The federal Centers for Medicare and Medicaid Services (CMS) released on April 9 the Medicare billing information for physician providers after decades of litigation by the American Medical Association (AMA) seeking to block the release. [http://www.reuters.com/article/2014/04/09/us-usa-medicare-data-idUSBREA3809H20140409] Some of the dollar figures for federal moneys paid to individual physicians have been shocking, but those of us who have studied the economics of maternity care should not be surprised. It is basic economics that markets in which consumer access to information is blocked, and also where real competition has been suppressed, will be characterized by high prices.

The Big Push for Midwives Campaign supports the release of provider billing information because it benefits women and their families. Consumers should have access to information that could affect decisions about their healthcare, including the choice of provider and the cost of a provider's services. An informed public is better equipped to exercise not only health care choices, but also political speech, especially now that private health plans are required to provide maternity coverage. This kind of data educates both citizens and policymakers about the direct and indirect costs related to healthcare and allows better informed decision making.

Why did the AMA fight to suppress this information for so long? The assumption that consumers are ignorant and need to be protected from information goes back to early American court cases from the 1700s. Back then even physicians did not understand what diseases were and how they spread. Most people could not read and had very limited education. Even if they could read, the information was stuck in books in far-off universities. This remained true even during much of the last century.

Today, most people can read and have access medical and health care information on the internet. They could have had access to this cost-related information if the AMA had not impeded access. Women and their families should have access to whatever information they need that could affect their health care decisions, including relative costs, so they can make intelligent decisions based on the evidence.

The heart of midwifery is educating women and their families so that they make informed decisions instead of keeping them ignorant and dependent on providers. Releasing information like this is a good first step. We need to make this information user-friendly and to educate both citizens and policymakers to compare many factors – costs, outcomes, consumer satisfaction – so they can understand and use the information effectively. Consumers need this information for health care decision, and policy makers should be looking at and comparing what the federal government pays for physician services versus the services of other health professionals, such as midwives.

Fire up the PushMediaMachine, we are back in business! We live to Push again! Many thanks and lots of hugs and kisses to all of you incredibly wonderful Pushers and other folks who chipped in on this latest fundraising effort.

Because you reached down and gave what you could, the Big Push for Midwives campaign's "50+ Shades of Green for CPMs" fundraiser was a pretty solid success.

Although we did not quite reach our goal of $5,000 (and anyone who wants to tip us over the top is still happily encouraged to do so), we got SOOOO close that our media relaunch is a definite GO.

We are thrilled to report that we will now be able to sign up again with our media software vendor, pay our loyal social-media-maven intern his back wages, and be back to our old PushNewsRelease and PushAlert tricks again real soon.

Don't forget to visit the Newsroom and get signed up for PushAlerts!

If you have any favorite reporters, bloggers, media outlets who you want to make sure are on our lists, please pass their contact info on to [email protected].

The Big Push for Midwives campaign belongs to you.

• It isn't the website alone (although we do have a lovely website).
• It isn't the Facebook page alone (though we're delighted to have so many fans!)
• And it certainly isn't just the steering committee.

We are here to help you in the PushStates out and to keep the Big Push for Midwives campaign going, but we are not a top-down organization, rather, we are the essence of grassroots. The Big Push campaign has always been the work of a coalition of the PushState groups, and our focus has always been to create a mutual-help project for all the consumers and midwives pushing in the statehouses and sharing ideas, strategies, successes, and setbacks to create efficiencies and interconnectivity.

For this coalition to be be sustainable, we realize that it will be necessary for periodic fundraisers. Please think of these as chipping in to keep your coalition going. A natural question is what other sources of funding might be available to us?

Our applications for grants have not been successful for the most part. Grant-makers don't seem to get it that, without licensing CPMs, nothing else really matters much—Medicaid, education, federal "recognition," schmoozing with midwives from the rest of the world, really none of it.

So long as nearly half of the women in the US lack access to Certified Professional Midwives (CPMs) just because they live in the wrong state, License First has to be the policy priority. We won't stop sharing this message.

So, again, THANKS SO MUCH to all of you and to everyone else who helped us turn 50+ shades of green into some much-needed green dollars.

Here at the Big Push for Midwives, we highlight the fundamental importance of state licensing laws. While we all share in the excitement of the news that CPMs and the CPM credential are making headway in the U.S. Congress and in the halls of government in Washington, D.C., the excitement is more than a little tempered by the reality that unless and until CPMs are licensed in a particular state, no federal legislation will take effect in that state.

To wit, as birth centers are learning, state Medicaid plans will NOT cover freestanding birth center services unless the birth center holds a state license, and state Medicaid plans will NOT cover professional services of midwives in birth centers unless the midwives are licensed.

The same will inevitably be true with education loan repayment programs and other federal initiatives. The National Health Service Corps is simply not going to place a CPM in a maternity care shortage area of a state where CPMs are not licensed, and CPMs who are not licensed by their state cannot be eligible for Medicaid reimbursement.

Likewise, in January 2014, when the provider non-discrimination provision of the health care reform law went into effect — it is requiring all health insurance companies and managed care plans to include all categories of state-licensed health professionals in their networks — CPMs will NOT qualify for inclusion with other health professionals unless they are licensed.

Under the U.S. Constitution, only state legislatures—not the federal government—can license health care providers. The Constitution reserves this power strictly to the states. Ultimately, it is state licensure that will ensure that all women have access to CPMs, making them easier to find by legally qualifying them to practice under state agency standards, and making them more affordable by covering their services under private insurance and Medicaid.

So, now is the time for us to re-double our "in-state" efforts. Walking the halls in state legislatures is the most important thing that can be done — right now — to advance midwifery in the United States.

Here at the Big Push for Midwives Campaign nerve center, we are inspired by all of the incredible efforts performed daily by the hard-working, dedicated, unsung, and amazing PushState advocates. What each of you are doing for mothers and babies (and their babies and their babies) every day, against nearly insurmountable odds, in so many states across this great country. But it is important to note: we see you, we honor you for all that you are doing, and we are here from sea to shining sea to support you in any and every way that we can.