Children's Monitor Online
A Public Policy Update from the Child Welfare League of America

   
   
Vol. 22, Issue 28: 7/27/2009   
Headlines

Two House Committees Approve Health Reform Bill

Senate Vote on Health Reform Delayed until After Recess

House Takes Up Labor-HHS Appropriations

Early Learning Fund Bill Passes House Committee

Olivia Golden Presents New Book on Child Welfare Reform

CWLA Continues Survey on Prevention

Key Upcoming Dates for Congress



Two House Committees Approve Health Reform Bill

Two of the House Committees with jurisdiction over health reform passed legislation out of Committee that would overhaul our nation’s health care system. On July 17, the Ways and Means Committee approved the tri-Committee’s health reform legislation, the America’s Affordable Health Choices Act (H.R. 3200), with a vote of 23-18. Three Democrats on the Ways and Means panel voted against the bill. Later on July 17, the Education and Labor Committee also voted H.R. 3200 out of Committee with a vote of 26-22. Three Democrats on that Committee also voted against the bill.

H.R. 3200 was introduced jointly by the three House Committees on July 14. The bill would place shared responsibility on individuals, employers, and the government to ensure that the vast majority of Americans have health coverage. Exceptions to the requirement would be available for individuals facing hardship and the smallest businesses, with other small businesses able to get a tax credit. Effective in 2013, Medicaid would be expanded by the House bill to cover all individuals falling below 133% of the federal poverty level ($14,400 for an individual). To cover more of the uninsured and provide choice, an insurance exchange would be created whereby individuals and small businesses could purchase coverage, with the option to buy a public plan. Certain benefits would be mandatory--including preventive services, rehabilitative and habilitative services, mental health, and substance abuse services--and, for children, vision, hearing, and oral health services.

The third House Committee with jurisdiction over health reform, the Energy and Commerce Committee, worked diligently on H.R. 3200, but had to postpone mark-up for a couple of days last week so that discussions could take place to ease concerns of the Committee’s fiscally conservative “Blue Dog” Democrats. Energy and Commerce Chairman Henry A. Waxman (D-CA) was able to reach verbal agreement with members of the Blue Dog Coalition that an independent advisory council would set Medicare rates in order to keep cost down. Other issues had to be worked out before Waxman would resume committee mark-up.

House Speaker Nancy Pelosi at a press conference last Wednesday indicated that the House has the votes they need to pass health reform legislation. The House is scheduled to begin its month-long recess on July 31. A possibility remains that the House would not adjourn until further work on health reform is accomplished, but Pelosi also stated last week that she is “not afraid of August” and believes that the House can quickly resume work on health reform once it returns.

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Senate Vote on Health Reform Delayed until After Recess

Two Committees in the Senate have been working on separate pieces of health reform legislation. The first, the Senate Health, Education, Labor and Pensions (HELP) Committee, passed its bill on July 15 with a party-line vote, 13-10. Like the House bill, the HELP Committee’s reform legislation would place shared responsibility on individuals, employers, and the government to ensure that most Americans receive health coverage. An individual hardship exemption would be available and to help make coverage affordable, the HELP Committee’s bill would provide sliding scale subsidies to individuals up to 400% of the federal poverty level. Small businesses would not be held to the insurance requirement, but other employers would have to offer coverage to their employees, contribute at least 60% of the premium cost, or pay $750 per full-time employee who is not offered coverage. The HELP Committee hopes to expand the Medicaid program to cover individuals below 150% of the federal poverty level. The HELP Committee's version, like the House bill, currently includes a public health insurance option.

Key members of the Senate Finance Committee continued bipartisan closed-door meetings to finalize their health reform bill. Mid-week, Senator Orrin Hatch (R-UT) dropped out of the Finance Committee talks, but three Republicans--Ranking Member Charles Grassley (R-IA) and Senators Olympia Snowe (R-ME) and Michael Enzi (R-WY)--remain. Discussions largely centered around keeping the overall package’s cost down. Once Finance Committee language is released, it will have to be marked up, voted out of committee, and then merged with the Senate HELP Committee’s bill. Senate Majority Whip Richard Durbin (D-IL) and Majority Leader Harry Reid (D-NV) have both said publicly that the full Senate will not vote on health reform legislation prior to its August recess, which begins August 7.

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House Takes Up Labor-HHS Appropriations

The House has started to debate the appropriations bill for the Departments of Labor, Health and Human Services, and Education (Labor-HHS). It is one of the last of the 12 appropriations bills the House must act on before leaving for Congress’s August break. Overall, the bill includes $160 billion in discretionary spending, which is an increase of $5.6 billion from this year’s funding level. It is also in line with what President Barack Obama had requested, spending approximately $50 million less. The bill, which funds all three departments, also provides $567 billion in mandatory funding, most of which applies to HHS and represents mandatory funding for Medicare and Medicaid.

The bill does not differ dramatically from what the President had asked for in specific programs such as Head Start, which received an increase of $120 million to $7.2 billion. The bill provides approximately $7.3 billion for Title IV-E mandatory/entitlement programs, which include foster care, adoption assistance, and kinship care. The bill does not fund the President’s Early Learning Challenge or the home visiting programs but that is due to the fact these new proposals are being addressed under health reform, and funding is expected to come from a college loan reform bill and through the health reform bills. The bill provides funding for some of the Administration’s other new priorities, such as $20 million for innovative programs that can reduce long term foster care, $10 million in planning grants for Promise Neighborhoods, $35 million for social innovation grants, and $110 million for a teen pregnancy prevention initiative which is funded by transferring funding from abstinence-only approaches.

The $20 million to reduce long-term foster care would be a competitive grants program whose goal is to focus on program approaches and policies that have been successful in reducing the number of children who spend a very long time in foster care. The Administration envisions an incentive feature that would reward successful initiatives. The social innovation fund would provide support for community-based efforts that seek to tackle social problems or challenges by building partnership at the local level. The Promise Neighborhood initiative is based on the current Harlem Children’s Zone, which is a comprehensive school-based program that wraps services and supports to young children and their families at a very young age and continues that support throughout the child’s school years. President Obama highlighted the Children’s Zone and its successes often during last year’s campaign.

If the House completes work on all 12 appropriations bills, they will leave for the August break still on target to complete all appropriations by the start of the federal fiscal year on October 1. To accomplish that, however, the Senate will have to move on a number of appropriations bills in September with the competing priority of health reform. The last time Congress approved all appropriations before the start of the fiscal year was 1996.

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Early Learning Fund Bill Passes House Committee

Last week, the House Committee on Education and Labor passed the Student Aid and Fiscal Responsibility Act of 2009, H.R. 3221. Although the bill is written to reform the way college loans are provided and financed, Title IV of the bill creates an Early Learning Challenge Fund. The fund would provide an early down payment on President Obama’s efforts to better coordinate services and support to the birth to age five population. One part of that effort is the home visiting legislation that is being debated as part of health care reform, but another important effort is better coordination and greater funding between Head Start, child care, and state pre-K programs.

The new Early Learning Challenge Fund would be competitive grants to states to coordinate services and standards for and between those early childhood programs. Coordination is actually required as part of the state application and planning process. The overall goal of the new initiatives is to improve early learning standards across programs, enhance program review and monitoring, improve and provide comprehensive professional development, improved support for parents who may use or enroll their children in one or more of the programs and to improve outcomes for children participating in these early learning programs. The legislation also directs the U.S. Department of Health and Human Services (HHS) and the Department of Education to jointly administer the program. The funding is set at $1 billion a year from 2010 through 2019. Funds are raised through the changes that the overall bill makes to the college loan process. The bill would convert college loans to a direct lending program by the federal government. Currently, the college loan process is split between private lenders and direct federal loans. By converting from private loans to direct lending, the bill is projected to save $87 billion over the next 10 years. The bill is being passed as part of a reconciliation process, which is due to be enacted by October 15 of this year.

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Olivia Golden Presents New Book on Child Welfare Reform

The Urban Institute held a Child Welfare Forum on Uniting Leadership, Policy, and Research to Serve Vulnerable Children and Families on July 24. Olivia Golden, who recently published a book entitled Reforming Child Welfare, was amongst the panelists present; the book was the basis of most of the discussion. Also on the panel was Brenda Donald, the secretary of the Maryland Department of Human Resources, who worked closely with Golden while at the DC Child and Family Services Agency, a CWLA member. Christine Calpin was also present and discussed her previous experience as associate commissioner of the Children’s Bureau and as a staffer on the House of Representatives Ways and Means Committee. Barbara Pryor, who is a legislative assistant for Senator John D. Rockefeller (D-WV), gave an overview of child welfare legislation, and discussed the progress that has been made while also sharing some of the challenges that are going to be inevitable going forward with child welfare reform. Donna Shalala, the longest serving Secretary of Health and Human Services (HHS) and current president of the University of Miami, spoke about her tenure at HHS.

The major themes from the forum included determining what the biggest challenge or battle will be when fully reforming child welfare, the complexities of families involved in the child welfare system, and the administrative burden on child welfare workers. In addition, panelists discussed the role of early childhood in the child welfare system, the role of the federal government in reforming child welfare, and what role, if any, evidence-based practice should play in reform. Finally, the panelists attempted to address dealing with an imperfect system, and how to get the most out of that system and its workforce.

From a policy standpoint, there were recommendations to increase funding prevention and other front-end services, improve the data collection systems, and strengthen coordination between schools and the child welfare system. In the field, the panelists recommended working on ways to correctly identify services and needs of these vulnerable families, and to begin to shift focus from means testing to targeting geographic areas that may be in need of prevention services. The panelists agreed that the child welfare system is complex, that reform has to be ongoing and will take the collaboration and cooperation of the families, the community, and policymakers.

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CWLA Continues Survey on Prevention

Last fall, CWLA posted a brief poll on our website asking what the White House Conference on Children and Youth should focus on. In the poll, individuals were asked to select three top issues. Prevention of child abuse and neglect was ranked by 16% of respondents as the number one priority--coming in ahead of other critical areas such as strengthening child protective services (14%) and youth transitioning out of foster care (11%). As a result and to continue the process, CWLA is going to use these survey findings to gather more information on each of the critical issues. We are asking you to take a new three-minute survey focused on prevention. Take the prevention survey and tell us what prevention services exist in your community. Are there waiting lists? How would you describe prevention?

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Key Upcoming Dates for Congress

July 22-24: Target date for House to debate and pass Labor-HHS appropriations
August 1-September 7: House summer break
August 8-September 7: Senate summer break
October 15: Deadline for budget reconciliation instruction

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