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Fate of Home Visitation Program Is Tied To Health Reform Bill

In May, when President Obama released his budget proposal for fiscal year 2010, he requested funds -- $124 million for the first year -- to create a federal program to send nurses to the homes of low-income women who are pregnant or caring for babies. The idea was to scale up fledgling programs that, according to randomized and controlled studies, improve women's and children's health and well-being and can reduce healthcare costs in the long run.

Home visitation doesn't appear in the Labor-HHS-Education appropriations bill moving through Congress this month; it was proposed to reside on the "mandatory" side of the funding column and therefore not be subject to the year-to-year appropriations process. But it does have a spot -- for the moment at least -- in the massive health-care reform bills being shaped in fits and starts this summer.

The program is part of the text of H.R. 3200, the health care bill being jointly developed by three committees in the House of Representatives.  Two committees -- the Education and Labor and Ways and Means Committees -- have already voted yea for the parts of the bill that are under their jurisdiction. A large chunk of the home visitation program would become law with an amendment to the Social Security Act, which puts it under the jurisdiction of the Ways and Means Committee.  That committee kept the program intact but dropped its price, authorizing it as a five-year, $750 million program instead of the $1.75 billion that was initially proposed.

Now there is just one more hurdle on the House side before the bill can get to the floor: The Energy and Commerce Committee, which is responsible for approving changes to Medicaid. Advocates are hopeful that Medicaid provisions relevant to the home visitation program will be included in whatever version of the bill the committee will eventually pass.

That's not even half the battle, though. Over in the Senate, it is likely - but not guaranteed - that the program will become part of its version of health care reform. Advocates are anxiously waiting for action from the Senate Finance Committee -- as is anyone who is following the fate of health care reform this summer.

Another Senate panel -- the Health, Education, Labor and Pensions Committee - has already voted on the portion of the health reform bill that is under their jurisdiction. But alas, it doesn't hold the reins on the home visitation sections and so has no direct impact on how or whether this program will survive the legislative process. That isn't to say, of course, that members of the HELP committee who have championed early childhood programs are not involved in advocating for its inclusion.

Sen. Harry Reid announced last week that the full Senate will not try to bring the bill to a vote before September, so it's possible that we will not see any more movement on this particular proposal until after Labor Day.

So what would this home visitation program look like? Early Ed Watch provided details of Obama's proposal back in June, and the bill under consideration started from that outline. In essence, it would issue grants to states to help them pay for nurses or other professionals who visit the homes of poor women who are pregnant and/or have young children.

Yet more details come from a bill originally introduced as the Early Support for Families Act on June 2 in the House Ways and Means Committee by Jim McDermott (D-WA), one of the committee's members and chair of the Subcommittee on Income Security and Family Support. The House version of the healthcare bill has now taken up that bill's language. It would be up to individual states to determine whether the program must employ nurses, social workers, early childhood specialists or trained volunteers, but all states would have to show evidence of their programs' effectiveness. Advocates have been debating what that evidence should look like. The bill passed by the House so far is not limited to randomized controlled trials, which can be expensive, but it does require evaluations of how children and mothers are faring before and after the program is established.

To follow the nitty gritty details of the bill, you have to look at two different parts. One piece, section 1904, would establish the grant program to provide funds to implement a system of home visitation at the state level that would apply to mothers of children "under the age of school entry." (That's the section putting home visitation under a subsection of the Social Security Act.) The other, section 1713, adds an option to the Medicaid law allowing states to get reimbursed under Medicaid for nurses visiting the homes of eligible pregnant women and mothers of children under 2.

Meanwhile, outside the halls of Congress, more scientific research has appeared to support the argument for making these kinds of investments in a child's earliest years. A study released last month by Child Trends shows that when infants are raised in high-poverty conditions, their cognitive abilities start to decline, with disparities showing up as early as 9 months of age. By 24 months of age, researchers report, the differences become even more pronounced.

Also in June the Journal of the American Medical Association published commentary by James A. Mercy and Janet Saul, two researchers at the National Center for Injury and Prevention. They stressed that helping children at very early ages not only gives them a chance for better cognitive skills and school performance, but can also make a profound difference in their long-term health. The article reiterates the findings of the Nurse-Family Partnership , one of the most often cited models for home visitation programs, which has been shown to reduce abuse and injury, improve cognitive and social skills and return economic dividends to society over time.

"The time has come," the authors wrote, "to act on scientific knowledge about preventing early exposure to adversity and promoting positive child development." We couldn't agree more. As the home visitation program moves through Congress, we'll keep you updated on what shape it takes.


I doubt it's a coincidence

I doubt it's a coincidence that Rep. McDermott sponsored this bill and Seattle's White Center neighborhood is home to a cutting edge home visitation program backed by the Gates Foundation.

Government in private homes

Government needs to stay out of the homes of private citizens. They have no right under any pretense to demand visitations to homes no matter the income level. If a parent request a visit that is one thing. If not, stay out.