A View From Washington: How Long in Limbo?
June 2017

Brent Ewig
Director of Public Policy & Government Affairs
Association of Maternal & Child Health Programs

In the last issue of Pulse I wrote about how predicting what happens next on major questions about national maternal and child health policy is about as effective as looking into a Magic Eight Ball. Since then, Congress passed the only major legislation sent to President Trump’s desk this year – an Omnibus Appropriations package that we were very pleased to see includes a $3.5 million increase for the Title V Maternal and Child Health Services Block Grant. (See additional details in our alert.)

Although six months late, this bill finalizes action on fiscal year 2017 appropriations allowing Congress to turn its attention to setting federal program budget levels for fiscal year 2018, which begins in less than five months. Any day now, we expect the administration to release its full FY 2018 budget proposal with details on how it would allocate its previously announced $54 billion in reductions to domestic programs to offset a commensurate increase in defense and security spending.

While we expect the release of this budget to set off an intense debate, we are encouraged that congressional leaders from both sides of the aisle are expressing concern that $54 billion in reductions to these limited accounts will be difficult to enact. While public health groups across the spectrum will respond to the president’s budget, our strategy is focused on continued advocacy with potential congressional champions who can help protect critical MCH funding from deep cuts. We continue to ground our message on how the MCH Block Grant embraces evidence, delivers results and honors state flexibility. Your help in carrying this message to your elected officials will be needed soon and is much appreciated.

On the same day that Congress finalized the Omnibus Appropriations bill, the House of Representatives narrowly passed a revised version of the American Health Care Act that advances efforts to repeal and replace the Affordable Care Act. See a nonpartisan summary of the latest version of the bill.

Passage of the House bill now shifts action to the Senate, where conventional wisdom says senators will need to make major changes to the House provisions to garner enough support for passage. The policies under consideration with the most potential impact on MCH include:

1. How will they handle the phase-out of the ACA’s Medicaid expansion and imposition of a per-capita cap on Medicaid spending? Several Republican senators from states that expanded Medicaid are on record with concerns about ending the expansion, thereby increasing the number of uninsured.

2. How will they address the House provisions to allow states to opt out of the requirement for insurers to cover the ACA’s essential health benefits, including maternity care and preventive health services with no cost-sharing? Senators have been less outspoken on this to date.

3. Will the Senate concur with the House amendment allowing states to weaken the pre-existing condition exclusions by allowing insurers to charge individuals potentially unaffordable amounts for coverage? The impact for children with special health care needs is of great concern.

At press time, various working groups of senators are reportedly meeting to consider these policies, although no bill has been produced and there is little indication about when to expect additional details. Even if the Senate can craft a bill that can pass, many analysts think the changes needed to gain Senate agreement will be unacceptable to the more conservative House.

So where does that leave us? As the Magic Eight Ball would say, Outlook Hazy – or, if we could add a new option: stuck in limbo.