View From Washington

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

The votes have been counted, the balloons have dropped, and the cheering and/or crying is beginning to fade. So as the election dust settles, we can begin to discern some of the key takeaways and potential impacts on maternal and child health programs.

The big headlines are easy: President Obama won a second term. The Democrats retain control of the Senate and the Republicans will continue to lead the House. In short, the balance of power – in terms of chamber control and numbers of Republicans and Democrats - has not changed much. Furthermore, neither side seems able to claim a new overwhelming mandate from the voters. And yet, voters did signal that they want the leaders of both parties to work together to find solutions and forge compromises that move the country forward.

The impact on MCH programs is less clear. Here is how it might play out on two key issues and what AMCHP is doing on your behalf:

Budget: Perhaps most pressing post-election question is if and how will Congress address the pending fiscal cliff. As AMCHP has reported at length, the automatic across the board cuts set to go into effect in less than 60 days will cut nearly $50 million from the Title V MCH Services Block Grant. Total cuts will be close to $1 billion from the MCH enterprise when you factor in cuts to WIC, Title X Family Planning, the range of vital Centers for Diseasse Control and Prevention (CDC) programs for moms and kids, and the critical research conducted by the National Institutes of Health.

With the election over and a lame duck Congress convening, AMCHP is monitoring developments closely, working in broad coalitions. In the initial days after the election, House Speaker Boehner seemed to indicate a willingness to put revenues in play but, as always, the details will be key. The president, in a pre-election interview that was originally off the record, expressed his view that a messy grand bargain can be achieved that will make $2.50 in cuts for every $1 in new revenue.

Clearly additional cuts are possible, so we continue to press for a balanced approach that rejects further cuts to the battered non-defense discretionary part of the budget, which largely funds public health. Our view is that any deal needs to take into account the cuts public health programs have already contributed to deficit reduction and preserves the tight caps set in law by the Budget Control Act last year.

Time will tell if a deal can be struck before the cliff is reached. There is the potential that a sequestration-avoiding deal could be even worse for public health, so AMCHP is working to guard against that. In the coming weeks, expect additional updates and alerts on this critical issue.

Health Reform: In this case, the election results more clearly signal that the legislative architecture of the Affordable Care Act is likely safe for at least the next few years. While the electorate is clearly still divided on the support for the ACA, the combined reelection of the president and the Supreme Court decision largely upholding the law means that the business of implementation will continue. We do expect there will be continued attacks emanating from the House but, like the past two years, they are not likely to gain traction in the Senate.

The critical question is, will these factors accelerate action in states that to date have been reticent to pursue implementation? Look for movement in the coming weeks as states will make final decisions if they want to operate their own exchanges, allow the federal government to run them in their state or develop a state-federal partnership.

However it plays out, AMCHP continues to develop resources for state Title V programs and their partners to support your work in implementation, which are available on the AMCHP health reform center Web page here.