Six months ago, Carol Leonard closed the doors to her Hopkinton birthing center, Longmeadow Farm, and stopped delivering babies, ending a 30-year midwifery career. The reason was simple: Leonard said she couldn't afford to stay in business anymore.
Although she gets reimbursed by Medicaid for her poorest customers and her wealthiest ones pay on their own, Leonard said her bread-and-butter patients, middle-class women with private insurance, had deserted her because the state's largest insurance companies won't cover births at the center.
Today, the House will consider a bill that would require insurance companies to cover midwives who deliver babies in their homes, birthing centers or their patients' homes. Currently several insurance companies only cover midwives who deliver babies in hospitals, known as nurse-midwives, and not home-based midwives, called New Hampshire Certified Midwives.
"I think women who are having children need as many options as can be offered," said Sen. Sylvia Larsen, a Democrat from Concord, who sponsored the bill. The bill passed the Senate by a wide margin in March.
"With the reduction of the number of OB/GYNs in the state, it expands ability of women to find birthing opportunities near their homes, " Larsen said.
There are currently about 16 at-home midwives in the state; they deliver between 2 and 3 percent of New Hampshire's babies, according to the New Hampshire Midwives Association.
Insurance companies like Anthem, Cigna and Harvard-Pilgrim do not provide coverage for at-home midwives because they aren't licensed like hospital-based midwives and they don't have admitting privileges according to Paula Rogers, a lawyer who represents the New Hampshire branch of the health insurers trade association. Many at-home midwives also don't carry liability insurance, relying instead on contracts with their patients.
"Insurance companies do not agree that certification is equivalent to licensure," Rogers said. New Hampshire Certified Midwives must complete coursework, an apprenticeship and be certified by a six-member council that includes an obstetrician.
Judith Gillen is another long-standing midwife who has recently closed down her center.
Gillen, 54, shuttered the Borning Room, her birth center in Keene, after five years, last December. For her too, the reasons were all financial.
"During the five years, most of New Hampshire changed over to Cigna and Anthem," she said. "When I started the bulk of people had small insurance companies that were willing to reimburse."
At its height, Gillen estimates that the Borning Room delivered between 10 and 20 percent of the babies in Keene.
Monica Stevens, a midwife in New Hampton, has developed her own formula for staying in business, despite seeing only a third of number of patients she would like to see: "I work another job," she said. "And I live on less money."
Midwives also say that at-home births cost a fraction of what hospital births cost, arguing that insurance companies could actually save money by giving patients the option of home delivery.
"The issue is not health care dollars, it's power and control," Leonard said. "If there's a mandate that's going to save them hundreds of thousands of dollars, it's not rocket science."
But health insurance companies say a mandate - any mandate - drives up the cost of care for everyone. They also argue that the New Hampshire certification isn't enough.
"These midwives, frankly, can't meet the credential standards,"said Beth Roberts, Harvard-Pilgrim's New Hampshire director. Letting midwives into the health care network without requiring them to meet standards, Roberts said, would be giving them special treatment.
Cigna spokeswoman Lindsay Shearer said the demand for nurse-midwives doesn't seem to be there.
"(We haven't had) an overwhelming response from our members asking for this service," she said. (next page »)
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