AMCHP Policy Team Year in Review
By Brent Ewig, MHA
Director of Public Policy & Government Affairs, AMCHP
This past year AMCHP made tremendous strides in building advocacy capacity to strengthen your voice in our nation’s capital. Our policy team has been guided by the vision of the Board to increase AMCHP’s visibility, strengthen our advocacy effectiveness and increase member involvement. We also took strategic direction from AMCHP’s Legislative Committee, which set an ambitious eight point legislative agenda early last year.
The following is an update on how each of these priorities fared in the 110th Congress, with highlights of what AMCHP has done on your behalf in support of our shared mission to support state MCH programs and provide national leadership on issues affecting women and children.
Increase Title V MCH Block Grant Funding to $850 million
In 2008, AMCHP made solid progress in raising the visibility of the Title V MCH Block Grant program on Capitol Hill. This peaked in April when Sen. Chris Dodd (D-CT) led passage of a non-binding budget resolution amendment recommending an increase in MCH Block Grant funding. Speaking on the Senate floor, Senator Dodd stated “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…On behalf of Senators Hatch, Schumer, Durbin and others, we hope that members will be in favor of something that has enjoyed broad support.”
AMCHP conducted 51 visits with staff of key Congressional Appropriations Committee members to share state profiles and our key messages on why full funding for the Title V is needed. Despite these efforts, a sour economy and record high federal deficit is putting extreme pressures on Congress to limit discretionary spending. For FY ’09, the Senate Appropriations Committee recommended flat funding the MCH Block Grant at $666 million while the House Appropriations Committee proposed a modest increase to $675 million. In response to threats from the White House to veto any spending bills that exceed the president’s request, the Congress passed a Continuing Resolution in September that provides flat funding for all federal programs through March 2009.
At press time, reports indicate that the Congress is assembling an omnibus package of all unfinished FY ’09 appropriations bills (including Labor-HHS) and is poised to complete action in early January with President-elect Obama expected to sign it into law shortly after taking office. AMCHP is advocating now for the slightly higher House proposal and will continue our push for full funding of $850 million in fiscal year 2010 bill. While we are not satisfied with these results, we feel confident that more policymakers on Capitol Hill are aware of the funding plight of Title V than ever before. In the year ahead, we will build on this momentum, and hope that if you are planning to attend the AMCHP Annual Conference that you will make visits to Capitol Hill (in accordance with your state’s advocacy rules) to tell the story of how Title V is making a difference for women, children and families in your state!
Support Newborn Screening Legislation
The Newborn Screening Saves Lives Act became law on April 24, 2008. This act authorizes about $45 million to improve education and expand newborn screening programs to improve detection and treatment and to implement recommendations for all states to screen for a minimum of 29 disorders. AMCHP staff worked closely with the March of Dimes and others to push for passage of the bill by conducting meetings with key Congressional offices, calling additional Congressional offices to urge support, signing on to coalition letters urging passage, and releasing a press statement asking for Congressional action and thanking the lead sponsors. A summary of the bill’s provisions is now posted on our website.
For FY 2009, the House proposed $5 million while the Senate bill proposes to fund newborn screening activities at the FY08 level of $1.8 million. The Senate bill also creates a separate budget line item to fund the Newborn Screening Saves Lives Act. We continue to work with March of Dimes in a coalition seeking appropriations to implement the bill, and will conduct an annual meeting plenary session in February to highlight how the bill became a law and what to expect with its implementation.
Support Universal Health Care Coverage and Access
In 2008, AMCHP’s Health Care Finance and Legislative Committees engaged in an ongoing dialogue about how to best position AMCHP to be an effective advocate for inclusion of a specific focus on MCH in any national health reform plans that may emerge. The Committees conducted a review of the AMCHP Principles of Health Reform and Framework for Analyzing Health Care Reform Plans that were produced in the early 1990’s, and produced a new set of AMCHP Principles for Health Care Reform that the Board approved in their November meeting, along with our A 100 Day Policy Agenda to improve the health of women, children and families. We have shared both documents with the Obama Transition Team.
On the health reform front, things are moving very quickly in Congress, and we recently conducted 11 meetings with key Congressional staff working on health reform legislation. Sen. Max Baucus (D-MT), Chair of the Senate Finance Committee, expects to have health reform bill language ready in early January. We have shared information with his staff and others on how Title V helps accomplish coordination between programs through its systems building function. We also shared how states conduct their MCH needs assessment, including a focus on unmet preventive health needs. We discussed how states invest some block grant funds in both primary and secondary prevention and because Title V funds are so limited we have discussed how states weave programs like Title X, WIC, and numerous CDC grants into a statewide system of preventive services for MCH populations. Based on the guidance of AMCHP’s Board, we did not discuss any specific future amendments to Title V but rather focused our conversations on the opportunity to use health reform legislation to strengthen the enabling, population-based prevention, and systems building/infrastructure functions of Title V.
All of the staffers with whom we have met understand and agree MCH programs should be strengthened in future health reform work. They also acknowledge that despite the clear need to shift toward a preventive health focus there is no clear path yet to assure that stable and adequate funding will be available for public health programs in the future. We will continue to watch closely and advocate for strengthening MCH at every opportunity we have in the future.
Protect Medicaid Funding and Repeal Harmful DRA Provisions
In February 2008, AMCHP submitted comments to the Centers for Medicare and Medicaid Services (CMS) opposing their regulation proposing to make changes to Medicaid Targeted Case Management services. This regulation went into effect in March 2008, but due in large part to widespread and vocal opposition from a broad coalition of organizations, including AMCHP, Congress passed a moratorium on six Medicaid regulations, including Targeted Case Management. The moratorium prevents the implementation of these regulations until April 1, 2009.
AMCHP has done additional analysis and communication with our committees and membership around the impact of the targeted case management rule and the moratorium. We continue to work with the other groups in coalition to advocate for the permanent repealing of the Targeted Case Management regulation as well as any other regulations that would negatively impact services for women and children.
Address Autism and Other Developmental Disabilities
In FY 2008 the Combating Autism Act was proposed to be funded at $162 million. AMCHP continues to be a vocal advocate for all children, particularly those with special health care needs, to have access to a medical home. We signed on as a member of the Patient Centered Primary Care Collaborative (PCPCC) in order to represent the voices of children and families in the fast moving, payer-focused medical home movement. AMCHP leadership and staff are also coordinating with the American Academy of Pediatrics (AAP) on initiatives to advance the medical home concept both in policy and practice. AMCHP staff has discussed opportunities to collaborate and coordinate efforts on the AAP-led National Center for Medical Home Implementation.
We have met with leaders from MCHB to discuss AMCHP’s role in assisting state MCH leaders in advancing medical home in their states. By tracking the work of demonstration projects, both through the work of the National Academy of State Health Policy and the Centered Primary Care Collaborative, as well as conducting outreach to our members to determine their involvement with medical home in their state health programs, AMCHP has strived to keep members abreast of medical home implementation in state health programs.
Advocate for Full Funding of the Preventive Health Services Block Grant
In March, AMCHP signed on to letter organized by the Association of State and Territorial Health Officials (ASTHO) to all Members of Congress urging them to reject the FY09 Budget proposal to eliminate the Centers for Disease Control and Prevention’s (CDC) Preventive Health and Health Services Block Grant and instead to continue funding for this program at the FY05 appropriated level of $131 million.
Like all HHS programs, the Preventive Health Block Grant is flat funded through next March due to the Continuing Resolution. We also signed on to an August 15 letter organized by the Trust for America’s Health to Representatives Roybal-Allard, McGovern, Granger, Moran, DeGette and Castle in support of a resolution expressing the sense of the House that there should be an increased Federal commitment to prioritizing prevention and public health for all Americans.
Partner to Support Comprehensive Approaches to Chronic Disease (with emphasis on programs addressing the childhood obesity epidemic)
The majority of our activity in this area has been linked to participation in two coalitions – the National Advocates for Nutrition and Activity and the Partnership to Fight Chronic Disease. AMCHP also signed on to a June 19 letter organized by the National Alliance for Nutrition and Activity to House and Senate Appropriators in support of increased funding to $65 million for CDC's Division of Nutrition, Physical Activity, and Obesity to enable CDC to fund all states at a minimal level. The Farm Bill reauthorization included some provisions promoting better nutrition policy, however no other significant legislation was moving on this issue in 2008.
Support Efforts to Promote Safe Communities and Prevent Childhood Injuries
In May AMCHP released a press statement at a Congressional hearing on childhood injury calling on full funding of the MCH Block Grant and increased funding for CDC’s Injury Center. We continue to explore opportunities with the STIPDA affiliate, Safe Kids Coalition, and others for opportunities to increase advocacy in this area.
Make Contraceptives More Affordable and Eliminate the Need for States to Seek Medicaid Family Planning Waivers
AMCHP stayed up to date on this issue in 2008 through our Women’s Health coalition partners. As of December 2008, there were 27 states that sought the Medicaid Waiver for family planning services. AMCHP included expansion of SCHIP and Medicaid programs to cover comprehensive family planning services as part of our 100-Day Policy Agenda for the new Administration and Congress. No significant legislation was moving in 2008 specific to contraception or Medicaid family planning.
A Look Ahead: AMCHP's Policy Team in 2009
AMCHP’s Legislative and Health Care Finance Committee is beginning now to craft our 2009 legislative priorities. While there is great hope that a new Congress and Administration will be more supportive of funding for proven and effective public health programs including the Title V MCH Block Grant, the expected record federal deficit will create monumental challenges for increased funding. Now more than ever it is crucial for those who are able to join us in making the case with Congress on why Title V is essential to assuring that services and systems are in place to improve the health of all women and children.
At the same time, prospects for health reform will create tremendous opportunities to create a more equitable and efficient health system. AMCHP is working diligently on your behalf to make sure that the programs you run and populations you serve through Title V will be considered and strengthened as Congress moves forward on this historic undertaking. The opportunities and challenges before us are substantial. With your active engagement and support, we feel strongly that AMCHP is in a great position to succeed in our mission to provide leadership on issues affecting all women and children.