View from Washington


Change is in the Air

By Brent Ewig, MHA
Director of Public Policy & Government Affairs, AMCHP

Major change is coming to Congress, the White House and the nation! Regardless of your political affiliation, the election results reflect a strong desire among voters for a new direction. It is our hope that this direction will include renewed support for MCH, and we want to share several actions AMCHP is taking to adapt our strategies to the new political landscape in Washington to better advocate on your behalf.

It is first worth noting that the paramount rate-limiting factor for any change will be the record federal deficit, estimated to be exceed half a trillion dollars next year. This means AMCHP will need to re-double our efforts to advocate for MCH funding by sharpening our message to reflect the current economic crisis. Now more than ever we need to demonstrate how investments in MCH services are cost-effective and an investment in our economic future.

While there is good reason to believe we will have a more receptive audience in Washington, it is also instructive to recall that the Title V MCH Block Grant only increased by about $30 million in the early years of the Clinton Administration when there was last one-party control in Washington. Clearly we have a lot of work to do, and we believe that with your help AMCHP can make an effective case to improve MCH funding and support in the years to come.

Preparing for a New Administration – As AMCHP CEO Mike Fraser notes in his column, the buzz in Washington is all about transition. There are three key issues we are engaging in with during this transition: who will be the key new health policy leaders in the Obama Administration; what they will propose in their budget; and what leadership they will provide on health care reform. Things are fluid and changing daily, but here’s what we know so far:

On personnel, it is still too soon to know who the key leaders at HHS will be, but we do expect that Cabinet nominees including HHS Secretary will be put forward in the weeks and months ahead. [Note: At press time, it is being reported that former Senate Majority Leader Tom Daschle is President-elect Barack Obama’s choice to lead the Department of Health and Human Services.] Sub-cabinet leaders will also be nominated in the months to come but expect anywhere from 6 to 12 months for a full contingent of HHS political appointees to emerge.

We do know who some of the key health advisors were in the campaign, and expect they will continue to be influential in the transition and shaping early health proposals in the Administration. Two of the key advisors AMCHP will be reaching out to include Neera Tanden and Dr. Dora Hughes. Neera was the Director of Domestic Policy for the Obama Campaign and formerly served as Sen. Clinton’s Legislative Director. Dr. Hughes is Sen. Obama’s legislative assistant for health in his Senate office and formerly worked at the Commonwealth Fund. There are many others who will be influential – likely including several former Clinton Administration officials. We will look to connect with them all to share our advocacy priorities on your behalf. Please let us know if you have any relationships with any of the expected key players as that access can be tremendously helpful to reinforce AMCHP’s advocacy messages and get insight into potential new priorities.

Switching to the issues, on budgets again the controlling factor will be the exploding federal deficit and the pressure that will create to hold the line on any new spending. We do know that Candidate Obama was clear that they would look line by line through the budget to make sure they are rewarding programs that work and eliminating those that don’t. Fortunately, Title V’s recent top PART rating provides confidence we can demonstrate results, but it’s unclear if incoming Administration will use that tool or something new. Either way, we will be sharing information with the President’s transition team about Title V and why support at the fully authorized level of $850 is needed.

We also know that Sen. Obama stated repeatedly on the campaign trail that health reform will be a top priority in his Administration. While most are familiar with the broad outlines of the plan he campaigned on, the actions now really turns to Capitol Hill where key committees are taking his lead and beginning to explore what kind of reform is possible.

To convey our message, we have drafted a set of AMCHP’s Principles for Health Reform which were developed by our Legislative and Health Care Finance Committee and endorsed by our board in the week after the election. These will be shared with both the Obama transition team and every single member of Congress and their staff. To support our other advocacy, we also developed a 100 Day MCH Policy Agenda to convey AMCHP’s support for a range of practical MCH budgetary, legislative and regulatory priorities that the new Administration can use to inform their early agenda and begin within their first 100 days. While the list of policy options is not comprehensive, we hope it conveys a practical set of things Congress and the Administration can achieve for MCH while the broader health care reform dialogue begins.

In the months ahead, we will include additional perspectives on what the changes in Congress mean for future MCH policy, and what to watch for in the debate on health care reform. In the meantime, I want to highlight how AMCHP Members can become more involved in our advocacy efforts during this critical and exciting time:

  • Let us know if you have relationships with key national policymakers that already are or can become champions for MCH.
  • Educate new members of Congress and their staff by sharing one-pagers and information on what the impact of Title V is in your state and where you stand on the national and state Title V performance measures.
  • Document and share impact of eroding funding, ideally through stories that demonstrate the impact on individual’s lives and specific communities.
  • If you haven’t already, sign up for AMCHP’s Legislative Alerts and watch for them in early ’09.
  • If allowed by your state’s regulations, begin planning now to make Hill visits during AMCHP’s Annual Conference on Monday February 23rd! 

Change is definitely in the air in our nation’s capital. We look forward to continuing to work together to make MCH a top priority with the new Administration and the 111th Congress.