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 MCH Policy: What We Saw, What We Expect to See

By AMCHP Policy Staff (Brent Ewig, Carolyn McCoy, Carolyn Mullen & Karen VanLandeghem)

Budget Advocacy – A Look Back

One, two, three DEFENSE. 2012 marked the year of the defensive lobbyist. AMCHP put our stake in the ground and defended the Title V MCH Services Block Grant, the Prevention and Public Health Fund (PPHF) and other public health programs against attacks from the left and from the right. We pounded the pavement alone and with organizations like the American Congress of Obstetricians and Gynecologists, the March of Dimes and the American Academy of Pediatrics. We conducted 109 meetings asking Congress to preserve and sustain the Title V MCH Services Block Grant, avert sequestration through a balanced approach, and protect public health. We met members of the administration, including chief advisor to President Obama, Valerie Jarrett, to discuss sequestration and its impact on state and local MCH.

Our fact sheets, memos and talking points were widely distributed and used by key audiences. Specifically, one Sunday morning an advisor to President Obama stated, "This [AMCHP talking points on the Prevention and Public Health Fund] is great. Having sources other than us document the Fund’s use is helpful." The White House then shared our talking points with reporters.

As a result of efforts in both the House and Senate on the fiscal year 2013 appropriations bill, the Title V Block Grant received a small proposed $1.4 million increase, which is considered a great success in this environment. We strengthened our partnerships with other national organizations and continue to expand the breadth of the AMCHP-led Friends of Maternal and Child Health Coalition. Members of Congress spoke about the Title V MCH Block Grant on the floor of the House of Representatives.

Unfortunately, the promise of these small successes may never be realized. Congress continues to battle over budgetary issues. We lost significant ground on the PPHF when a portion of it was used as a pay for Medicare reimbursements for doctors. The small increase for the Title V Block Grant could be torn away by sequestration, now delayed until Mar. 1 by the last minute New Year’s Eve fiscal cliff deal.

Our members and advocates are fatigued and tired of constantly playing defense. Yet, in this fatigue we must remember the age old quote that our sports coaches shout from the sidelines, "Offense wins games, but defense wins championships." Let us hope that we played defense well enough to preserve the foundational funding critical to improving maternal and child health.

Advocacy – A Look Ahead

If 2012 was the age of the defensive lobbyist then 2013 is expected to be a year of the captain navigating the ship through rough waters, uncharted territory and staying the course despite the obstacles.

AMCHP anticipates another challenging year as it relates to the budget and authorizing legislation. A perfect storm is brewing for the upcoming months with an expected vote to raise the debt ceiling in February or March, sequestration scheduled to occur on Mar. 1, the continuing resolution expiring on Mar. 27, the president’s budget expected in March, and the fiscal year 2014 appropriations process beginning in earnest. Moreover, during this time public health will be asked by Congress and the administration how it will change after implementation of the ACA.

Additionally, efforts to reauthorize some of the expiring provisions of the ACA, including the Title V Maternal, Infant, and Early Childhood Home Visiting (MIECHV) and Personal Responsibility and Education Program (PREP), will begin in earnest. The fate of these programs may be challenged especially with the intense focus on the budget.

If we peer into our crystal ball, our advice is, "Be prepared, be alert and ready to spring into action." We will be relying even more heavily on our grassroots advocacy in the upcoming year to continue to make the case for sustained funding for the Title V Block Grant and other related programs.

As always, the AMCHP policy team stands ready to work on your behalf.

Together we can and will succeed.

A Look at the Affordable Care Act – Past and Future

Looking Back

Hurry up and wait….hurry up and go! When the Supreme Court ruling on the constitutionality of major parts of the ACA was pending, many states and federal agencies were hesitant to make any big moves on implementation of the law in 2012. By the end of June, and on the last day that the court was in session, the ruling came down. The Supreme Court upheld the constitutionality of the individual mandate but struck down the penalty to states if they did not expand Medicaid, leaving it as now optional for states.

Even after the Supreme Court ruling, states and federal agencies seemed shrouded in uncertainty when it came to implementation of the ACA. Many states moved forward, knowing that things might change after Nov. 6, 2012, while others held off on activities related to implementation of the law. With the reelection of President Obama, the pace of implementation is now at full speed with many states pushing forward and federal agencies, particularly the Centers for Medicare & Medicaid Services (CMS), releasing long awaited ACA rules and regulations.

The National Center on Health Reform Implementation at AMCHP monitored and analyzed federal-level initiatives related to the ACA, gathering input from states on the impact of certain provisions as the events of 2012 unfolded. AMCHP provided rapid and ongoing analysis related to both the Supreme Court ruling and the presidential election; member-only conference calls and webinars were convened to allow members to not only hear from AMCHP policy staff, but also engage directly with peers in other states.

Now that implementation of ACA has gained momentum, regulations issued by implementing agencies are appearing in the Federal Register at record pace. AMCHP staff are monitoring and analyzing the regulations in partnership with other child and family health organizations in Washington, DC and, where appropriate, providing comments. Recently, AMCHP also encouraged its members to submit comments to the U.S. Department of Health and Human Services (HHS) on the proposed benchmark health plans, especially where it relates to habilitative services. AMCHP also submitted comments to HHS on the essential health benefits proposed rule in addition to comments submitted earlier in the year on the preliminary essential health benefits bulletin.

Also, AMCHP is leading a project funded by the W.K. Kellogg Foundation to enhance the capacity of state MCH programs and their partners to collectively optimize opportunities presented by the ACA and other national initiatives to improve birth outcomes and maternal and infant health, with a particular focus on reducing health disparities and ensuring racial equity. In addition to the ACA, we know that Title V and Medicaid are longstanding programs that have provided important coverage and supports to women and their families, particularly those who are low income. The project focuses on three overall focus areas with evidence-based policies and practices: 1) preconception health and health care, 2) promoting healthy births, and 3) advancing breastfeeding. The work is framed within a broader life course approach. This project is multi-pronged and includes an Action Learning Collaborative (ALC) to strengthen state efforts to advance preconception health through health reform, publication of policy briefs on preterm birth and breastfeeding, and a major effort to develop Life Course Indicators.

Looking Forward

Implementation of the ACA and overall efforts to reform health care delivery systems will likely occur for many years to come, but 2013 represents a critical year in anticipation of the insurance expansions that will take effect on Jan. 1, 2014. In terms of support for the ACA, continued opposition in some quarters is expected, while overall, the federal government will push forward on implementation of the law as a top priority. AMCHP will continue to monitor ACA implementation, including additional ACA regulations, at the federal level and provide analysis to its members.

At the state level, the implementation of health insurance exchanges for some remains front and center, while others will navigate a partnership with the federal government, and others still will turn the task over to the federal government entirely. AMCHP, as in the past, will continue to advocate at the national level for the involvement of MCH leaders to be involved in the critical decisions as states and the federal government move toward the October deadline when the "open" sign is turned on for enrollment in the insurance plans offered in the health insurance exchanges and states choosing to expand Medicaid.

The decision to expand Medicaid for state leaders also remains a hot topic. AMCHP will continue to track and develop resources on the implications of the Medicaid expansion for maternal and child health populations.

In addition to the health insurance side of the ACA, other initiatives roll out in 2013. Starting on Jan. 1, 2013, in an effort to increase the number of Medicaid providers, the ACA requires states to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase is fully funded by the federal government. Along with other system reforms, the federal government also will roll out initiatives, such as bundled payment pilot programs and funding for the Strong Start for Mothers and Newborns initiative from the Center for Medicare and Medicaid Innovation.

AMCHP continues to support state MCH leaders in their important role in implementation and monitoring the numerous and wide-ranging aspects of the ACA. We continue to provide resources, technical assistance and support to members in the form of national webinars, policy briefs and fact sheets, learning collaborative, and other strategies. The work of the National Center for Health Reform Implementation focuses in four core areas: 1) coverage and access to care, 2) insurance and health service delivery reforms, 3) prevention, and 4) quality. As always, our goal is to meet your needs and provide unparalleled member service. To that end, please let us know how we are doing and what we can do to better support you in 2013.