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Implementation of the Affordable Care Act

Issue Summary

Signed into law on March 23, 2010, the Affordable Care Act (ACA) contains numerous provisions impacting a wide range of health care related issues.  The overarching goals of the legislation were to increase the number of people with insurance coverage, improve the design of existing policies, and increase the quality of care provided in the U.S., all while taking significant steps to control costs.

Key issues for midwives include:
  • Increasing Medicare reimbursement for midwives to 100% of that received by physicians
  • Requiring Medicaid programs to provide coverage for birth center services and the services of providers working in birth centers
  • Expansion of the eligibility criteria for Medicaid  
  • Creation of the new Health Insurance Marketplaces and requirements related to plans offered through the Marketplaces
  • Defining the "essential health benefits" (EHB) that must be covered by insurers both inside and outside of the Marketplaces
  • Providing assistance for education of midwives 

Available Literature and Resources

Government Resources
Non-Governmental Resources

ACNM Resources


  • On October 20, 2014, ACNM submitted comments to the Department of Health and Human Services regarding a proposed regulation responding to the Supreme Court's decision in the Hobby Lobby case, which exempted closely held, for-profit organizations from complying with a requirement in the Affordable Care Act that insurance plans cover all FDA approved contraceptive items and services.
  • On June 10, 2014, ACNM submitted comments to CMS regarding implementation of the provider non-discrimination language contained in the ACA (6/10/2014)
  • On February 25, 2014, ACNM submitted comments to CMS regarding plan network adequacy determinations (2/25/14)
  • On January 21, 2014, the Coalition for Quality Maternity Care (CQMC), led by ACNM, submitted a comment letter to CMS regarding proposed plans for a Quality Rating System to be used to evaluate health plans offered through the Health Insurance Marketplace.
  • ACNM Response to Concerns over Provider Anti-Discrimination Language in the ACA (8/26/2013)
  • ACNM Signs onto Letter Opposing Blunt Amendment.  The Amendment would allow employers to refuse coverage for any service on religious or moral grounds.
  • ACNM Signs onto Letter Urging Coverage of Contraceptives under the ACA (November 17, 2011) 


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