View From Washington

How Health Reform Might Impact Infant Mortality

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

September is infant mortality awareness month, so now is an opportune time to look at how provisions included in health reform might impact this leading MCH issue. First the bad news: there is unfortunately no explicit mention of reducing infant mortality in any of the four health reform bills passed by Congressional Committees to date. The good news is that each of these proposals would extend affordable health insurance to the estimated one in five women of childbearing age who are currently uninsured.  

That means roughly 13 million women who would have a much better chance of receiving regular preventive services and early access to prenatal care if they were to become pregnant. Additional reform provisions would ensure that maternity and well child care services have to be included in any basic benefits package, and the practice of gender rating insurance premiums would be prohibited. 

But one thing we know from public health science is that health insurance – while fundamental and essential – is insufficient to improve population health outcomes. The preconception care movement also tells us that focusing on prenatal care by itself might simply be too late. Our best opportunities to improve birth outcomes and prevent infant mortality likely come from focusing on upstream interventions across the lifespan that prevent or mitigate the chronic disease and other risk factors that might cause poor health and poor birth outcomes. In other words – and in what has become an AMCHP advocacy mantra on Capitol Hill – healthy kids start with healthy moms and healthy families. 

Fortunately, bills under consideration in Congress include several key provisions that could move preconception health recommendations into practice and have an impact on reducing infant mortality. Here are the highlights: 

The House Tricaucus and Senate HELP Committee bills, through their creation of a National Prevention and Wellness Strategy and the Public Health Investment Fund, would help reorient our health system towards prevention of disease and injuries. 

National Prevention and Wellness Strategy
The federal government does not currently have any mechanisms or plans that coordinate health policy across government to assess our public health status, establish national priorities, and identify health goals and objectives. Provisions in these bills call for the creation of a national strategy to accomplish these goals, and were they to become law, you can rest assured that AMCHP will advocate that improving our nation’s current ranking of 29th in the industrialized world in infant mortality rates has to be a national priority. 

The Public Health Investment Fund created by these bills would be at full implementation of roughly $10 billion annual and dedicated funding stream for public health and prevention that is needed to meet the many health threats we must face, including infant mortality and its contributing factors. The Fund would build upon what we know already works and to test new approaches. It would prioritize prevention and health, not just treatment. Particularly under the House proposal, the Fund would support core public health infrastructure to help state, local and tribal health departments meet their responsibilities and would ensure adequate levels of accountability. The Fund also authorizes and finances the U.S. Community Preventive Services Task Force and the Task Force on Clinical Preventive Services. It provides the resources they need to provide public health practitioners and policymakers with the information we need to make the best decisions about preventive health. 

Finally, through the creation of a Public Health Workforce Corps and preventive medicine and public health training grant programs, the bill would help to address the persistent workforce shortages that state and local health departments and MCH programs are experiencing. 

None of these provisions are a silver bullet solution to the persistent and complex problem of infant mortality, but taken together they would go a long way to providing the commitment, leadership and resources we need to improve.