Child Health in America: Making a Difference through Advocacy

CHAPTER SIX: Legislative Advocacy

144 Legislative Advocacy There are at least three reasons to confront child health problems through the policy route: social justice, administrative burden, and creative pragmatism. Driven by concerns for justice, some child health advocates deem that societal forces are hurting rather than helping children . They find it unfair that any child lacks health insurance or that any family is forced to choose among fundamentals such as food, shelter, day care, and health care. Appalled that children are denied resources, they look to the promises of the Constitution to address basic human concerns. Administrators and health care managers select the legislative path when the poor functioning of their systems convinces them that the general health care system is out of kilter. When their clinics and hospitals are subsidizing health care services that others should be paying for, these managers quite naturally look to the legislature for fiscal relief. Innovative program planners move to the 20,000-foot view and ask basic questions about how societal priority is driven. These activists suggest legislative and systems solutions that churn up the old order. They dare to design new policies. They propose change through stepwise action. Table 6.1 lists federal legislation passed between 1916 and 1997 that supports the activities of child health clinicians. These laws set standards and regulate public and private systems. They provide money and personnel to health care agencies to immunize children, build clinic buildings , screen for hearing problems, and test for lead poisoning. The laws launched discretionary programs for babies with thalassemia, for example . They allowed for pilot testing of health surveys in school and alternative therapies at home. Through the policy route, advocates have made sustainable change for children and youth on the local, state, and national levels. The chapter outlines the legislative process and defines principles of legislative and systems-level advocacy. A review of four major pieces of child health legislation (Title V, Medicaid, SCHIP, and IDEA) illustrates these principles. Literally thousands of child health advocates worked to establish these major laws. Knowledge of the provisions of these four 6 laws gives child health advocates a foundation for securing the health of children. Understanding the process by which the laws are passed gives some pragmatic hints for future action. The Legislative Process Figure 6.1 maps the progress of a bill from the day it is introduced until it is signed into law. The bill makes its way by separate tracks through the House and the Senate, from committee to subcommittee and back again to the full committee,before the full House or Senate ever discusses it. Because a bill can be substantially modified at each stage, the House and Senate versions may differ greatly when they are passed. A conference committee reconciles the differences and presents a final version to the House and Senate for their approval. The bill is then sent on to the president for him to sign or veto. Each of the ups and downs, twists and turns offers opportunities for child health advocacy. Table 6.1. Major Child Health and Health-Related Federal Legislation, 1916–97 Year Legislation Impact or Outcome 1916 Child Labor Act,P.L.64-249 Prohibits interstate commerce of items produced by the labor of children under 16 years 1935 TitleV of the Social Security Act,P.L.74-271 Maternal and child health services,services for children with disabilities,child welfare 1946 Hospital Survey and Construction Act, $75 million for the construction of hospitals after P.L.79-725 World War II 1955 PoliomyelitisVaccination Assistance Act, Virtual eradication of polio in the United States P.L.84-377 1961 Community Health Services and Facilities By 2005 there were 1,000 federally qualified health Construction Act,P.L.87-395 centers serving 15 million people in the United States 1962 Vaccination Assistance Act,P.L.87-868 Controlof diphtheria,tetanus,measles,mumps,rubella 1962 Establishment of National Institute of Child Research on childhood illness with subsequent Health and Human Development,P.L.87-838 interventions to counteract disease 1965 Amendments to the Social Security Act Established a program of health insurance for the poor Title XIX,Medicaid,P.L.89-97 1966 Head Start as part of Economic Opportunity Act, Over 1 million preschool children served in compreP .L.88-452 hensive education and health programs annually in 19,000 centers and 829 home-based programs 1970 Lead-Based Paint Poisoning Prevention Act, Provided funds to treat victims of lead poisoning and P...