy in the future.