Each year, Congress must pass spending bills to keep the government running and fund federal agencies, including critical public health programs. In late December 2022, after months of negotiations, Congress enacted a spending bill for fiscal year 2023. This omnibus package, which totaled more than 4,000 pages, included key ACOG funding priorities and major legislative wins reflecting years of ACOG advocacy, such as a permanent option for states to provide 12 months of postpartum Medicaid coverage.
Key ACOG funding priorities in the bill include …
- A $25 million increase for the CDC Safe Motherhood programs, which include support for state maternal mortality review committees and perinatal quality collaboratives
- A $3.3 million increase to support the work of the Alliance for Innovation on Maternal Health program
- An $87 million increase for the Title V Maternal and Child Health Block Grant
- A $26 million increase for HRSA’s State Maternal Health Innovation grant program
- A $3.5 million increase for screening and treatment for maternal depression
- A $3 million increase for the National Maternal Mental Health Hotline
- Critical investments to support women’s and maternal health research at NIH, including …
- A $17 million increase for the Office of Research on Women’s Health
- A $3 million increase to support research on the effects of COVID-19 on pregnancy, lactation, and postpartum health with a focus on individuals from racial and ethnic minority groups
- Resources to establish an advisory committee to monitor and report on the implementation of the recommendations from the Task Force on Research Specific to Pregnant Women and Lactating Women, a long-standing ACOG priority
Congress also took positive steps toward improving maternal health outcomes with the creation of a permanent option for states to provide 12 months of postpartum Medicaid and Children’s Health Insurance Program coverage through a simplified pathway. This critical policy, established under the American Rescue Plan Act, would have expired in 2027 if Congress had not taken action. While this provision is a step in the right direction, ACOG remains committed to advocating for mandatory 12-month postpartum coverage under these important programs.
The omnibus bill also included the bipartisan Restoring Hope for Mental Health and Well-Being Act of 2022, which includes the Into the Light for Maternal Mental Health and Substance Use Disorders Act, a Congressional Leadership Conference ask! These provisions will support screening and increased access to treatment for maternal mental health and substance use disorders. With reports that rates of maternal mental health conditions have increased in recent years, ACOG was thrilled with the enactment of these critical provisions and looks forward to the successful implementation of this important, lifesaving legislation.
Additionally, the bill included various other provisions from bills endorsed by ACOG, such as the PUMP for Nursing Mothers Act, a bill that expands workplace protections for employees with a need to express breast milk, and the Pregnant Workers Fairness Act, which prohibits employment practices that discriminate against making reasonable accommodations for qualified employees affected by pregnancy, childbirth, or related medical conditions.
Of note, while the omnibus bill partially mitigated the 4.5% cuts to physician payment under Medicare in 2023, ACOG is deeply disappointed that Congress is allowing physicians to experience yet another cut. These significant payment cuts have a negative impact on the mental well-being of physicians striving to practice in an increasingly unsustainable environment. The cuts also threaten overall access to care, as the current rates do not adequately cover the cost of care and further jeopardize the future of private practice. The proposed mitigation is inadequate, and ACOG will continue to advocate for financial stability for physicians through baseline increases reflecting inflation in practice costs and the elimination, replacement, or revision of budget neutrality requirements to allow for appropriate changes in reimbursement.
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