If you’ve been following the twists and turns of the health care debate over the past year, you likely know that the Senate narrowly passed its version of health care reform on Dec 24. Now, the House and Senate must reconcile two considerably different bills. Rather than go through the formal process of a joint conference committee to iron out the differences,  negotiators are expected to rewrite the Senate  legislation, send it to the House for a vote, and then give the Senate final approval. The results of this process could have major implications for a United Way priority–home visiting for low-income families.

A major challenge confronting  House and Senate leaders is the desire to keep the overall cost of the health care reform package from going over the $900 billion mark set by President Obama as his acceptable upper limit.  At $894 billion, the House bill is quite close to this threshold.  The Senate’s measure logs in at $871 billion.  As the differences between the two are resolved, movement toward accepting provisions passed by the House run the risk of raising the final pricetag.

Why does this matter for home visiting? Both bills still contain provisions for support of home visiting but the amount of funding and how it is allocated is different in each case.  The House is proposing a program of home visitation service with mandatory funding of $750 million over five year, plus provisions for states to spend Medicaid funds on nurse home visitors. The  Senate, on the other hand, is proposing $1.5 billion in mandatory spending over five years for home visitation.  In terms of allocation mechanisms, the Senate is proposing guaranteed funds through the Title V Maternal and Child Health Block Grant, and the House would guarantee support for home visiting services from the Title IV of the Social Security Act (child welfare), plus a separate provision of an option for states to apply Medicaid funds to pay for home visitation to eligible families.  The House bill is fashioned around language introduced by Washington Congressman McDermott (D-Seattle) in HR2667, the Early Support for Families Act.  The final federal home visiting funding could take any one of these formats or some combination of two or all three.

It is possible that as the negotiators look to cut the projected costs that home visiting could be axed.  But congressional staffers have felt that since home visiting has been in the bill since the beginning that it has a high chance of remaining.