Celebrating the 75th Anniversary of Title V

Special: Celebrating the 75th Anniversary of Title V

Dr. James F. Quilty, Jr.

AMCHP Past President (1989-1991) 

My tenure as AMCHP presidency and events immediately afterward championed the indomitable bond linking MCHB and its first Director Vince Hutchins with AMCHP. We experienced genuine pride in advancing the health of America's mothers and children during those years. However, historical events at the decade's inception dwarfed our accomplishments as surely as Shakespeare's Hamlet role overwhelmed that of his friend Horatio.

My introduction to MCH in early spring 1981 came during its potential Waterloo. Never politically strong MCH found itself clamoring for life vests. President Ronald Reagan's "Morning Again in America" budget that year targeted MCH and other health and human service programs for fiscal bludgeoning. That spring - paraphrasing Hemingway - "the bells soon would toll for MCH." Those in the know at MCH federally and AMCHP understood: the daunting task of reversing the projected budget cuts amounted nearly to a mission impossible.

Having taken the Title V position two and half months previously I understood practically nothing of the looming destruction. During the previous five and a half years, following return from Bangkok and the Foreign Service Medical Corps, I assumed increasingly complex administrative responsibilities. In Ohio, Antoinette Eaton, MD, soon to become the first woman President of the American Academy of Pediatrics, recently had resigned as Ohio's MCH Division Chief. She encouraged me to consider replacing her. Since the line to assure my family received a paycheck was remarkably short - and with Toni's gentle prodding, abetted by Elizabeth Aplin, MD (who had saved Ohio's then Crippled Children's Bureau) - I accepted and embarked upon a challenging, mostly satisfying 12-year odyssey.

The still un-energized state Title V directors would convene in March in San Diego, CA for that year's annual meeting. My personal thoughts probably drifted further from MCH issues than those of most directors. My Uncle John, a World War II interloper from his native Buckeye state to California in 1942, had sustained a "widow-maker" heart attack days before the meeting began and died several weeks later. The trip thus blended family and official business. By the meeting's second day its altered course truncated much of the family time.

AMCHP in those years played a lesser role in national maternal and child health policy development. Ideas meshed with visionary leadership to sustain MCH through decades of lean funding. Since its inception in 1912 as the Children's Bureau and its 1935 statutory incorporation as Title V of the Social Security Act, MCH limped along relying upon our shared vision. The Bureau performed multiple vital tasks but always lacked sufficient funding. Medicaid enactment in 1965 nearly vitiated our raison d’être. Now Reagan promised to balance the budget, while reducing taxes, on the sinewy structures of MCH and safety-net companions. After all these programs, administratively speaking, became non-essential that spring. These programs’ eviscerated budgets would absorb a retroactive 25 percent budget cut. The administration promised a further 25 percent cut for its next fiscal year. A further budget move placed many previous stand-alone programs into a MCH Block Grant! States would make their own decisions on division of Block funds.

After the first day, schmoozing about in a lovely hotel among the gentle breezes of Mission Bay, I spent the evening with Johnny's family. My parents arrived as Dad bid a tearful adieu to his younger brother. The next day AMCHP changed forever. The now deceased Drs. Ed Liss from Illinois and Iowa's John McQueen and other knowledgeable colleagues, whose names would quickly became family to me, preempted the scheduled session to invoke what I'll call 'Josie's Probing Question': "Are you (i.e., Directors) just going to let this budget hacking happen?!"

Who's 'Josie'? Hopefully all AMCHP readers have heard of Josie Gittler! An attorney in Iowa's School of Law, AMCHP's legendary lobbyist worked with Dr. McQueen, Director of Iowa's Program for Handicapped Children. All State Title V Directors would become well acquainted with Josie over the next few months. That day, knowing little about the issues, I merely listened as Bernie Guyer (MA), Bill Hollinshead (RI), Dick Nelson (MN), Peter Van Dyck (UT) and a symphony (except for a mild nay-saying cacophonous undertone) of other state leaders collegially formulated a detailed plan to reverse the intended budget rollback. Several hours along Josie accepted the directors' invitation to lead our educational effort of Congress (nobody mentioned lobbying). Many directors, here-to-for precluded from contact with their Congressional delegation, committed themselves - where not forbidden by state statute - to herald the agreed upon agenda upon Josie's beckoning.

The meeting's final day established a component of AMCHP as a 501(C) 3 organization The plan's vital link was Josie. She would reach designated state directors wherever they happened to be and whenever exigent time frames demanded it. That spring Josie and Dr. McQueen synchronized our many Congressional blitzes, by phone and foot to educate targeted offices. Under Josie's leadership we implemented a comprehensive lobbying plan, developed extensive call lists, and coordinated our nascent plan with AAP, Children's Defense Fund and other such organizations.

Fortune shone upon MCH that late summer 1981. When President Reagan signed the annual HHS budget we celebrated MCH's return to nearly full funding. We also celebrated the new AMCHP.

Like all needed directors, I participated liberally in these 'educational' efforts. My formal AMCHP roles began two years later in a vote for Region V AMCHP Councilor. Ed Liss and I tied. Ed, 'complaining' he was too old, withdrew (each of us had voted for the other). In 1987 the directors voted me President-elect. During my executive years, AMCHP established a permanent Washington, DC presence with Cathy Hess as our first director. No decision in those years turned out better. Catherine demonstrated imaginative, organized and dedication skills daily. AMCHP became 'a player' inside the beltway thanks to her leadership. She selected talented, equally talented professional staff. Working closely with Dr. Hutchins we maintained our organization's now modestly robust presence. Speaking of Dr. Hutchins – he never forgot MCH's target population. He traversed the MCH landscape with a political acumen that generally served his staff and the several states - the boots on the ground - extremely well and eminently fairly. For Dr. Hutchins his "fire in the belly" was an understanding of our fragile human nature. He could play a waiting game while simultaneously encouraging - through a camouflaged answer - others to pursue ends he was prohibited from pursuing. He was forever leading even while following. He would bend aside when directed. But he never moved out of the way!

Hundreds of phone calls, dozens of trips to our nation’s capital, national speeches ad absurdum and an amazing Ohio Title V staff allowed me to devote hundreds of hours to AMCHP, all time well spent! Kathy Peppe, RN, MSN, followed me as Ohio's Title V director and several years later as AMCHP President. She epitomized the quality of our MCH program.

Throughout my 12 years as a Title V director AMCHP annually helped repulse efforts by MCH budget slashers. As in many states we used MCH Block funds to encourage state General Assemblies to increase state budgets as our fore-bearers in the 1912 Children's Bureau had done. As depicted memorably at the start of Title V's 50th anniversary celebratory film, the family of MCH must remember always to never cease pushing those 'buggies.'

Additional work always remains! Good luck in your continuing efforts.