View from Washington


Help Wanted: MCH Champions 

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

Every politician loves babies, right? Take this standard election season photo-op and add an avalanche of evidence on the economic benefits of investing early in the health and education of children, and you might think it would translate into making children a higher priority in federal policymaking. Instead, it is quite clear that we often have a leadership deficit that consistently leaves children out when it comes time to decide federal budget priorities.  

To illustrate this point, a recent report by the non-partisan advocacy group First Focus shows that while federal expenditures have grown over the past four and a half decades, the share of domestic spending focused on children has fallen 22 percent since 1960. Furthermore, their report estimates that the children’s slice of gross domestic product will decline from 2.6 percent in fiscal year 2007 to 2.2 percent by fiscal year 2018.  

How can this be? The explanation we often hear on our visits on Capitol Hill is that policymakers “of course support the MCH Block Grant” and would even like to support an increase, but unfortunately there is just no new money to go around. That’s understandable — but frustrating when we consider that some health programs have done well.  

The two most notable examples of this in recent years are the National Institutes of Health (NIH) and the Community Health Center (CHC) program. Both of these programs have seen their budgets double over the past decade — while the MCH Block Grant has been reduced by over $60 millions since 2003. But rather than see their success as competition, I argue that we can look to the growth of both NIH and CHC’s as inspiration and learn some leadership lessons from their success. Three important components of their success include: 

1) a clear demonstration of unmet need and a viable solution to address it;

2) a large and active network of grass-root advocates; and

3) committed Congressional champions who make the program a priority in their appropriations requests.  

On the first point, advocates for these programs have shown that even in times of war and budget deficits, those who do a good job of demonstrating unmet needs and showing a credible solution to meet them can receive the resources they need. MCH programs certainly have the data to show unmet needs. On almost every visit we make to Capitol Hill, we try to highlight these key facts: 

  • Improvements in reducing infant mortality have stalled as preterm and low birth weight births have increased. The United States currently ranks 29th in infant mortality rates in international comparisons.
  • Racial and ethnic disparities persist across several indicators, with the black infant mortality rate double the rate for whites.
  • Maternal mortality rates have not improved in recent decades.
  • Childhood obesity is a national epidemic, with some age groups experiencing a three fold obesity rate increase in rates over the past two decades.
  • Teen pregnancy rates recently rose for the first time in 14 years

We also share proof that the MCH Block Grant offers a credible solution to meet these needs. This is evident in the program’s recent recognition with the highest rating possible on the White House Office of Management & Budget’s Performance Assessment Rating Tool (PART), where the MCH Block Grant is one of only 19 percent of all federal programs to earn the rating of “effective.”  

When it comes to grassroots support, however, we know we have a long way to go. Our programs lack the ready made network of clinics or labs that both the CHC program and NIH have. Members of Congress can visit these sites and see first hand the work that is being done to help their constituents. We need to think creatively about how to show policymakers the work that Title V is supporting.  

Over the past year we have had some success in reaching out to important friends and partners of MCH programs in key states, and we’ve also added over 4,000 MCH professionals and advocates to our database. These partners now receive regular updates on the work their state MCH programs are doing on behalf of women, children and families. Our hope is that these friends will be better empowered to help us tell the story of how Title V MCH funds make a difference in the lives of families where they live and will answer our call when we ask for help weighing in during key decision points in the federal appropriations process. We need all the help we can get sharing these stories with policymakers. We did receive some feedback from Hill staff that they heard more about Title V this year then they have in a while. We need to build on that momentum.

The third factor that many successful programs have but is largely missing for the MCH Block Grant is a vocal group of Congressional champions who understand these programs and make sure that they are not overlooked when appropriations decisions are made. Here too we made some progress this past year when an opportunity arose to work with Senator Chris Dodd (D-Connecticut) in support of a budget amendment he offered to recommend full funding of $850 million for the MCH Block Grant. Sen. Dodd gave a speech on the Senate floor where he acknowledged that “The MCH program is critical to the health and well-being of millions of families across this country, including some of the most vulnerable members of our society. Years of funding cuts and level funding have stretched maternal and child health programs to their limits… Now it's time for us to ensure that the money will be there to continue the success of these vital programs.”

While the Dodd amendment passed, it unfortunately did not convince members of the Appropriations Committees to significantly change their proposals for funding MCH in fiscal year 2009. While his leadership was a tremendous step forward, it also underscored the need for us to garner additional MCH champions — preferably on the Appropriations Committees — so that we know we have advocates in the room when the tough funding decisions are made. In the coming year, we will continue to work all three of these advocacy strategies, and look to build upon the momentum begun this year. With a continued drumbeat about unmet MCH needs, an expanded grassroots network, and additional work to cultivate more MCH champions on Captiol Hill, we will increase our chances for success for the families we advocate for.