View From Washington

Health Reform Legislation Passes!

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

On March 21, the view from Washington changed in a seismic way when the U.S. House of Representatives passed a health reform package consisting of the Patient Protection and Affordable Care Act by a final vote of 219 to 212 and the Health Care and Education Affordability Reconciliation Act of 2010, also by a final vote of 220 to 211.  

Throughout this debate, AMCHP has used electronic media to try to keep our members, partners and friends in touch with the latest news from our nation’s capital. While we may not be on the forefront of Facebook, Twitter, and other emerging social media, we have tried to use the trusty stand-bys of email, our website – particularly our Health Reform Resource Hub – and interactive audio-conferences to offer multi-media options to learn what health reform means for state MCH programs.   

So What Happens Next?

President Obama signed the Patient Protection and Affordable Care Act into law on March 23. The Senate will begin debate on the final budget reconciliation changes approved by the House soon after. Once the Senate bill is signed it will set in motion the process to expand health insurance coverage to 32 million Americans including close to 9 million children and 12 million women of reproductive age in 2014. This will happen regardless of the fate of the reconciliation bill in the Senate, although that action could be completed in the next week or two. 

More immediately, a number of the insurance reform consumer protections, prevention and public health investments will begin this year including the new Title V home visiting state grant program. A summary of the changes that take effect within the next year is available here, and a longer implementation timeline through 2014 provided by the Ropes and Gray law firm is here 

As a reminder, an official summary of the final budget reconciliation changes is here, and AMCHP’s summary of MCH-related highlights from the Patient Protection and Affordable Care Act is here. Pending Senate completion, we will quickly work to combine these into one final summary. A more extensive summary of the prevention, public health and workforce related provisions in the bill is available from the Trust for America’s Health here.  

Immediate Impact for State Title V MCH Programs

As reported by AMCHP over the past several months the passed bill adds a new Section to Title V of the Social Security Act and provides $1.5 billion over five years for Maternal, Infant and Early Childhood Home Visiting Programs. The bill will require states, as a condition of receiving the MCH block grant funds for FY2011, to conduct a needs assessment to identify communities that are at risk for poor maternal and child health and have few quality home visitation programs within six months of passage. This means the clock could start ticking as early as March 23.  

A summary of the home visiting program provided by the Senate Finance Committee is here, and the full legislative text for the home visiting program is here. The statutory requirements for the elements to be included in your state needs assessments are listed on pages 561-564. We will be working with Federal partners to get as much information as we can about next steps for your program and share that with you. 

The law specifies that the program will be jointly administered by the Maternal and Child Health Bureau and the Administration for Children and Families (page 580). The law also specifies that eligible entities to receive the grants are “a State, an Indian Tribe, Tribal Organization, or Urban Indian Organization, Puerto Rico, Guam, the Virgin Islands, the Northern Mariana Islands, and American Samoa.” Because of the lack of specificity, we assume that MCHB and ACF could issue guidance asking state governors to designate a lead state agency, but we do not know that this is the case and will be seeking clarification. It may be a good idea for you to connect with your state health agency leadership and key partners from other agencies including child welfare, early education, child care, Medicaid, and others to lay the groundwork for the collaboration that will be needed to optimally implement this in your state. 

What Else is Specifically in Health Reform for Title V MCH Programs?

Among the many important provisions, the bill adds two additional new sections to Title V: Section 512 providing an initial grant of $3 million to support Services to Individuals with a Postpartum Condition and their Families and a new Section 513 providing $375 million over five years also through ACF for Personal Responsibility Education Grants for state programs "to educate adolescents on both abstinence and contraception for prevention of teenage pregnancy.” The bill also restores funding for the Section 510 abstinence education grant program. There is no word yet on how this program will mesh with the new evidence-based teen pregnancy prevention funds. Finally, the bill restores the Section 501 Family to Family Health Information Center Funding. 

The bill also creates a $7 billion Prevention and Public Health Fund (over five years) but specifically indicates that only programs authorized by the Public Health Service Act are eligible. Since Title V is under the Social Security Act it will likely not be directly eligible for support for this fund, but those resources may support many of the CDC and other HRSA programs that address MCH needs. 

Stay tuned for additional information on what health reform means for state MCH programs and our plans to support state MCH roles in implementation.