Home Visiting Works Act of 2017

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on H.R. 2824.

Madam Chair, I yield myself such time as I may consume.

Madam Chair, I rise in support of H.R. 2824, the Increasing Opportunity and Success for Children and Parents Through Evidence-Based Home Visiting Act. This bill would reauthorize the Maternal, Infant, and Early Childhood Home Visiting Program, known as MIECHV, for 5 years and make sure the program continues to focus on results.

I would like to note, this bill represents the first full reauthorization proposal Congress has considered for this program.

The Ways and Means Human Resources Subcommittee, which I chair, held a hearing on the program earlier this year. We solicited feedback from stakeholders, marked up a bill in committee, and today we are debating this bill on the floor. This is how Congress is supposed to work, and this bill is an example of Congress getting its work done.

The MIECHV Program helps support State and local efforts to provide voluntary, evidence-based home visiting services to parents and children living in communities that put them at risk of poor social and health outcomes, including in rural areas like those I represent.

Unlike many other programs that focus on money spent or people served, this program focuses on achieving real results for families. Specifically, this program promotes school readiness of young children, increases economic self-sufficiency of families, improves prenatal health and birth outcomes, and prevents childhood abuse and neglect.

Madam Chair, I have had the opportunity to see firsthand what home visiting looks like. In March, I spent time in Nebraska with the Panhandle Public Health District's Healthy Families America program in western Nebraska. The program focuses on improving the economic success and school readiness of vulnerable children and families in three Nebraska counties: Scotts Bluff, Morrill, and Box Butte.

During my visit, I met with Dawn, one of the program participants, who told me what it was like for her to work with a home visitor. Her home visitor helped her find a stable home and a steady income to provide for her growing family. These are the types of outcomes we should be expecting when we have programs to help those who are struggling to get ahead.

MIECHV works because funding is tied to evidence. Unfortunately, MIECHV is the exception, as few Federal social programs have been evaluated at all, and almost none condition funding on evidence of whether the program actually works.

In the Better Way agenda put forward by House Republicans last year, we proposed doing more of what MIECHV does: measuring how well programs are working to focus funding on those which produce real results. When we spend limited taxpayer dollars to help those in need, we must make sure we are spending money on effective programs. To do otherwise is a disservice to both taxpayers as well as those we are seeking to help.

On March 15 of this year, the Human Resources Subcommittee held a hearing on MIECHV. In the hearing, we heard from those with firsthand experience with home visiting programs, and their input was invaluable as we developed this proposal.

Both before and after the hearing, we sought input from States and others about how the program was working and how it could be improved and strengthened. These conversations also informed the bill before us today.

I should also note, there is broad bipartisan support for MIECHV, including from dozens of national organizations and hundreds of State and local organizations, including business leaders, law enforcement officers, faith-based groups, healthcare providers, child welfare advocacy organizations, and early education providers.

While I understand some of my colleagues would like to continue this program or even increase its funding without an offset, under the rules that govern this Chamber and our current deficits, it would be irresponsible and against the rules of this Chamber to fund this program without finding ways to reduce spending elsewhere. That is why we are considering this as part of a package of two bills today: this bill and the Control Unlawful Fugitive Felons Act of 2017, which will be considered later this week during its own debate.

Instead of increasing our Nation's debt, we should be doing more of what we are doing here today: prioritizing Federal spending and focusing on what works by improving the integrity of one program to provide funding for another.

Madam Chair, I am grateful for the time we are spending here today to consider the reauthorization of this important program, and I appreciate the opportunity to stand in support of this bill today.

I reserve the balance of my time.

House of Representatives,

Committee on Energy and Commerce,

Washington, DC, September 18, 2017.

Hon. Kevin Brady,

Chairman, Committee on Ways and Means,

Washington, DC.

Dear Chairman Brady: I write concerning H.R. 2824,

Increasing Opportunity through

Evidence-Based Home Visiting Act, which was additionally

referred to the Committee on Energy and Commerce.

I wanted to notify you that the Committee will forgo action

on H.R. 2824 so that it may proceed expeditiously to the

House floor for consideration. This is done with the

understanding that the Committee's jurisdictional interests

over this and similar legislation are in no way diminished or

altered. In addition, the Committee reserves the right to

seek conferees on H.R. 2824 and requests your support when

such a request is made.

I would appreciate your response confirming this

understanding with respect to H.R. 2824 and ask that a copy

of our exchange of letters on this matter be included in the

Congressional Record during consideration of the bill on the

House floor.

Sincerely,

Greg Walden,

Chairman.

Madam Chair, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Meehan).

Madam Chair, I yield 4 minutes to the gentleman from Michigan (Mr. Bishop).

Madam Chair, I yield 2 minutes to the gentleman from Kansas (Mr. Estes).

Madam Chair, I yield 3 minutes to the gentlewoman from Indiana (Mrs. Walorski).

Madam Chair, I just want to add for the Record that the State of Florida matches their funds more than 2 to 1 already, so I am anxious to present the data here as it becomes necessary and is helpful to the exchange here.

Madam Chair, I reserve the balance of my time.

Madam Chair, I yield myself such time as I may consume.

Again, I would like to take this time to thank my colleagues for taking the time to consider the reauthorization of this important program.

The MIECHV Program has bipartisan support due to its focus on achieving real results for families. This program works because its funding is tied to real evidence. It is imperative that we continue this program in a responsible way, partnering with States to increase the program's success.

I might repeat that for emphasis. It is imperative that we continue this program in a responsible way--a reasonable way, I will add--as we partner with States to increase the program's success. This bill shows how we can prioritize our Federal spending, focusing on programs with evidence that shows they actually work.

I look forward to moving this bill forward to reauthorize the MIECHV Program so more Americans can get the help they need to get ahead.

Madam Chair, I yield back the balance of my time.

Madam Chair, I have an amendment at the desk.

Madam Chair, I yield myself such time as I may consume.

Madam Chair, this amendment seeks to establish a careful balance between two competing views in regards to where and how home visiting programs

should be operated. The law requires States to operate home visiting programs in areas of highest need. However, some States expressed concern that they have been required to operate home visiting programs in areas where they were likely to fail, as they were not permitted to take into account staff and community resources and other requirements of a home visiting model when choosing where to operate.

In the bill I introduced with my colleagues, we allowed States to take these considerations into account, and States were generally pleased with this change. However, since the introduction of the bill, we have received additional feedback that some changes might be needed to make sure States could take into account these factors but not simply avoid serving actual areas with the highest need, including rural areas and remote areas that I represent, as well as others.

During the Ways and Means markup of this bill, Representative Sewell offered an amendment to address this problem. Although we did not include her actual amendment in the reported bill, as we did not have enough time to review it and consider any unintended consequences, Representative Sewell and I have been able to review her proposal since the markup and discuss its implications. I am pleased today to offer this bipartisan amendment to address the concerns she and others have raised.

Specifically, this amendment, combined with the language in the underlying bill, allows States to take into account staffing, community resources, and other requirements when determining how to operate their home visiting programs, while requiring that they operate at least one home visiting model in those communities with a high need for services. This ensures States do not shy away from some of the most difficult areas, which are often those that need home visiting services the most.

I am glad we have been able to work together on this bipartisan amendment, and I urge my colleagues to support the amendment as well as the underlying bill.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, again, I am grateful that Ms. Sewell and I could work together to come up with this amendment. I certainly urge its adoption as we do move forward with the bill.

Mr. Chairman, I yield back the balance of my time.

Mr. Chairman, I claim the time in opposition to the amendment.

Mr. Chairman, since the creation of the MIECHV Program, States have been required to demonstrate their home visiting programs result in measurable improvements in six benchmark areas specified in the law.

One of the benchmark areas States can choose to focus on is ``improvements in family economic self-sufficiency.'' Yet, as the result of changes made last year under the prior Presidential administration, ``economic self-sufficiency'' no longer means what you think it means--increasing work and earnings. Instead, it was defined as whether you have health insurance or are in school.

Clearly, this is not what Congress meant when the program was created and included the concept of economic self-sufficiency. So this bill would make sure that States, if they choose to focus on family economic self-sufficiency as one of the four benchmarks of the six, would measure employment and earnings as a part of that metric.

Again, States can choose among six different benchmarks when they decide which home visiting programs to operate and what goals they would like to achieve within those previously established by Congress. They don't have to choose this metric, as I mentioned earlier. However, when they do explicitly set out to increase economic self-sufficiency-- emphasis on the economic--information on work and earnings must be part of what is measured to determine whether they have achieved their goal. I believe it is absolutely critical that this intent be restored in the law.

Mr. Chairman, I urge my colleagues to oppose this amendment and support the underlying bill, and I reserve the balance of my time.

Mr. Chairman, again, I urge my colleagues to oppose the amendment as well as support the underlying bill, and I yield back the balance of my time.

Mr. Chairman, I claim the time in opposition to the amendment, even though I am not opposed to it.

Mr. Chairman, I support this amendment, the Maternal, Infant, and Early Childhood Home Visiting Program, that is designed to serve families with young children living in communities at risk of a range of negative outcomes.

Today, HHS allocates money for MIECHV based on the share of children under age 5 in families at or below 100 percent of the Federal poverty line living in each State and territory.

It is imperative that the distribution of funds is done using the most accurate and up-to-date information so we can use our limited resources to target those most in need.

I thank the sponsors of this amendment, Representatives Murphy, Gonzalez-Colon, and Velazquez, for bringing this issue to our attention and for offering this amendment.

Mr. Chair, I reserve the balance of my time.

Mr. Chairman, I urge support of this amendment and the underlying bill so that we can help children.

Mr. Chairman, I yield back the balance of my time.

Mr. Chair, I move that the Committee do now rise.

Madam Chair, I yield myself such time as I may consume.

Madam Chair, following the wisdom of Frederick Douglass, who said it is easier to build strong families, strong children, than to repair broken men, I introduced my first bipartisan home visiting bill over a decade ago, in 2005. Since 2005, home visiting has been uniquely bipartisan--until today.

Research is clear. Home visiting makes kids and families stronger, healthier, and safer. In my home State of Illinois, MIECHV improved program coordination, reinforced the emphasis on proven models, and expanded availability of services. Unfortunately, the majority's approach has rejected bipartisanship and made timely reauthorization of home visiting less likely.

H.R. 2824 presents substantial cuts to home visiting and threatens the effectiveness of services for vulnerable children and families. Equally bad, the rule under which we are considering this bill conditions home visiting help to vulnerable families on harming seniors and persons with disabilities. Although we are not voting on that provision today, the rule we are considering this bill under makes it an inescapable part of it.

I join with over 110 civil rights, disability, and aging agencies to strongly oppose the Republican effort to pay for home visiting services that strengthen vulnerable children by stripping certain low-income seniors and those with severe disabilities of basic income they need to survive.

H.R. 2824 also is inconsistent with bipartisan Senate legislation introduced last week, which rejected the most controversial and problematic changes in H.R. 2824 in order to keep what works.

So what should the House have done instead of H.R. 2824?

826 organizations urged the House and Senate leaders to ``reauthorize this important program for 5 years, with a doubling of funding from $400 million, annually, to $800 million, annually, to allow States, territories, and Tribes to expand these services to more children and families.'' Yet H.R. 2824 fails to increase funding by even one penny.

Currently, MIECHV dollars serve only about 6 percent of eligible families and less than 50 percent of eligible Tribes. I tried to offer a fully paid-for alternative to double funding for home visiting over 5 years without harmful policy changes but was not allowed a vote in committee or on the floor.

One of the most harmful policy changes is a new ``State match'' requirement, which would be in addition to the ``maintenance of effort'' requirement already in law. Just as with their failed healthcare bill, this Republican bill pushes their fight to make States pay more for services, while harming vulnerable children and families as collateral damage. There is no doubt that the State match in this bill will reduce home visiting in many States and Tribes, cut services, and harm families.

The Republican bill further undermines successful home visiting by changing it from a program to improve child development and parent- child relationships to a failed jobs program. Defining a core outcome of MIECHV as increased employment and earnings will gut Federal home visiting. Not one--not one--of the evidence-based models is a job training program. Not one.

This bill says, if any program wants to improve economic self- sufficiency, it shall include employment and earnings. Further, the bill applies stringent, unrealistic outcome standards.

H.R. 2824 is failure by design for home visiting. Later today, I urge my colleagues to support Congressman Pascrell's amendment to strike this change.

After a decade of bipartisan efforts to increase Federal funds for home visiting, I am deeply saddened that H.R. 2824 now is the House Republican priority list for cutting funding, reducing services, and undermining the infrastructure that so many have worked to build. I unequivocally oppose this harmful bill and its discriminatory pay-for, joining the good company of the NAACP, the American Academy of Pediatrics, Justice in Aging, National Women's Law Center, and the Arc of the United States, to name just a few.

I urge my colleagues to oppose H.R. 2824 so that we can move quickly on to a bipartisan approach which builds on home visiting's considerable strength.

Madam Chair, I reserve the balance of my time.

Madam Chair, I yield 2 minutes to the gentleman from Michigan (Mr. Levin).

(Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Madam Chair, I yield 5 minutes to the gentleman from Texas (Mr. Doggett), who has long been a champion on these issues.

Madam Chair, I yield an additional 1 minute to the gentleman from Texas.

Madam Chair, I yield 3 minutes to the gentleman from California (Mr. Thompson).

Madam Chair, I yield 2 minutes to the gentlewoman from Florida (Ms. Castor).

Madam Chairwoman, I yield the gentlewoman an additional 15 seconds.

Madam Chair, I yield myself the balance of my time to close.

Madam Chair, we know that home visiting works. There is no doubt about it. It is evidence based. Nobody has spoken anything that one would say it was not needed. It works for families and children in communities across our country. We agree about that on a bipartisan basis.

So we should not be here today debating a partisan bill, a bill that home visiting experts say poses a risk to the program's survival. We should be moving forward on a bipartisan bill without policy changes that might shut down home visiting in some communities or set it up for failure.

I hope that my colleagues will vote for the amendments being offered today that will improve the bill, but I also have some concerns about the State match.

No matter what we say, think of States and territories that have just been devastated by the floods and hurricanes. It is going to be very difficult for them to come up with the match money to keep some programs alive.

So I hope that my colleagues will vote for the amendments being offered today that will improve the bill. I regret that there will not be enough of them to make this the bill that we had hoped it would be.

Madam Chairwoman, I urge a ``no'' vote, and I yield back the balance of my time.

Madam Chair, across our country, there are thousands of children, thousands of families, that have a really big stake in what happens with this bill.

I support evidence-based home visiting programs, and I support them not just by talking about them, but by providing them the resources they need to reach more children and make a difference in their lives.

This whole program, ``home visiting,'' is a little bit of a misnomer. This is not about going out to pay a social visit, to join a club or something. This is about skilled professionals working with young parents to help them be the parents they want to be. It is about family values. It is about strengthening and protecting families, particularly disadvantaged families.

Our home visiting programs give these families the tools that they need. I have seen how successful they have been in San Antonio, in San Marcos, in Austin, and across Texas.

A story was shared with me recently when I met with Alaska and Jimmy Martinez from San Antonio. During their first year in college, Alaska became pregnant. She felt she was going to have to drop out of school, and then they met with Susan, with the Nurse-Family Partnership there in San Antonio, and she gave them some referrals and some assistance. They were able to learn more about the development of their child and how they could prepare their family for that child's arrival.

Now, Alaska is about to finish her associate's degree. Jimmy is pursuing his business degree, and they are happy to have a beautiful 2- year-old son.

That is the way this program is supposed to work so people don't sink into poverty. They are lifted up and so are their children. This is just one of thousands of success stories from across the country--the family that unexpectedly finds they have a child with severe disabilities, or maybe just the more common experience of the family that has a baby who cries all night long, and they don't know what to do about it.

Too often, that is the kind of thing that ends up in a slap here, a slap there, and child abuse. Too often, it ends up with that child just being put in front of the television set instead of working with the child to deal with these real-life problems.

Some reforms were mentioned, alleged reforms, in this bill. I have served on this subcommittee through a number of terms of Congress. We have had some excellent witnesses, Republican and Democratic, and I have yet to hear a single witness call for a single one of the changes that they are proposing to impose on this program as obstacles to its success.

We haven't had an academic expert. We haven't had a stakeholder. We haven't had a single witness come forward and say: Please change this program so it cannot achieve the success that it is having today.

This is an evidence-based program. What does that mean? It means it is based on fact, not just on hope or good intention, as a number of our programs are. It means there is peer-reviewed data showing that this program works to reduce child abuse and to solve other problems.

The chairman, the advocate for this bill, tells me that they recognize this in the great Republican blueprint, and they want to do more of this. Well, if they want to do more of this, why are they creating one obstacle after another and causing one group after another to oppose those changes?

What about the resources to get the job done? As so many of the Republican witnesses before our subcommittee have acknowledged, we are helping a fraction of the children who are eligible for these kind of services.

I think you could call this bill the Republican 6 percent solution, because about 94 percent of eligible families in America don't get a penny of assistance out of this program. This program

that they say is so good, they want to praise it as an evidence-based program--and well they should, and well they have in the course of the several years I have served on the committee--this program is frozen at the same amount of funds that it had 5 years ago.

Though the need has grown, though the fraction of children who are served is minuscule compared with the need, they refuse to provide the resources to help other families like Alaska and Jimmy's.

It is clear, we can't just throw money at this problem or any other, but sometimes the only substitute that I hear from my Republican colleagues is to throw words at the problem like we have heard today: caring, soothing, empathetic words, but words that are no substitute for meaningful action.

Indeed, it is great to hear about support for an evidence-based program. Where is the evidence for these changes?

Madam Chair, where is the evidence today? It couldn't be produced in committee. Where is the evidence for one of these changes? Where is the evidence for freezing this funding?

We proposed to fully fund it, and I proposed to do it with a simple tax compliance measure that wouldn't have raised taxes on anyone, but it would have provided the resources for this home visiting program to do its intended purpose.

This measure, as proposed, should be rejected, and we ought to support genuine home visiting that reaches more American families and protects them, just as it has for so many families in Texas.

Mr. Chairman, I have an amendment at the desk.

Mr. Chair, this amendment would strike the provision in the bill that would add increasing employment and earnings to the Maternal, Infant, and Early Childhood Home Visiting Program, or MIECHV, as it is generally referred to.

I, obviously, share the goal of increasing employment and earnings across the country. However, home visiting is not an employment program. It is a program to strengthen families to make kids healthier, safer, and more ready to learn when they start school. Those are the outcomes home visiting models strive for, and those are the outcomes they achieve.

I mentioned the other day in the Ways and Means Committee that I know the good that these programs do firsthand. In Passaic County--because most of these programs are run through counties throughout America--our home visiting program worked with a pregnant mom expecting a child with a heart defect.

The baby required open heart surgery shortly after being born last July. After the surgery, the newborn continued to have health complications. At times, his mom felt depressed and hopeless and feared that her child was not going to survive.

The home visiting program's family support worker was able to assist the mom by connecting her to services, providing her with emotional support, and acting as a liaison with the hospital where her son was.

We know the negative impact that postpartum depression can have on new moms and their babies. The home visiting program was able to connect this mom to supportive services and resources and alleviate her depression so that she could be a healthy and pleasant mom. I am happy to report that, after nearly 3 months in the hospital, this little boy was finally able to go home, and his mother continues to work with the home visiting program in northern New Jersey.

I don't think anyone can hear that story and not see value in the services that were provided. The home visiting program helped a mom, like so many other mothers across America, navigate her newborn son's healthcare crisis and manage the mental health issues associated with it.

But under the provision that my amendment is seeking to strike from the bill, this outcome would not be measured as a success. There is something wrong with that.

Most home visiting models focus on families with newborns or very small children and focus on building a parent-child bond. That is a fact. Many home visiting programs focus on teen parents and young mothers, and the priority is to keep them in school and make sure they continue their education.

There are currently 18 evidence-based home visiting models. None of them

provide employment services, none of them measure employment and earnings.

Home visitors have raised concerns that having to ask families about employment and earnings would be intrusive when you know what the focus of the program is, and would undermine the relationship they are trying to build with families.

Even if the data is collected without specifically asking families for it, knowing their performance is being measured based on their client's labor force participation--here is the kernel of the issue-- will likely make home visitors feel they have to press their clients to work even if, like in the case of the mom in Passaic County, that should not be the main object.

Additionally, this bill provides no new funding. We are not asking for any new money here. Any resources devoted to supporting work would have to be diverted from MIECHV's core purposes.

I urge my colleagues, Mr. Chairman, to support this amendment to make sure children and families served by this program get the support and service that they truly need.

Mr. Chairman, I reserve the balance of my time.

Mr. Chairman, as I said, there are currently 18 evidence-based home visiting models. Also, there is nothing added to the budget; no extra currency I am asking for.

I would ask the sponsor of the bill what he would tell this woman from Passaic County, New Jersey, one of many examples that I have. I ask him what his answer would be to that woman.

Mr. Chairman, I yield back the balance of my time.

Mr. Chair, I demand a recorded vote.

Mr. Chairman, I have an amendment at the desk.

Mr. Chairman, my amendment would eliminate the dangerous cuts to Tribes who don't meet the bill's match requirement. I urge all of my colleagues to support it.

I am proud to represent a number of Tribal communities in the Puget Sound region that each have a rich history, identity, and culture. But they face unique challenges.

The need for home visiting services is particularly high among American Indians and Alaska Natives. Young people who live on reservations are twice as likely to become teen parents. Nearly three- fourths of the parents served by Tribal home visiting services live below the Federal poverty level. And the majority of Tribal beneficiaries have less than a high school diploma.

The good news is that Tribes are already using home visiting resources to implement evidence-based models that have decreased depression, substance abuse, and stress among parents, while improving health among children.

Seventy-seven percent of Tribal home visiting programs have improved family outcomes in at least four different areas, such as improving maternal and newborn health, increasing school readiness, reducing domestic violence, and strengthening parents' economic self- sufficiency.

The bad news is the need for help in Indian Country has far exceeded the limited funding available through the home visiting program. In fact, less than half of qualified applications for Tribal home visiting can be granted under the current funding levels.

Some States have tried to address these shortages with State resources, like my home State of Washington, which has voluntarily used State funding to meet the needs of Tribal families. But it is not enough.

The underlying bill provides no new resources to address the nationwide shortfall in Tribal funding. Instead, it adds a match requirement that could be the end of home visiting on reservations altogether.

Most Indian Tribes struggle economically and already face challenges providing help to families. I understand that Tribal administrators have said almost none of them could meet the match requirement in this legislation.

Indian Tribes have also generally considered Federal match requirements to be a violation of Tribal sovereignty. As such, they may have to refuse the funds and shut down home visiting programs if the bill is enacted with the match requirement.

I appreciate that the chairman has delayed the implementation of the Tribal match and reduced it to 30 percent. But, realistically, the effect will be simply to give Tribes more time to shut down their home visiting programs. The match requirement will still be completely unworkable for them in 2022.

The Federal Government has a responsibility to our Tribal communities to do everything we can to support their people, strengthen their families, and expand economic opportunity.

Mr. Chairman, the underlying bill takes a dangerous step in the wrong direction for our Tribes, but we still have the opportunity to stop it.

Mr. Chairman, I urge my colleagues to vote ``yes'' on my amendment, and I yield back the balance of my time.