By Alyson Northrup
Government Affairs Specialist
Association of Maternal & Child Health Programs
A U.S. Senate committee recently advanced legislation on an issue of increasing national attention that maternal and child health (MCH) professionals are tackling head-on: maternal mortality. The behind-the-scenes story of this bill provides a good example from the world of MCH on how a bill becomes a law.
The basics of the bill
S.1112, the Maternal Health Accountability Act, was introduced and referred to the Senate Committee on Health, Education, Labor, and Pensions (HELP) in May 2017. The lead sponsors are a bipartisan pair: Sen. Heidi Heitkamp (D-N.D.) and Sen. Shelley Moore Capito (R-W.Va.). A companion bill in the House – H.R.1318, the Preventing Maternal Deaths Act – was introduced by Rep. Jaime Herrera Beutler (R-Wash.) in March 2017.
The bill seeks to build on state-led solutions to tackle the problem of maternal mortality by providing funding and technical assistance to states to establish or expand maternal mortality review committees (MMRCs). Over the past few decades, several states established MMRCs. Federal partners and national organizations worked to support states' efforts to identify best practices for establishing and operating MMRCs, storing and sharing maternal mortality review data, and turning maternal mortality review findings into action to prevent future maternal deaths.
Where did the bill come from?
Prior to introduction of the bill, dozens of stakeholders, including AMCHP, contributed to a process over several years to develop the ideas and legislative language that later became the federal bill text. Ultimately, this process identified providing greater federal support for MMRCs as a key policy solution, and a group of interested members of Congress wrote a bill to help states expand their efforts. A coalition of national organizations, including AMCHP, the American College of Obstetricians and Gynecologists (ACOG), the Association of Women's Health, Obstetric & Neonatal Nurses (AWHONN), March of Dimes, Preeclampsia Foundation, and the Society for Maternal-Fetal Medicine (SMFM), among others, provided technical assistance and rallied behind the bill's introduction.
How the bill passed through the committee
It took just over a year from when Sens. Heitkamp and Capito introduced S.1112 to when the Senate HELP Committee approved the bill. Compared with most bills in Congress, this was major progress occurring at lightning speed.
What helped push S.1112 through the committee process? It was a bipartisan effort. It supported the expansion of ongoing activities that were tested in the "laboratory of states." And national awareness and outrage over maternal mortality in the United States was growing. This increased awareness was fueled by significant national press attention, in particular, the NPR/ProPublica 2018 Pulitzer Prize finalist series "Lost Mothers."
Each of these factors helped S.1112 overcome the first hurdle to committee consideration: getting the attention of the committee leadership and staff. Sens. Heitkamp and Capito advocated for the HELP Committee to prioritize the bill by writing a letter to the committee's leadership, Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.). Similarly, organizations that supported the bill urged the HELP Committee's leaders to take action, including by sending a coalition letter asking them to include S.1112 in a markup of bills focused on the opioid epidemic. While the HELP Committee did not ultimately include the bill in the opioid-focused markup, Sen. Murray publicly pledged to consider S.1112 in committee the following month. This was a turning point.
The HELP Committee staff for Chairman Alexander and Ranking Member Murray worked collaboratively to come to agreement on a version of S.1112 that they could pass through their committee. Organizations with technical expertise provided feedback to ensure that any changes made to S.1112 maintained the intent of the bill and would be workable on the ground. For example, AMCHP emphasized that it was important for the bill to retain a standard for confidentiality of MMRC proceedings in order to preserve their purpose as public health surveillance.
An obstacle rises, then falls
The bill text that Chairman Alexander and Ranking Member Murray agreed to had the support of several stakeholders, but it had one big problem: It provided no new funding for the grant program it created. To address this, Sen. Murray offered an amendment with Chairman Alexander's support during the markup that authorized 12 million dollars for each year of the program. This was five million dollars more per year than the original bill proposed. AMCHP and other organizations mobilized to reach out to every member of the HELP Committee and encourage them to vote "yes" in support of Sen. Murray's amendment and the final bill. The HELP Committee approved Sen. Murray's amendment and S.1112 unanimously.
What's next and what are the prospects of the bill becoming law?
S.1112 is now a committee-passed bill, which is no small feat, but it still has a way to go before becoming law. AMCHP and the Association of State and Territorial Health Officials (ASTHO) recently wrote to Senate Majority Leader Mitch McConnell (R-Ky.) and Senate Minority Leader Chuck Schumer (D-N.Y.), urging them to bring up S.1112 for consideration by the full Senate as soon as possible. In the House of Representatives, the bill faces steeper odds. The House Energy and Commerce Committee has yet to take any action on the bill. With a tight timeframe between now and the end of this session of Congress at the end of this year, the congressional champions of the bill, advocacy organizations, public health leaders, and the media will need to keep up the drumbeat on the importance of passing this bill in order to get it across the finish line this year.
One cause for optimism: The Senate appropriations legislation for fiscal year 2019 includes a proposal to fully fund the activities outlined in S.1112 and H.R.1318 (see Safe Motherhood section on page 2). If approved, that funding could jumpstart the grant program proposed in S.1112 and H.R.1318 and facilitate passage of the bill into law.