In recent years AMCHP’s advocacy work has been substantially shaped by a fascinating dialogue on how to best use evidence to drive policy. We’ve seen up close how politics can challenge the simple notion that we should use evidence to guide policy and have seen an extended debate illustrating how science and politics sometimes clash.
Considering that this clash goes back at least to the days of Galileo, I suppose none of us should be too surprised. Nevertheless, during the debate over the Affordable Care Act, there was an interesting sideshow created by relatively small provisions calling for comparative effectiveness research. To scientists and policy analysts, the notion of finding out which intervention works best seems fundamental. To politicians, the specter that scientifically proven results might be direct payment policies sounded dangerously close to rationing care, or at least threatening to some favored special interests.
More immediate to our field, two excellent MCH case studies emerged in recent years that demonstrate the promise and challenge of rigorously using evidence to drive policy. The most high profile examples are the Maternal, Infant and Early Childhood Home Visiting program created by the Affordable Care Act and creation of a Teen Pregnancy Prevention Initiative in the Consolidated Appropriations Act of 2010.
Former director of the White House Office of Management and Budget Peter Orszag presented a clear picture of the forces at play in their development in an article he published in June 2009 entitled “Building Rigorous Evidence to Drive Policy.”
Orszag wrote, “For these two very different subjects [home visiting and teen pregnancy prevention], we’re using a similar, two-tiered approach. First, we’re providing more money to programs that generate results backed up by strong evidence. That’s the top tier. Then, for an additional group of programs, with some supportive evidence but not as much, we’ve said: Let’s try those too, but rigorously evaluate them and see whether they work. Over time, we hope that some of those programs will move into the top tier — but, if not, we’ll redirect their funds to other, more promising efforts.”
This same article put the writing on the wall for all of us who work with the Title V MCH Block Grant programs when he went on to say this:
“This design differs from the typical approach. We haven’t simply created a block grant and told states they can do whatever they want, nor have we dictated a particular program design and told everyone to follow it [emphasis added]. Instead, we’ve said that we’re flexible about the details of the program; we only insist that most of the money go toward the programs backed by the best available evidence, and the rest to programs that are promising and willing to test their mettle.”
This perspective helps us clearly understand the difficulties we face in advocating for the Title V MCH Block Grant. It signals the interest policymakers have in very specifically directing increasingly limited resources, which is something AMCHP needs to take into account when developing our policy agenda and strategies. In no way does this signal we should give up on the block grant concept, but it does help us better understand the challenges we face advocating in a landscape made even more complex by the relentless focus on deficit reduction.
For the latest on AMCHP’s advocacy for the Title V MCH Block Grant, please visit our Legislative Alert page here.