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 View From Washington

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

As 2013 winds down, we at AMCHP are looking over the MCH policy horizon to determine our 2014 federal policy agenda. In addition to the expected budget battles and need to continue defining a vital role for Title V MCH programs in an ACA environment, one of the anticipated centerpieces for next year’s agenda will be advocating for congressional reauthorization of the MIECHV program. We’ve even begun laying the groundwork this year and are working with a strong coalition to ensure broad support in 2014.

By way of background, most programs created by Congress are authorized for five years, which allows future Congress’s the opportunity to regularly review each program’s performance, assess its value, and determine if the level of funding is appropriate. The current five-year MIECHV authorization will expire on Sept. 30, 2014 which means that absent congressional action, no new funds would be available for the program in FY 2015.

Now in the old days, most program reauthorizations happened with relatively little drama and were generally close to on time. However, in recent years, the increasingly partisan Congress has missed deadlines and become less amenable to the compromises essential to legislative progress. That observation is not exactly a news flash, but assessing the landscape that will impact MIECHV reauthorization, there are a couple additional elements that add even more complexity to an already nuanced situation.

First, the MIECHV program was created with a mandatory rather than discretionary appropriation, which means that as long as the authorization is in effect the funding is automatically available at the beginning of each fiscal year. This is generally a really good thing as it insulates the program from the vast uncertainties that have accompanied the discretionary appropriations process, which has become badly broken in recent years. However, one key difference is that congressional appropriators can – and often do – provide funds to programs whose discretionary (as opposed to mandatory) authorization has expired. Our best understanding is that Congress would not have this option with an expired mandatory program.

Second, MIECHV was created as part of the ACA. Again it is not exactly breaking news to report that the ACA doesn’t enjoy broad bipartisan support. One of the main challenges to our work now is making the case that supporting young families who are voluntarily seeking assistance to build healthier, stronger families and communities should not be seen as partisan regardless of how the program was enacted.

Finally, perhaps the biggest hurdle MEICHV needs to overcome is the fiscal tab. Extending the current authorization even at is existing level – which we know will only reach a small portion of the eligible population – for five years is a $2 billion (with a B) proposition. As you all are painfully aware, the 2013 sequestration has taken nearly $1 billion from MCH programs operated by CDC, HRSA, NIH, and USDA’s WIC. In a nutshell, the MCH community is struggling mightily with how we advocate for increased resources for programs with demonstrated needs in the face of indiscriminate cuts to all the programs we care about. We are essentially operating in a potential zero sum environment and need to balance priorities more carefully than ever before.

AMCHP is taking a leading role to address each of these challenges head on and is working as part of a larger coalition of stakeholders including advocates and the home visiting models themselves to make the case to Congress that the vital investment in MIECHV needs to continue and be expanded. We will likely be calling on you in 2014 to share the successes your state is making in expanding home visiting services and convincing policymakers that this investment need s to continue and grow.

All best wishes for a great 2014!