In 2008, candidate Barack Obama offered a plan "to empower Americans with disabilities," promising to support universal screening — key to early help for children and families.
In particular, his campaign promised to support a national goal to re-screen all 2-year-olds for developmental disorders.
That's the age when some conditions, including autism, start to appear.
While it's not clear what the Obama campaign meant by "setting a national goal," there are key signs the Obama administration has prioritized early childhood screening.
That's a big deal, experts say.
Early diagnosis means a chance for early treatment that can lessen the long-term impact of developmental disorders on kids, said Roxane Kaufmann, director of early childhood policy for Georgetown University Center for Child and Human Development.
And while organizations such as the American Academy of Pediatrics have for years encouraged routine developmental screening, in 2009 only half of pediatricians reported regularly using such screening tools.
Under the Obama administration, there's been real progress toward a goal of universal screening, said Sara Rosenbaum, a professor of health policy at George Washington University.
The most important changes came in the Affordable Care Act, the president's signature 2010 health care legislation:
• Bright Futures guidelines, published by the American Academy of Pediatrics, are now the standard for preventive care that many insurers must now cover without a co-pay. The guidelines include general developmental screening at ages 1 ½ and 2 ½, plus specific autism screening at 1 ½ and 2 years old. Still, employer plans with grandfathered status aren't required to meet these guidelines.
• Expansion of Medicaid, which includes developmental screening coverage that varies by state but must meet "reasonable standards of medical practice," will boost the number of low-income kids with access. But the Supreme Court ruled states may opt out of the federal Medicaid expansion, which may limit the law's impact.
Other changes under the law will increase kids' access to doctors, such as growth in Community Health Centers and boosted Medicare payments to primary care physicians, said Brent Ewig, director of public policy for the Association of Maternal and Child Health Programs.
The law's changes are "a major victory for kids," he said.
Now the challenge is educating doctors and parents so kids benefit from new guidelines and coverage.
"That's always been the issue with all preventive screening guidelines," Ewig said. "We've got a lot of work to do there to educate both providers and patients."
The Health and Human Services Department says it's doing just that, with a "robust multi-agency effort" to make sure states have comprehensive newborn and childhood screening programs, and to help develop guidelines, test screening tools, raise public awareness and train health workers.
For example, a workgroup was launched in late 2010 to improve screening, diagnosis and treatment under Medicaid, which will release a series of strategy guides for states. Grants under the Affordable Care Act target high-risk children with home visits. The Administration for Children and Families is funding a study on Native American reservations, among other efforts.
Obama promised to "support setting a national goal to provide re-screening for all 2-year-olds." The Affordable Care Act offers the clearest progress on this promise, with new guidelines for preventive care and an expansion of Medicaid. Meanwhile, federal health agencies chip away at challenges to universal screening. Still, efforts stop short of universal access. We rate this a Compromise.