How to Achieve Woman-friendly Policy One Legislator at a Time

by the ACNM Government Affairs Committee

Minnesota midwives with Senator Al Franken (D-MN)

Last month, more than 450 midwives and midwifery students traveled to the US Capitol to educate members of Congress on issues vital to the sustainability and growth of midwifery practice and to discuss our legislative agenda. Here is a peak into how midwives promoted woman-friendly policy one legislator at a time:

I ended up meeting with my representative by myself. I expected to meet with an aide, but ended up meeting with Representative McGovern (D-MA) himself! After recovering from my initial shock, I spoke with him about midwifery in Massachusetts and encouraged him to support the MOMS for the 21st Century Act. Not only was he nice to me, but he agreed to cosponsor the bill! As a student nurse-midwife, this was the perfect introduction to lobbying, and I am so glad that I participated!
~Christian M. Ornburn, SNM, ACNM Student Representative, Massachusetts

I had difficulty getting an appointment with Congressman Ruben Hinojosa (D-TX), but was able to obtain a meeting with his aide. I met with his aide in the office for 30 minutes to discuss midwifery issues and care of women in the Rio Grande Valley. As I was leaving, I ran into my representative. I introduced myself, thanked him for his vote for health care reform, and told him how pleased we were that Medicaid payment for birth centers was included in the bill that passed. He asked me to continue our discussion and join him in the congressional elevator. I mentioned that it said congressmen only, and he smiled and said, “You are with me.” We boarded a guarded train and continued to discuss women and children's health care issues. Next he took me to a waiting area and asked me to write my name and telephone numbers while he went to cast a vote. He returned in a few minutes, took me to the exit where I could catch a taxi or bus to the Lobby Day reception, and handed me his card.
~Nivia Nieves Fisch, CNM, Texas

My visit with Congressman Robert Andrews (D-NJ) could not have gone better! Though he was in the middle of voting, his health legislative aide whisked me off to the Capitol building because Mr. Andrews wanted to meet with me himself. The congressman and I spent a very pleasant 30 minutes discussing midwifery, health care reform, and the future of maternity care in the US. Before I could ask him, he volunteered to cosponsor Rep. Roybal-Allard's MOMS for the 21st Century bill.
~Robyn Carlisle, CNM, Mt. Royal, New Jersey

I first became aware of the importance of educating our legislators during graduate school. I quickly learned that unless the senator or representative had previously had some formal health care education, they couldn’t possibly be aware of the issues we providers face almost daily. What does it take for the issues to become important to them? The answer, at least in part, was demonstrated by the scores of midwives calling on our legislators during Lobby Day. I thoroughly enjoyed experiencing the momentum that our Washington midwife contingency exhibited during meetings with our senators’ assistants. I felt our voice was heard, and that felt great!
~Susan Collins, CNM, Washington

Midwives of Washington State

My Top Ten Legislative Wish List for 2010

by Heather Bradford, CNM, ARNP,
Chair, ACNM Government Affairs Committee

Because every woman deserves a midwife, here’s what I’ll be advocating for in the coming year:

1. Reimburse Midwives Fairly Under Medicare. I’m eagerly watching the health care reform package, which includes provisions from HR. 1101/S. 662 – the Midwifery Care Access and Reimbursement Equity Act of 2009. That’s right! After more than 20 years of work, our bill is part of both the House and Senate reform packages. This bill would allow for equitable reimbursement of certified nurse-midwife (CNM) services under the Medicare Part B fee schedule. Compared to physicians, we currently are reimbursed at just 65% for our services. Passage of health care reform will provide CNMs reimbursement equal to physicians under Medicare.
2. License Certified Midwives (CMs). Even though the CM credential is considered equivalent to the CNM credential, CMs are licensed to practice in only three states—New York, New Jersey, and Rhode Island. I want to see legislation introduced in at least 10 states that would provide full practice equity and licensure of CMs.
3. Reimburse Birth Centers Under Medicaid. HR. 2358/S. 1423 (The Medicaid Birth Center Reimbursement Act) would provide improved access to birth centers for pregnant women covered by Medicaid. It has already passed in both the House and the Senate as part of the health care reform package, and is awaiting final passage.
4. Reimburse Midwives Fairly Under Medicaid. I want to see legislation introduced in at least 10 states that would allow midwives to receive equitable reimbursement under Medicaid. Currently, only 28 states provide equitable reimbursement.
5. Recognize Midwives as Primary Care Providers. Midwives do more than care for pregnant women and babies. We specialize in women’s health throughout the reproductive life cycle. Therefore, midwives should be recognized in all state and federal legislation as primary care providers wherever the term is used.
6. Support Midwives Who Teach Students. More and more midwives are supervising students at academic health centers. However, there is no incentive for health centers to hire more, because midwives are not able to bill under Medicare for their supervisory role. Legislation needs to be introduced to address this.
7. Prevent Discrimination Against Midwives. We need a change to the Centers for Medicare and Medicaid Services (CMS) regulations to prohibit discrimination against midwives in hospital privileging.
8. Add Midwives to the VA. Midwives should provide care to female veterans covered by the Veterans Health Administration. All other advanced practice nursing groups are eligible providers, but midwives are not. The growing population of wounded women of childbearing age deserves a midwife, too.
9. Fund Nursing and Midwifery Education. I want additional funding for nursing and midwifery education within the Public Health Service Act (Title VIII) and the National Health Service Corps.
10. Protect Breastfeeding and Provide Tax Incentives for Businesses to Encourage it. As a breastfeeding mother of twins, I am ready for more legislation to be passed in this arena.
    

What would you like to see happen in 2010?

An Inside Look at the PAC Reception

by Heather Bradford, CNM, ARNP
Chair, ACNM Government Affairs Committee

While at the Annual Meeting, I had the distinct honor of introducing US Representative Jim McDermott (D-WA) as the keynote speaker at the Midwives-PAC Reception on Sunday night at the Seattle Convention Center. He was welcomed by a roaring crowd of over 60 midwives and 100 nurse-midwifery students who, with standing room only, were chomping at the bit to discuss health care reform and how midwives are part of the solution. Rep. McDermott is a senior member of the U.S. House of Representatives and a psychiatrist known for advocating for affordable access to health care coverage. Since 1993, he has introduced universal health care legislation in every Congress, and is again leading the way in drafting comprehensive health care reform legislation with recommendations for a robust public option provision.

There were several highlights to his speech. When he used the phrase, equal pay for equal services, we all cheered and clapped, as we are once again advocating for equitable reimbursement with respect to Medicare Part B services with our Midwifery Care Access and Reimbursement Equity Act of 2009 (HR. 1101/S. 662), and trying to encourage Rep. McDermott to cosponsor our bill. It was refreshing to hear him talk about the value of having varying types of providers provide health care so patients have choices, and his history of supporting midwifery in WA when he served as a state legislator.

The other highlight of the night was his encouragement for us to teach our legislators about midwives. There was a real “aha” moment, especially among the students, when he essentially said that if you don’t contact your legislators and let them know about your profession, they won’t know about you and will never be able to stand up for you. But if you do your part and advocate for yourself, you can really make a difference. As Chair of the Government Affairs Committee, this was music to my ears. Often I find many midwives only want to deliver babies and leave the grassroots lobbying to a select few. But unfortunately we can’t do it alone! Thank you, Rep. McDermott, for inspiring a room of over 160 to get in touch with our legislators and speak out.

So at the end of the night I was able to walk the Congressman and his staff out. We discussed how HR 1101/S. 662, our equitable reimbursement bill, is a reimbursement bill (which follows his agreement that equal services deserve equal pay), that ACOG was supportive of midwives receiving 100% under Medicare, and that the bill had been scored by the Congressional Budget Office at zero (meaning it wouldn’t cost the government a dime). And with those words I proceeded to the bar to order a glass of wine to toast with my colleagues a successful event. Because that is what the Midwives-PAC is all about – access to legislators. By soliciting dollars from ACNM members, the Midwives-PAC facilitates the direct exchange of information between members of Congress and midwives and gives us the opportunity to speak out about our profession and our health care policy agenda.