pt. Bill of Rights

Nurses Activism


Grassroots Network Message 106019 2nd ACTION ALERT! Patients' Bill of Rights

Dear Friends,

This is another CALL TO ACTION from Citizens for Midwifery!

The Patients' Bill of Rights was passed by the Senate late Friday 6/29, and now will be debated in the House. Therefore, it is time to WRITE LETTERS to your Representatives in Congress. And if you haven't yet written to your Senators, it is not too late - the bill will be amended in the House, and if passed, the two different versions will go to a conference committee; both Senators and Representatives will be on that conference committee which will

further amend the bill.

This opportunity to bring the Midwives Model of Care ™ to the attention of our elected officials in Washington continues! Again, please note that this action has been initiated by Citizens for Midwifery, not by any midwifery organization(s).

And Pam Maurath will be going to Washington on THIS MONDAY, July 2, and will deliver copies of any letters you have faxed or e-mailed to her by the end of Sunday, July 1. But even if you can't make that deadline, do go ahead and FAX or EMAIL to your members of Congress TODAY!

You can use the same information as in GNM 106018. You can even use the same letter you already sent to your Senators, with a cover note to your Representative.

Below is the important information from GNM message 106018. (This time we are making sure that all url's, etc., are actually in the text!) Also, the CfM website which was temporarily down, is now "up" again.

From GNM 106018 (with a few changes since the bill has been passed by the Senate and is now going to the House):

Citizens for Midwifery has heard from many people who have been frustrated to discover that their HMO plans do not pay for cost-effective midwife-attended out-of-hospital birth. At this time, the Patient's Bill of Rights, a consumer protection bill (at least in theory), does not mention or provide for any kind of midwifery care under HMOs. Let's let our Senators and Representatives in Washington know what WE want! Any version of the bill that

is passed should include language that assures access to midwifery care in all settings, in other words, says that women in HMOs should not be limited to obstetricians for maternity care, but should have the option of choosing a midwife. The addition of just a few words in one part of the bill would

address this deficiency:





(1) IN GENERAL- If a group health plan, or a health insurance issuer in connection with the provision of health insurance coverage, requires or provides for a participant, beneficiary, or enrollee to designate a participating primary care provider--

(A) the plan or issuer shall permit such an individual who is a

female to designate a participating physician who specializes in obstetrics and gynecology as the individual's primary care provider OR A NATIONALLY-CERTIFIED AND STATE-REGULATED MIDWIFE, AS THE INDIVIDUAL'S MATERNITY CARE PROVIDER; and ...

You can read the entire bill at:>> click on "health care" (doctor icon on lower right) and look for "read the text...".


While the addition of these words to the bill would not mean that CPMs and licensed midwives would automatically be included in HMOs and other insurance policies, leaving them out (the present wording) would certainly give HMOs, etc., good reason not to include these providers in their policies.

The suggested language does not include unregulated midwives, even if they are apparently legal, because HMOs and other insurance plans try to minimize their legal vulnerability by including only providers that are credentialed and government-regulated. However, even with this limitation, the inclusion

of midwifery services (in all settings) would be a huge step forward. No matter what state you live in, write to your Senator and Congressperson TODAY to tell them you want HMOs to include the choice of midwifery care in all settings.

The reality is that our suggested change probably will not be included -- it will be a real coup if we even get even one minute of attention in the midst of all the high-powered lobbyists. And even if it is passed by Congress, the bill is likely to be vetoed by President Bush. However, this opportunity to communicate to Congress about midwifery should not be passed up! Also, Pam

Maurath will be going to Washington in a few days and can deliver directly to Sen. Daschle's office copies of your letters and e-mails along with additional midwifery information. The more letters, faxes and e-mails there are, the more Sen. Daschle will realize that this is an important issue to consumers. In addition, Pam has volunteered to stuff all the Senate mailboxes with midwifery information including the Midwives Model of Care


In the next reply is the continuation of the original text and what and how to do it. Please do it tonight or Today:p


244 Posts

Here is what to do:

1. Read the sample letter, etc., below.

2. Find a fax or e-mail address for your Senator and for your Representative. Go to: > click on your state, then scroll down to "Congressional Delegation" to find links to websites for each Congressperson, with contact information. Last week we focused on our Senators, NOW IT TIME


3. Write a BRIEF letter TODAY!

***State what you want first, i.e., the change in wording; to be effective, it would be good if we all ask for the same change.

***Even if you are in a state that does not license or recognize direct entry midwives, getting this language included is still important - you and family members may not always live in that state, your state may eventually enact regulatory legislation for these midwives, and nurse-midwifery should also be

a choice under HMOs. ***Include something personal (also brief) about why this is important to you.

***Below is an example of a letter, but be sure to put the main ideas in your own words.

***The important point is that women should have access to midwives (direct entry midwives as well as nurse-midwives) and out-of-hospital birth, and these should be included in ANY federal health care bill.

***Several fact sheets on the Citizens for Midwifery web site>> include pertinent information you could use in your letter, but just the fact that nurse-midwives already are legal everywhere and direct entry midwives already are regulated in 18 states is a strong argument for HMOs to include "nationally credentialed and state-regulated

midwives" as a choice for maternity care.

***Your personal item could be first-hand experience, or about a family or friend, or just general principle that this good choice should be included in the bill. Costs and access are important issues related to this bill. Safety is less of an issue as we are talking about already-licensed midwives - i.e.,

those states have already decided the safety issue, which is not really the focus of the Patients' Bill of Rights.

***Legible hand-writing is great for faxed letters; typed letters are fine also.

4. Fax or e-mail the letter to your Representative TODAY or AS SOON AS


5. Also fax or E-mail a copy of your letter to Pam Maurath (fax:

212-866-7626; e-mail: > IMMEDIATELY. She will be going to Washington, DC on this Monday, July 2, and will personally deliver

copies of all of the letters (with a cover letter and additional literature) to appropriate offices. She will also make sure the most important Senators and Representatives receive additional information regarding the change in wording we want.

6. Send to your Congressperson (federal Representative) a copy of the letter that you are sending to your Senator, with a cover note, or write an original letter to your Representative..

Here is an example of a letter:

The Honorable [name of Senator or Representative]

(fax # or address)

Dear Mr. [or Mrs., Ms.] [Name],

[if you know this person is championing this bill, you might start with something like "Thank you for working for consumer protection in health care..."; or whatever is appropriate...]

[who you are, what you are writing about, and what you want done] I am your constituent, and I am writing about the Patients' Bill of Rights, just passed by the Senate and now to be debated in the House. Any version of the bill that comes up for a vote should include language that assures access to midwifery care in all settings. For example, this bill would be improved by

adding the words "or a nationally-certified and state-regulated midwife, as the individual's maternity care provider" to the following section of the bill:


(a)(1)(A )the plan or issuer shall permit such an individual who is a female to designate a participating physician who specializes in obstetrics and gynecology as the individual's primary care provider OR A NATIONALLY-CERTIFIED AND STATE-REGULATED MIDWIFE, AS THE INDIVIDUAL'S MATERNITY CARE PROVIDER; and ...

[a factoid or two] Nurse-midwives practice in all 50 states, and 18 states also license certified professional midwives. Midwifery care has been proven over and over to be safe, effective, cost-saving, and satisfying, whether practiced in hospitals, birth centers or at home. HMOs should include midwives as a choice for maternity care, but the current language of the bill does not mention midwives at all.

[a personal angle] Fifteen years ago my husband and I had to pay out-of-pocket to have our baby at home with a nurse-midwife. Even though this midwife-attended birth cost much less than having our baby in the hospital would have cost, our insurance plan would not pay. With all the focus on

reducing the costs of healthcare, surely HMOs should be encouraging women to use midwives in the setting of their choice (in or out of the hospital).

[repeat what you want done] Increasing numbers of pregnant women want the safe, healthy choice of midwifery care, whether in hospital, birth center or at home, and HMOs should make this option available. Please make sure the Patients' Bill of Rights includes language assuring that HMOs must offer the

Midwives Model of Care - the option of choosing a midwife for maternity care.


[your name]

[your home address, phone number, e-mail, somewhere on the letter, whether

e-mailed or faxed]


Grassroots Newsletter:

Susan Hodges - Gatekeeper

Debbie Pulley - Mailer

This was sent to my email as an attached file and I was asked to forward it to as many concerned individuals as possible ASAP!;)

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