By Amy Haddad
Director of Public Policy & Government Affairs
Association of Maternal & Child Health Programs
It seems like Congress missed the memo about the importance of aligning state and federal resources! Although Congress has known for over two years that federal funding for the Children's Health Insurance Program (CHIP); Maternal, Infant and Early Childhood Home Visiting Program (MIECHV); Personal Responsibility Education Program (PREP); Family to Family Information Centers; and others would expire on Sept. 30, we found ourselves well into October without an official extension of these programs. Instead, many members of Congress have dismissed any sense of urgency and insisted that states will have enough funds to carry themselves for a few extra months. In doing so, they have ignored the reality of how states must formulate their own budgets by certain deadlines and the fact that few state legislatures are in session year-round.
Adding to the complexity of reauthorizing these programs are funding offsets and controversial policy changes. For example, the bill being considered in the House for reauthorizing PREP, Family to Family Information Centers, Community Health Centers, and other programs would offset funding by slashing the Prevention and Public Health Fund by over 50 percent! As AMCHP wrote in a letter to the Energy and Commerce Committee, drastically reducing prevention and public health efforts to accomplish these extensions is counterproductive to accomplishing our shared goal of keeping our nation's women, children, and families healthy.
The House version of MIECHV reauthorization proposes to add a state match requirement, which would leave states responsible for coming up with 1:1 match of federal funds by 2022. While most states are already making their own investments in home visiting programs – and several are exemplifying how to align federal and state resources to maximize the services that can be provided to vulnerable families – the reality is that many if not most states would be unable to reliably meet this requirement and could risk losing all federal funding for MIECHV. The good news, however, is that a Senate version has been introduced to reauthorize MIECHV for five years without imposing a new state match. AMCHP, along with partners in the Home Visiting Coalition and other advocates, is urging Congress to pass this version instead, and we welcome your efforts to join us!
As of writing, the prevailing wisdom is that funding for CHIP, MIECHV, and the others may not be fully addressed until Congress also has to tackle the Dec. 8 deadline for appropriations – another can that was kicked down the road, as fiscal 2018 appropriations should have been completed by Sept. 30). In the meantime, AMCHP will be working hard with partners to urge Congress to ditch the harmful policy changes and damaging offsets while also stressing the urgency of completing its work as soon as possible.
Sept. 30 was also a milestone for those of us tracking efforts to repeal the Affordable Care Act. Attempts to repeal/replace/repair Obamacare through the process known as reconciliation (which means it would only require 50 votes, rather than the usual 60, to pass the Senate) effectively expired Sept. 30, leaving Congress more or less having to start from scratch. In the meantime, the greatest changes to ACA implementation are being executed by the administration via moves such as rolling back the contraception coverage mandate (by expanding employer exemptions from compliance) and severely curtailing outreach and enrollment efforts for 2018. Interestingly, though, while the administration has generally touted state waivers and flexibility, it also recently rejected a waiver application from Iowa that seemingly embraced a lot of conservative ideas. Furthermore, the sudden resignation of Health and Human Services Secretary Tom Price and uncertainty about who his successor will be leaves further questions about the possible direction of the department with implementing the ACA.
In other words, more surprises may be in store for how the administration deals with critical questions surrounding ACA policy. Stay tuned for AMCHP's legislative alerts and monthly national policy calls for the latest updates.