As your constituent and a supporter/patient of certified nurse-midwifes caring for the health care needs of women in our community, I ask you to cosponsor the "Midwifery Care Access and Reimbursement Equity Act of 2009," (H.R.1101) as introduced by Rep. Ed Towns (D-NY) and Rep. Fred Upton (R-MI).

In August of 2007, midwives celebrated as the House version of this legislation passed as a provision of the Children's Health and Medicare Protection Act (CHAMP); this provision would increase the rate of Medicare reimbursement for midwifery services. The Congressional Budget Office assessed the cost of this provision in the CHAMP Act to be zero given that midwifery services represent such a small portion of services provided within the program. Final Medicare legislation from the Senate did not contain the provision however.

Certified nurse-midwives and certified midwives are highly educated health professionals. Each must complete a post-baccalaureate educational program, state licensure, and passage of a national certification examination to practice in the United States.

The Medicare program reimburses certified nurse-midwives for primary care services, as authorized by state law. Since 1988, Congress has authorized certified nurse-midwives to provide maternity-related services to Medicare-eligible women with disabilities who are of childbearing age. Since 1993, Congress authorized certified nurse-midwives to also provide additional services outside the maternity cycle. All women covered by the program would be eligible for these well woman services.

In its June 2002 report to Congress, the Medicare Payment Advisory Commission (MedPAC) unanimously recommended that the percentage of part B reimbursement for certified nurse-midwife services to be increased by Congress. MedPAC also highlighted the high quality of care provided by certified nurse-midwives.

In addition, this equity legislation has had the support of many health care organizations, including the American College of Obstetrics and Gynecology (ACOG), the American Nurses Association (ANA), the National Perinatal Association (NPA), and the National Rural Health Association (NRHA).

While most states reimburse certified nurse-midwives/certified midwives at the same rate as other obstetrical/gynecological providers under Medicaid, a 35% disparity in reimbursement exists within the Medicare program. This disparity is a barrier to women's access to obstetrical/gynecological providers of their choice within the Medicare program.

Health disparities in the U.S. continue to be a critical problem. Midwives have historically cared for those populations most at risk for health disparities in areas of high infant mortality, preterm birth, low birth weight, sudden infant death syndrome, maternal mortality, breast and cervical cancer, and HIV/AIDS infection among women.

Providing equitable reimbursement for the high quality primary care services of certified nurse-midwives and certified midwives will aid in improving women's access to necessary care. I ask you to cosponsor H.R.1101 today by contacting Rep. Towns' office at (202) 225-5936.

If you have questions regarding this issue, please feel free to contact me or Patrick Cooney, the Federal Representative for the American College of Nurse-Midwives, at (202) 347-0034 or via email at patrick@federalgrp.com. Thank you for your attention to this request.