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Lowering costs of healthcare by increasing access to midwives and nurse practitioners
The cost of healthcare in the United States is expensive and cited as a reason for needing healthcare reform.1 The average American will spend $10,000 on healthcare in a year. This is especially hard for the youngest generation of adults, Millennials, as 70 percent have only about $1,000 in savings and 30 percent have no savings at all.2 However, it is not just Millennials who have little or no savings—57 percent of Americans have only $1,000 in savings.3 A medical expense can cause many problems for those who have little savings. This is especially concerning for women who plan on having children because the cost of childbirth in the hospital will be unknown until the bill comes in.
In Illinois, the average cost for a vaginal delivery is $7,5264— ours is among the states with the highest costs of childbirth.5 The national average is closer to $30,000 charged by the hospital and about $15,000 covered by insurance with a $2,000 out-of-pocket cost for patients.6 If your out-of-pocket costs are more than $1,000, chances are you could be one of the 60 percent of Americans who could not cover that expense when the bill comes.
Medical debts like those associated with childbirth are a leading cause of foreclosure and bankruptcy. According to one study, medical bills account for 23 percent of hardships leading to foreclosure.7 According to that same study, a medical cause led to 57% of foreclosures.8 According to different studies, medical causes account for between 26 percent9 to 62.1 percent10 of bankruptcy cases. It makes sense that a medical cause would lead to foreclosure and bankruptcy because an illness would often require time off and possibly job loss. This is especially the case with childbirth because the United States does not mandate paid leave, so families could lose income when they add a child. It is clear that medical debts and expensive healthcare are a public policy problem. One way to decrease the cost of healthcare is to expand access to freestanding birth centers, midwives, and nurse practitioners.
In 2007, Illinois approved licensing freestanding birth centers in a pilot program, but the rules were not finalized until 2011.11 Since then, only two birth centers have been built, one in Chicago and one in Bloomington. Birth centers are less expensive than hospitals and expand access to needed care.12 It is unfortunate that only two have been licensed and built in Illinois thus far.
In nearly every General Assembly session there will be a proposal to expand midwifery in Illinois to those who do not have advanced nursing degrees. They would be called certified professional midwives. There is one pending currently;13 however, it hasn’t passed. Illinois licenses nurse midwives and nurse practitioners as advanced practice registered nurses. Current Illinois law requires that they practice with a collaborative agreement with a physician.14 However, if they have 4,000 hours of clinical experience and 250 hours of continuing education, they may have full practice authority and do not need collaborative agreements with physicians.15 While this is the new law, the rules implementing it are not yet finalized, so no advanced practice nurses have been licensed yet.16 This is a good step for Illinois healthcare consumers—Midwives are proven to be a cheaper option for pregnant women.17 But in Illinois, midwives are not well-integrated into healthcare for women, which means that midwives face regulatory barriers and problems with payor restrictions from insurance.18 Similarly, nurse practitioners are also proven to provide cheaper care.19 The public policy of Illinois should shift to better integrating midwives and nurse practitioners into healthcare and assuring that they are reimbursed and covered by insurance. The new law indicates that the policy is shifting, which is a welcome sign. This will hopefully help decrease the out-of-pocket costs of care for Illinois consumers.
Much of the debate over healthcare reform focuses on insurance. While insurance is an important consideration, an equally important consideration is the cost of medical care and how that interacts with insurance and medical debts. If it is important to reduce the costs of care, then expanding access to cheaper care must be addressed. Allowing midwives and nurse practitioners to practice on their own will hopefully lead to a decrease in costs so Illinoisans are not driven to bankruptcy and foreclosure by medical bills.
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