Medicaid reimbursement will be available for Certified Professional Midwives working in licensed birthing centers. I am hoping this will open up the door for midwives to open up birthing centers all across the nation, allowing low income women living in rural and underserved areas better access to midwifery-based maternal and child care. This is a win-win situation for women and midwives-hopefully providing choices in health care that more effectively address the cultural differences in the communities where these women live. When women feel honored, and are being cared for and served by providers that understand their culture, language and social norms, it will create an environment of support and empathy-rather than one that may leave women feeling scared and powerless at a very vulnerable time in their lives. Midwives can now effectively serve these women knowing that their work will be paid for by insurance.

The law puts in to place the Equitable Reimbursement Act for Certified Nurse Midwives. Previously, Certified Nurse Midwives were reimbursed by Medicare (federal) at a rate 35% less than other providers creating a barrier to health care for women receiving Medicare. Now, Certified Nurse Midwives will be able to provide care to poor and at-risk populations at full reimbursement rates, creating a scenario where CNM’s will be able to market their services to these populations who could greatly benefit from a midwife model of care.

Pre-existing conditions such as previous c-section, pregnancy and history of domestic violence will no longer be held against women and used against them to deny them health coverage. This has been a ridiculous state of affairs that has been going on for decades. If a woman of childbearing age was applying for health insurance, her premiums would be higher simply because there was the possibility that she might become pregnant in the future. This happened to me. I’m very pleased about this particular provision.

Although I was a bit dismayed to read about the executive order they needed to enact to ensure that abortion services are not covered under the new legislation, evidence has suggested that women who have access to health care are less likely to have abortions in the first place- thereby reducing the abortion rate. The issue is covered nicely here. I understand how the issue of abortion is such a hot button, and I really feel that our society is not ready for abortion to be federally funded- but maybe someday…

All in all, this a great victory for those of us in health care-and for all women. Congratulations Democrats! I am really proud of our leaders for getting this passed in the face of such opposition.

Hello, my name is Lori, I am 40, and I have crappy health insurance.  Like a good informed citizen, I got a mammogram shortly after my 40th birthday because that was the ‘right’ thing to do according to the medical powers that be.  This decision was made by me based on the recommendation and guidelines, that were changed just today by the U.S. Preventive Services Task Force. I am applauding this decision and here’s why.

I really didn’t think much about mammograms.  I had heard they are uncomfortable, but possessing a high threshold for pain, I wasn’t worried.  I had the mammography, and then I went on vacation with my family for spring break.  I got a call on our 3rd day of vacation that they found ‘something suspicious’ and wanted me to come back for more testing after I returned.  That made my vacation so relaxing….let me tell you.   I went back for a second mammogram and an ultrasound upon my return.  Indeed there was a lump there and they couldn’t tell if it was solid or liquid.  They said, ‘let’s just wait 6 months and retest it’.  Six months later, I went in for another ultrasound.  The lump was still there, although it hadn’t grown.  I could elect to do nothing and wait another six months, or I could have a biopsy.  Of course, I elected for the biopsy.  After all, who wants to die at 40 with three young children?

Well, I had the biopsy, which was not a pleasant experience at all.  The pent up anxiety I must have been feeling, but was apparently suppressing,  all came spilling out in the form of uncontrollable tears on the third of four arrows they shot into my breast.  Both the doctor and the ultrasound technician wondered why I was crying.  Hmm.

I was crying because I had to imagine life without me and what that might be like for my kids.  I was crying because I was pissed that my body could let me down.  I was crying for the worry I saw in my husband’s eyes.  I was crying because of the love and support I had felt from good friends and family who knew I was going through this.   I was crying because the nurses were so generically nice that I wanted to punch them.  I was crying because I didn’t want to be in a hospital gown, lying on a table with warm goo on my breast. I was crying because it HURT to be stabbed in the boob four times.

Then my husband picked me up.  I cried.  I said it felt barbaric and I just didn’t think that was very necessary…and I had to wait two very long days for a result.  Then, when the doctor did call, my phone didn’t ring for some reason (the day I decided to divorce my Iphone and AT&T on charges of betrayal) and I lay awake all night reading in to the doctor’s message that he left on my voicemail.  The next morning I found out the results were negative.  Thank god.

I posted the good news on facebook.  You wouldn’t even BELIEVE the number of women friends who commented that they too had gone through the same ordeal-sometimes more than once.  All of these women are between ages 40 and 45.  The percentage was just way too high.

This is when I really got mad.  I kept saying to whomever would listen…  Isn’t there something wrong with this picture when the rate of women who went through all this and had NOTHING wrong was probably hovering around 95%.  If you could bottle our collective anxiety it would be more fierce than any atomic weapon.  These are women, mostly mothers of young kids who don’t want to die.  Which is of course, why we subject ourselves to these tests.  Hell, we’d probably all have full body CT scans if you let us.  We don’t think about the anxiety until we are faced with it.

Do mammograms save enough lives to justify routine screening in (relatively) young women with no history or medical issues?  The American Cancer Society  thinks we should keep going on the path we have set.  The task force says NO.  They say that although 15% of women over 40 do detect breast cancer through mammography (the other 85% detect breast cancer another way) , many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test.

My collective bill for 2 ultrasounds and 2 mammograms, one biopsy is going to run me at least $2000.  I have a $5000 deductible.  I know that these tests save lives, but as a routine test in 40 year olds with no medical history?  I think the only people routinely benefiting from this screening are doctors and their pocketbooks.