This social historiography tells the story of the origin of the Newborns' and Mothers' Health Protection Act of 1996. In the 1980s when the federal government reduced allocations to states' Medicaid programs as a cost saving measure, hospitals, initiated early discharge of patients to save costs. Given four million births annually, childbirth is the most frequent reason for hospitalization in the United States. Hospitals discharged Medicaid insured mothers and newborns very early at twenty-four hours for a normal birth and seventy-two hours for a cesarean. Other insurers adopted similar managed care strategies in the early 1990s.
By 1995, unionized nurses from New Jersey, bolstered by a national outcry against early maternal discharge, and individual states legislative actions, met with staff in Senator Bradley's (Democrat, NJ) Washington, DC office to request a federal law that would extend hospital length of stays for maternity patients. The result was the creation of the Newborns' and Mothers' Health Protection Act of 1996 (Newborn's Act). Insurers must now reimburse hospitals a minimum length of maternity stay of forty-eight hours for a normal birth and ninety-six hours for a cesarean birth.
This historical investigation found that a revival occurred in professional nursing organizations' voice in health care policy. The American Nurses Association, the National Association of Pediatric Nurse Practitioners, and the Association of Women's Health, Obstetric and Neonatal Nursing, not only testified at the congressional hearing for the Newborn's bill, but also helped craft the bill that became law. One nursing specialty, Public Health Nursing, at one time a cornerstone for autonomous nursing practice, was omitted from the NMHPA policymaking. As a nursing section of the American Public Health Association, it is now considering options to become more visible in health care policy development.
Second, this study suggests that the federal government may have attempted price-fixing when it recommended in 1982, and again in 1983, that other insurers also limit reimbursements to hospitals to contain costs. In one last finding, congressional lawmakers omitted costly Medicaid insured mothers from the NMHPA law, but regulations formulated in 1999 captured this vulnerable group of mothers and newborns.
