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“Young women need to see this film, which shows what is possible. Medical and nursing students need to see it, as do family practice and ob/gyn residents, whose training is almost only about surgery and pathology. No wonder we are in trouble!”
Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), ABFP, Emeritus Professor of Family Practice and Pediatrics, University of British Columbia and BC Children’s & Women’s Health Centre
The Patient Protection and Affordable Care Act was signed into law last Tuesday, March 23, 2010. It includes a number of changes that will improve the quality of maternal and infant care in the U.S. Following is a list of the most encouraging measures:
--Starting in 2014, pre-existing conditions—including giving birth, having a cesarean section, or being the victim of domestic abuse—will no longer be used to deny insurance coverage to women.
--Certified Nurse Midwives (CNMs) providing services to clients insured by Medicare must be reimbursed 100% starting January 1, 2011 (currently they are reimbursed only 65%). This is important because Medicaid, which covers at least 43% of births in the U.S., bases many of their reimbursement rates on Medicare’s reimbursement rates.
--Licensed birth centers will now be covered by Medicaid, meaning that licensed care providers including Certified Professional Midwives (CPMs) providing services in these centers to Medicaid-insured clients will be reimbursed for their work. Medicaid will also reimburse the birth center for its facility fees in the same way that hospitals and clinics are reimbursed for these fees.
--The Melanie Blocker Stokes MOTHERS Act was passed, providing $3 million for new grants to provide services to women with or at risk of developing post-partum depression or post-partum psychosis and their families. The Act encourages continued research into the causes and treatments for these conditions.
--The Fair Labor Standards Act of 1938 was amended to require that employers provide nursing mothers reasonable break time to express their breast milk for 1 year following their child’s birth. Employers must provide these employees with a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public.
--States, tribes, and territories will be given $1.5 billion to implement maternal, infant, and early childhood home visiting programs with the goal of reducing infant and maternal mortality.
--A new pregnancy assistance fund was established, providing $25 million annually for ten years to institutions of higher education, high schools and community service centers to help pregnant and parenting students obtain housing, prenatal and delivery care, childcare, foster care, adoption services, parenting education, and post-partum counseling services.
It is hugely important that barriers preventing women from obtaining insurance, seeking prenatal and delivery care from CNMs or at birth centers, and breastfeeding at work have been lifted. The new funds to help fight post-partum depression and provide comprehensive services to expecting and new mothers will help more children spend the first years of their lives in stable, nurturing environments.
Unfortunately, the news isn’t all good. As National Organization of Women president Terry O’Neill points out, the new bill still permits insurance companies to charge women higher premiums in large group plans. Permanent legal residents of the U.S. must live in the U.S. for five years before they can apply for Medicaid, and undocumented people cannot purchase private health insurance under the provisions of the new bill. The bill leaves 15 million people in the U.S. without medical coverage. What’s more, the majority of women now covered by private insurance plans will lose their access to coverage for abortion care, and need to pay for separate insurance to cover this. This compounds the vulnerability of many pregnant women who will not be able to access the care they need at this important point in their lives.
How do you feel about the passage of the Patient Protection and Affordable Care Act? What impact will it have on you and your family?
For more information, please see
Terri O’Neill, National Organization of Women: “Health Care Reform Victory Comes with Tragic Setback for Women's Rights,” http://www.now.org/press/03-10/03-21b.html
Jodi Jacobson, RH Reality Check: “The Health Care Bill and Women's Health: Wins, Losses, and Challenges,” http://www.rhrealitycheck.org/blog/2010/03/23/updated-health-care-bill-w...
Association of Maternal and Child Health Programs, “The Patient Protection and Affordable Care Act Maternal and Child Health Related Highlights,” http://www.amchp.org/Advocacy/health-reform/Documents/Senate%20Bill%20-%...
American College of Nurse-Midwives, “Midwives Celebrate Equitable Reimbursement,” http://www.midwife.org/hr3590.cfm
Perinatal Pro Weekly Blog, “Postpartum Depression Legislation Becomes the Law of the Land!!” http://perinatalpro.com/blog/?p=788
Breast pumping at work provisions initiated by Representative Carolyn B. Maloney: http://maloney.house.gov/index.php?option=content&task=view&id=2052&Item...
Debra Pascali Bonaro is the director of Orgasmic Birth and co-author of the book Orgasmic Birth, Your Guide to a Safe, Satisfying and Pleasurable Birth Experience. Debra helps birth pros and new families all over the world learn about the details of gentle birth. Visit www.debrapascalibonaro.com to join in a webinar, attend a destination workshop and learn more about natural childbirth.