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 Legislative Corner

AMCHP Partnering to Lead National Mobilization for Women, Children and Families on Oct. 26
AMCHP, the National WIC Association, and the National Family Planning & Reproductive Health Association invite you to join us in an unprecedented National Mobilization for Women, Children and Families on Oct. 26. The goal is to flood Capitol Hill with a unified message opposing MCH and women’s health program cuts.

Register here for an optional pre-event webinar on Tuesday, Oct. 25 at 3:30 p.m. EST. On Oct. 26, all three organizations will issue a coordinated Action Alert asking you – in accordance with your organization’s rules on advocacy – to call and write members of Congress with the simple message that you oppose any efforts to cut core programs for women, children and families, including Title V, WIC and Title X. Additional background information is available here and more details will follow. Mark your calendar now to join in this coordinated action, and share this message with friends and supporters as we need everyone’s help to stem the tide.

Federal Budget Update
The federal government continues to operate on a Continuing Resolution (CR) though Nov. 18, while Congress reportedly continues to negotiate final health program funding levels for FY 2012. At the same time, the Joint Select Committee on Deficit Reduction (Super Committee) continues to meet behind closed doors to come up with a proposal for cutting at least an additional $1.2 trillion from the federal budget over the next 10 years.

FY 2012 Title V MCH Block Grant Appropriations 

  • For FY 2012, the Senate Appropriations Committee has passed a bill proposing a $50 million cut to the Title V MCH Services Block Grant, citing the increase in funding from the new Maternal, Infant and Early Childhood Visiting Program as the primary justification. The cut would be divided, with $20 million reduced from the core state maternal and child health funding and $30 million reduced from Special Projects of Regional and National Significance (SPRANS).
  • In the House, a proposal was offered but not yet voted on, where the Title V MCH Block Grant would be reduced by only $1.8 million, however, mandatory funding for Home Visitation, the Prevention Fund and Title V Family Planning would be eliminated.

How the negotiations ultimately end remains to be seen. Congress is planning on breaking up the appropriations bill into several smaller spending packages of “minibuses”(bundling two or three funding bills into one) rather than attempt to pass one large funding bill containing every federal program known as an “omnibus.” The hope is to pass the remaining funding bill before the end of the current Continuing Resolution (CR) and prior to the deadline for the congressional Super Committee to make its recommendations.

First up is a bill that combines Agriculture, Commerce and Transportation. The level of difficulty in passing this initial bill might set the stage on how easily the remaining funding bills will go through without significant fights. The Labor HHS Appropriations Bill, which sets funding for the Title V MCH Block Grant and other critical MCH programs, is typically seen as the most contentious. The Senate and the House seem far apart on both proposed funding levels and political ideology. Because the House is seeking to rescind mandatory funding provided under the Affordable Care Act and eliminates Title X, among other things, this increases the likelihood that this bill will be the last piece of legislation Congress addresses. AMCHP continues to advocate for adequate funding for the Title V MCH Block Grant in any final bill.

AMCHP Organizes Advocacy for Title V with Super Committee
Thirty four leading national organizations serving women, children and families have joined with AMCHP to send a letter to the Joint Select Committee on Deficit Reduction (the Super Committee) in support of the Title V MCH Block Grant program. The letter asks Congress “to carefully consider the current condition of our nation’s public maternal and child health system before imposing any additional budget cuts to the Title V Maternal and Child Health (MCH) Services Block Grant and other critical programs that serve women, children and their families.” A copy of the letter is available here.

The Super Committee continues to meet behind closed doors to come up with a proposal for cutting at least an additional $1.2 trillion from the federal budget due by Nov. 23. The work of the committee becomes increasingly important because if the group is unable to finalize a proposal, automatic across-the-board cuts split between both defense and non-defense domestic discretionary spending will occur. 

While it is not yet known what ultimately the committee will recommend, we have been told repeatedly that “everything is on the table” for consideration. Many groups are concerned about any proposed changes to Medicare, Medicaid and Social Security and have communicated their concerns to the Super Committee. AMCHP has conducted meetings with a majority of the committee members asking the group to consider the amount of cuts that have already occurred to the Title V MCH Block Grant and what the effect of drastic additional cuts would mean to women, children and children with special health care needs.

Institute of Medicine Report on Essential Health Benefits
On Oct. 7, the Institute of Medicine (IOM) released a report entitled “Essential Health Benefits: Balancing Coverage and Cost.” It outlines a process to help the Department of Health and Human Services (HHS) define the minimum benefits that certain health plans must cover as directed by the Affordable Care Act. The charge of the committee specifically was not to decide what is covered in the essential health benefits (EHB), but rather to propose a set of criteria and methods that should be used in deciding what benefits are most important for coverage.

Below is a brief summary of some of the key recommendations included in the report:

  • HHS should explicitly consider costs as a factor in deciding what health benefits must be provided by insurance plans.
  • By May 1, 2012, the Secretary should establish an initial EHB package guided by a national average premium target. The starting point in establishing the initial EHB package should be the scope of benefits and design provided under a typical small employer plan in today’s market. To specify the initial EHB package this scope of benefits should then be modified to reflect:
    • The 10 general categories specified in the Affordable Care Act (ACA) – ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorders services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services including oral and vision care.
    • The criteria specified in this IOM report for the content of specific components.
  • Current state insurance mandates should not automatically be included in the EHB package but reviewed in the same way as other potential benefits.
  • Only medically necessary services should be covered and decisions by insurers about what is “medically necessary” should depend on the circumstances of an individual case.
  • For states administering their own exchanges that wish to adopt a variant of the federal EHB package, the Secretary should use statutory authority to grant such requests.
  • HHS should update the EHB package annually beginning in 2016. The benefit package should be based on credible evidence of effectiveness.
  • A National Benefits Advisory Council should be established to offer external advice on updates, data requirements and the research plan.
  • HHS should consider both the cost of the current package and medical inflation when updating the benefits. HHS, working in partnership with others, should develop a strategy for controlling rates of growth in health care spending across all sectors in line with the rate of growth in the economy.

HHS may choose to adopt or reject the recommendations included in this report. During the next couple of months, HHS will host a series of listening sessions to gather input from all stakeholders to help them define the priorities for coverage. It is still unclear when HHS will release the proposed regulation on the essential health benefits. AMCHP staff will participate in the listening sessions and continue to follow these developments closely.