PROVIDENCE – Since its founding in 1994, when Rhode Island Kids Count was first located at the former Rhode Island Foundation headquarters in the Jewelry District, the advocacy group for children in Rhode Island has pursued an inclusive strategy to bring everyone to the table, particularly legislative leaders, by radiating an optimistic approach, sharing success stories, honoring parents, seeking consensus, and by compiling the most comprehensive statewide database on the health and wellness of Rhode Island children.

The annual Rhode Island Kids Count Factbook has become a critical policy tool, serving as both a dictionary and thesaurus when it comes to defining the facts and the context around children’s health in Rhode Island.

Over the past 22 years, Rhode Island Kids Count has proven to be an indefatigable force in its advocacy on behalf of children, amassing a solid track record of accomplishment, many of which were proudly proclaimed at the 16th annual Celebration of Children’s Health, held on Monday, Nov. 14, at the Providence Marriott.

A disruption in the force
The election of Donald Trump as President, and with it, the one-party Republican majority rule in Congress, threatens to upend the bipartisan national coalition around health care and children’s health, despite the stiff-upper-lip optimism expressed by many advocates here in Rhode Island.

Occurring a week after Trump’s the election, the mood at the annual celebration of children’s health was tinged with a mixture of somberness, disbelief, as well as exhortations from advocates not to become discouraged.

What a difference a year makes:

• At last year’s celebration in 2015, Gov. Gina Raimondo called attention to the fact that the entire Rhode Island Congressional delegation was in attendance, saying: “It’s not an accident that the rate of health insurance has improved from 95 to 97 percent. It’s because of leadership.”

This year, only Sen. Jack Reed was in attendance. [Both Raimondo and Reed were speakers at a statehouse ceremony honoring National Diabetes Month, held right before the luncheon gathering.]

[For the record, Raimondo recycled part of her 2015 speech this year, saying: “When I talked to other governors, I’m proud to say that 97 percent of Rhode Island children have health insurance. Not everyone can say that.”]

• At the 2015 celebration, Raimondo also singled out the health care agency directors who were in attendance, including Dr. Nicole Alexander-Scott at the R.I. Department of Health and Maria Montanaro from the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, and Anya Rader Wallack from the state Medicaid office. “Thank you, ladies,” she said.

Both Montanaro and Rader Wallack have since departed the Raimondo administration. Alexander-Scott was traveling. Elizabeth Roberts, the secretary of the R.I. Executive Office of Health and Human Services, did not attend, apparently on vacation. Deborah Florio, the acting interim director of the state Medicaid office, received a community leader and partner award.

• In 2015, R.I. Senate President Teresa Paiva Weed was introduced as the “godmother of RIte Care,” in recognition of her long-term championing and support for the program that went back two decades.

This year, Paiva Weed spoke with ConvergenceRI in advance of the speaking program, saying: “We don’t know yet what President Trump will embrace. Today is a celebration of RI Kids Count and children’s health, programs that existed prior to Obamacare being enacted.”

Paiva Weed continued: “I have confidence that the new President, with a new Senate and a new House of Representatives, will continue to embrace health insurance for children. This has been a bipartisan initiative from the very beginning.”

“Certainly, it gets more complicated when you look at the other aspects of the Affordable Health Care law, which reached a broader population,” she said. “But we have been able to build a consensus, in a non-partisan way, that children under 18 need to be insured. Economically it’s smart – and it is the right thing to do.”

Paiva Weed then reminisced a bit with ConvergenceRI about the successful efforts in 1996 to reform the state’s welfare laws, as part of a collaborative group that included Gary Sasse [then from RIPEC], Linda Katz, Jane Nugent and Bill Allen from United Way of Rhode Island, among others, a generation of advocacy ago.

• Two years ago, in 2014, R.I. House Speaker Nicholas Mattiello attended the annual celebration, along with Sen. Sheldon Whitehouse, Rep. James Langevin, Rep. David Cicilline, R.I. Senate President M. Teresa Paiva Weed, and Lt. Gov. Elizabeth H. Roberts.

It was Mattiello’s message – and his commitment to insuring all of Rhode Island’s children, that was the biggest take-away from the luncheon, as ConvergenceRI reported.

Mattiello praised Elizabeth Burke Bryant, executive director of Rhode Island Kids Count, as his “favorite” advocate. In addition to his focus on creating jobs and growing the economy, Mattiello pledged to help Rhode Island Kids Count achieve its goal to have 100 percent of all children living in Rhode Island covered by affordable, comprehensive, high-quality health insurance.

This year, Mattiello, apparently re-elected after a bitter election that was decided by absentee ballots, was scheduled to attend but a conflict was reported to have arisen, according to Burke Bryant.

Celebrating the past, worried about the future
In the opening presentation, Deputy Director Jill Beckwith showcased Rhode Island’s leadership, displaying the facts around the achievements in children’s health in 2016 were showcased, compared to the rest of the nation:

• Rhode Island was first in the lowest number of teen deaths, first in the lowest number of adolescent cigarette use, first in the highest number of childhood immunizations, third in the lowest number of infant mortality, fourth in the lowest number of childhood deaths, fifth in the highest preventive dental care, seventh in lowest number of teen deaths, seventh in the lowest incidence of adolescent obesity, eighth in the lowest level of adolescent alcohol drinking; ninth in the number of overweight adolescents, 12th in the number of preterm births, 15th in children’s health coverage, and 15th in the number of low birth-weight infants.

In terms of national excellence, according to Beckwith, the state’s signature health care program, RIte Care, was a top quality performer in child health measures in 2016:

• RIte Care health plans received top ratings when compared to Medicaid health plans in the U.S.; 93 percent of pregnant women received timely prenatal care; and some 95,737 children, 45 percent of all children under the age of 18 were enrolled in RIte Smiles, in the companion program for dental care.

Darkness at the edge of town
But this year’s event was different for all other previous celebrations: it came a week after Donald Trump became the President-elect, and with that sea change, it translated into potentially much darker time for federal and state policies for children’s health and well being.

There are some who have pointed to the role that Ivanka Trump is projected to play in the new administration on behalf of children and families and childcare as a favorable reading of the tea leaves. But it becomes difficult to envision exactly how that squares with the promotion of the $10,800 bangle she wore during the recent 60 Minutes interview after the election, sent out in a “style alert” to fashion journalists last week, hawking it as “her favorite bangle from the Metropolis Collection.” Apparently, there is also a bargain-basement version being sold for $8,800.

And, when it comes to mental health issues, Stephen Bannon, the newly appointed chief strategist in the Trump White House, proclaimed his views in December of 2015 interview: “I’ve got a cure for mental health issue[s],” said Bannon. “Spank your children more.”

Whether Bannon may claim that he was being sarcastic, or making a joke, or being glib, it doesn’t matter. As Maya Angelou said, “When someone shows you who they are, believe them; the first time.”

The anti-bully pulpit
Susan Orban, the director of the Washington County Coalition for Children and a leader of anti-bullying efforts among school children, received a community leaders and partners award at the celebration of children luncheon on Nov. 14.

For Orban, her focus is on the local needs of children rather than the distractions of the national political debate.

“If there continues to be kids in need, as long as that’s true, there continues to be a need for activists, like me and the folks in this room, to continue this work,” she told ConvergenceRI.

When asked about her coalition’s continuing efforts to prevent bullying, Orban said: “We held our fourth annual “Talk It Up” against bulling earlier this month. And, we’re pleased to be participants in the Rhode Island Kids County issue brief later this month, sharing our work at that meeting.”

Elections have consequences
Yes, elections have consequences. The Nov. 14 celebration included a slide detailing what could potentially be at risk in Rhode Island:

• There is Medicaid expansion; HealthSource RI; essential health benefits for children, including dental benefits; coverage until age 26 on parents’ health plans; Medicaid coverage for former foster youth up to age 26; pre-existing condition protection; prohibition on annual and lifetime limits; no-cost preventive care; and the individual mandate.

Beyond that, there is a need to renew the Children’s Health Insurance Program, or CHIP, in 2017.

Reed had spoken earlier that morning at the grand opening of the state’s first Neighborhood Health Station in Scituate, a partnership between WellOne and the Scituate Health Alliance, turning Dr. Michael Fine’s vision in a bricks-and-mortar establishment in the shopping center on Route 6 across from Cindy’s.

After the ribbon cutting, Reed spoke with ConvergenceRI about the challenges ahead in health care under a Trump administration.

“We have our work cut out us for us,” he said. “I think there is a sense on both sides of the aisle that we have to fulfill, that have to be done thoughtfully and carefully.”

Reed continued: “Elections have consequences, but we have also to make sure that we keep on track.”

How does Reed see  his role?

“I think the best thing we can do is to bring to Washington the real experiences of Rhode Island, which, as today [demonstrates], this is not only a great medical model, it’s a great economic model. If you can provide affordable access to thousands of people, you are going to avoid costs, and make people stronger, healthier and more productive. That’s the message.”

Whether that message will be heard and resonate in Washington is another question.