All Fall Down: A Lack of Support for Evidence-Based Social Policy

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Photo Illustration by C. J. Burton

When Shanice Beckles met Brenda Tuggle, it seemed as if her life was closing in on her. Beckles was pregnant and 16, overwhelmed and out of options. Her dream of becoming a nurse was slipping out of reach.

Today, three years later, Beckles displays her newly obtained high school diploma on the living room table in her Jamaica Plain apartment. She’s enrolled at Northeastern University, she tells me confidently, and plans to become an occupational therapist. And her two-year-old special-needs son is thriving.

She says none of this would have been possible without Tuggle, her home visitor from a local Healthy Families America program. Wherever Beckles was—her father’s place in Roxbury; a shelter in Waltham after her father threw her out; or this apartment where I’m talking with her now—Tuggles visited with her, mentoring her in child-rearing and helping her navigate the thickets of government assistance.

“Brenda has been there, and Healthy Families has been there, to support me, making sure everything’s okay with my son and with me,” Beckles says. “I don’t know where I’d be without this program and Brenda.”

The program that brought the two women together has been successful all across the state, for Beckles and hundreds of other struggling first-time parents. It owes its existence in large part to a little-known provision in the Affordable Care Act—a.k.a. Obamacare. Known as the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, it has brought $21 million into Massachusetts to fund Healthy Families and similar programs.

What’s important to note, though, is that MIECHV doesn’t choose the programs it funds based on heartwarming anecdotes or “common sense” policies. Instead, it’s a rare instance of governmental support for what’s known as “evidence-based” policy—these programs must demonstrate results by participating in scientifically rigorous testing using randomized control studies. The idea is that by testing the success of social programs in a science-based and systematic way, the government can, over time, discover the best public policy—in fields such as education, public safety, and child health.

Normally, the political process chokes off all attempts at evidence-based policymaking. This is the story of how one good evidence-based policy slipped in through a side entrance, when nobody was looking—and why it will probably be eliminated next year.


I first learned about the home-visit program in 2007, through a conversation with Bill Woodward, of the University of Colorado’s Center for the Study and Prevention of Violence. It was just after the Virginia Tech massacre. After dismissing one policy proposal after another as either unproven or ineffective, Woodward told me that there is only one thing that’s been proven, through actual evidence, to reduce violent crime: a program called the Nurse-Family Partnership.

That program, one of several accredited for MIECHV grants, has decades of data demonstrating its positive effect on school readiness, child and maternal health, economic self-sufficiency, child maltreatment, juvenile delinquency, family violence, and crime. Not only that, the Nurse-Family Partnership is a deficit reducer: For every dollar spent on it, taxpayers save about $5 on such things as food stamps, Medicaid, and incarceration.

It’s a no-brainer, but Woodward was pessimistic about implementing it on a large scale. Politicians, he told me, don’t tend to spend their efforts on expensive programs that show benefits many years down the road.

He’s correct. Indeed, even as Woodward and I spoke, Congress was already demonstrating the point. Beginning in 2005, Democratic Congressman Danny Davis, of Chicago (whose district is home to Healthy Families America), and Republican Senator Kit Bond, of Missouri (home to a similar program called Parents as Teachers, created when Bond was the state’s governor), drafted a bill they would go on to introduce many times: the Education Begins at Home Act. It would have spent $500 million over three years on evidence-based home-visit programs.

“We have always known that an ounce of prevention is worth a pound of cure,” says Davis, whose work in public health began in 1969. “Because we’ve had researchers in the field, it became measurable. That assessment makes a big difference.”

This bipartisan bill, proven to accomplish important policy goals, and backed by data showing it would save public funds over the long term, died a quiet death year after year. Among the unanticipated roadblocks: The Christian conservative movement protested. EdWatch, an advocacy group founded by supporters of Minnesota Congresswoman Michele Bachmann, called the bill an example of the “insatiable appetite that the radicals in charge of Congress have for control over the hearts and minds of our nation’s youngest children.” For its part, the Home School Legal Defense Association lobbied and testified against the bill, and told its members that it would “impose unelected officials’ educational agendas, which may prove offensive and contrary to many families’ moral and religious beliefs.”

In 2008 Republicans tried to amend the bill by adding a ban on any visits to undocumented parents—even if the child involved were a U.S. citizen. When Democrats rejected the amendment, Republicans voted against the bill.

It’s easy to blame Republicans, but it’s not as if Democrats have expended any political capital on this bill, or almost any other evidence-based policy initiative. That’s partly because they tend to have more fealty to existing programs than to evidence of what new programs might actually work. They also maintain an unfortunate fealty to budgetary “scoring”—by the White House Office of Management and Budget (OMB) and the Congressional Budget Office (CBO)—that ignores, for the most part, evidence-based policy research. When the CBO scored the Education Begins at Home Act, for instance, it looked primarily at what it would cost, overlooking the evidence that it would reduce spending in the long run. (That attitude has slowly begun to change, and the former OMB director Peter Orszag recently coauthored an article in the Atlantic that urged more evidence-based policymaking.)


Efforts to pass the Education Begins at Home Act may have failed, but they did get the attention of an acquaintance of Congressman Davis named Barack Obama, who, in 2008, happened to be looking for anti-poverty policies to espouse in his presidential campaign.

Obama mentioned home-visit programs in a speech about poverty during the 2008 campaign, and after his election, he included $124 million for the Nurse-Family Partnership in his first budget proposal. Congressional Democrats snipped it from the budget—at least in part because it didn’t include their own favorite home-visit programs, as the Education Begins at Home Act did (even though, frankly, some of those programs have far less proof of success than the Nurse-Family Partnership). A few months later, an agreement was reached to put the funding into the bill that would become Obamacare, using the wording from the Education Begins at Home Act. The dollar figures were pumped up to $1.5 billion over five years, which, according to Brent Ewig, the director of public policy at the Association of Maternal & Child Health Programs, makes it “probably the biggest single new investment in women and children in our lifetime.”

And yet you’ve probably never even heard of it. That’s because—overshadowed by the scope and controversy of the bill it was tucked into—it passed almost entirely without public discussion or debate. (The House Republican Conference did, briefly, attack the provision as “Billions for Babysitters,” but it didn’t stick.) So what will happen when Congress has to act on the program in a separate bill, that people will notice? We’ll soon find out.


As big a deal as it was, that $1.5 billion in funding was only enough to get the Education Begins at Home Act up and running. Along with several other programs authorized by the act, MIECHV—the Maternal, Infant, and Early Childhood Home Visiting program that helped Beckles—will end after September 2014 unless Congress passes a reauthorization bill. No such bill has yet been introduced.

Davis, Ewig, and others say they’re hopeful such a bill will materialize, but there is little reason to be. Republicans, who control the House of Representatives, keep trying to repeal Obamacare in its entirety—and have also tried to repeal specific portions of it, including the home-visit grants. It seems unlikely that they will vote for reauthorization. And there is little indication that Democrats have the gumption, let alone the ability, to push for the passage of a big expenditure in the coming election year.

That raises questions about what will happen to people like Shanice Beckles all over the country if the rug is pulled out from under these programs. Here in Massachusetts, they’ll continue even without the Obamacare funds (Paul Cellucci was instrumental in establishing the funding as governor in 1998), but they’ll be greatly scaled back. More than anything, a significant investment will go to waste. “We’re in the buildup phase,” says Ben Tanzer, the spokesperson for Healthy Families America. “People are getting trained, sites are being set up.”

Also wasted will be the opportunity to gather data on all of this rigorously established programming. “It’s a central problem in social spending in this country,” says Jon Baron, president of the Coalition for Evidence-Based Policy, in Washington, DC. “There’s not much emphasis placed on evidence. Home visitation was kind of the exception that proved the rule.”

For her part, Beckles is getting the benefits of that brief exception—and, judging by what I’ve seen, she will repay that many times over by being a productive citizen and an efficacious parent. Conservatives and liberals alike should want to spend more money on programs that do that.

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