By Brent Ewig
Director, Public Policy and Government Affairs
Greetings from our nation's capital! After an intense campaign season, the new president has taken office, and he and his allies in Congress are beginning work that could have major implications for maternal and child health policy in the United States.
Before previewing what lies ahead, here's a quick rundown of highlights from the past year:
In June 2016, the Senate Appropriations Committee approved a fiscal year 2017 Labor, Health and Human Services and Education bill that proposed to fund the Title V Maternal & Child Health Services Block Grant at $641.7 million – an increase of $3.5 million from FY 2016. The increase would be directed to Special Projects of Regional and National Significance. In describing the increase, the committee directs the Health Resources and Services Administration to fund a study related to child health and development in states with high child poverty rates.
In July 2016, the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies proposed to continue current funding levels for the Title V MCH Block Grant at $638.2 million.
A final bill reconciling these different levels was never completed; instead, in late September, Congress passed a continuing resolution allowing for continued funding of most programs for 10 weeks at their current levels minus a .5 percent across-the-board cut, including for the Title V MCH Block Grant. Included in that bill was $37 million in new funding to allow the administration to begin implementing programs to address the opioid epidemic, as directed by the Comprehensive Addiction and Recovery Act, which was signed into law this past summer.
After nearly nine months of inaction, Congress finally reached a bipartisan agreement in September to include $1.1 billion in Zika funding in the continuing resolution. AMCHP, along with a broad coalition of over 90 public health groups, had been pressing Congress to pass emergency funding to address Zika.
After the elections, Congress punted again on completing a final funding bill and passed another continuing resolution to fund the government through April 28, 2017, meaning that completion of FY 2017 funding will overlap with the initial work on FY 2018 funding levels, which could create confusion and further delay.
Looking ahead, AMCHP is monitoring expected policy changes in three key areas: 1) repeal and replacement of the Affordable Care Act; 2) potential budget cuts; and 3) prospects for reauthorization of key MCH programs – including the Maternal, Infant and Early Childhood Home Visiting Program, the Children's Health Insurance Program, the mandatory portion of Community Health Center funding, the Personal Responsibility Education Program and Family to Family Health Information Centers – all of which expire on Sept. 30, 2017.
Repeal and Replace: Before President Trump took office, Congress passed a budget resolution in mid-January setting in motion the process to repeal the Affordable Care Act. On his first full day in office, President Trump signed a sweeping executive order ordering the Secretary of HHS and others to "waive, defer, grant exemptions from or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any state or a cost, fee, tax, penalty, or regulatory burden on individuals, families, health care providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance or makers of medical devices, products or medications."
So, while it's clear that repeal is in motion, as of press time there is much less clarity about the timing and content of replacement plans. AMCHP plans to monitor this situation closely and advocate that any replacement plan maintains and ideally improves services for MCH populations.
Potential for Budget Cuts: During the campaign, candidate Trump proposed an annual 1 percent reduction in the non-defense discretionary portion of the federal budget. The week of his inauguration, however, reports emerged that the administration is preparing a blueprint that would eliminate several programs and reduce federal spending by $10.5 trillion over 10 years. At this time, there are no additional details on these emerging plans, but they are expected in late April. AMCHP is monitoring this situation very closely and stands ready to work with members, partners and elected officials from both sides of the aisle to make the case for sustained investments in lifesaving MCH services.
Reauthorization of Key MCH Programs: After a busy and likely tumultuous winter and spring, Congress is expected to turn this summer to the need to reauthorize a number of key MCH programs outlined above. AMCHP is participating in and helping lead a number of coalitions engaged in making the case that Congress should reauthorize programs providing critical services and, where possible, expand services to meet documented needs. While most of these programs have enjoyed bipartisan support, the new policy environment and continued budget pressures indicate we should expect a debate on the pay-fors to continue these programs.
Moving forward, we plan to intensify our messaging on how investments in the health of mothers, children and families strengthen our nation's safety, security and economic strength. We will use cost-effectiveness data to support our case where available and we especially appreciate your help in documenting unmet needs and contacting legislators as appropriate to urge swift action. Stay tuned to AMCHP's Legislative Alerts for updates on all these issues, as well as opportunities to advocate with your elected officials in accordance with your organization's rules.