George Orwell never wrote about health insurance, but his ghost hovers over the current health-care debate, providing inspiration for all manner of fears about Big Brother-like intrusions by the government into the lives of ordinary Americans.
First was the rumorpromoted by high-profile Republicans like Sarah Palin, Newt Gingrich and Iowa Senator Charles Grassleythat Democratic health care plans would create "death panels" which would pass judgment on which citizens deserved to live. Next, a White House suggestion that people who have received e-mails with questionable information about health reform forward those to get clarification was reported by Fox News as a trap to collect the names and e-mail addresses of health reform opponents for an "enemies list."
Now conservative opponents of health reform have found a new threat: home nurse visits to low-income parents. "We are setting up a situation where Obama will be invading parent's [sic] homes and taking away their children," one columnist warned on RightWingNews.com. That something as harmless as home nurse visits has become a target of conservative ire is surprising because of its longstanding popularity with both Republican and Democratic lawmakers. But health reform advocates are scratching their heads at the attacks for another reason: funding for home nurse visits was largely included in health reform legislation to accommodate social conservatives.
"Optional Coverage of Nurse Home Visitation Services" certainly doesn't sound controversial. The initiative, which has existed in various forms at the state and local level for decades, would fund programs that "provide parents with knowledge of age-appropriate child development in cognitive, language, social, emotional, and motor domains...modeling, consulting, and coaching on parenting practices; [and] skills to interact with their child." Most similar programs have nurses visit the homes of low-income parents, usually before and after the birth of their first child, to teach them about nutrition, anger management and other parenting issues.
A series of longitudinal studies of home nurse visits have found that they can have powerful positive outcomes for both parents and children. One University of Colorado study found that 15 years after receiving home nurse visits, low-income unmarried mothers were more likely to be employed and less likely to have used welfare services, and their children were less likely to be victims of child abuse. Another evaluation of a Memphis-based program found that nurse visits improved the chances that parents would stay together after the birth of their child. Researchers say the programs are also linked to higher birth weights, increased involvement from fathers and improved school readiness for kids.
In others words, home nurse visits are exactly the kind of pro-family policy that social conservatives would embrace. And they have. The home visitation provision in health reform legislation was modeled on a bill authored by Republican Senator Kit Bond of Missouri. Bond went through a parenting education program in Missouri when his son was born three decades ago and has been a fan of the idea ever since. "Being a parent is hard work," he says, "and babies don't come with directions."
Home visits have been so popular with conservatives that the idea kept coming up during conversations White House aides hosted with pro-life advocates earlier this year in an effort to find common ground on abortion. And when Democratic Reps. Tim Ryan and Rosa DeLauro drafted the abortion reduction bill they introduced last month, they specifically included funding for home nurse visits as a way of accommodating pro-life preferences for policies that support women who decide to give birth instead of having abortions.
But that was before conservative anxiety over health reform reached its boiling point. In mid-July, Lindsey Burke at the right wing Heritage Foundation drew attention to the home visitation initiative, calling it a "troublesome provision...that would bring state workers into the homes of young families." Action hero and conservative activist Chuck Norris picked it up from there, penning a column sounding an alarm about "Obamacare's home intrusion and indoctrination family services, in which state agents prioritize houses to enter and enforce their universal values and principles upon the hearts and minds of families across America."
As with voluntary end-of-life-care counseling, optional home visits have morphed into "mandatory home inspections" in the words of health reform opponents, who charge that the provision is part of a "stealth agenda" to judge conservative parents unfit and remove their children into protective services. It's an unexpected evolution for a pioneering conservative idea.