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 View from Washington

By Brent Ewig, MHS
Director of Policy, AMCHP

Spring has finally arrived in our nation’s capital! Along with the cherry blossoms and warmer weather, we finally have a reprieve from the long winter of budget discontent and a small ray of good news to share. On Apr. 10, President Obama released his fiscal year 2014 federal budget proposal, which proposes $639 million for the Title V MCH Services Health Block Grant. This amount represents level funding with fiscal year 2012 and is an increase over the estimated final fiscal year 2013 levels when factoring in sequestration and other across the board cuts. Additional details are available in the AMCHP Legislative Alert here.

This proposed funding represents a major interim victory considering the challenges we are facing both with discretionary budget caps and continued questions about why Title V should be maintained at current levels once the ACA insurance expansions take effect. For more than a year, we have been taking on those twin threats in our advocacy, and the president’s budget is confirmation that our collective voice is being heard.

AMCHP also is pleased to share that the president’s budget includes a proposed investment of $15 billion over the next 10 years to extend and expand evidence-based voluntary home visiting programs. This is a tremendous statement of support and demonstrates the commitment of the administration and the prioritization of early childhood investments. The proposal is all the more important as it sets the stage for reauthorization of the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program that expires in 2014.

These victories are considered interim because at this point they are proposals and not law. So, what happens next and how can we help move this from proposal to reality?

Title V MCH Block Grant Funding: Right now the Senate and House committees with jurisdiction over public health funding are beginning to craft their spending bills for fiscal year 2014. We expect these bills should be publicly released in the late spring – early summer timeframe. It is anticipated that there will be considerable differences in the Senate and House proposals, with the House working under a much lower overall cap than the Senate. Nevertheless, AMCHP will be advocating for Congress to provide $640 million for the Title V MCH Block Grant along with adequate funding for other key MCH programs.

As these bills work through the legislative process this summer and fall, the big question will be if the Senate and House can come to a final compromise on program funding levels in time for the start of the 2014 fiscal year on Oct. 1, 2013. If past is prologue, we are likely to see yet another continuing resolution in the fall funding the federal government at 2013 levels, but that is a long way off and our current priority is getting the highest possible funding level in both bills. Please stay tuned for AMCHP Legislative Alerts that will keep you informed of major developments and allow you to add your voice in favor of sustained MCH funding at critical junctures in the annual appropriations debate.

Home Visiting Expansion: On this front the details are more fluid. As a reminder the current mandatory Title V funding for the MIECHV program runs through fiscal year 2014, meaning that Congress will need to act sometime within the next year and a half to reauthorize or extend that funding. Prior to the president’s proposed expansion, we anticipated that reauthorization in this austere environment would be challenging. Having the president weigh in so forcefully for continuation and expansion – and identify the tobacco tax as the proposed revenue source – should change the momentum on the upcoming debate. AMCHP is now partnering with interested groups to work in coalition to support the continuation and expansion. It is hard to predict what the timing of congressional action may be, but be assured, AMCHP will keep you up to date and ask to add your voice to the debate when needed.

Sequestration: While final details on the 2013 sequester have not been publicly shared with HHS grantees as of press time, it is important to remember that sequestration is set to occur in current law for the next nine consecutive years unless Congress acts to prevent it. The next likely opportunity for sequestration to be debated is when Congress votes to raise the debt limit, likely sometime in June or July. Without congressional action, most mandatory programs, including MIECHV and the Personal Responsibility Education Program (PREP), that serve adolescents and others will be subject to an additional 7 percent cut on Oct. 1, 2013, and discretionary programs will not face across the board cuts but will have their funding levels limited by a lower overall budget cap – ensuring that cuts would be inevitable.

So, while this report started with a partly sunny outlook, it is clear there is much work ahead if we are to avoid cuts to programs serving women, children and families. We look