I’m pleased to present the fifth and final 2025 nominee for the MHF Defender Award!
Rep. Jamie Thompson is back in the line-up after being nominated for our first award last year. By no coincidence, she is a nurse, and speaks here to fundamental issues of an area of healthcare she knows well.
Background
Facts of maternal care access in Michigan
- Many hospital OB services have closed.
- Fifteen counties in Michigan have no maternity care at all; another fourteen are limited.
- Midwives have started free-standing birth centers.
- Medicaid and most insurance plans will not reimburse unlicensed facilities.
The argument: we have to license free-standing birth centers to help more women access quality care.
If this sounds familiar, it’s because only ten years ago the same argument was used to license midwives.
What went wrong?
The fallacies
- Coverage lowers healthcare costs.
- Medicaid reimbursement ensures financial health for healthcare facilities.
- Licensing improves quality of care.
None of these are true.
A glance through the bill will show you why.
“My time is yours” – not anymore.
The reason midwives have such a reputation for quality care is their dedication to patients. They could say, and often did, “My time is yours.”
Sadly, this bill robs from the time midwives dedicate to birth center patients, and redirects it to satisfying state requirements. Previously, midwives completed a birth certificate (pg. 1). The bill inflates their paperwork with 10 more pages of legal demands (pp 18-28).
The bill also imposes a financial burden of $500 per year (pg. 7) plus a one-time fee of $2000 (pg. 8) for free-standing birth centers.
This is a significant change for individual midwives who for a fee in the $1000 range, would care for women throughout pregnancy and for months after attending the delivery. Try getting a year of OB care for ten times that!
Three midwives testified about likely harms from the bill. One was especially clear.
“High costs of doing business and low reimbursement rates,” she emphasized, “are one of the main reasons for closures of Labor and Delivery units in small rural hospitals to begin with.”
Bill supporters frequently cited expert organization standards.
Lawmakers often miss a centuries-old truth: businesses set high standards in law for self-serving reasons.
Imposing fixed standards on new start-ups elevates current owners’ status and income. In market terms, this limits entry, competition, and innovation.
Michigan license barriers also benefit job growth for government regulators.
What do experts, regulators, and Medicaid/insurance payers all have in common?
None of them are there with the mother while she is expecting, delivering, or caring for her baby. Not one. Are these really the people you’d want deciding your care?
Healthcare freedom offers better solutions.
1. Give start-ups free rein. Competition will pressure everyone in maternity care to achieve quality and keep prices low.
2. If family and local resources fail, give pregnant women funds to spend at their choice of birthing location. An HSA could ensure the funds are spent on healthcare, without imposing Medicaid license restrictions.
The full hearing on this controversial bill is worth a watch: testimony begins at minute 28:48.
The bill became law.
