Last week, Missouri’s Supreme Court justices heard arguments on both sides of the dispute about whether a provision legalizing midwifery should remain in the free-market health insurance reform bill, HB 818, that the General Assembly passed last year. The Missouri Medical Association contested the provision, arguing it violated the single-subject requirement for amending the state Constitution.
It looks as though the Court may base its decision on its interpretation of that requirement, rather than on any reputed benefits or drawbacks of midwifery itself. From the Post-Dispatch:
Assistant Attorney General John McManus argued that the provision indirectly related to health insurance because lawmakers could not insure midwives if the practice was illegal.
Making it legal "is the initial step," he told the court. "The Legislature can’t take any other steps with relation to health insurance and certified midwives unless they take this step."
Several judges questioned that argument on Wednesday.
"Had the title been worded, ‘An Act relating to health care services,’ there would have been no problem," said Judge Stephen Limbaugh.
Chief Justice Laura Denvir Stith said that under McManus’ argument, lawmakers could legalize almost anything in the bill. "It seems that anything that’s insurable can be put in this bill," she said.
A few months ago, I wrote an op-ed about midwifery and concluded:
Hopefully, this provision will be resurrected — either on appeal, or through a less controversial legislative action. It’s important that consumers be allowed autonomy not only in choosing insurance policies, but also in choosing what type of care they want to receive.
Regardless of what the Court decides about the technical validity of this particular provision, there’s little question that legalizing midwifery is a good idea. Several advocates of midwifery submitted an amicus brief to the Court that provides thorough arguments about the benefits of the practice, and answers the objections of critics. An excerpt:
Contrary to the AMA’s unsupported assertions about home birth safety, the “clear preponderance of medical literature” suggests that home births, when they are planned and attended by a well-trained professional midwife, in fact, may be less dangerous for mother and baby than giving birth in a standard hospital […] Among the myriad studies on home birth, the only study cited by the AMA to support its assertion that home birth is risky is the only one to have found otherwise, yet this study has serious design flaws that undermine its validity.
Ultimately, though, determining which side has a greater degree of evidence to support its claims of health and safety is of much lesser importance than the simple question of freedom that is so often overlooked in these debates: Should you have control over your own choice of medical care, or should the choice be left to politicians?
