Remarks to the Secretary’s Advisory Committee on Infant Mortality

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By HRSA Administrator Mary K. Wakefield

July 9, 2014
Rockville, MD

Good morning.  I want to begin by thanking all of the committee members for your time and efforts dedicated to this committee and also thank you for your leadership in working with us on a number of fronts to reduce infant mortality in America.

Last year when I spoke with you I discussed the recommendations you had developed in your January 2013 report to the Secretary, the “Framework for a National Strategy” to reduce infant mortality.  I mentioned to you that the recommendations aligned very well with ongoing HRSA activities and priorities.

Today I’d like to tell you what actions are currently underway at HRSA and HHS that are relevant to and support the focus of your recommendations.  I think we’re making progress in a number of areas.

The first strategic direction of the 2013 report was pretty straightforward in its statement but, of course, highly complex in its attainment:  to improve the health of women before, during and beyond pregnancy.  

Clearly, for more than two decades, prenatal care had been the cornerstone of our national strategy for reducing infant mortality.  But when efforts to increase prenatal care utilization did not cause a significant improvement in birth outcomes, most experts came to recognize that to improve pregnancy outcomes in the U.S., we also have to improve women’s health before pregnancy.

And the real game changer in implementing that strategy – the change that puts health care for women across their lifespans in reach -- is, of course, the Affordable Care Act -- the most important piece of legislation for maternal and child health in the last 50 years.

As some of you know, over 8 million individuals have signed up for health insurance through the Marketplace, and that number continues to climb.  And 3 million previously uninsured young adults have been able to remain on their parents’ health insurance plan until age 26.

In terms of expanded access to Medicaid and the Children’s Health Insurance Program alone, 5.2 million additional individuals have enrolled in health insurance coverage through those two programs since open enrollment began.

In Kentucky alone, Medicaid expansion has helped to reduce the number of uninsured individuals by half.

The 24 states that have yet to expand Medicaid could collectively provide health insurance coverage to 5.7 million of their neediest, poorest residents and boost their economies at the same time.  Instead, to date, those 24 states are leaving substantial federal dollars on the table even as their residents struggle with the same old worries about how to pay for health care when injury or illness strikes.  So clearly there’s more work to do in states that haven’t yet expanded Medicaid.  

Women also benefit from the ACA’s prohibition on the discriminatory practice of gender rating – charging women higher premiums because of their gender.  The ACA also prohibits the practice of denying coverage for pre-existing conditions like breast cancer and ends lifetime caps on benefits, which is expanding access for millions of women with chronic conditions.

And, as you all know, millions of women, children, and families are benefiting from access to preventive services mandated by the ACA.  This particular and vitally important element of the law speaks to your strategic direction #3 from last year’s report:  “deploy evidenced-based preventive interventions to a new generation of families.”

An HHS study released last month found that about 76 million Americans in private health insurance plans are now newly eligible to receive expanded coverage for one or more recommended preventive health care services, such as a mammogram or flu shot, without cost sharing, because of the Affordable Care Act.

Of those 76 million Americans with expanded access to free preventive services:

• 18.6 million are children who are able to receive coverage for immunizations; vision screenings; and hearing screenings at no out-of-pocket costs to families, for example.
• And 29.7 million are women who can receive coverage for preventive services like mammograms and screenings for obesity and cervical cancer.

There’s still a lot we need to do, and I encourage you to help us continue to get the word out about the coverage options that are available right now.   For example, some people don’t know that they are eligible to sign up for health care coverage whenever a life circumstance changes their connection to health insurance, say through getting married -- or divorced – having a baby, or graduating from college.  The option to sign up associated with life changes continues throughout the year.

Additionally, we know that, too often, folks who now have health insurance – many for the first time -- may not be aware of the range of ACA benefits that I just discussed.  They may think, incorrectly, that preventive services like mammograms aren’t covered or even wonder why those services are important.  I can tell you that two days ago I was explaining this very point to someone when I was back home in North Dakota.  

So once we’ve gotten folks enrolled, clearly we still have work to do.  To help us with that, our colleagues at CMS have created a new website called “From Coverage to Care” to help health care providers  with patients and others on topics that many of us take for granted, but that may be foreign to a lot of those newly insured Americans, such as:

• What it means to have health insurance;
• How to find the right provider;
• When and where to seek health services; and
• Why prevention and partnering with a steady source of care is important for good health.

From Coverage to Care is a great addition to the next phase of our ACA outreach.  It’s information that can be made available through schools, board rooms, class rooms, exam rooms, patient waiting rooms.  

I encourage you to go the Coverage to Care site at marketplace.cms.gov and familiarize yourselves with those resources.  They’ll be valuable for all of us as we enter this new phase of outreach.

We’re also making progress on your strategic direction #2 -- ensuring access to a continuum of safe and high-quality, patient-centered care -- by continuing to invest ACA funds into the ongoing expansion of the HRSA-supported community health center network and the National Health Service Corps.

Because the ACA’s authors recognized the critical need in this country to boost access to primary care infrastructure as they expanded access to affordable health insurance, they invested $11 billion over five years in health centers, which -- through a network of 9,500 health center sites, from mobile vans to new multi-story clinics -- deliver primary care to anyone who seeks it.

Health centers now deliver primary and preventive care to more than 21.7 million patients (2013) – and that’s up from 17 million when President Obama took office.  Going forward, the President’s FY 2015 Budget asks Congress to continue this sharp focus on primary care by requesting funding that would allow health centers to serve approximately 31 million patients next year.

This much-needed boost to the primary care infrastructure provides a comprehensive range of services, including oral health, behavioral health, and vision care, in addition to traditional primary health care.  

Of course, many health centers employ primary care providers who joined HRSA’s National Health Service Corps, including approximately 400 pediatricians who have committed to practice in underserved areas in exchange for student scholarships and educational loan repayments. Thanks in large part to the ACA, they are among the 8,900 physicians, nurses, dentists and other providers helping to expand access to health care services for the most vulnerable.

Let me move next to your Strategic Direction #6: Maximize the potential of interagency, public-private, and multi-disciplinary collaboration.  In this direction, we’re pleased that preliminary data from March of this year show notable gains from the Collaborative Improvement and Innovation Network initiative to reduce infant mortality and improve birth outcomes in HHS Regions IV and VI.  

The data indicate a 28 percent decline in non-medically indicated early term deliveries – that translates to approximately 68,000 early, elective deliveries averted since the first quarter of 2011.  The regions also report a 6 percent decline in smoking among pregnant women during that same time frame.

While we cannot attribute the decline in early deliveries and in smoking among pregnant women entirely to the Infant Mortality CoIIN, we are satisfied that it has provided a solid platform to accelerate momentum and sustain improvements across the initiative’s five priority areas.

And we are sufficiently encouraged by the new data that we plan to take the Infant Mortality CoIIN to all regions of the country and make it a national movement before the end of 2014.

Finally, I’d like to tell you about our efforts to reframe and transform our Healthy Start program, which respond directly to your report’s strategic direction #4 -- to reduce disparities by investing in high-risk, under-resourced communities.  And since elements of the planned transformation of Healthy Start include strategies to improve quality, expand access to care, and invest in surveillance systems to measure outcomes, the changes actually touch on multiple strategic directions.

One of the most prominent revisions to Healthy Start is a new information system that will capture grantees’ efforts to enroll clients in Medicaid and connect them with the community health care system.  As implementation of the ACA progressed, many Healthy Start grantees already expanded their outreach and enrollment activities.  And a survey taken earlier this year anticipates that each Healthy Start grantee will enroll an average of 150 clients per month in health insurance coverage.  This work is critically important.

And beginning September 1 of this year, HRSA will begin collecting client-level data from each woman and infant served to determine initial health status and needs at enrollment; track services received; and then measure the real-time impact of those services throughout the client’s participation in Healthy Start.

Before the end of this fiscal year, we plan to announce three sets of new and competing continuation Healthy Start awards.  Two sets of awards will focus on improving women’s health by promoting quality services; strengthening family resilience; increasing accountability; enhancing performance monitoring; and encouraging community collaboration around a common agenda.

The third set of awards – called the Leadership and Mentoring Healthy Start awards – will establish a Healthy Start CoIIN.  You’ll hear more details about those plans later today.

With that, I thank you for giving me this time to explain what HRSA has done over the past year to support your work and for allowing me to share with you our plans to reduce infant mortality and improve women’s health in the future.