We tell ourselves there is a core value shared across the political spectrum: Democrats and Republicans, policymakers and taxpayers, all of us, would supposedly do anything to reduce the burden of parents’ poverty on their kids, if only we could afford it.
What if we knew how to change the odds for kids growing up in poverty by reducing infant mortality, improving test scores, and cutting down on the number of kids (and parents) who end up in jail?
What if we could do it with a program that paid for itself by creating savings in other programs? And, what if we could get big banks focused on their bottom line to provide funding — banks that would only get paid if the program actually saved money and changed lives?
If only such a program existed, of course we would do it. Right?
This program does exist. It is called Nurse-Family Partnership (NFP). It is a home visiting program that pairs specially trained nurses with high-risk first-time moms from pregnancy until their kids’ second birthday.
That meaningful early intervention pays huge dividends later. There is nearly four decades of research showing, among other results, a significant cut in the risk of infant mortality and abuse in the home; improved math and reading scores in sixth graders, and at least 50% fewer arrests of teens, and their moms, 15 years later.
And the funding mechanism I described exists too. It’s called a “social impact bond” or “Pay for Success.”
The good news is that NFP has support on both sides of the aisle and already serves families in 43 states, including New York. And increasingly, budget officers and private investors are interested in Pay for Success models that leverage private dollars to expand public programs that provide long-term benefits and savings. (In fact, Gov. Cuomo created the first state Pay for Success program in 2013, for programs like NFP.)
The problem is that we are tiptoeing toward a solution that we know works, when we should be running. Today there are about 2,800 families enrolled in NFP in New York, but more than 40,000 eligible new moms each year.
In business, when an initiative is proven over decades, solves a persistent problem, and yields savings, you expand it aggressively. That’s what government must now do with NFP.
This coming Tuesday, at a forum with the NYU School of Nursing and the Wagner School, I am proposing Universal Nurse-Family Partnership in New York, to be funded in part with Pay for Success. That means every eligible first-time mom would be offered the program before her third trimester.
If half signed up, universal availability would cost a little more than $100 million a year in new spending. But, with Pay for Success, taxpayers would only be on the hook if it worked, as rigorously measured in state savings and lives changed. If it didn’t succeed, the banks and their investors would foot the bill.
The challenge is that the legislature needs to put the money aside upfront. And while NFP does not have many opponents, it exists outside the political battles of today. It is the policy equivalent of motherhood and apple pie: Everyone loves it, but supporting it proves nothing about your willingness to take on the status quo. Without enemies, it also lacks powerful patrons.
The moment is ripe for a dramatic expansion. The $1 billion new investment in Universal Pre-K for New York City is more likely to be meaningful if it is built on the foundation NFP provides.
In the fight over what to do with the state’s $5 billion one-time surplus, this should appeal to right and left, since it is fiscally sound — the state does not pay unless the savings are realized — and expands fairness for poor kids that need it most.
Most importantly, Universal NFP is the right thing to do. It is what we all tell ourselves government would do, if it only could.
Squadron is a state senator representing lower Manhattan, Williamsburg, Greenpoint and Downtown Brooklyn.
