Midwife Reflects on Government Affairs Committee (GAC) Experience and Lobby Day 2010

My ACNM legislative tenure ended on a great high. The Midwifery Care Access and Reimbursement Equity Act of 2009 passed last March; as of January 1, 2011, the CNM reimbursement rate will increase from 65% to 100% of the Medicare Part B fee schedule. My other role as chair was to help organize midwives from across the country for Lobby Day.

ACNM hosts its Annual Meeting in DC once every four years so midwives can meet with their legislators in person on Capitol Hill and discuss issues vital to the sustainability and growth of midwifery. This is one of the most important personal contributions we can make to our profession. I am so proud and thankful that more than 450 midwives (from forty nine states) met with more than 300 offices that afternoon. It was quite a sight to walk up and down the streets of the Capitol and see midwives on every corner. As a Washington state midwife, I was quite proud of our strong contingency. More than 25 of us met with Senators Murray and Cantwell’s offices, and then split into individual groups and met with each US representative (or their staff) from our state.

The focus of our visit was a new bill that ACNM is championing called the MOMs 21 Act, which stands for Maximizing Optimal Maternity Services for the 21st Century. This bill will improve maternity care outcomes for mothers and babies and bend the cost curve of our maternity care expenditures in the US. It has many components, and the section we are most interested in will establish reimbursement for midwives who supervise residents, medical students, and student midwives in academic health centers.

After we met with our legislators, nearly 450 of us gathered at a nearby restaurant for a Capitol Hill reception, where we rehashed our day, celebrated equitable reimbursement under Medicare, and watched 10 legislators (or their staff) receive ACNM awards for their contributions to midwifery and women’s health. The highlight was when Senator Menendez (D-NJ) ended his speech by saying, “I love midwives!” I had tears in my eyes and felt so proud that midwives have such vital voices on Capitol Hill. I hope you can join us the next time we are in DC. Putting a face on midwifery for our legislators is essential to effect change in the laws that regulate our practice.

Heather Bradford served on ACNM’s Government Affairs Committee (GAC) since 2001, including three years as chair. She received an ACNM Public Policy Award at the Capitol Hill Reception.

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

A Win for the Little People

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

Tuesday, March 23, was a big day for many Americans when the President signed major health care reform legislation into law. But Tuesday was an even BIGGER day for midwives. Under this new law, after 19 years of hard work, certified nurse-midwives (CNMs) will be equitably reimbursed for their services under Medicare beginning January 1, 2011.

It would seem like receiving our current rate—65% of what physicians receive from Medicare—wouldn’t be that much of a hardship on a day-to-day basis for most midwives, as we don’t care for many women covered by Medicare. But receiving 100% is a very important change because Medicare often serves as the gold standard of reimbursement rates. For example, I just learned last week that Aetna is reducing its reimbursement rate in Washington State (and many other states) for nurse practitioners, physician assistants, and certified nurse-midwives to 85% of what physicians receive starting June 1. It’s not a coincidence that they did not apply these new rates to certified nurse anesthetists, as they currently receive 100% under Medicare. Other insurers who have a discrepancy in rates include Blue Cross Blue Shield and Regence, and I am sure there are many others. There are also 22 states where Medicaid currently reimburses CNMs less than 100% for their services. What’s their reasoning? That’s the interesting part—they don’t have to give one.

When we midwifery advocates lobbied on this bill, we explained to legislators that a pap smear is a pap smear is a pap smear. Meaning—it doesn’t matter what the letters are after your name; as long as you are qualified and licensed to perform it, you should be equitably reimbursed. But for CNMs, this took a lot of education, phone calls, e-mails, letters, trips to DC, and downright begging to convince legislators to understand. I have been lobbying on this bill since 2001, and there were many midwives that came before me who are celebrating just as loudly as me. So, here’s a toast to us little people who have finally won one in the battle against the giants. Watch out, private insurers and Medicaid states. The new gold standard rate for CNMs is 100%.

Editor’s note: If you have been involved in gaining support for equitable reimbursement for CNMs at any point in time—by contacting your members of Congress, visiting Capitol Hill, or working to mobilize support—help ACNM thank and celebrate you by sending your name, picture, and a sentence or two about your involvement to pr@acnm.org. And, while you’re at it, leave a comment on this post!












From left to right: ACNM Executive Director Lorrie Kline Kaplan; Midwives-PAC President Katy Dawley, CNM, PhD, FACNM; Representative Jim McDermott (D-WA); ACNM Government Affairs Committee Chair Heather Bradford, CNM, ARNP; ACNM President Melissa Avery, CNM, PhD, FACNM, FAAN.














Senator Al Franken and Brielle Stoyke, CNM

Top 10 Reasons to Attend Lobby Day

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

Once about every four years, ACNM hosts its Annual Meeting in DC. Why DC? We need your voice. On Tuesday, June 15, we hope hundreds of midwives will storm Capitol Hill to meet with their legislators (two senators and one US representative) and discuss issues vital to the sustainability and growth of midwifery. This is one of the most important personal contributions you can make to your profession. Not convinced? Here are my top 10 reasons why you should lobby on Capitol Hill in pumps and pearls or shirt and tie instead of spending the afternoon touring the White House in shorts and a T-shirt.

1. Only you can tell the story of midwifery. Our lobbyist can talk about our issues until he is blue in the face, but only you can share the stories of your clients and the barriers you face in caring for them.

2. You don’t have to worry about what to say or do because we have all the answers. Set your mind at ease by attending the one-hour Lobby Day Prep session the morning of Lobby Day and then hop on the ACNM-provided buses to the Capitol. We’ll also provide maps to get you home.

3. There is power in numbers. Every constituent that attends sends a stronger message to our members of Congress.

4. You will feel empowered after this experience. This is the third time I have helped organize Lobby Day, and it’s probably my most favorite part of the job.

5. Meet with your legislators and their staff in a more casual setting at the Capitol Hill Reception immediately following Lobby Day. Tickets sell fast, so buy one when you register for the Annual Meeting.

6. Show your children and practice partners the importance of political action. What better civics lesson can you teach your child?

7. Meet other midwives from your home state. All midwives from each state go together to meet with their two senators. Midwives from different congressional districts then divide into small groups and meet with their House representatives.

8. Have a picture taken of you and your member of Congress to hang in your office or home. All legislators are happy to do this.

9. Earn two contact hours. Simply lobby and complete a lobbying evaluation form afterward.

10. Every woman deserves a midwife. Even if you’re not a fan of your elected official, there are some things we can all agree on, including access to midwifery care.

June 15 seems like a long way off, but the time to plan is now:

• Find out if visits have already been scheduled for your district or state.
• Make an appointment for your district or state.
• Learn more about Lobby Day.
• Not a midwife? You can still advocate for midwifery!