View From Washington

Affordable Care Act - One Year Later

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

This issue marks the one year anniversary of passage of the Affordable Care Act (ACA). For the past year, AMCHP has worked hard to help our members and partners better understand and begin to implement what is no doubt one of the most sweeping pieces of legislation we will see in our lifetime. This column looks back on significant implementation actions taken in the past year, shares AMCHP’s current priorities, and looks ahead to future opportunities and what you can expect from AMCHP. 

Leading to Support States
Even before the health reform law passed, AMCHP anticipated member’s needs for objective information, timely notice of federal implementation actions, analysis of the myriad options, opportunities and challenges facing state MCH programs and public health agencies. We also advocated on behalf of the strong leadership areas where state MCH programs have a key role such as assuring services for children with special health care needs, promoting home visiting, building integrated systems and assuring quality.  

To organize this work, AMCHP created a National Center for Health Reform Implementation (the Center) that serves as your central point of contact on all things health reform. The purpose of this Center is to provide state maternal and child health leaders and their partners with the information, tools and resources to optimize the opportunities presented by the ACA for improving services, systems, and health outcomes for MCH populations. Lead staff for the Center is AMCHP Associate Director Carolyn Mullen and Senior Advisor Karen VanLandeghem, and we especially appreciate and recognize the support of funders for this Center including the Commonwealth Fund, the Kellogg Foundation and Centers for Disease Control and Prevention.  

Implementation Updates
The most recent product of this Center is an up to the minute summary of key federal actions taken to date on key MCH provisions. This document provides details on which federal regulations have been issued, where HHS is asking for public input, where AMCHP has provided policy guidance on behalf of state MCH programs, and what funding opportunities have been announced in the past year. This resource will remain posted to the AMCHP health reform hub and be updated as needed. 

Current Priorities
The Center works under the guidance of the AMCHP Legislative & Health Care Finance Committee and board of directors who together recently approved a 2011 policy agenda including the following ACA implementation priorities: 

  • Immediate Opportunities 

o    Implement the Home Visiting Program - $1.5 billion over five years

o    Advocate that an adequate portion of the Prevention and Public Health Fund address MCH issues - $7 billion over five years

o    Implement the new Personal Responsibly Education Program focused on teen pregnancy prevention - $375 million over five years and coordinating with Teen Pregnancy Prevention Initiative ($100 in FY 2011), continued Abstinence Only Education grants ($250 million over five years), and Pregnancy Assistance Fund ($125 million over five years) 

o    Seeking opportunities for uninsured children with special health care needs to receive assistance via temporary high risk pools - $5 billion over five years

o    Partner in support of Community Health Center expansion - $11 billion over five years starting in FY 2011

  • Intermediate Opportunities 

o    Promote the comprehensive benefit package design including application of the Bright Futures for Children guidelines for all plans and development of Bright Futures Guidelines for Women

o    Implement important provisions promoting expansion of medical homes

o    Assure strong MCH representation on new boards and commissions, particularly guiding key national indicators development and Adult Medicaid Quality Measures with opportunities to focus on women’s health, preconception and maternity care  

  • Long Term Opportunities 

o    Contribute state MCH expertise to state exchange design including creation of the essential benefits package

o    Support Medicaid expansion under ACA including coordinating outreach and enrollment with MCH programs and improvements to EPSDT

o    Anticipate increased demand and assuring provision of enabling services, care coordination, population-based prevention and systems building services

o    Assure health system capacity and other crucial activities leading up to the 2014 coverage expansion 

These priorities provide a road map and work plan for the Center’s work, balanced by analysis of emerging opportunities and changes made in response to any shifting priorities in the state and federal policy landscape. 

Looking Ahead
As noted previously, AMCHP has embarked upon this work with sensitivity to the fact that partisanship and divisive politics result in differing levels of enthusiasm for implementation across the states. At our most recent board meeting, our leadership discussed the implications of this divisiveness as well as how efforts to repeal, defund or judicially block implementation are all playing out at the state level. AMCHP’s leadership came to consensus that as the ACA is the law of the land, and as the role of the executive branch is to execute or implement the law, AMCHP’s implementation work should continue until and unless some authority tells us to stop.   

We therefore plan to continue to track closely and report on all relevant state options, opportunities and challenges with health reform, and again commit to providing you with the information, tools and resources to optimize the opportunities presented by the ACA for improving services, systems and health outcomes for MCH populations.