View From Washington

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

Greetings once again from our nation’s capital! A historic debate over health reform is well under way and while battle lines are being drawn there remains significant optimism that this might be the year that health reform finally happens. I am writing this column the day after the Senate HELP Committee passed the first major Congressional health reform proposal, and the House is beginning to mark up their reform legislation today. The Senate Finance Committee legislation is also expected any day.


House leaders are continuing to pledge action on a bill by the full House of Representatives prior to the scheduled August recess, while timing of action by the full Senate is much harder to predict. What is clear is that the next few weeks and months will be critical in determining whether a health reform bill can garner enough votes to pass both chambers and be signed into law this year.


We are scrambling to analyze and summarize what each leading proposal means for MCH populations and state public health programs. We will soon circulate summaries of key MCH provisions, and please check the AMCHP Health Reform Resources Hub regularly for new information. We are also continuing to advocate for health reform that incorporates AMCHP’s three principles that 1) promote affordable coverage for all Americans; 2) includes a benefits package that addresses the unique needs of women, children, adolescents, and children with special health care needs; and 3) recognizes that health care is essential but insufficient to improve health and therefore invest in state public health and MCH programs.


Consistent with the theme of state and local collaboration, I do want to highlight one of the key provisions in both the Senate HELP and House health reform proposals that we think could directly improve this relationship. Both the Senate HELP and House tri-committee bill propose dramatic investment of new public health funding to make sure there are more adequate resources to support public health at the federal, state and local level. Specifically, each bill proposes the creation of a Public Health Investment Fund that at full implementation would provide roughly an additional $10 billion annually and above current funding levels to support public health programs.


Having a much bigger pie to split up among federal, state and local agencies should go a long way to reducing the all too familiar tension that impedes state/local collaboration – namely wrangling over limited resources. This tension is exacerbated in times like these when both state and locals are faced with dramatically eroding public health funding. The perceptions and arguments are familiar – the locals think that states horde all of the money and the states think that direct local investments without a state coordination role promotes fragmentation and duplication. I may be naïve, but having significantly more resources to support all three legs of the three-legged stool of our federal/state/local public health system should help ease this tension and allow us to refocus our energies on our shared goals to promote the health of all women and children in America.