American Pediatric Society & Society for Pediatric Research

Public Policy Council

 August/September 2003 Legislative Report 

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As Congress recessed for the month of August, the majority leadership of the House and Senate applauded their accomplishments so far in this first session of the 108th Congress, and set forth a full and ambitious agenda for September.  The first 7 months of the 108th Congress were consumed with two main issues: Iraq, and the economy.  With the country entering and theoretically ending war with Iraq during the first months of 2003, the continuing US involvement in the Middle East and other issues surrounding homeland security and bioterrorism dominated much of the debate on Capitol Hill.  Moreover, a troubled economy, a record deficit—$450 billion—and battles over taxes—not to mention the first Presidential primaries and party caucuses only 5 months away—continue to weigh heavily on the minds of Members of Congress. 

A clear message was sent from key Members of Congress early this year—funding for discretionary health programs was going to be exceedingly tight, and even as the House moved quickly on its FY 2004 Labor/HHS/Education appropriations bill, that message proved true. When Congress returns in September, the Senate will be taking up its version and the message is likely to be the same.  Nevertheless, the health community continues to work hard for - at the least - comparable funding levels to FY 2003 for some programs significantly cut.  Additionally, hoping to capitalize on the momentum set by the Senate in passing its pediatric rule legislation in July, the pediatric community is working with key House members to see that a hard-fought victory is realized for pediatric drug testing in this Congress.  Members of the American Pediatric Society, Society for Pediatric Research and the Association of Medical School Pediatric Department Chairs are urged to reach out to their Members of Congress in August and for the remainder of this session of Congress to advocate for key health and pediatric-specific issues.

The following is an update and summary of recent federal legislative and regulatory activities of interest to the pediatric academic community that will assist you in your advocacy.  This report includes information on the following issues:

• Pediatric Research

• Pediatric Rule

• Pediatric Workforce

• FY 2004 Appropriations

• Health Insurance Coverage and Access to Healthcare

• Immunizations

• Join the Federal Advocacy Action Network

• How To Contact Congress/White House

• 2003 Congressional Calendar

PEDIATRIC RESEARCH   

National Institute of Health (NIH)/Appropriations: Through its work with the Ad Hoc Group for Medical Research Funding, the PPC continues to support an adequate increase above current year funding for the NIH in FY 2004. The Ad Hoc Group for Medical Research Funding is a coalition of more then 300 patient and voluntary health groups, medical and scientific societies, academic and research organizations, and industry. In addition, the PPC continues to advocate for an increase in funding for the National Institute of Child Health and Human Development (NICHD) to $1.3 billion in FY 2004. NICHD is currently funded at $1.2 billion.

After essentially completing the five-year doubling of the NIH budget, the President's FY 2004 budget proposal contained a very modest 2% increase—$27.7 billion—for NIH.  The full House provided $27.6 billion in its FY 2004 L/HHS/Education bill; the Senate Appropriations Committee provided $27.9 billion. The Senate is scheduled to begin its floor deliberations on its version of the FY 2004 L/HHS/Education appropriations bill in early September.

ACTION NEEDED: Urge your senators to support the proposed Specter/Harkin amendment to the FY 2004 L/HHS/Education bill (S.1356) to increase funding by $1.5 billion for the NIH - a 9.2% increase above the FY 2003 appropriations for NIH.

National Children's Study: The National Children's Study (NCS) - a national longitudinal study of environmental effects (including physical, chemical, biological and psychosocial) on the health and development of more than 100,000 children across the United States - is currently still in the planning phase. The pediatric community continues to be very involved in this important study. The Study's Advisory Committee, which includes several pediatricians, will convene again in September and the National Children's Study Assembly, "the primary vehicle for sharing information among stakeholders," will take place in Atlanta, Georgia on December 17. Further information and updates are available at http://www.nationalchildrensstudy.gov. 

The Public Policy Council and the Ambulatory Pediatric Association have proposed for the 2004 PAS public policy plenary session a panel discussion and update on the National Children's Study. Duane Alexander, MD, director of NICHD, has tentatively agreed to present. The PPC is exploring other speakers involved with the NCS. Elena Fuentes-Afflick, MD, MPH, a member of the PPC, will moderate the panel discussion.

Pediatric Research Loan Repayment: Last year the NIH released its new loan repayment program for pediatric and clinical researchers (http://www.lrp.nih.gov), which allows for eligible researchers and trainees supported by governmental (including AHRQ) and private, nonprofit grants to apply to NIH for loan repayment. Applications for extramural NIH loan repayment for FY 2004 will open September 1, 2003, and will close December 31, 2003.  Eligibility criteria and other program information are listed on the NIH website at www.LRP.nih.gov.

The pediatric academic community is working with the 108th Congress to ensure continued support for these important loan repayment programs across a spectrum of pediatric research needs.

FY 2002 Pediatric Research Initiative Report to Congress: In late July, the NIH released its annual report to Congress and the public on the FY 2002 Pediatric Research Initiative.  This report, mandated by the Children's Health Act (PL 106-310), outlines the total funds the NIH has obligated to pediatric research and shows the new NIH funding opportunities in FY 2002 that increased support for pediatric biomedical research and training. Senator Mike DeWine (R-OH) has indicated his intention to offer a non-binding sense of the Senate resolution during floor debate on the FY 2004 L/HHS/Education bill to continue to support and encourage ongoing pediatric research at the NIH.

Therapeutic Cloning - Legislation: In February 2003, Senators Orrin Hatch (R-UT), Dianne Feinstein (D-CA), Arlen Specter (R-PA), Edward Kennedy (D-MA), Tom Harkin (D-IA), and Zell Miller (D-GA) introduced S.303, a bill that would ban human reproductive cloning but allow somatic cell nuclear transplantation (SCNT) to move ahead with federal oversight. The Human Cloning Ban and Stem Cell Protection Act of 2003 makes it a crime to clone or attempt to clone a human being, but permits nuclear transplantation to be conducted on unfertilized eggs for up to 14 days, under strict ethical and federal regulation. This bill currently has ten co-sponsors. On the House side, also in February, the House Judiciary Committee approved H.R. 534, a bill sponsored by Reps. Dave Weldon (R-FL) and Bart Stupak (D-MI), that would totally ban all human cloning, including SCNT.  The committee rejected by party-line votes a number of amendments offered by Democrats, including proposals to allow the use of SCNT for therapeutic and research uses and to permit the importation of medical treatments derived from human cloned embryos. After defeating an alternative amendment, the House passed the bill on February 24, by a vote of 241 - 155. Senators Sam Brownback (R-KS) and Mary Landrieu (D-LA) introduced a Senate companion bill to the Weldon-Stupak legislation, S.245. The Brownback-Landrieu bill currently has 28 co-sponsors. At the time of this writing there is limited activity on these bills.

Agency for Healthcare Research and Quality (AHRQ)/Appropriations: Throughout the budget process the PPC, as part of a broad-based coalition, the Friends of AHRQ, has supported increased funding for AHRQ -  $390 million - in FY 2004. AHRQ's current funding is  $303.7 million including $55 million for research on reducing medical errors. President Bush's FY 2004 budget proposal recommended $279 million - a decrease of almost $25 million.  Both the House-passed appropriations bill and the Senate Appropriations Committee approved bill contain level funding - $303.7 million - for FY 2004. 

Impact on Research of the Health Insurance Portability and Accountability Act (HIPAA): This past April, the new federal health information privacy regulations took effect. These regulations are part of the Health Insurance Portability and Accountability Act (HIPAA) and require new practices and policies of all medical schools and teaching hospitals institutions. The Association of American Medical Colleges (AAMC) formed a consortium to monitor and document the effects of HIPAA on medical and health services research to identify any needed legislative or regulatory relief efforts in the future. The AAMC has developed a database to receive and record credible data on HIPAA's impact on research, and ultimately use the information gathered to inform future policy recommendations. The Public Policy Council is participating in this consortium. In the first two months the AAMC's database was in place, nearly 100 case reports were completed and submitted. The responses focused on the following areas: recruiting subjects, consent process/interaction with participants, IRB review and approval, and general burden of new systems (time, cost, etc.).  For further information and to report the impact of HIPAA on research visit the AAMC web site http://services.aamc.org/easurvey. For questions or comments contact the AAMC Division of Biomedical and Health Sciences Research, (202) 828-0484.

IOM Committee on Clinical Research Involving Children: The IOM has convened a Committee on Clinical Research Involving Children to review and consider federal regulations, federally prepared or supported reports, federally supported evidence-based research, and other sources of available information related to research involving children.  The Committee is chaired by Richard Behrman, MD, Executive Chair of the Pediatric Education Steering Committee of the Federation of Pediatric Organizations and includes several pediatricians, including Drs. Russ Chesney (a member of the PPC), Francis Sessions Cole, III, Robert "Skip" Nelson, David Poplack, Bonnie Ramsey and Stephen Spielberg. A public hearing and meeting was held July 9–11, 2003. Christine Gleason, MD, representing the APS/SPR and APA, David Schonfeld, MD, representing the AAP, and George Dover, MD representing AMSPDC were among those participating in this hearing.  The statements of all of these and the participants from the meeting are available at www.iom.edu/subpage.asp?id=13665.  The Committee will finish its work in December; its report to Congress is scheduled to be released in March 2004.

Secretary's Advisory Committee on Human Research Protections: The inaugural meeting of the Secretary's Advisory Committee on Human Research Protections (formerly known as the National Research Protections Advisory Committee) met on July 22, 2003.  SACHRP was chartered in October 2002 to advise the Secretary of the Department of Health and Human Services (HHS) on issues concerning research involving human subjects, with particular emphasis on special populations such as neonates and children, prisoners, and pregnant women, embryos, and fetuses.  In addition, the committee is responsible for reviewing selected ongoing work and planned activities of the Office of Human Research Protections (OHRP), such as a review of assurance systems, the application of minimal research risk standards, and the ongoing monitoring and oversight of institutional review boards (IRBs) and the institutions that sponsor research. SACHRP indicated that it will look to create a pediatric working group after the IOM Committee on Clinical Research Involving Children report release to address pediatric-specific issues.  Additional information, including its charter, can be found on the Committee's website, at http://ohrp.osophs.dhhs.gov/sachrp/sachrp.htm.
 

PEDIATRIC RULE

The Pediatric Rule: In October 2002, the U.S. Federal District Court in Washington, DC, struck down the Pediatric Rule, saying Congress never intended to give the FDA power to require drug companies to test adult medicines commonly given to children.  In December, the American Academy of Pediatrics and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) filed a motion in federal court asking for the right to intervene in the lawsuit over requiring drug companies to test medicines used in children because the FDA decided not to appeal, stating that congressional action is the surest and swiftest way to ensure that the Pediatric Rule is restored.  The appeals process is now in motion.  The AAP and EGPAF are preparing appellate briefs this month, with follow-up response briefs due in the fall and oral arguments before the U.S. Court of Appeals scheduled for January 22, 2004. 

Legislation to Codify the Pediatric Rule: In the 108th Congress reinstating the Pediatric Rule remains a top priority for the pediatric academic societies working under the leadership of and in partnership with the AAP. 

In March, Senators Judd Gregg, (Chair of the Senate Health, Education, Labor and Pensions Committee (HELP)), Edward Kennedy (D-MA), Mike DeWine (R-OH), Christopher Dodd (D-CT), and Hillary Clinton (D-NY) introduced and reported out

S. 650, the Pediatric Research Equity Act of 2003.  This bipartisan legislation restores critical components of the 1998 pediatric rule, including:

• A presumption that drug and biological products that will be used in the pediatric population will be studied in those populations if the labeled indication occurs in infants, children or adolescents;

• A permanent authority for FDA to require pediatric studies of certain drugs and biological products;

• Immediate implementation of the pediatric study requirements upon enactment of the law;

• No delay in approval of drugs for adult indications.

The pediatric community, including APS, SPR, AMSPDC, has endorsed the legislation.

On July 23, 2003, in a win for children's therapeutics, the Senate passed S. 650 by unanimous consent, as amended.  In a manager's amendment offered on the floor by Senator Gregg, the two outstanding issues - enforcement and effective date - were appropriately fixed, although a sunset provision remains.

On July 25, Representatives Jim Greenwood (R-PA), Anna Eshoo (D-CA) and Deborah Pryce (R-OH) introduced H.R. 2857, the Pediatric Research Equity Act of 2003, the House bill identical to the Senate-passed bill.  The pediatric community is working aggressively to see that the House Energy and Commerce Committee consider this legislation and then bring the bill to the House floor in September. 

ACTION NEEDED: Urge your Representative to support H.R. 2857, the Pediatric Research Equity Act.  This legislation is identical to the Senate-passed bill, S. 650. While the PPC does not support the provision in the bill that time-limits the authority of the FDA to require pediatric testing, we join with the AAP in believing that the Pediatric Research Equity Act is strong legislation that at long last establishes in law the right of children to the same kind of drug safety and efficacy information that was previously available only to adults.
  

PEDIATRIC WORKFORCE

Children's Hospitals Graduate Medical Education (CHGME): The President's FY 2004 budget contained only $199 million for CHGME. The pediatric academic community is continuing its efforts with the National Association of Children's Hospitals (NACH) to vigorously advocate for adequate and sustained funding—$305 million ($292 million plus an adjustment for inflation)—in FY 2004.  The House-passed L/HHS/Ed bill contained $305 million for CHGME in FY 04; the Senate committee language contains less, at $290 million. 

Titles VII and VIII-Health Professions Training Grants/Appropriations: As in FY 2003, the President's FY 2004 budget removed all funding for primary care, interdisciplinary community projects, training for diversity, and public health. The president proposed only $11 million for the Title VII program, although it does address the nursing shortage through a modest increase for Title VIII. Current funding for Titles VII and VIII is $421.2 million. On June 26, the Senate Appropriations Committee approved a bill that provides only $133 million for both Title VII and VIII in FY 2004. Of this, $113 million is designated for the Title VIII nursing programs (level with the FY 2003 level), leaving just $20 million for all of the Title VII health professions programs. Of this $20 million, $9.9 million is specified for the Scholarships for Disadvantaged Students and $5.5 million to expand the pediatric dentistry program, leaving approximately $5 million for ALL of Title VII health professions programs. For all intents and purposes, the majority of Title VII programs, including the General Internal Medicine/General Pediatrics cluster, have been essentially eliminated by the Senate Appropriations Committee. 

The full House approved the FY 2004 Labor/HHS/Education bill on July 10, providing $391 million for the program - a 7.1 percent cut below last year.

The PPC has joined over 40 national organizations in the Health Professions and Nursing Education Coalition (HPNEC) to support $550 million for the Title VII and VIII programs in FY 2004. In addition, the pediatric community continues to support innovative training for generalist pediatricians through appropriate funding for the General Internal Medicine/General Pediatrics program, that is part of Title VII, of at least $40 million.  This represents a step towards a multi-year effort to achieve a funding level of at least $69 million for the General Internal Medicine/General Pediatrics programs, as recommended by the congressionally-established Advisory Committee on Training in Primary Care Medicine and Dentistry. Ongoing advocacy to restore funding for the health professions training program is crucial in the 108th Congress.

Reauthorization: The Title VII program was due to be reauthorized in 2002 but was not; therefore, it will likely be taken up in the 108th Congress. This process, if past years are any example, may well take quite some time. The pediatric community is continuing its conversations with colleagues in the internal medicine community.  We certainly appreciate the involvement of members of the pediatric academic societies as reauthorization moves forward.  If you or your colleagues have examples of how Title VII is working in your institution, or comments on changes or additions that might be needed in the reauthorized bill, please do let us know. (Contact kbutterfield@aap.org).

ACTION NEEED: Urge your Senators/Representative to restore and support adequate funding for health professions training programs of at least the House passed funding level of $391 million, and $40 million for general internal medicine/general pediatrics.  Describe specific examples of its importance in faculty development and to training/educating more pediatricians in a variety of ambulatory/community based settings.
 

FY 2004 APPROPRIATIONS

Meeting a timeline that hasn't been met in several years, Congress began the FY 2004 appropriations process in earnest in late Spring, with the House completing most of the 13 bills comprising the total federal government spending package by July's end.  In May, the PPC submitted a written statement for the hearing record to the House Appropriations subcommittee. The statement focused on the importance of ongoing biomedical research including increasing pediatric research at the NIH, supporting the training of more pediatric investigators such as through the pediatric loan repayment program, support for Children's Hospitals graduate medical education, increasing the funding for Title VII programs, and the inclusion of children in clinical trials.  The PPC statement is available at http://www.aps-spr.org/Public_Policy/2003_Docs/Statement0516.htm.

On June 25, the full House Appropriations Committee adopted the Labor-HHS-Education bill; the Senate Labor-HHS-Education Subcommittee also approved its bill on June 25, with the full Committee passing the bill the following day.  On July 10, the full House approved the measure.  Senate Majority Leader Frist (R-TN) has indicated that the Senate will take up its bill immediately upon returning from its recess the week of September 1.   The House and Senate versions of the spending package are not dissimilar.  For example, the Centers for Disease Control and Prevention would receive $4.55 billion in the House bill and $4.4 billion in the Senate.  Ryan White AIDS funding would be set at $2 billion under both bills. The National Institutes of Health is slated to receive $27.6 billion in the House measure and $27.9 billion in the Senate's measure.  Children's Hospital GME is set at $305 million in the House, $290 million in the Senate.

During consideration of the FY 2004 L/HHS/Education appropriations bill on the House floor, a troubling amendment offered by Rep. Toomey (R-PA) to prohibit the NIH from funding five specific research grants was narrowly defeated, by a vote of 210-212.  The amendment challenged the peer review process at the NIH and required that funding for these grants, including three of the five that were sexual health-related research grants, be redirected toward other research. It is possible that during full Senate consideration an amendment similar to the House's Toomey amendment could be offered. In anticipation, the PPC has joined with many others in the research community in signing a letter supporting the NIH's merit review process.

Overall, the final FY 2004 L/HHS/Ed appropriations package faces several possible hurdles including under-funding for education and several public health programs such as health professions, immunizations, and HIV/AIDS prevention.  In the end, debate on this bill could go well into the late fall, although the hope obviously is that it will happen sooner.

ACTION NEEDED: The August congressional recess is an excellent opportunity to participate in town hall meetings that your senators/representative may be convening. Urge them to support the highest level of funding for maternal and child health programs important to your community including biomedical and health services research, independent children's hospital, mental health, programs addressing infectious diseases, e.g., West Nile, SARs, TB, HIV/AIDS, and substance abuse prevention and treatment programs.
 

HEALTH INSURANCE COVERAGE AND ACCESS TO CARE

SCHIP FUNDING: There are two State Children's Health Insurance Program (SCHIP) funding problems for which a legislative remedy is needed.  The first is the almost $3 Billion in unused SCHIP dollars that have already or are scheduled to revert back to the federal treasury by September 30, 2003, and the second is the program funding "dip," a drop in program funding by more than $1 billion this year and in each of the next two years, the result of the balanced budget deal enacted in 1997. Over the next three years, SCHIP program funding will be reduced by 26 percent.  The combination of the "SCHIP Dip" and rising SCHIP enrollment could cause many states to have insufficient funds to continue to fund their programs.  The Office of Management and Budget (OMB) estimated that national SCHIP enrollment will decline by 900,000 children between 2003 and 2006 due to these reductions in federal funding.

Prior to departing for its summer recess the House and the Senate passed H.R. 2854, legislation that would extend the use of $2.7 billion of unspent SCHIP dollars from FY1998-2001. Fifty percent of unspent funds would stay with the states and the other half would be redistributed to those states that have already spent their allocations. This legislation also would allow those states that had pre-existing Medicaid expansions (up to at least 185 percent of FPL) to use 20 percent of their original SCHIP allocations on these beneficiaries-reimbursing the state for the difference between their Medicaid FMAP and the enhanced SCHIP rate. In addition, to ensure that all states will be able to use a portion of its allocations on its pre-existing Medicaid expansions, specifically New Mexico, a technical correction bill was unanimously passed by the Senate (S. 1547) that changes the definition of a qualifying state from "at least 185 percent FPL" to "at least 184 percent FPL."  It is our understanding that the House is expected to pass this correction in September.

MediKids: On March 11, 2003, Representative Pete Stark (D-CA) and Senator John Rockefeller (D-WV) reintroduced the MediKids legislation (H.R. 1205/S. 588) legislation first introduced in the 107th Congress. The pediatric community strongly supports this legislation which would create a unified health care system that would achieve the goal of health insurance for all children regardless of family income.  MediKids would make coverage automatic and promote equity, family responsibility, choice, and uniform benefits.  The MediKids legislation currently has 6 Senate cosponsors and 45 House cosponsors.
 

IMMUNIZATIONS

Federal Legislation: Several legislative proposals have been introduced to address the Vaccine Injury Compensation Program (VICP). In April, Sen. Bill Frist (R-TN) introduced the Improved Vaccine Affordability and Availability Act  (S.754) - similar to a bill introduced last year by Sen. Frist with additional modifications recommended by the Academy and the Advisory Commission on Childhood Vaccines (ACCV).  Mark-up on this important legislation has been postponed numerous times, and it remains unclear when it will be considered.  The principles that any amendments to this important legislation must be measured are:

1. The Vaccine Injury Compensation Program (VICP) must guarantee a safe and stable supply of childhood vaccines;

2. The scientific credibility of the VICP must be preserved; and

3. The VICP must stand as the first contact for all alleged vaccine-related injuries before pursing legal action.

Also, this year, Senators DeWine (R-OH), Clinton (D-NY), and Reed (D-RI) introduced S. 371, the Childhood Vaccine Supply Act. Echoing the recommendations of the General Accounting Office's September 2002 report, S. 371, requires a national six-month stockpile for routine childhood vaccines, and requires manufacturers to give one-year's advance notice when they intend to stop producing a vaccine, enabling the CDC and FDA to better monitor the supply stream of vaccines coming into the market, and allows them more time to prepare for potential shortfalls.

IOM Vaccine Financing Report: On August 4, the Institute of Medicine released a report Financing Vaccines in the 21st Century: Assuring Access and Availability.  The report proposes a new vaccine financing program involving a federal vaccine insurance mandate, subsidy, and voucher plan. The mandate would require all insurance plans to include vaccine benefits, and the federal government would subsidize health plans and providers for the purchase costs and administration fees created by the vaccine mandate.

The report is available on the IOM website, at http://www.iom.edu/report.asp?id=14451.

ACTION NEEDED: Urge your senators to support and pass S.754 to strengthen the vitally important Vaccine Injury Compensation Program and S. 371 to ensure an adequate supply of childhood vaccines.  
 

CONSIDER JOINING THE AAP FEDERAL ADVOCACY ACTION NETWORK (FAAN)

The American Academy of Pediatrics invites you to become a member of the Federal Advocacy Action Network (FAAN).  Coordinated by the AAP Department of Federal Affairs, FAAN is a network of AAP members who help support federal legislative and regulatory activities from their position as constituents.  FAAN members play an important role in passing federal legislation that benefits children and pediatricians.

The AAP Department of Federal Affairs gives FAAN members the information and tools you need to persuade your legislators.  For example, each month via e-mail you will receive FAAN MAIL with updates on AAP legislative priorities in Washington, D.C.  We will keep you up to date with timely information with "THIS JUST IN."  You will also receive "SPECIAL ALERTS" when immediate action is needed by you on a key issue. 

To join FAAN go to the Members Only Channel of the AAP web site, www.aap.org/moc, and click on Federal Affairs, then click on Join FAAN and follow the easy directions.   The Members Only Channel has some great tools to make your advocacy work easy.  Find the names of Congressional representatives, contact legislators via e-mail, read about daily congressional activity, view actual bills and use the media contact list.

If you are already a member of FAAN, thank you!  If you are interested in joining FAAN and have questions, please contact Kristin Butterfield (kbutterfield@aap.org) in the AAP Department of Federal Affairs at 800/336-5475.  Together we can make a real difference for children and pediatricians!  
 

HOW TO CONTACT YOUR MEMBER OF CONGRESS:

Write: Be courteous, to the point, and include key information, using examples, if possible, to support your position. Address only one issue in each letter and, if possible, keep the length to one page.

Call: You can contact your Senators and Representative's office by calling the Capitol Hill Switchboard at 202-224-3121. If you do not know who your Representative is, the switchboard operator will be able to direct you to the proper office. Ask to speak to the staff member who works on health care issues. Be prepared to leave a very short message as well as your name and address. You can also call your legislators in their home districts: information about local offices is available on the Academy's Members Only website at www.aap.org/moc

Fax: Most offices have fax machines, so you can call and ask for the fax number if you would like to fax your letter. Some offices do not give out their fax numbers, however.

E-mail: All of members of Congress now have e-mail addresses, but there is no set format for them. We suggest calling the member's office to get an accurate e-mail address or visit www.aap.org/moc the Members Only website of the American Academy of Pediatrics. 

HOW TO CONTACT THE PRESIDENT: 

Write:
The Honorable George W. Bush
The White House
1600 Pennsylvania Avenue
Washington, DC 20500

Call: 202-456-1414

Fax: 202-456-2461

Email: president@whitehouse.gov