Ninth Annual Maternal and Child Health Epidemiology Conference / December 10-12, 2003

Medicaid/SCHIP:  How Do We Help Congress Understand Their Importance to MCH Populations?

PEGGY BAILEY:  Well, I want to thank you for having me here today, and I'm really excited to present.  The title of my presentation is, "Where's MCH on the Legislative Agenda?"  From the abstract, it focuses a lot on Medicaid and SCHIP, but I'm going to present a little bit broader focus because over this past year and over next year, there are going to be a lot of legislative changes that are going to be relevant, that we're going to need really strong data from you in the community.  And as I talk about the data and how the data impacts Congress, I'm talking about qualitative as well as quantitative data to remember that when we're trying to educate Congress, a lot of both kinds of data are vitally important. 

First, I want to just introduce AMCHP, the Association of Maternal and Child Health Programs.  We're the association, as Karen pointed out, for the maternal and child health and children with special health care needs directors at the state level.  We also have associate memberships that any of you could be an associate member of AMCHP as an individual member and as researchers.  Our staff focuses on communicating best practices and communicating federal policy information to our membership and making sure that our membership can communicate with policymakers at the state and federal level, and our staff focuses on these areas. 

Now, I'm going to get into the current legislation, and then we'll get into the outlook for next year and then areas of influence that each of you can have and then I'm going to talk a little bit about how to build advocacy efforts using the data that you collect every day.  And that's really important because being able to educate policymakers--we're not naïve as to think that every policy decision is necessarily based on evidence that we see in the communities, but if we can communicate that evidence to policymakers, at least when they make decisions, they know what they're deciding and we can hold them accountable.  We can say, "We told you that this is what was going to happen," or "We told you that these are the access barriers that exist."  And we as AMCHP and you and your communities can hold policymakers accountable for the decisions that they make.  Because of our membership, one of the biggest things that we focus on from the policy and advocacy standpoint is the Title V Block Grant.  And I have some up-to-date information for those of you who are interested. 

The Block Grant was included in the omnibus package that Congress is looking at right now.  The House passed that omnibus bill, which totals over $800 billion, on Monday.  The Senate will probably take that up in January, probably the week of January 20.  The way they wanted to do it was to pass it in the House and then have the Senate approve that legislation by a voice vote, which would basically constitute five people in the back of the room approving an $800 billion bill.  While the Democrats decided that they didn't like that and even if it is a foregone conclusion that this bill's going to pass, they wanted to have some substantive debate about some of the pieces of information in it, so they're going to delay that vote until after Christmas, and they are going to have a debate on it when they come back in January. 

The important thing for us to know is that in the President's proposal, there was a $20 million increase that was suggested, and this was based on the strong performance measures.  The President's budget cited that the Maternal and Child Health Program was moderately effective, and I know that may sound a little condescending, but that was really good.  That was really good.  Not many programs got an effective, and not many programs got moderately effective either, and that was because the performance measures and the data that you're able to provide to the state, the state's able to provide to the Maternal and Child Health Bureau.  Unfortunately, though, Congress wasn't able to hold to that increase, and the Block Grant is going to be flat funded.  It's flat funded in the bill, but there is a .059 across-the-board cut of all programs in order to find some increases for education.  So the Block Grant is actually going to end up being decreased.  And then some of your states, there's going to be a decrease because of some of the census data. 

There's going to be a decrease because of the way that the Bureau does the formula; there's going to be further cuts at the state level.  And there are some important set-asides for oral health, mental health, epilepsy, newborn hearing screening, and the abstinence education programs got an increase, and the total of that is $75 million for those programs.  Next year's outlook is pretty bleak.  The budget numbers that we expect to see are going to be worse than this year, and we're going to see very few increases in domestic programs.  On top of that, it's a presidential election year so that in Congress very little gets done because pretty much half the Senate is running for president, so they won't be around.  And that dictates the tone of the debate depending upon how things work out.  And then the legislative calendar is shortened because of the conventions and the caucuses and the primaries.  But given this bleak news, we can't give up.  There are important services that the women and children that we see every day need from all of us, and there are important pieces of legislation that are going to move through that's going to affect them.  Of course, we still want to see an increase in the Block Grant.  Welfare reauthorization's probably going to happen next year, probably in the late winter and early spring. 

AMCHP is specifically looking at children with special health care needs and making sure that individuals, parents, and caregivers of children with special health care needs, that that time counts as work so that they can stay home and be able to take care of their children or an adult with a special need.  The Immigrant and Children's Health Improvement Act, that would allow pregnant women and immigrant children to have access to Medicaid and SCHIP at the state level.  The preemie bill there is a bill that the March of Dimes put together, and it's actually two bills:  one to increase Medicaid and SCHIP coverage for pregnant women, and another bill to increase research at NIH.  Also on the agenda for next year will be Medicaid reform.  It's still going to be on the table.  Many people at the Centers for Medicare and Medicaid services think that Medicaid reform is more important than even Medicare reform, and we've seen how that debate's gone.  The President's proposal in this spring included putting caps or block granting Medicaid to the states. 

The National Governors Association couldn't agree on that proposal, and the Republican governors and the Democratic governors each submitted separate recommendations for how to reform Medicaid services.  Also, the House of Representatives has developed a task force, but unfortunately, it's not a bipartisan task force.  It's solely made up of Republicans, so we're not quite sure how that will help.  If there's a proposal that comes out of the House, it's unlikely that it'll be able to go anywhere in the Senate because it's a much more bipartisan body.  In the reform debate, an area that you can be of great help is being able to put a face on the people who get Medicaid services.  The reform debate has been solely focused around cost and cost effectiveness and maintaining costs, and it's not about the services that people are trying to be able to get.  As services are cut at the state level, as you start to see trends and effects of what those services have meant for access for kids, it's important for you to get that information to advocates and to policymakers so that we can make educated, evidenced-based arguments when we're going to Congress. 

Future issues that we want you to be aware of is that the Children's Health Act of 2000 is going to be up for reauthorization in 2005.  So you'll start to hear AMCHP talk about the Safe Motherhood Initiative, the Healthy Start, and other issues that were within that bill because we're going to start now in getting ready for what are the things that need to be fixed in those pieces of legislation and proving that that legislation is important enough to be reauthorized, that we don't want it just to die in Congress.  Also, SCHIP is going to be reauthorized in 2007, and now is the time to start showing the benefits of SCHIP, the gaps in SCHIP, and the recommendations that you would make as researchers and data collectors on how to make SCHIP an even stronger program and maybe expand it to other populations.  And of course, we always want to expand the Maternal and Child Health Block Grant.  So at AMCHP, our advocacy goal for you is that when any representative, senator, state policymaker is about to make a decision about MCH and children with special health care needs, they want to remember to ask us. 

They need to ask us what impact this is going to have on women and children.  But in order to do that, they need to have relationships with every one of you and with us because in Washington we can only do so much.  They want to know how is this going to affect the person that's going to vote for me, and the only people that can tell them that is you.  So to build those relationships, you need to make sure that as you collect your data, you do it in a way that is easily translatable to the layperson, that you invite policymakers to facilities and to clinics to be able to see what's going on, that you have your kids go and intern in their office, and that every publication and report that you do, you do it in a way that is accessible and that you actually send it to your representatives' offices so that they can start to see what is going on in their communities. 

One of my favorite advocacy stories--I used to work in agriculture, and one of the representatives from Oklahoma was telling a story that an insurance lobbyist found out that she had the same first name as his wife, so she would call his office and just give her first name, and she would automatically get sent directly into his office.  And he said, "You know, I couldn't even be upset because she found an angle, and she used it."  And she was able to get in to him and talk to him and convince him of what she wanted, and that's what we all have to do.  We all have to see ourselves as advocates for the communities, for the women and children that we're trying to serve and to figure out the ways to communicate them. 

The other important part of this, too, is to communicate to them while they're at home.  A lot of times when you're in DC, you may go and visit them, but a lot of times, their schedules are easier when they're at home and they're actually in their office.  So if you've done a recent report or there's a new pamphlet out, go by their office on your way home and drop it by and explain to them what it is and then let them know that they can contact you or that they can contact us.  If you send the information to us, too, we can help back you up on that information.  Now, the way that AMCHP works, we work a lot in coalitions with other people in the health care community.  We work with the March of Dimes, the Academy of Pediatrics, the Children's Dental Health Project because there's so many issues that affect MCH communities, and we can't be an expert on everything.  So it's important for us to work within our partners and to expand our partners every day to be able to advocate for our populations. 

So in conclusion, funding increases are going to be difficult, but we have to stay optimistic.  Little changes can go a long way to helping you do your jobs better and to also help the women and children that we're advocating for, and that's the way it's going to happen.  There aren't going to be major pieces of legislation over the next year or two that are going to move that will have some grand title like "Better Health for Women and Children."  It's going to be little pieces that we try to attach things to.  And in order to do that, we need strong evidence from the communities as to what will work.  And it's never too late to start to create and cultivate relationships, and that's really what it's all about is policymakers knowing you, knowing us, being able to access us when they have questions, and being able to turn around information as quickly as possible.  And so you can use this to contact us if you have any questions or if there's work that you're working on that you want to make sure that we're able to use in our advocacy efforts, please send us anything, and thank you for having me today.