My Story for the Congressmen (Links to Arizona)

So on Tuesday (Jan 27th) I had my first meeting with the Health Legislative Assistant (LA) in Senator Kyl's office. Joe went with me to help me out in case I froze, forgot my name, my organization's name, or said something dumb. I was nervous but I did okay. Here's the basics of my spiel.



I tell them that I am an ob/gyn in Phoenix, AZ and that I would like to discuss a couple issues with them. The first is the ACOG Health Reform Agenda. I gave him a copy along with a fact sheet I had made with multiple health indicators/stats (number of women with high blood pressure, number of pre-term deliveries, women who have had a mammogram within the past year, number of teen pregnancies, etc) compared to the Nation's numbers. (By the way- Arizona is huge on teen pregnancies, big surprise.) I discuss with them that it is essential that we provide prenatal care. I explain that 40% of all births in the US are Medicaid assisted, and that 13% of all pregnancies are uninsured. I tell them that pregnant women, whether they come for prenatal care or not DO come to the hospital to deliver, often with many complications, so we are paying for their care anyway and I urge that we provide prenatal care rather than just emergency and birth care. Then I give them two examples.

1. Is a woman who was sent to us in Phoenix from a rural area of Arizona. The ob/gyn in the rural town is in a solo practice and has many uninsured patients. In discussions with him I know that he only provides care that the patients can pay for because he cannot afford to cover so much of the cost himself. So if they can pay for the labs, they get labs etc. This patient ended up in the hospital very, very sick and was transferred to us because she was also pregnant. Upon exam it was discovered that she had a recto-vaginal fistula from a rectal cancer. But because of her inability to pay her diagnosis was delayed despite seeing a doctor. When I spoke with her doctor, he felt absolutely terrible and I could hear in his voice and in his words how hard it was for him to even maintain his practice with so little support and resources.

2. A woman that I took care of not long ago who had no prenatal care. She was quite ill and had an emergency c-section upon arrival to the hospital for very elevated blood pressures. We lost the mother and the baby remains in an intensive care unit. She had no prenatal care and no insurance. Had she come in earlier, I'm not sure we would have had a better outcome for the baby because her pressures were so high she probably would have delivered prematurely no matter what. But maybe we could have caught how sick the mother was sooner.

According the the March of Dimes, a premature birth costs the private insurer $41,610, and that is based on an average of 16.8 days in the NICU. So you can just imagine how much this baby, who has been in the NICU for over two months is costing the system. I use these stories to show them not only how difficult it is to provide good care, especially in rural areas, but how much we are paying for birth and emergency care and that is why covering prenatal care is essential! Lastly, I ask them to look over the Reform Agenda that there will be many ob/gyns in Washington over March 1-3 for the Congressional Leadership Conference and that we will be discussing these issues with them again.



I have given this speech (in addition to the Health IT and Comparative Effectiveness requests listed in previous blog) to 4 health LAs now. Senator Kyl's office, Senator McCain's office, Representative Moran (1st district Kansas), and Representative Shadegg's office (3rd district Arizona). Representative Moran's LA was very interested in what kind of tests, labs, and exams we did during the prenatal period. She was interested in what diseases and conditions we looked for that could possibly provide better outcomes and less NICU time. I went through a lengthy list of everything from the killers like pre-eclampsia, to diabetes, to domestic violence. She seemed impressed. It dawned on me that our officials may not understand that prenatal care is more than just checking a woman's weight and screening for diabetes- that we are monitoring for life-threatening conditions. It is so important for us to educate them on how important these services are and the extent of what we do since they don't have the advantage that we do of being in the clinic each day.



Ob/gyns- I urge and encourage you to make a list of the cases you see. Patients who could have had much better outcomes had they received care, patients who slipped through the system, patients you wanted to help but felt bound for whatever reason. Just jot them down and have a couple salient in your mind for any time you get an opportunity to advocate for your patients. These are the stories that our elected officials need to know about!



Here are the links to the Members I have met with from Arizona. I will do a separate entry for Representative Moran in Kansas. I have found these links helpful as you can quickly read their biographies, recent statements, recent legislation, etc. They are also good if you are ever going to visit Washington as there are some tours you have to arrange through your member of Congress, so they all have links for constituent services as well.

Senator Kyl- http://kyl.senate.gov/

Senator McCain- http://mccain.senate.gov/public/

Representative Shadegg- http://johnshadegg.house.gov/