January 2018 Health Policy Update
Submitted by Fred Main
Clear Advocacy, LLC
Happy New Year!
The CNMA Health Policy team is looking forward to what 2018 has in store for our nurse-midwifery physician supervision removal bill, AB 1612.
This bill was introduced in the California legislature at the start of 2017 and is slowly traveling through the Assembly. The bill was last passed out of theAssembly Business and Professions committee in April, despite opposition from both the California Medical Association and ACOG. The bill has been quiet since April as our bill author, Asm. Autumn Burke, looked for ways to negotiate with the physician organizations to remove their opposition. CNMA and our bill co-sponsors, California Birth Center Association and United Nurses Associations of California (UNAC), met in person with ACOG and CMA leadership and lobbyists in early December. At that meeting, organized by Asm. Autumn Burke's office, we had a very productive and positive conversation about nurse-midwifery and a mutual willingness to continue working together to pass a bill that is acceptable to all. CMA specifically wants to be sure that our bill addresses how/when CNMs are expected to seek physician involvement in care.
The next steps in 2018 are approaching quickly! The bill will likely go next to Assembly Appropriations committee the week of January 15 and then to the full Assembly for a vote before the end of the month. Asm Burke is dedicated to this issue and if the bill does not get out of Appropriations, we may re-introduce the bill again next month. We will not give this up!
Want to get involved and help us get this bill passed? We will be posting action alert information online via Facebook and Twitter, as well as the midwivespass1612.com website. You may have already received a Voter Voice Action Alert from ACNM — please take a minute to complete.
The next several weeks of the legislative session are going to be fast and furious for our bill. Check out our video conference vimeo.com/250869082 to learn about the many possible outcomes for AB 1612 and to hear about what CNMA members might expect in the coming weeks with AB 1612.
The Health Policy team has divided the needed CNMA membership actions into two phases.
Jan 2nd-Jan 17: Campaign with Appropriations chair and members of committee; soliciting support via Voter Voice for "allies" (eg CANP, repro health groups, etc)
Jan 10th: Assuming bill will be heard/voted on in Appropriations on 1/17, letters of support to the Appropriations Chair and members are due to committee by 1/10, but social media messages can continue until the day of voting. Please use sample tweets and Facebook messages provided by CNMA online.
Jan 17th: Last Appropriations hearing prior to 1/19 house of origins deadline.
If bill DOES pass Appropriations Committee, it will be voted on in full Assembly by end of January
Constituent letters of support should be sent to Assemblymembers immediately after Appropriations vote; CNMA will send another Action Alert to members.
Stay tuned for subsequent social media plan and communications plan that will need to happen before Assembly vote at end of January.
If bill passes Assembly at end of January, then it begins its journey to the Senate Business + Professions Committee.
March/April 2018: Register for and attend Lobby Day.
If bill DOES NOT pass Assembly Appropriations Committee, it will likely be reintroduced as a NEW BILL by Feb 16th
March/April 2018: Register for and attend Lobby Day.
Stay tuned for social media and communications plan for this new bill as it starts over in Assembly Business & Professions and Appropriations Committees (with a new bill number).
April 27th: last day for bill to be heard and passed out of Business + Professions and Appropriations.
AB1612 - Show Your Support!
Our bill to remove physician supervision, AB1612, is coming up for vote in the Appropriations Committee in Jan. Now is a good time to educate the public and your representatives in Sac about the importance of physician supervision removal. For more information on AB1612, please see our FB page: https://www.midwivespass1612.com/tweet-for-california-nurse-midwives
Post to Facebook, Twitter and Instagram POSITIVE reminders of the importance of full practice authority for CNMs (see this article: http://www.slate.com/blogs/better_life_lab/2017/11/06/nurse_midwives_are_trained_life_saving_professionals_why_are_we_holding.html, and the Moskowitz article.
Because the bill needs to move out of the Appropriations Committee, EVERYONE should contact Chairperson Lorena Gonzalez-Fletcher specifically via mail, email or phone and tell her to vote YES on AB1612: https://a80.asmdc.org/article/contact-lorena.
If YOUR representative is a member of the Appropriations Committee, please contact them directly to vote YES.
See also the list of Appropriations Committee members and their Twitter handles below left.
Keep it positive and upbeat!!! We are just setting the stage for a big push in Jan.
Thanks for your help in this important effort!
Appropriations Committee Members and Twitter Handles
Lorena Gonzalez Fletcher: Dist 80
Frank Bigelow: Dist 5
Richard Bloom: Dist 50
Rob Bonta: Dist 18
William Brough: Dist 73
Ian Calderon: Dist 57
Ed Chau: Dist 49
Susan Eggman: Dist 13
Vince Fong: Dist 34
Laura Friedman: Dist 43
James Gallagher: Dist 3
Eduardo Garcia: Dist 56
Adam Gray: Dist 21
Reginald Byron Jones-Sawyer, Sr.: Dist 49
Jay Obernolte: Dist 43
Eloise Gomez Reyes: Dist 47
Tweeting is easier than you think!
Sample Tweets can be found at:
New to Twitter? Click here for Twitter 101.
Worth a Listen!
We applaud Freakonomics for their astute podcast of “Nurses to the Rescue.” This podcast is worth the listen!!! Like Nurse Practitioners (NPs), Certified Nurse-Midwives (CNMs) are Advanced Practice Nurses with graduate level education and rigorous training. In California, our current Bill (AB1612) to remove physician supervision for CNMs has been met with similar opposition from CMA. This is our third attempt to remove physician supervision for CNMs in order to meet the growing demand for women’s health and maternity care services throughout the State. Nine California counties do not have an OBGYN! This podcast explains why full practice authority for Advanced Practice Nurses is so important.
Current regulations make it difficult for nurse-midwives to practice equitable, team-based care. In effective team-based care, each provider is integral to the team and each is able to offer the full scope of what they have to offer, which ultimately provides better health care overall. The “supervision” concept creates a sense of hierarchy that is antithetical to effective team-based care. As providers tethered to physicians, CNMs are unable to promote midwifery care without supervisory permission. Physician supervision also fosters interprofessional tension because of the erroneous idea that the physician is legally responsible for the CNM’s actions.
Midwives are often invisible within the healthcare system by not being counted/included as providers by insurance companies or hospitals. Currently, Medi-Cal and private health plans do not track where CNMs work and what we do. That means our impact is often invisible to policy makers, insurance companies, and the general public—but not to budget administrators, who may well eliminate a CNM “line item” because our worth is not known.
Removal of the word “supervision” would expand market opportunities for CNMs and the physicians with whom we collaborate. It will also make it easier for a CNM to obtain hospital privileges and become a full hospital staff member; to work with physicians who are no longer fearful of liability issues; to start a midwife-owned private practice; and to contract with health plans. Likewise, it will be easier for hospitals to hire the appropriate number of CNMs and physicians required for optimal patient care rather than basing hiring decisions on supervision ratios. Removal of supervisory requirements does not, of course, preclude a CNM from working within a physician or hospital group if she or he so chooses.
The Health Policy Committee is responsible for assisting in the fulfillment of these specific purposes of the California Nurse-Midwives Association (CNMA):
- Represent the membership regarding issues impacting the practice of midwifery in the state of California in accordance with the bylaws and policy guidelines of the American College of Nurse-Midwives.
- Promote the health and well-being of women and families in the state of California by furthering the profession of midwifery.
- Establish a mechanism for cooperation with other groups and organizations in promoting the health and well-being of California families.
- Achieve legislation and regulation that is favorable to midwifery practice.
- Support and foster appropriate professional licensure regulations and legislation related to midwifery and women’s health issues in California.
Wondering how to get involved?
Join fellow CNMA members that are active proponents of our health policy goals, in either the Health Policy Committee (3 yr commitment) or the Health Policy Workgroup for smaller projects:
- Engage locally: Determine what is going on in your local chapter. Does your chapter have a Health Policy liaison? What issues face your local CNM community?; Where do CNMs work in your community? Can you identify local supporters? Build a relationship with your local representatives.
- Attend CNMA Lobby Day! Volunteer to help organize!
- Make in-district lobbying visits with your legislator, closer to home!
- Help CNMA fundraise!
- Represent CNMA at coalition, BRN, or other meetings!
Contact the Chair or Vice Chair of the CNMA Health Policy Committee to find out how you can help.