Remarks to the Association of Maternal and Child Health Programs

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by HRSA Administrator Mary K. Wakefield, PhD, RN

February 13, 2012
Washington, D.C.

Thank you, Michael (Fraser, CEO of AMCHP), for your terrific leadership of AMCHP in its long-time partnership with HRSA.  And thanks to all of you for being here this morning.

I want to start off today by saying how happy we are to have Dr. Michael Lu as the new Associate Administrator in our Maternal and Child Health Bureau.

I imagine that many of you heard him speak yesterday, so you have a good idea why we are so fortunate to have his commitment and his expertise at HRSA.

I’d also like to recognize HRSA staff that are here – please stand.

Looking back, we are four months from the 100th anniversary of the creation of the Children’s Bureau, the organizational precursor to HRSA’s Maternal and Child Health Bureau.  

And looking forward, we are two years from full implementation of the Affordable Care Act, which is one of the most significant laws to support the health of mothers and their children since the Social Security Act was passed in 1935.

And while the ACA doesn’t go into full effect until 2014, since President Obama signed the law there has been significant progress, already, to celebrate.  

Clearly, a lot has been said and written about the law – some of it not always entirely accurate – so let me take a moment to highlight some of the provisions that have an immediate and very real impact for children and families:

• The law prohibits companies from denying insurance coverage to children with pre-existing conditions.  That’s a vital benefit, for example, for children with inherited or acquired disorders.
• The law allows youth and young adults to remain on their parents’ health insurance plans until age 26.  Did you know that already, as a result of this law, 2.5 million young people have gained coverage?  And an even greater number of parents have gained immeasurable relief.  This part of the law alone could eventually affect up to 8.6 million uninsured young adults nationwide.
• The law also eliminates lifetime caps on benefits, which relieves a particularly cruel burden on children with chronic conditions that require regular costly therapies.  
•  And in a few months, beginning August 1, the law will require most new and revised health insurance plans to provide a comprehensive set of preventive services for women with no cost sharing.  Those preventive services include well-woman visits, support for breastfeeding equipment, domestic violence screening and contraception coverage.  

These are just some of the important new coverage provisions impacting mothers and children. However, the Administration’s priority on the health and well-being of mothers and children is evident in many of the other provisions of the ACA that go beyond health insurance coverage. Let me mention a few of them.

Just last week Secretary Sebelius announced $40 million in funds for an initiative called “Strong Start” to help reduce the increasing number of preterm births in America and ensure that more babies are born healthy.  I believe Dr. Lu may have mentioned it yesterday.

Through this initiative, the Center for Medicare and Medicaid Innovation will award grants to health care providers and coalitions to support the testing of enhanced prenatal interventions.  

At HRSA, we too have responsibility for other ACA-funded initiatives.  For example, the Healthy Weight Collaborative is a national, data-driven quality improvement effort to share and spread evidence-based and promising interventions to prevent and treat obesity for children and families.  Teams comprised of representatives from primary care, public health and local communities are implementing, testing and disseminating evidence- and experience-based interventions to prevent obesity.  Ten teams are participating and 40 more teams will be added.

The Collaborate for Healthy Weight Initiative relies on many partners, including AMCHP, which, as you may know, is part of the consortium of national partners.  You can find more information about the initiative and how to participate at www.CollaborateForHealthyWeight.org.

Also illustrative of the support for mothers and children was the Affordable Care Act’s creation of the five-year, $1.5 billion Maternal, Infant, and Early Childhood Home Visitation Program.

Under the Home Visiting program, nurses, social workers and others visit pregnant women, young children and their families in high-risk communities.  There, they provide counseling and intervention services that research shows are associated with improved health outcomes.

In terms of health care services, we’re typically very good at delivering intensive services to newborns in hospitals, but too often that’s where the care stopped.  The Affordable Care Act recognizes that it doesn’t make sense to send new mothers home with little or no support only to see them return later through the emergency room door.  Home Visiting represents an opportunity to reach and teach families and, in the process, strengthen the health of infants and their mothers.

Also critically important to health care in this country has been the President’s determination to expand access to primary care, and that focus is one of HRSA’s principal responsibilities under the Affordable Care Act.  In terms of primary care, we are making good headway in putting clinicians’ boots on the ground where they are needed most.

With about 10,000 clinicians currently in the field, for example, we have almost tripled the size of the National Health Service Corps since President Obama took office.  That expansion from just 3,600 primary care Corps clinicians in 2008 resulted from the Affordable Care Act’s investment of $1.5 billion over five years to expand their ranks.  From nurse midwives to pediatricians to dentists and others, Corps clinicians now serve more than 10.5 million patients in underserved communities.

On a parallel track, our grantees in the Community Health Center network have boosted the number of patients they serve to an all-time high of 19.5 million people at more than 8,500 sites.  The Affordable Care Act invested $11 billion over five years to support and expand health center operations.

Health centers serve a lot of the populations you care for.  More than a third of all health center patients are children under the age of 19, and almost 60 percent of them are women and girls.

For much more detail about how the Affordable Care Act impacts specific people and populations, I strongly urge everyone here to check out the website and become familiar with www.healthcare.gov. Healthcare.gov is the most comprehensive information source available on the new law, and as new information is made available it’s posted there.

Let me wrap up by telling you how encouraged I am to see many states involved in efforts to implement the Affordable Care Act and in efforts to diminish infant mortality.

Here’s one example: 28 states are now on their way toward establishing Health Insurance Exchanges — a key component of health care reform.  These Exchanges are one-stop marketplaces where consumers can choose a private health insurance plan that fits their health needs.  Beginning in 2014, the Exchanges will offer consumers the same kinds of insurance choices that members of Congress get.

Here’s another example: 23 states recently qualified for $296 million in federal bonuses for increasing the number of insured children within their states, while streamlining procedures to make it easier for kids to get in – and stay in – the CHIP and Medicaid programs.

Meanwhile, all 59 states and jurisdictions are answering the call to step up the fight against infant mortality. And the states in HHS Regions 4 and 6 are now targeting behaviors that impact birth outcomes, including a focus on reducing elective preterm deliveries and promoting smoking cessation, among other strategies.

In addition, some states are looking at strategies such as improving access to interconception care, promoting safe sleep positions, preventing infant injury, and perinatal regionalization to reduce infant mortality in their states.

To see what HRSA is doing in your state related to these and other programs, I recommend that you visit a new tool available on the HRSA home page at www.hrsa.gov.  The tool is called “HRSA in Your State,” and it features information on current HRSA grants down to the county level.  It also provides state-specific information on health centers, NHSC clinicians and the communities they serve, and the number of participating 340B providers.

This is the kind of information each of you can use to determine other federal assets in your state.  You can use the information there to look for opportunities to collaborate around a shared agenda, targeting shared populations, that you and other HRSA grantees serve though our federal investments.

In addition to reviewing this tool, I know you’ll share and learn more about the various emerging state-based approaches and strategies over the next couple of days.  And I know that as part of this conference, key players from each state will be working collaboratively on ideas that can be shared across regions.

As you learn and share, please don’t keep those ideas to yourselves. We want to hear them – especially when it comes to ways to improve coordination, enhance quality and share data.

Through all of our efforts we need to ensure that resources are used as effectively and efficiently as possible, and that takes cooperation and commitment – from local to state to federal levels.

It isn’t about preserving silos of funding – it’s about aligning resources.  At the federal level, we know we have work to do in improving our own internal coordination, too.  For example, inside HRSA, coordination between MCHB and our Bureau of Primary Health Care will be one of Dr. Lu’s primary focus areas in the year ahead.  I imagine you heard him say so yesterday.

I know it is Michael Lu’s priority, and it is shared by Jim Macrae, his counterpart in HRSA’s Bureau of Primary Health Care, which oversees the Community Health Center network.

Through our collective commitment, under the Affordable Care Act, there has never been a better time to make a lasting difference in the lives of America’s women, infants and children – together.

And with our new tools, and a renewed commitment to work across programs and health sectors, we look forward to engaging this agenda with AMCHP and with each of you.