June 29, 2012

Dear Colleague,

By now, you've heard the news aboutthe US Supreme Court's decision yesterday to uphold the Patient Protection and Affordable Care Act (ACA). As President of an organization that has been very involved in the implementation of the ACA thus far, I am writing to share ACNM's perspectives on this decision and how it fits within the mission and values of our organization.

In short: we heartily applaud the Supreme Court's decision. ACNM proudly supported the ACA in accordance with our Seven Key Principles of Health Care Reform. Studies show unequivocally that women are disproportionately affected by the shortcomings of our health care system. As midwives, we see these deficiencies every day. Many women simply do not have access to good primary care or maternity care, sometimes leading to tragic individual results-and appalling national health statistics. The ACA includes several provisions benefiting women and families and opens new opportunities for midwives to assume a greater role in providing high-quality, cost-effective care to the millions of Americans who currently lack adequate health insurance coverage.

We know as well as anyone that this sweeping law is not ideal and that we have significant work ahead of us to make it more effective in meeting the needs of women and their families. ACNM's staff and leadership have devoted countless hours to working on ACA implementation-advocating in this time of change on behalf of women and families, our members, and the midwifery profession to eliminate health disparities and increase access to evidence-based, quality care. At times our work has been highly rewarding, and at others it has posed daunting challenges. Regardless of our individual views on the ACA, this is a time of historic change in US health care, and we have an important role to play.

As midwives, we are each, in our own way, on a mission to reform health care in this country-to make sure that all women have access to excellent care. As the ACA is implemented, our clients will turn to us for assistance in navigating the changes, and we need to be ready to help. Let's use these times of change to redouble our efforts to ensure that women have access to the high-quality care they deserve.

It is also critically important that ACNM is organizationally strong and that we remain actively engaged in ACA implementation over the years to come. We must continue to bring forth the voices of the women we serve, and remain ever-vigilant on the impact of the law on our members, on access to midwifery care, and on the ability of midwives to practice autonomously to the full extent of our education and training. The ACA established Medicare payment for services provided by certified nurse-midwives (CNMs) at 100% of the physician fee schedule. ACNM and our state affiliates are working to implement this victory across all Medicaid programs. ACNM also continues to advocate for federal recognition of certified midwives (CMs), and for CNMs and CMs to be fully recognized as primary care providers under the ACA. We expect that there will be refinements and improvements to the ACA, which we hope will include clearer guidance on a range of issues including needed reforms in maternity care quality and improved recognition as medical staff for midwives in hospitals in every community.

We encourage you to learn more about the specific provisions of the ACA. Key resources include ACNM's Health Reform Issue Brief series; Childbirth Connection's "U.S. Health Care Reform Legislation Offers Major New Benefits to Childbearing Women and Newborns," and the Kaiser Family Foundation's "Impact of Health Reform on Women's Access to Coverage and Care." 

We welcome you to send your thoughts and reflections on this historic occasion to [email protected] . I look forward to working with our health care community as we move forward to implement the ACA.


Holly Powell Kennedy, CNM, PhD, FACNM, FAAN
American College of Nurse-Midwives