The type of health care available, the manner in which it is provided, and the cost of providing care depend on the mechanism and amount of reimbursement to different providers from third-party payers. An analysis of reimbursement must consider what services would be covered, what amount would be reimbursed, and who would control the reimbursement process. The paper discusses the implications of differing payment mechanisms, analyzes precedents in nurse-midwifery reimbursement and current legislative proposals before Congress, and outlines suggested strategies to precipitate change. Without independent reimbursement, which is a cornerstone of independent practice, the freedom of nurse-midwives to engage in their chosen profession is seriously jeopardized.