Barney Frank once quipped that Republicans who call themselves pro-life “believe that life begins at conception and ends at birth.”
Nowhere would that punchline land harder than on the current Congress, composed of lawmakers who are at once pushing past the boundaries of Roe v. Wade, while undermining a range of policies that would make life slightly less difficult for expectant and new mothers.
The GOP tax reform proposal initially came after the adoption tax credit, while Congress has allowed the children’s health insurance program to expire and, now, is doing the same for a program that funds nurses and social workers to coach at-risk new moms, beginning during pregnancy and lasting until the child turns 2 years old.
The programs have lapsed as Republicans struggle to find ways to pay for them, even as they gallop toward an unpaid-for series of corporate tax cuts that could cost the government trillions in lost revenue.
The lapsed program that has received the least attention is also one of the most effective. The Maternal, Infant, and Early Childhood Home Visiting program was launched as a pilot program by the Bush administration, which then signed it into law after it was implemented as legislation by a Democratic Congress in 2008. It is routinely held up as a model of evidence-based policymaking, because the law sets an outcome Congress wants, but leaves it to people on the ground to get there and prove that they got the result they promised.
It began largely as a program involving nurses or social workers, but has expanded to other paraprofessionals who have been able to ease a new mom into the daunting world of parenting.
The program expired at the end of September due to congressional inaction and battles over its funding. Though MIECHV is relatively small, it’s part of a package of programs meant to help vulnerable children and families, along with the Children’s Health Insurance Program, or CHIP, which expired at the same time.
The House introduced a bill, H.R. 2824, to reauthorize MIECHV — pronounced “McVee” by wonks on the Hill — for five years, but the legislation also included a provision requiring states to match the federal funding dollar for dollar. In many states, that would simply end the program. House Republicans have since walked back some of that insistence on matching by allowing a plethora of options to count toward the state match, but depending on how it’s counted, anywhere between five and 38 states would no longer be able to fund their programs, as many red states with low tax rates and skimpy social spending would unable to make their match.
The Republican report on the program attempted to put it in the most optimistic light, focusing on how many could make the match, arguing that “more than a dozen states appear to exceed the FY 2022 match requirement today, and other states are likely to already meet or exceed this requirement.” Another way of putting it: Most states would not come up with matching funding, and the program would collapse.
Compounding the problem is a new strain of thinking in the post-Obamacare GOP, in which a sizable chunk of state legislators oppose all matching programs on principle, arguing that it amounts to federal coercion.
Karen Howard, vice president of Early Childhood policy at First Focus, a children’s advocacy organization, said organizations in the Home Visiting Coalition don’t support the state matching provision because they expect “states will curtail services and some states will not be able to make the match.”
The bipartisan Senate legislation, led by Sens. Chuck Grassley, R-Iowa, and Bob Menendez, D-N.J., would reauthorize MIECHV for five years without the state match provision. But the Senate has been bogged down with larger, ideological fights, like the Affordable Care Act repeal attempts and now major tax reform, preventing action on smaller programs that receive wide bipartisan support.
The Senate Finance Committee, which has jurisdiction over the MIECHV program, in October released a discussion draft of extender programs that they would package and take to the Senate floor. The extender draft includes a two-year extension for MIECHV.
Sen. Orrin Hatch, chair of the Finance Committee, didn’t have any updates on the status of MIECHV legislation but did say the program is “something I’m interested in,” in a brief hallway interview with The Intercept.
“We obviously want this reauthorized for five years without a state match and for no less than level funding, which is $400 million per year,” Howard said. “We’re really urging Congress to get this really good, bipartisan-supported program that’s really working for children and families. It’s accountable, states like it. There’s a tribal program that’s very successful as well that’s part of MIECHV.”
Howard said the Home Visiting Coalition has been working for about 14 or 15 months to urge Congress to reauthorize funding.
“We have bipartisan support in Congress. … I can’t think of anyone who opposes this program because it’s accountable and it’s working,” she said. “States have embraced this program and have really implemented it, and the programs that they’re seeing on the ground are doing great work with children and families.”
The expiration of funding for the program means “states right now are continuing to deliver home visiting services to families,” Howard said, “but pretty soon we think that states will have to curtail services.”
“Most of the models make a multiyear commitment to families and the longer we go, into December and January, the more likely that programs will start to freeze enrollment, curtail services, and ultimately, if they don’t get their money, shut down their programs,” she said. “Those are the consequences in the simplest form.” Recruiting workers to the program also becomes a challenge as Congress allows it to lapse.
Home visiting has existed as an intervention program for decades. Typically, a visitor will come to the home of a pregnant mother during her pregnancy and, though there are various models, will often continue until the baby is a toddler. The visits are on a weekly, biweekly, and sometimes monthly basis.
The leap from being childless to becoming a parent is one of the greatest a person will take, and it’s often done in the dark. Home visitors provide a variety services to families, including screening children for developmental delays, providing guidance on topics like breastfeeding and safe sleep practices, and providing referrals to address postpartum depression, substance abuse, and family violence.
Data from state and nonprofit grantees found 98 percent of participants showed improvement in areas, like maternal and newborn health, crime, domestic violence, and family economic self-sufficiency.
“What we see is improvement in birth outcomes, early childhood health outcomes, improvements in parenting skills, reductions in child abuse and neglect, as well as preventable injuries, reductions in reliance on welfare, reductions in substance abuse, improvements in school readiness of the child, and improvements in parental economic
stability,” Howard said. “And those models and the services have been vetted through rigorous tests over many, many years.”
Parents and children who have received home visiting have seen improvements “lasting over 15 and 20 years.”
“As the child entered adolescence, they’ve seen reductions in criminal activity, improvements in health, improvements in family stability, improvements in parental income, as well as parents getting their GED and going on to higher education and more gainful employment,” she added.
The MIECHV program has provided almost 3.3 million home visits over the past five years, according to the Maternal and Child Health Bureau. In fiscal year 2016, around 74 percent of participating families had household incomes at or below the federal poverty line, and 22 percent of newly enrolled households included pregnant teens.
Many of the parents the visiting program serves are young teenage moms and other vulnerable parents, like mothers and fathers “who may have been in the child welfare system themselves, who may have really significant challenges from poverty to