2008 AGENDA: MAWS is seeking a cap on the midwifery licensing fee of 10% of the cost of operating the midwifery program or $100, whichever is less, given findings that we are saving the state at least $473,000 per biennium. This would bring midwives back into the profession and continue to benefit the state in terms of improved maternal and neonatal health outcomes and reduced unnecessary c-sections, which are expensive and can result in complications for both mother and baby.
Because of these long-term financial and health benefits to the state, we are also seeking an exemption from RCW 43.70.250, which requires each individual health care profession to bear the full cost of funding its own regulatory program.
BACKGROUND: Last year, the legislature directed the Department of Health to conduct an independent study of the impact of licensed midwifery on costs of Medicaid births. The study’s findings show that licensed midwifery is saving the state money, at least $473,000 per biennium, in addition to promoting better long-term health outcomes. Including cost savings to private insurance carriers, we are saving more than $2.7 million per biennium. Compared against the biennial cost of operating the program, $277,000, this shows a net benefit to the state which is the rationale for lowering our licensing fees.
NEED: Midwives pay among the highest fees of any licensed health care professional in the state, yet do not have high salaries. The result of recent fee increases (the fee more than doubled in 4 years from 2001 to 2005, up to $978 per year) is that many licensed midwives were forced to leave the profession. By 2005, Washington had fewer than 100 licensed midwives throughout the state.
At the same time, through our health care reform debate, the state and private health insurers are exploring options to reduce medical costs by addressing preventative care and better management of chronic diseases. Midwives help ensure better health outcomes in these areas in the following ways:
- They provide very intensive prenatal care, decreasing the incidence of low birth weight and increasing the likelihood of healthier babies, which are indicators of long-term health;
- Low-risk births with midwives are less likely to result in cesarean sections, which are associated with complications such as infection, longer postpartum recovery time, placental problems in future pregnancies, and lower breastfeeding rates;
- Breastfeeding – which is a key way to boost the baby’s immunity (and therefore long-term health) as well as prevent obesity -- is more likely to occur and last longer if a midwife attends the delivery.
We need more midwives in Washington State, not fewer, if we are to think about health care as caring for health, rather than just treating diseases. Midwives are a key part of the solution for life-long health and should not be forced out of the profession due to exorbitant licensing fees.
Because we are concerned that the needed overhaul to the regulatory structure requiring each medical profession to fund its own regulatory program is not being implemented, we are seeking an on-going exemption from that provision of the RCW. In 2006, the state studied this issue: If the legislature addresses a system-wide fix, MAWS would continue to support the “three-tier” approach for health care professionals, in which credential holders would pay a fee based on their classification as either a licensed, certified, or registered health care professional. This model not only represents a fairer and more equitable approach to setting fees; it would also enhance government efficiency by reducing the number of accounts to be managed and allow for greater flexibility in the allocation of program resources. In the meantime, licensed midwives should be exempt from the requirement that each program be self-financed.
CONTACT: Audrey Levine, MAWS Legislative Liaison, at (360) 709-0888, nelsaud@comcast.net or Laura Hitchcock, MAWS Public Policy Consultant, at (206) 276-6637 or laurahitchcock@seanet.com.
