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Campaign Promises and Election Victories: What Do They Really Mean for Our Future?

By YaMinco Varner

Throughout the 2012 election cycle, Democrats and Republicans agreed on one thing: that the election would serve as a mandate for the future of the Affordable Care Act (ACA). Democrats declared that since the enactment of the ACA in 2010, over 3 million young adults have been allowed to stay on their parents' health insurance plans, decreasing the number of uninsured young people; that 86 million people now have access to preventative services; and that seniors are saving money on their prescription drugs. Republicans, on the other hand, claimed that the Medicaid expansion would negatively impact state budgets by placing undue burden on states that are already struggling. They insisted that the long-term costs of the ACA would be absorbed by consumers and well-intentioned employers. Finally, they contended that certain provisions of the law infringed on the religious and individual freedoms of Americans--and that it therefore had to be repealed.

When President Obama and Governor Romney hit the campaign trail, they tried to convince voters that this election was about the future of health care in America. Obama made the case that Americans deserved access to affordable health care coverage, regardless of whether they had a preexisting condition, and vowed to ensure that under a second Obama administration, health insurance companies wouldn't be able to deny access to care on this basis.

At the Democratic National Convention, families were featured who had benefited from the protections provided under the ACA. In addition, ads ran in key battleground states, featuring families talking about how the law had saved them from having to worry about how they would access health care when they or their loved ones needed it most. Romney remained steadfast in his belief that the ACA constituted a government takeover of health care and pledged to repeal the law on his first day in office. His team highlighted small business owners who spoke frankly about their apprehensions regarding the ACA and what it would mean for their ability to provide health care insurance for their employees. Some spoke to their fears about being hit with fines for failure to comply with certain provisions in the law, which consequently would hinder the likelihood that they would be able to hire in the future. Unfortunately, both sides exploited the very fears that the law was designed to assuage; mainly, that the law would help families who had been unable to access affordable health care, and that the individual mandate (which required everyone to obtain some level of coverage) would bring down the costs across the board (for employers and consumers alike).

When Governor Romney selected Congressman Paul Ryan (R-WI) as his running mate, some criticized his selection, arguing that Ryan, in his former role as Chairman of the U.S. House Budget Committee, authored The Path to Prosperity: A Blueprint for American Renewal, which proposed drastic cuts to entitlement programs, including Medicare and Medicaid. The criticism also seemed to center on the fact that in 2006, when Romney was governor of Massachusetts, he signed a health care insurance reform law that expanded the state's Medicaid program (for tens of thousands of children and families)--which, in light of his campaign promises to repeal the Affordable Care Act (including its Medicaid expansion), seemed inconsistent. While Governor Romney offered few specifics with respect to what a potential Republican Administration would propose to do with the Medicaid program, many took his selection for VP as a clear sign of what the future of Medicaid would look like under his administration. This would include block granting the program, which Republicans maintain is better for states. It is important to clarify, however, that a Medicaid block grant would set a cap on funding states receive to run their program, and potentially leading to enrollment caps, reduced services, and out-of-pocket expenses for children and families who are currently enrolled in Medicaid on the basis of not being able to afford health care coverage in the private market. Furthermore, it leaves the 2014 expansion under the ACA in limbo, without any clear indicator how of Republicans would cover the estimated 17 million people expected to sign up for the program; the funding under the block would likely be set at a level proportionate to the level of funding for covering the current beneficiaries (with respect to inflation).

The passage of the ACA in 2010, and of the Children's Health Insurance Reauthorization in 2009, gave President Obama the opportunity to make a defining statement about his vision for providing health care coverage to poor children and their families, as well as for other vulnerable groups that tend to make up the Medicaid population--including the disabled, the elderly, and children and youth in foster care. On the campaign trail, Obama renewed his commitment to care-access for the most vulnerable, condemning Republican efforts to turn Medicaid into a block grant, which would cap funding to what is currently an open-ended entitlement.

If, in fact, the election was about voters deciding which vision for America they supported, then it's safe to say that the majority of Americans voted for an administration that will be responsive to the growing needs of the vulnerable children and families, the disabled, and those who require a strong safety net that meets their most pressing needs. But what does that actually mean for future of Medicaid? For starters, it means that by 2019, most--if not all--states will have expanded their Medicaid and CHIP programs, just as they have done since Medicaid and CHIP were first enacted (though there has always been a reasonable degree of hesitation on the part of governors when the federal government has pushed for the expansion of Medicaid and CHIP). This alone ensures greater access to Medicaid coverage for children and youth currently in foster care, and for former foster youth who are now eligible for Medicaid until the age of 26.

Although they are not hot-topic issues with the general public, other provisions were included in the ACA that affect children and families who are involved with the child welfare system. Studies estimate that teen childbearing costs taxpayers $9.1 billion annually; $2.3 billion of these costs fall on the child welfare system, as children born to teen mothers are at increased risk of ending up in foster care and CPS. For the first time ever, the ACA provided federal funding for home visiting programs that target at-risk families and provide them with parenting services and equip families with the skills needed to ensure that the children and families will thrive in safe and healthy environments. The ACA also authorized funding for programs designed to educate adolescents on abstinence, pregnancy prevention, and a variety of healthy life skills, targeting at-risk populations including the homeless, those in foster care, teen parents, youth with HIV, and other vulnerable groups.

While the election will largely be viewed as a win for President Barack Obama and the Democrats, it is important to remember not only the lives that will be saved by the access to coverage provided under the ACA, but also the lives that will be improved. Children who come into the child welfare system are at higher risk for physical and mental health issues, stemming either from the maltreatment that led to their placement or from preexisting health conditions and long-term service needs. In addition, they often present unique challenges that are the direct result of exposure to several facets of trauma, including domestic violence, physical and emotional abuse, parental mental health problems, substance abuse, neglect, and poverty. Although their advocates weren't called upon to be featured in campaign ads or invited to speak about the importance of the ACA for children and families in the child welfare system, voters across the country--whether they realize it or not--voted to ensure that these often-forgotten children have a brighter and healthier future to look forward to.

YaMinco Varner is a Policy Associate at CWLA.

West Virginia Juvenile Drug Court Proving Successful

By Nicole Thieman

West Virginia Judge Darren Tallman is seeing positive results from youths undergoing alternative sentencing for drug-related offenses in Wood County's newest Juvenile Drug Court (JDC). Now one of 12 JDCs in West Virginia, Wood County is an example of an emerging trend in the judicial system.

Instead of sentencing youths to residential drug treatment centers that often have lower success rates and are more costly, states are exploring alternative programs for youths battling substance abuse. The Wood County JDC's treatment model, established in conjunction with the state's Supreme Court and modeled after other successful JDCs, is a four-phase, in-home program for juvenile offenders aged 10 to 17.

"Once a child has been found guilty of something criminal-based or status-based like truancy or they are a runaway, we are part of the sentencing phase," says Tallman. The Wood County JDC has grown from one referral to 22 since its inception, which can be attributed to the success of the program.

Depending on the severity of his or her situation, a youth in the program meets with the court anywhere from once a week to once a month. Each offender's case is monitored and their progress evaluated by a treatment team consisting of the judge, a probation officer, and a behavior specialist. As part of the program requirements, the youth undergoes individual and family counseling, community service, and regular drug tests. After the youth completes the final stage of the program, he or she graduates drug-free.

"It's different from other programs because immediate steps are taken if a rule is broken," says Tallman, who occasionally receives calls late at night about a youth who has fallen out of line with the program--but sees this kind of individualized attention as a sign of the treatment method's success.

"I tell the kids every week that this program is for them individually and that what they want to make out of their lives is up to them. I say 'think of yourself at 30 and think what 30-year-old Sally would say to 15-year-old Sally,'" Tallman says.

The uniqueness of the treatment method is that it does not remove the youth from his or her current environment, but works within the youth's own ecology, instituting immediate rewards for successes and sanctions for program violations.

Dr. Jeff Randall, an Assistant Professor within the Family Services Research Center at Medical University in South Carolina who has done research on Juvenile Drug Courts, asserts that it is important not to remove the youth from his or her environment. He notes that it is necessary to analyze the youth's whole ecology--parents, coaches, friends, teachers--to develop a support network that will help the youth in the most effective way and identify problem areas.

"Many times, youth are getting into trouble because of things in their environment--if a kid is getting drugs from a buddy, taking them completely out of their environment is only temporarily effective because that buddy will be there when they get back," says Randall. "Skills have to be taught in the actual environment where the problem is occurring."

Tallman agrees. "You can't lock kids up forever," he says. "This is where they live, and teaching them to be successful where they live is much more successful than taking them out and putting them right back in."

He adds that affordability is one of the reasons behind the push for specialized courts--the cost of a residential treatment center is greater than that of a Juvenile Drug Court, since in the latter the youth remains at home and attends his or her same school.

Although proven effective, not every state has a juvenile drug court, mainly due to the costs associated with their operation. JDCs, however, reduce long-term costs and are less expensive than residential drug treatment types.

Tara Kunkel with the National Center for State Courts agrees, noting that stopping an issue early on is more cost-effective than dealing with it down the road. Investing in a Juvenile Drug Court, she says, saves money because it removes individuals from the system and helps to stop a downward spiral of drug abuse that can lead to other behaviors like early pregnancy and continued substance abuse. "It is easier to help a kid at 15 with drugs rather than someone who has been a heroin addict for a long time," says Kunkel.

Kunkel recently helped to start a Juvenile Drug Court for the state of Virginia, and says that the popularity of JDCs is increasing; research is proving that these courts not only conserve costs, but are more effective for youth. "It is important to have JDCs because the challenges of substance abuse and experimenting among young people are driving our juvenile court system and the drug court model is very research based and can address issues that go on in a family," says Kunkel. "It is far more effective than traditional probation and is more cost-effective in this day and age."

For states interested in starting a Juvenile Drug Court or those wanting to establish more effective statewide standards within their state's JDCs, Kunkel maintains the best place to start is the National Association of Drug Court Professionals (NADCP, www.nadcp.org) or the National Center for State Courts (www.ncsc.org). "Typically, most states approach standards by looking at NADCP's key components that define at a very broad level how drug courts should operate and they are broad enough to meet every court's needs," she says.

Wood County's JDC currently has the capacity for 25 young adults in its program, and in November 2012, the marked its two-year anniversary. Tallman acknowledges that youth in the program have their good and bad weeks, but says that overall, the program has been effective.

"We are getting really good feedback and have some really tough kids doing 180s. Some schools say they can't believe it's the same kid," he says. "For many, this is the first time in their life that they've had this much structure."

Nicole Thieman is a former editorial intern at CWLA.

To comment on this article, e-mail voice@cwla.org.

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