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Title V Technical Assistance Meeting

 View from Washington

Taking Stock of Lessons Learned from Budget Battles

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

As Washington again teeters on the verge of another government shutdown over the federal budget, we have the opportunity to step back and reflect on some of the trends we've seen over the past year and lessons learned from our advocacy for MCH programs.

First, the application of evidence-based policymaking has moved to the forefront and was particularly strong in the run up to reauthorization of the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) last April. This feature appears to be here to stay. Second, we are increasingly engaged in difficult conversations about return on investment (ROI) and how that is shaping the health funding landscape

Looking first at evidence based policymaking and its application in the debate about reauthorization of MIECHV, then chairman of the House Ways and Means Subcommittee on Human Resources Rep. Dave Reichert (R-WA) said this last year: "For my part, I am interested in how we can apply the basic discipline of this program – which uses taxpayer funds to support what we know works to help children and families – to other government programs that today can't say the same thing." While there is clearly a vote of confidence in the efficacy of home visiting here, there also is the clear warning that other programs should be on notice to show their evidence.

This is why I am particularly pleased that the recent transformation of the Title V MCH Services Block Grant has such a strong focus on developing evidence-based strategies to support each of the state selected performance measures. This will allow us to assure policymakers that the Title V MCH Block Grant is not a blank check approach but rather continues a strong focus on accountability by ensuring application of the best available evidence. Those wanting to learn more about the Title V MCH Block Grant transformation can visit here.

On the ROI front, we are increasingly asked by key staff on the Hill to demonstrate how taxpayer funds supporting our program not only save lives but also save the government money, with one particular staffer insistently asking for a breakdown in Medicaid vs. Medicare savings to be expected from injury prevention programs.

Building on the Power of Prevention report that AMCHP compiled a few years back to synthesize the cost effectiveness of MCH programs, we are confident that many interventions can demonstrably save lives and dollars. The difficulty we are facing in this particular environment is countering a search for a single, silver bullet intervention, instead of supporting a systems approach that we know is needed to generate collective impact. The prospect of continued austerity signals that programs will continue to be pitted against each other, to the detriment of a comprehensive and effective public health system. We will continue to make the best case we can on your behalf. As always your thoughts and stories illustrating success in this area are welcome here – we love to hear from you.