Capital View on Kids

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The latest news on children and families in Washington D.C.

Affordable Care Act Stands Along With Children’s Provisions

On Thursday, June 28 the Supreme Court ruled in National Federation of Independent Businesses V. Sebelius, Secretary of Health and Human Services (http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf ) that the Affordable Care Act (ACA, 111-148) stands.  With that action a number of important provisions for child welfare and for vulnerable families will stay in place. It is seems unclear however how the Court’s ruling in regard to Medicaid could impact child welfare programs and other federal programs that direct states to meet specific requirements and rules as a condition of that state accepting federal funds.  As part of the challenge to the ACA states claimed that the Medicaid expansion was unconstitutional.  A number of third parties including some child welfare groups signed onto amici briefs in opposition to the state position.  Concern is that many requirements, including those guiding state child welfare systems are enforced because states accept child welfare funding through Titles IV-B and Title IV-E of the Social Security Act. The ACA in 2014 expands Medicaid to all people at 133 percent of poverty.  The expansion however is totally covered with federal funding in the first years with the federal match going down slightly to 90 percent.  If a state rejects the expansion the penalty as it is with other parts of Medicaid requirements and requirements under much of child welfare and similar programs is the loss of the federal funding for the program.   The Court did side with the states but seemed to suggest that the ACA expansion was a separate program from the rest of Medicaid.  The Court’s majority opinion did state, “Congress may attach appropriate conditions to federal taxing and spending programs to preserve its control over use of federal funds…” but they then went on to say, “[the ACA expansion served] no purpose than to force unwilling states to sign up for a dramatic expansion in health care.” The opinion gives states the choice to not expand Medicaid coverage by rejecting the new funds.

With the upholding of the ACA several provisions critical to child welfare populations and vulnerable children did stay in place including:

  • Starting in 2014, youth below the age of 25 who were in foster care for a period of six months or more can continue to receive health care through Medicaid,
  • No child can be denied health care coverage based on a pre-existing conditions (such as a form of cancer or diabetes) this provision is already in place,
  • The Children’s Health Insurance Program (CHIP) is extended through September 30, 2019,
  • Currently in effect, parents may be able to keep their dependent children on their health insurance plan up to age 26. An estimated two and a half million young adults have health insurance coverage as a result of this provision.
  • Once the exchanges are in place in 2014, families may be able to purchase child-only insurance packages.  This could be important to some kinship families where the family may not be a part of the child welfare system or be categorically eligible for Medicaid coverage through another program such as TANF.
  • Finally but critically the ACA included $1.5 billion in mandatory funds for a new Home Visitation Grant Program under Title V of the Social Security Act to support state evidence-based infant, and early childhood visitation models. The mandatory funding for this program will increase from $350 million this year to $400 million in FY 2013.

Many legal observers felt that if the court did strike the mandate and the Medicaid expansion they would leave in place the remaining pieces (separate titles of the law) but in fact the minority opinion made clear that was not their goal.  After arguing for striking the mandate and striking the Medicaid expansion the four minority members (Kennedy, Scalia, Thomas and Alito) argued that the entire law had to go, “We have no reliable basis for knowing which pieces of the Act would have passed on their own. It is certain that many of them would not have, and it is not a proper function of this Court to guess which. To sever the statute in that manner “‘would be to make a new law, not to enforce an old one. This is not part of our duty.’” And thus they argued that even provisions such as the home visitation program would have been eliminated.

First Focus Releases Assessment of Federal Spending on Children

On Wednesday, June 27th, First Focus released its annual Children’s Budget for 2012 (http://www.firstfocus.net/cb2012).  Released at a budget summit, the report indicates that children now receive less than eight percent of federal funding while the Defense budget is more than three times that level of spending.  In addition, by 2014, interest payments as a result of the national debt will exceed what we spend on children.  The report also calculates that federal funding allocates seven dollars on the elderly for every dollar spent on children. The report actually shows spending increasing for children over a five year period going from $220 billion in 2008 to $276 billion in 2012 but shows spending declining between 2011 and 2012.  In addition most of the increases can be attributed to the American Recovery and Reinvestment Act (ARRA/stimulus funding) or it has come from mandatory programs such as health insurance (Medicaid and CHIP) or other low income support programs such as the Supplemental Nutrition Assistance Program (SNAP).  When discretionary spending is isolated, spending on children had a slight increase going from $73.5 billion to $77.3 billion which is actually a 2.6 percent decrease when adjusted for inflation. In regard to child welfare the report calculates that funding is the same in 2012 as it was in 2008 with a temporary bump up in between those years due to ARRA funding.  Funding was set at $8.8 billion in 2012 the same as 2008.

During the summit, First Focus presented Congresswoman Rosa DeLauro (D-CT) with an award in recognition of her child advocacy efforts. The Congresswoman is co-chair of the House Baby Caucus. In her remarks she discussed the vulnerable state for many children citing numbers: one in seven children in her home state of Connecticut, the richest state in the union, is considered food insecure or hungry; nationally 21 million of the 46 million people on food stamps are children.  The gathering also heard from author and columnist David Brooks who discussed the need to focus more attention on children in their earliest years. He emphasized the importance of personal relationships for children especially in the earliest years.  He also suggested that from a political perspective, their needed to be a political alliance between what he labeled urban liberals and southern evangelicals.  He argued that a path toward such an alliance could be found but it would require evangelicals acknowledging the role of government in addressing our problems and for liberals to acknowledge the importance of two-parent families.

Appropriations Update

The Congress goes on their July 4th break with the Senate passing eight of the 12 appropriations bills out of committee but they have not yet scheduled a floor debate for any of the bills.  The House has passed six bills on the floor and passed 10 through subcommittee and or full committee.  The two bills the House has not addressed are Interior and the Labor-Health and Human Services-Education (Labor-HHS).  It is likely the House’s failure to act on the Labor-HHS bill may have been affected by the Supreme Court ruling on the health care law.  A complete striking down of the law may have freed up some money (elimination of the Home Visiting program, for example).  It is also possible now that the House may take the same route as last year.  Last year they released a draft that eliminated much of the health care funding and then used some of the money to give some increases in areas such as Head Start.  Still it may be difficult to get enough votes to pass the bill out of committee. The Labor-HHS budget chart on important child welfare programs can be accessed at www.nationalfostercare.org

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