Cal Affordable MaternityCare Act of 2013 ~ making the legislation itself an effective vehicle for telling our story

by faithgibson on February 18, 2013

in AB1308, new regs & new legislative efforts, Physician Supervision Issues

The goal for the C.A.M. Care Act of 2013:

* Affordable maternity care in California by making physiologically-based midwifery care in birth centers and other non-medical settings easily available to Medicaid-MediCal eligible women by licensed midwives.

What does this means? Promoting legislation that:

** Includes the independent practice of licensed midwifery in the Medicaid-AIM reimbursement scheme so LMs qualify as Medicaid providers

** Requires health insurance companies (once again) to reimburse families for birth services provided by LMs

** Provides LMs with ability to consult and collaborate with physicians as a normal obligation of the doctor’s licensed to practice medicine in the state of California

** Requires med-mal carriers to cover any incidental liability as a part of the physician’s normal liability coverage

** Provides mfry clients with normal unfettered access to necessary obstetrical services, by insuring non-discrimination by other medical services providers (labs, ultrasound, referral to perinatal regional centers, etc)

** Establishes a mechanism for filing an ‘incident report’ for any circumstances in which a necessary service to a LM or her client family was denied or delay and resulted in a problematic outcome

** Authorizes independent access for LMs to necessary prophylactic and emergency drugs for the responsible practice of midwifery

How? — We need to turn politics on its head by putting mothers, midwives and California taxpayers in the driver’s seat. Here are my ideas for making that happen:

*** Support CAM’s lobbying efforts and all the time-tested avenues for political activism — letter-writing, personal visits to district offices, etc

*** Think Outside the Box by making creative and targeted use of social media — YouTube, Facebook, Twitter, other web-based opportunities for organizing our activism, including Skype and video conference calls

Obviously, this a ‘wish list’, but its always a tactical advantage to ‘demand’ twice as much as we need. But even more important, it makes the legislation itself the most effective vehicle for telling our story.  As midwives know all too well that the topic of midwifery and natural childbirth are kind of wonkie, wandering and hard for people not naturally interested in childbirth issues (men and career women, etc) to get a handle on.

For instance, talking about our efforts as  “The California Affordable MaternityCare Act of 2013” tells you that affordable maternity care is good and that we don’t currently have it in California. No need to teach or preach.

Describing the biil’s intent as “to make physiologically-based midwifery care easily available to Medicaid-MediCal eligible women in birth centers and other non-medical settings“, tells us that currently there is no mechanism to provide cost-effective physiologic care to healthy, low-income populations in California.

Each of the specific provisions listed — allowing LMs to qualify as Medicaid/MediCal providers (note that our law already defines the status of LMs as “equivalent to CNMs“), requiring insurance companies to reimburse LMs for legally provided services, requiring physicians to collaborate as normal part of their MD license, requiring med-mal carriers to cover incidental liability for care provided to clients of midwives as a normal part of their coverage, requiring medical service providers to provide medical services without discrimination (what a concept!), authorizing access to the drugs required by our own licensing act (mind-blowing idea!) — each of these statements tells the reader exactly what the problem is — i.e., that these things are not happening. 

This makes the legislative ‘remedy’ itself a description of the problem it is crafted to solve.

The question that remains in the mind of the readers is why California doesn’t already have those things?

The answer is ‘structural barriers’ built into the law that currently block LM from being able to be reimbursed when providing care to low-income women, that allow insurance companies to refuse to pay for legitimate services provided by LMs, and allow doctors, other medical service providers, and med-mal companies to systematically refuse to cooperate with midwives and their client families. Obviously, there is a pattern here that singles out midwives/mfry clients to refuse services that are otherwise ‘business as usual’ decisions.

The question behind that question is a simple binary yes/no:

Is this structural barrier inserted into the law by organized medicine to ‘safe guard’ innocent childbearing women from crazy, lazy, money-grubing, know-nothing midwives (Scarlett O’Hara’s maid)?

Or

Is it about historical prejudices against midwifery and maintaining the contemporary economic advantage of mainstream medicine?

When you connect up the dots, the answer is obvious and as close as the bill’s title: the California Affordable Maternity Care Act. Its name and its provisions tell us that all the structural barriers are (surprise!) all to the economic advantage of those controlling the system, that is, not to the advantage of midwives or childbearing women.

Telling our story through the language of our bill is also an effective mechanism to expand public and personal understanding of the institutionalized discrimination against the midwifery profession and non-allopathic forms of healthcare.

Judge Roman’s findings clearly identify the midwifery model of physiological management as “not a medical model”. As a method that is separate and distinct, he also stated that physiologically-based midwifery care is NOT available from within the current mainstream medical system.

This formally acknowledges the ‘natural’ economic competition btw the two professions. It identifies a financial motive behind the CMA-authored control over the midwifery profession by the obstetrical profession via the supervision clause. And it explains the institutionalized lack of cooperation by the obstetrical profession in subsequent years, as it universally refused to provide the very supervision that it legally imposed.

 

Here is what that looks like:

snake-Catches-bird
Judge Roman further noted that California LMs in general were “avidly seeking to be part and parcel of the healthcare team that serves the residents of California” and cited the lack of cooperation of med-mal carriers and the systematic hostility by obstetricians to licensed midwives as the reasons why the intent of the Legislature was not being carried out in relation to the ability of midwives to be integrated into the mainstream healthcare system.
When it comes to discrimination, I don’t think it could get any clearer, nor could it come from any more impeccable a source than Judge Roman.
The record is clear – women as maternity patients and women as providers of maternity services have been systematically and institutionally discriminated against both in historical and in contemporary times.
Of course, discrimination is just a garden variety abuse of power systematically applied to an entire group. However as a ‘label’ I would never use the term “abuse of power” in public. But I would describe the action verbs that abusers use to perpetrate their dastardly deeds, which is what each of the provisions of the California Affordable Maternity Care Act of 2013 achieves so nicely.

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