|
|
American Pediatric Society & Society for Pediatric Research Public Policy Council |
||||||||||||||||||||||||||||||||||||||
|
March 2006 Legislative Report |
|||||||||||||||||||||||||||||||||||||||
|
|
The
first session of the 109th Congress ended with a flurry of
activity, the likes of which have not been seen in some time.
A perfect storm of budget reconciliation and
discretionary spending bills, where both mandatory programs like
Medicaid and discretionary programs like NIH, Maternal and Child
Health Block Grant, and Title VII were targeted for major cuts.
Despite the incredible advocacy efforts of thousands of
pediatricians and others in the child health community,
discretionary programs funded (or not funded - as the case may
be) in the final FY 2006 appropriations bills took big hits,
jeopardizing the health care safety net for children on which so
many families depend. The safety net was further compromised by
the passage of deep spending cuts to the Medicaid program, which
the House of Representatives approved when they returned for the
second session of the 109th Congress in January. Our
sights are now set on and our energies are directed toward the
FY 2007 budget. The
President's budget, released on February 6, proposed $13.6
billion in cuts from Medicaid and the State Children's Health
Insurance Program over five years. The president's budget also
proposes to eliminate or cut funding for many other child health
programs, including Children's Hospitals Graduate Medical
Education (GME) program, Title VII health professions training
grants, newborn hearing screening, Emergency Medical Services
for Children (EMSC) program, and the National Children's Study.
The pediatric community will be urging Congress in the strongest
possible voice that funding for health programs must be
sustained and increased in the FY 2007 budget and appropriations
process. Your help
is critical if we are to be successful.
We'll be coming to you throughout the year to ask that
you make your Senators and Representative know how these drastic
cuts will harm children, and what the effect will be in your
communities. And,
yes, how voters will be taking notice of how Congress supported
child health programs in this upcoming mid-term election cycle.
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 in the weeks and
months ahead. We encourage you to share this information with
your colleagues. 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 to advocate for key health and
pediatric-specific issues.
This report includes information on the following issues: National
Institute of Health (NIH)/Appropriations: Through its
coalition work with the Ad Hoc Group for Medical Research, the
PPC engaged heavily in the fight to encourage an adequate
increase for the NIH in FY 2006.
Unfortunately, after months of hard work and advocacy,
the House and Senate in the final days of an extended session of
Congress approved an FY 2006 Labor/HHS spending bill that
contained $28.6 billion for NIH—an increase of just $153
million over FY 2005, the lowest increase to the NIH (less than
1%), in more than thirty years. That small increase, however,
was essentially wiped out by a provision in the FY 2006 Defense
Appropriations bill—also approved in the final hours of the
Congressional session—that made a 1% across-the-board cut to
all non-defense discretionary spending.
Therefore, the FY 2006 funding for the NIH is $28.4
billion reflecting a cut of $66 million. The
President's FY 2007 budget proposal for NIH is level funded at
$28.4 billion. Through
its work with the Ad Hoc Group the PPC will continue to seek
adequate and appropriate increases in funding for the NIH. The
advocacy community request for FY 2007 is a 5 percent increase
above the FY 2006 funding level. We will also continue to
support an adequate funding level for the NICHD of $1.35 billion
including sufficient funding for and stability of the National
Children's Study. NIH
Reauthorization: There has been a good deal of discussion
about the reauthorization of the NIH in this 109th Congress. The
last time the NIH was reauthorized was 1993. Rep. Joe Barton
(R-TX), the chair of the committee of jurisdiction, the House
Energy and Commerce Committee, has indicated his interest in
reauthorizing the NIH and to this end is circulating a draft
reauthorization bill. In general the draft legislation focuses
on the organization and functions of the Office of the Director
of NIH and its relationship to the individual NIH institutes and
centers, provides enhanced authorities for strategic planning
and support of trans-institute initiatives and creates a
detailed series of reporting requirements covering research and
other activities supported by the NIH. The draft also eliminates
several disease specific authorizations for appropriations and
reporting requirements. At this time it is unclear if or when
Congress will seriously address these concerns in the second
session of the 109th Congress. There are also several areas of
concern - such as stem cell research, fetal tissue research, and
conflict of interest issues, as well as some of the allegedly
"controversial" behavioral research grants - that may
further complicate the process as this moves forward in the
coming year. However,
at a recent congressional hearing Chairman Barton reiterated his
commitment that the reauthorization of the NIH is a top priority
this year. National
Children's Study (NCS): The PPC continues to be very
involved with and participates in various aspects of this
important national longitudinal study, and plays a leadership
role with other advocates, such as the March of Dimes, to secure
adequate and stable funding for the study. The Study continues to move forward, however, the
implementation of the study could be over before it even begins
if the president's proposed zero funding for the NCS in FY 2007
is approved by Congress. Sufficient
funds have previously been appropriated for the launch of at
least three Vanguard Centers and one Coordinating Center, but,
beyond the final pilot work, the outlook for funding of this
important study is uncertain at best.
It is estimated that the total cost of the NCS over 25
years will be between $2–$3 billion. The membership of the
reconfigured National Children's Study Federal Advisory
Committee includes several prominent pediatricians, including
Myron Genel, MD, chair of the Public Policy Council, former AAP
president Antoinette P. Eaton, MD, Edward R.B. McCabe, MD, PhD,
David Schonfeld, MD, chair of the AAP's Committee on Pediatric
Research, and Alan Fleischman, MD, who chairs the Advisory
Committee. There
are now seven Vanguard Centers, which will pilot and complete
the first phases of the Study:
The
pediatric community will need to work very hard to insure that
the NCS is allowed to go forward and that funding is available
for the implementation of the study in the year ahead. Further
information and updates are available at http://www.nationalchildrensstudy.gov. Pediatric
Research Loan Repayment: The NIH loan repayment program,
including pediatric and clinical research, continues to be a
successful and important option for early and mid-career
pediatric researchers. According to the NIH, over 500 new and
100 renewal applications were submitted to the Pediatric
Research LRP in FY 2004. Nearly 50 percent of the new
applications and more than 80 percent of the renewal
applications were funded. In FY 2004, more than 50 percent of
awards went to applicants with M.D. or M.D. /Ph.D. degrees. Also, half of the awardees were within 5 years of the receipt
of their doctoral degree. There
were 228 awards in FY 2004 for pediatric loan repayments in
contrast to 298 in FY 2003 and 168 in 2002.
It is very important that this program—which allows
eligible researchers and trainees supported by governmental
(including AHRQ) and private, nonprofit grants to apply to the
NIH for loan repayment—continue to be well publicized and
utilized by pediatricians to ensure ongoing funding for this
critical initiative. The
current extramural funding cycle is now closed.
Funding decisions will be announced in August 2006.
The next application will open in September 2006.
Additional information is available at http://www.lrp.nih.gov.
Publication
and Disclosure Issues in Clinical Trials:
This topic currently has great momentum, due in part to
the high-profile problems with Vioxx and other drugs.
Senator Chris Dodd (D-CT) has reintroduced from the 108th
Congress the Fair Access to Clinical Trials (FACT) Act of 2005,
S. 470. The
legislation calls for a clinical trial registry, accessible to
patients and health care practitioners, for ongoing clinical
trials for serious or life-threatening diseases and conditions,
and a clinical trials database of all publicly and privately
funded clinical trial results regardless of outcome, accessible
to the scientific community, health care practitioners, and
members of the public. The
bill currently has six bipartisan co-sponsors.
On the House side, Reps. Henry Waxman (D-CA) and Edward
Markey (D-MA) reintroduced in June 2005, H.R. 3196, a bill that
would expand on the National Library of Medicine's www.clinicaltrials.gov
database. Sponsors would be required to register all privately
and publicly funded studies of drugs, biologics, or medical
devices with safety or effectiveness endpoints as a condition of
obtaining Institutional Review Board (IRB) approval.
H.R. 3196 has 40 co-sponsors.
The PPC will work closely with the primary authors of the
legislation to make sure that the voice of the pediatric
research community is heard as this legislation moves forward in
the second session of the 109th Congress. Agency
for Healthcare Research and Quality (AHRQ)/Appropriations:
The PPC, as part of a broad-based coalition, the Friends of AHRQ,
supports a $440 million funding request for AHRQ in FY 2007.
The President proposed level funding at $319 million for
AHRQ in FY 2006 and again for FY 2007, with all funds allocated
via transfers from other public health service agencies. The
funding is designated for health information technology and
patient safety ($84 million), $15 million for clinical
effectiveness research and $17.1 million available for new
non-patient safety research grants. There is also interest by
the Senate to reauthorize AHRQ before the end of this session.
AHRQ should have been reauthorized in 2005. Secretary's
Advisory Committee on Human Research Protections (SACHRP): The
Secretary's Advisory Committee on Human Research Protections (SACHRP)
has a Subcommittee for Research Involving Children, which
includes several notable pediatricians. The subcommittee was
formed to provide recommendations for consideration by SACHRP on
interpretations of the requirements of HHS regulations 45 CFR
46.404-407 ("Subpart D") in order to help ensure that
children who participate in research are appropriately and
adequately protected. In
April 2005, the pediatric subcommittee finalized, after more
than a year, its recommendations for defining a number of terms
in Subpart D. These
recommendations are designed to increase the clarity and
consistency in research approvable under this section.
Among the concepts defined by the subcommittee are
uniform standard, minimal risk, condition, commensurate, and
vital importance. The
Subcommittee has submitted the recommendations in a letter to
HHS Secretary Leavitt. The next areas of consideration for the
subcommittee are issues of parental permission and child assent,
as well as further clarification of terms and decision-making
challenges found within section 46.405 such as
placebo-controlled and vaccine trials involving children.
Additional information, including its charter and the
pediatric subcommittee roster, can be found on the SACHRP's
website, at http://www.hhs.gov/ohrp/sachrp/index.html. Embryonic
Stem Cell Research:
On May 24, 2005, the House passed H.R. 810, the Stem Cell
Enhancement Act of 2005, by a vote of 238 to 194.
The bill—introduced in February 2005 by a Reps. Mike
Castle (R-DE) and Diane DeGette (D-CO)—modifies the current
stem cell policy, established in August 2001, by expanding the
number of stem cell lines that are eligible for federally funded
research. A
companion Senate bill, S. 471, introduced by Senators Arlen
Specter (R-PA) and Tom Harkin (D-IA), currently has 40
bipartisan cosponsors. On
December 16, the Senate unanimously passed the Stem Cell
Therapeutic and Research Act of 2005, which provides for the
collection and maintenance of cord blood units for the treatment
of patients and research, and to authorize the Bone Marrow and
Cord Blood Cell Transplantation Program to increase the number
of transplants for recipients suitable matched to donors of bone
marrow and cord blood. A number of Senators, including Sen. Tom
Harkin (D-Iowa), sought to amend the bill to include language
from the Castle/DeGette Stem Cell Research Enhancement Act (HR
810). Ultimately, the amendment was retracted, though the bill's
House sponsors and the Coalition for the Advancement of Medical
Research urged Senate Leadership to schedule a vote on H.R. 810
in early January. The pediatric community, working as part of a
broad coalition of patient and research advocacy groups, will
continue to urge Senate action on this bill in 2006.
Of course it is anticipated that even if both the House
and the Senate approve an embryonic stem cell bill, President
Bush has indicated his intent to veto the measure. In addition,
while the debate continues in Congress, several states have or
are contemplating introducing stem cell legislation following
the success of the 2004 California stem cell ballot initiative.
In
April 2005, the Committee on Guidelines for Human Embryonic Stem
Cell Research of the National Research Council and the Institute
of Medicine issued a report that provides guidelines for the
responsible practice of human embryonic stem cell research. Some
of the key recommendations of the report include:
On
February 16, 2006, the National Academies' National Research
Council and Institute of Medicine announced that they were
convening a new committee to provide updated guidelines on the
conduct of human embryonic stem cell research. According to the
press release, the "committee will periodically update the
guidelines issued last year by the Academies to reflect advances
in stem cell science. The guidelines are voluntary and intended
to enhance the integrity of human embryonic stem cell research
by encouraging responsible practices." The Committee will
be funded by private sources, including the Ellison Medical
Foundation, the Greenwall Foundation, and the Howard Hughes
Medical Institute. NIH
Conflict of Interest Regulations: In a Senate hearing held
in April 2005, key Senators indicated that some adjustments must
be made in the conflict of interest regulations that NIH
Director Elias Zerhouni, MD announced last year. Under the
rules, NIH employees will be barred from entering outside
consulting agreements with pharmaceutical companies, hospitals,
health insurers and health care providers. The guidelines also
forbid 6,000 top NIH employees from holding stock in
pharmaceutical or biotechnology companies, and require current
stockholders in the group to sell their shares. Other agency
employees must divest by the same date any holdings that exceed
$15,000 in value for a particular company. During the hearing
Senator Harkin told NIH Director Elias Zerhouni
"[t]hey are too onerous, and they must be redone,
soon before you lose more people. I think we've gone
overboard." Senator Specter added that the committee would
recommend ways to loosen the rules. In addition, Secretary of
Health and Human Services Michael Leavitt also indicated that
these regulations might need to be reviewed, in light of the
numerous comments received on the interim final ethics
regulations. Accordingly,
to allow time for this review and consideration, the deadline
for filing supplemental financial disclosure reports was
extended to October 3, 2005, and the deadline for divesting
financial interests prohibited under the regulation was January
2, 2006. Coalition to Protect Research: The Coalition to Protect Research is a coalition of organizations committed to promoting public health through research. Sexual health and behavior research is essential to providing a scientific foundation for sound public health prevention and intervention programs. The PPC, the Society for Adolescent Medicine, the AAMC and other groups continue to closely monitor the challenges to the peer review process and certain NIH grants that have arisen during the appropriations process from some members of Congress over the past three years. Following
the series of stakeholder meetings hosted by the AAP, the
Elizabeth Glaser Pediatric AIDS Foundation, the National
Organization for Rare Disorders (NORD), the National Association
of Children's Hospitals, and the Advanced Medical Technology
Association last year, the pediatric community has continued
legislative efforts to increase the access and availability of
pediatric medical devices for neonates, infants, children, and
adolescents. On
November 1, 2005, AAP along with Elizabeth Glaser Pediatric AIDS
Foundation, the American Thoracic Society and NORD hosted a
briefing for Senate Health, Education, Labor and Pensions (HELP)
Committee staff on the need for pediatric medical devices.
The briefing was well attended and FDA regulatory
pathways for medical devices were discussed fully. The
AAP has convened a Task Force on Pediatric Devices, chaired by
PPC member Dr. Jon Abramson representing the AAP and PPC.
The two-year Task Force, which has six members, will
provide leadership and direction on issues surrounding the
safety and effectiveness of existing devices and promote the
development of new medical devices that address the needs of
children. Congressional
Activities: Senate
staff remains interested, and staff is optimistic, about the
development of legislation in the second session of the 109th
Congress to increase access to pediatric devices.
The pediatric community will continue to meet regularly
with congressional staff to ensure that any legislation is
comprehensive and adequately addresses the needs of
pediatricians and their patients. GME
Financing in Children's Hospitals: The FY 2006 Labor-HHS-Education
conference agreement provided $297 million for the CHGME program
(inclusive of the 1% across the board cut).
The 2007 proposed budget from the president would reduce
funding for this program by two-thirds, to $99 million.
The President also asks Congress to "reform"
CHGME by targeting the remaining CHGME funding to only
children's hospitals that have the greatest financial need,
serve the largest number of uninsured patients, and train the
most residents. With
this proposed change in mind, the PPC will be working closely
with the National Association of Children's Hospitals (NACH) to
ensure adequate funding, as well as protect the original
statutory functioning of the CHGME program. Reauthorization:
Last July the Senate passed S.285, reauthorizing the CHGME
through FY 2010.
The legislation, the Children's Hospitals Educational
Equity and Research (CHEER) Act, authorizes $330 million for FY
2006 and "such sums as necessary" for subsequent years
to children's hospitals for expenses associated with operating
approved graduate medical residency training programs. The House
bill, H.R.1246, introduced by Representatives Nancy Johnson
(R-CT) and Deborah Pryce (R-OH), currently has 158 cosponsors.
The PPC will continue to work closely in collaboration with NACH
to secure final passage in the second session of the 109th
Congress. It is imperative that action is taken swiftly on
reauthorization in the House of Representatives in light of the
changes proposed by the Administration to the CHGME. These
changes include reducing funding dramatically and targeting the
remaining dollars to only children's hospitals that have the
greatest financial need, it is absolutely critical that
reauthorizing legislation be enacted as soon as possible. Titles
VII and VIII—Health Professions Training
Grants/Appropriations: Once again, the Title VII program has
been a target for near-elimination by the Administration and
Congress. As
in the previous four years, President's FY 2007 proposed budget
removed all funding for primary care, interdisciplinary
community projects, and public health. The President proposed
only $10 million for the Title VII program.
As in previous years, Title VII also faces major funding
threats in Congress. After
being slated for near-elimination in the House and Senate,
appropriations conferees added $52.7 million to the Title VII
programs, bringing the total appropriation for FY 2006 to $146.7
million (combined $297.8 for Titles VII AND VIII).
Specifically, $13 million was added to the Primary Care
Medicine and Dentistry programs, for a total appropriation of
$40 million - a 54% cut from FY 2005, but also not the
elimination that was slated for in the House. Following
a tradition of many years, the pediatric community continues to
vigorously fight to restore funding for health professions and
nursing education training under both Titles VII and VIII.
Through its leadership efforts with the Health
Professions and Nursing Education Coalition, the PPC will push
for the restoration of funds for this small but vitally
important program. In
addition, PPC staff is compiling examples of the real impact
that these severe cuts to Title VII will have on programs,
providers, patients, and communities. Reauthorization:
The Title VII program was due to be reauthorized in the
107th Congress (2002) but four years later Congress still has
not taken it up. The
pediatric community is continuing to have ongoing discussions
with colleagues in the internal medicine community in
anticipation of possible reauthorization in the 109th Congress
as well as a broader community that supports the primary care
medicine and dentistry provision of the Title VII program. Resident
Hours: In
March 2005, Rep. John Conyers (D-MI) reintroduced the
"Patient and Physician Safety and Protection Act of
2005" (H.R. 1228). The
bill establishes specific limits on work hours, allows residents
to file anonymous complaints regarding violations, and imposes
financial penalties for noncompliance. Specifically, the bill
limits postgraduate trainees to 80 hours of work per week and 24
hours of work per shift. They must have at least 10 hours
between scheduled shifts, at least one of every 7 days off, and
at least one full weekend off per month. The bill also limits
on-call responsibilities to no more than every third night.
H.R. 1228 offers whistleblower protections to individuals
who report violations to HHS, ACGME or hospital management, and
subjects hospitals to penalties of up to $100,000 for violations
in each resident training program in any 6-month period.
The bill—which has no cosponsors—has been referred to
the House Energy and Commerce Committee's Health subcommittee. A
Senate companion bill, S. 1297, was introduced last year by
former Senator now Governor Jon Corzine (D-NJ). The senate bill
has three cosponsors. FY 2006 BUDGET/APPROPRIATIONS On November 17, the House of Representatives—somewhat surprisingly—defeated FY 2006 Labor/HHS appropriations conference report 224 to 209. The following day, the Senate voted to send the bill back to a House-Senate conference committee to reach an acceptable compromise. While a number of factors contributed to the defeat of the bill in the House, certainly one of the main reasons was the bill's failure to fund critical health and education programs adequately. For example the Maternal and Child Health Block Grant was funded at $700 million a decrease of $24 million from FY 2005. So, the House and Senate resumed discussion, and on Tuesday, December 13, the House narrowly passed a slightly revised conference agreement, with additional funding for rural health programs and health professions (Title VII) to satisfy some of the 22 House Republicans who voted with all of the Democrats against the initial version. Because the revised legislation still cut or froze many health and education programs and provided the lowest increase to the NIH, less than 1%, in more than thirty years, Senate passage proved difficult. Finally, a threat from Senator Arlen Specter (R-PA) to attach the conference report to the FY 2006 Defense Appropriations bill—a must-pass bill—the Senate on December 21 approved the FY 2006 Labor/HHS-Education Appropriations bill by voice vote, clearing it for the President's signature on December 30, 2005—almost three months after the new fiscal year began. President
Bush released his 2007 budget Feb. 6 with a proposed $13.6
billion in cuts from Medicaid and the State Children's Health
Insurance Program over five years. The 2007 budget proposal came
just days after the 2006 budget reconciliation bill passed
Congress, which significantly cut Medicaid. The president's
budget also proposes to eliminate or cut funding for many other
child health programs, including Children's Hospitals Graduate
Medical Education (GME) program, Title VII health professions
training grants, universal newborn hearing screening, Emergency
Medical Services for Children (EMSC) program, and the National
Children's Study (NCS). The
president's budget is the first step in a months-long process
and is used as a blueprint for Congress to decide how to fund
programs. The PPC working with other members of the pediatric
community will continue to lobby Congress aggressively to
sustain and increase funding for child health programs until the
process is finished in October. In this election year, there is
some hope that congressional members will choose to help
children. HEALTH
INSURANCE COVERAGE AND ACCESS TO CARE Reconciliation
FY 2006: The House and Senate passed very different versions
of a spending-cuts bill (reconciliation) late last year.
The Senate bill did not hurt children on Medicaid, but
the House bill did. Just
before Christmas, the House-Senate conference agreement
(reconciling the two versions of the bill) came to a vote.
The House passed it by a vote of 212-206.
The Senate passed it 50-51, with Vice-President Cheney
casting the tie-breaking vote.
BUT, for technical reasons, the Senate deleted several
provisions, which meant the bill had to go back to the House for
an up-or-down vote. On February 1, 2006, he House of
Representatives passed the bill by a vote of 216-214, and the
president signed it shortly thereafter.
The
legislation will change federal Medicaid law and allow states to
offer scaled-back benefit packages for children.
It will also let states charge children in poor families
premiums for Medicaid coverage, and fees for prescription drugs
and some medical services.
However, the legislation did add as an amendment the
Families Opportunity Act (FOA). This program establishes a state
option to allow families of children with severe disabilities to
purchase Medicaid coverage on a sliding premium scale. However,
with cuts to Medicaid, FOA would once again be competing with
Medicaid dollars. While
the pediatric community's work at the federal level will
continue on this issue, state governments will need to decide if
they want to adopt any of these Medicaid options.
Pediatricians will need to persuade their governors and
state legislators to reject the options, and protect child
health care coverage and services. With
regard to SCHIP, currently, SCHIP is scheduled to be
reauthorized in 2007. Details
on the President's proposals related to an early reauthorization
have yet to be revealed; however, the pediatric community will
monitor this issue closely and will work to protect this program
for near poor children and families. Medicaid
Commission: On July 8, Secretary of Health and Human
Services Mike Leavitt, announced the members of his Medicaid
Commission. It includes 13 voting members and 15 non-voting
members with an additional two governors to be added later. The
advisory commission is charged with outlining recommendations
for Medicaid to achieve $10 billion in reductions in spending
growth during the next five years as well as ways to begin
meaningful long-term enhancements that can better serve
beneficiaries. The Commission, which held its first two meetings
in late summer, is chaired by former Tennessee Governor Don
Sunquist, and former Maine Governor Angus King serves as the
vice chair. Among the non-voting members are AAP immediate past
president Carol Berkowitz, MD and James Anderson, president and
CEO of Cincinnati Children's Hospital Medical Center.
On September 1, the Commission released its first report
to Congress, suggesting ways to realize the $10 billion in
savings. While most
of the recommendations did not impact children negatively, there
is concern that a proposal to add cost-sharing (co-pays) for
prescription drugs could pose a significant burden to pregnant
women and families with children. The Commission met again in
October of 2005 and late January 2006. The pediatric community
is working aggressively with Congress to preserve EPSDT and keep
cost-sharing out of the equation. The Medicaid Commission will
continue to meet in 2006 with an expected report on December 31,
containing longer-term recommendations on the future of the
Medicaid program. MediKids:
The MediKids Health Insurance Act of 2005 was reintroduced in
the first session of the 109th Congress by Rep. Pete Stark
(D-CA) in the House (H.R. 3055), and Sen. John Rockefeller
(D-WV) in the Senate (S. 1303). The bill creates a unified
health care system that would achieve the pediatric community's
goal of health insurance for all children and adolescents
regardless of family income.
MediKids would make coverage automatic and promote
equity, family responsibility, choice, and uniform benefits.
The House bill currently has 43 cosponsors; the Senate
bill has five. Kids
Come First Act of 2005: In late January 2005, Senator John
Kerry (D-MA) introduced the Kids Come First Act of 2005 (S.114).
The bill has ten cosponsors. This legislation is an effort to
provide affordable health insurance to all children up to 300
percent of the federal poverty level (FPL), with an emphasis on
reforms to Medicaid and SCHIP. Included in the proposal is a "swap" for the states
that would provide a 100 percent federal match for all children
in the Medicaid mandatory population, in exchange for their
expansion of their SCHIP program up to 300 % FPL.
The bill also includes outreach and enrollment efforts
that have long been supported by the pediatric community such
as: presumptive eligibility; 12-month continuous eligibility;
acceptance of self-declaration of income; no waiting lists for
children under SCHIP; no assets tests for children; and no
5-year waiting period for legal immigrant children (previously
supported Immigrant Children's Health Insurance Act
legislation). Importantly,
the legislation also provides for an increase in pediatric
provider payments under Medicaid.
Association
Health Plans (AHPs): The Small Business Health Fairness Act
has been reintroduced this Congress in the form of
S.406/H.R.525. The House bill passed in late July 2005. This
legislation allows association health plans - groups of small
employers that band together and purchase health coverage - to
be exempt from state regulation, oversight and mandates. Many
child and adolescent health organizations opposed legislation in
the 108th Congress, as it threatened the progress that has been
made in ensuring that insured children and adolescents have
appropriate access to preventive and well-child and adolescent
care because families who purchase health coverage from these
plans would no longer be protected by state laws.
The PPC will continue to work with the AAP and other
groups to urge Congress to consider legislative solutions for
small businesses that will provide affordable quality health
insurance to families. Genetic
Information Nondiscrimination Act of 2005: In February 2005,
the Senate by a vote of 98–0 passed the "Genetic
Information Nondiscrimination Act of 2005" (S. 306/H.R.
1227). This
legislation would prohibit health discrimination on the basis of
genetic information or services.
The bill prevents employers and health insurers from
discriminating against a person based on their predisposition to
a disease. Specifically,
the bill would bar employers from using individuals' genetic
information when making a hiring, firing, job placement or
promotion decision. The
bill would bar health insurers from underwriting based on
genetic information. The
bill would also establish privacy protections for genetic
information. In the House, three committees have jurisdiction
over the issue, the Education and Workforce, Energy and
Commerce, and Ways and Means Committees.
This shared jurisdiction will make House passage of the
bill, which has 166 cosponsors, a bit more challenging. EMERGENCY
MEDICAL SERVICES FOR CHILDREN (EMSC): The
President's FY 2007 budget once again proposed eliminating
funding for the EMSC program. The
PPC joined the AAP to vigorously and successfully oppose the
elimination of the program in FY 2006 and will do the same in FY
2007. The final FY
2006 appropriation for EMSC was $20 million. Reauthorization:
The Senate has introduced legislation to reauthorize the EMSC
program for five years. S.760, the Wakefield Act, when
reauthorized would allow the EMSC program to carry out its
existing initiatives and address gaps in care through its survey
and planning process. The
APS, SPR, and AMSPDC were among 32 organizations that signed a
letter to the Senate in early July 2005 supporting the Wakefield
Act. Vaccine
Programs/Appropriations: The final House and Senate
conference agreement included $461.4 million for immunization
assistance to states and localities under the section 317
program, $4.9 million for vaccine tracking and $58.5 million for
prevention activities (including $1.49 million for expanded
vaccine safety research) for a total of $524.9 million. In
addition the Vaccines for Children (VFC) program, which is
funded through Medicaid, includes $1.5 billion in vaccine
purchase and distribution support for FY 2006. The
President's FY 2007 budget included $324.9 million for the
section 317 immunization programs, $4.8 million for vaccine
tracking, and $77.5 million for prevention activities, for a
total of $407.3 million for all immunization programs.
This reflects a proposed transfer of $100 million from
Section 317 to the Vaccines for Children program. This proposal
may prove to be problematic because it could leave the VFC
program vulnerable to modifications and mischief that will not
help children and adolescents. The VFC mandatory program, at
$2.1 billion, received increased funding over FY 2006 to cover
the newly recommended memingococcal conjugate and hepatitis A
vaccines. Also
included in the President's budget is a proposed legislative
change to the VFC to allow underinsured children to receive VFC
vaccines at public health clinics.
Thimerosal
Legislation: In July 2005, Sen. Chuck Hagel (R-NE)
introduced a Senate companion, S. 1422, to a bill introduced in
the House by Representatives Dave Weldon (R-FL) and Carolyn
Maloney (D-NY), H.R. 881, to amend the Federal Food, Drug, and
Cosmetic Act to reduce human exposure to mercury through
vaccines. The Mercury Free Vaccines Act of 2005 is similar to
legislation introduced in the 108th Congress. Both H.R. 881
(with 72 cosponsors) and S. 1422 (no cosponsors) are awaiting
committee and floor action. As proposed in the bill, "a vaccine is a banned
mercury-containing vaccine under this section if 1 dose of the
vaccine contains 1 or more micrograms of mercury in any
form." There is an exception if the Secretary of HHS makes
a declaration of a public health emergency. In addition, the
legislation also includes a restriction on administration of
mercury-containing vaccines to children and pregnant women
manufactured for use in the 2006 - 2007 influenza season. There
are several effective dates including: July 1, 2006, the vaccine
shall not be administered to any child under the age of 3 years
old; and if the vaccine contains thimerosal, the vaccine shall
not be administered to any pregnant woman; and effective July 1,
2007, the vaccine shall not be administered to any child under
the age of 6 years old. There is also a public health emergency
exception in this provision. In the past two years, over 20
states have introduced legislation banning thimerosal in
vaccines and six states have passed legislation. Based on the
scientific data, including several IOM reports, the pediatric
community joined by other organizations such as the Sabin
Vaccine Institute, Every Child By Two, and others continues to
oppose this legislation. Several states are also introducing
anti-thimerosal legislation. Local pediatricians are working
extremely hard to oppose passage of these state-based proposals. Vaccine
Supply: Senators Evan Bayh (D-IN), Larry Craig (R-WY) and
Mary Landrieu (D-LA) have reintroduced legislation (S.375) to
address issues surrounding the manufacture, distribution, and
supply of influenza vaccine, as has Sen. Hillary Rodham Clinton
(D-NY), S. 1828. Also
Senators Mike DeWine (R-OH) and Hillary Rodham Clinton (D-NY)
reintroduced their bill (S.226) from last year that requires the
Secretary of HHS to develop a plan for the purchase, storage,
and rotation of a six-month supply of vaccines routinely
recommended for children and adults. The PPC will continue to
monitor any such efforts. STATE
OF THE ART PLENARY SESSION: Sunday, April 30, 2006, the
Public Policy Council and the Ambulatory Pediatric Association's
Public Policy Advocacy Committee will jointly sponsor a session
entitled New Resident Work Hours and Quality Care—Synergistic
or Antagonistic? Confirmed speakers include: David Leach, MD,
Executive Director of ACGME, Doug Jones, MD, representing the
Residency Review Committee for Pediatrics, and Ted Sectish, MD,
pediatric program director at Stanford University Medical
School. Richard Behrman, MD Executive Chair, Pediatric Education
Steering Committee, Federation of Pediatric Organizations will
moderate this session. LEGISLATIVE
BREAKFAST: Monday, May 1, 2006, 7:00am, sponsored by the
Public Policy Council for all attendees of the PAS meeting, is
entitled "Medicaid "Reform:" Can we Preserve our
Children's Safety Net?" with a presentation by Medicaid
Commission member Carol Berkowitz, MD, the 2004-05 AAP president
and former APA president. SPECIAL
SYMPOSIUM: Monday, May 1, from 12:15pm–1:15pm, The National
Children's Study: Status and Future Plans. The panel
presenters will discuss the current budgetary outlook, status of
the study, options to implement the study and respond to
questions from the audience. The panelists include: Duane
Alexander, Director, NICHD/NIH, Peter C. Scheidt, Director,
National Children's Study, NICHD/NIH, Alan R. Fleischman, Chair,
National Children's Study Federal Advisory Committee, New York
Academy of Medicine and NIH, and David Schonfeld, Chair, AAP
Committee on Research and Member, National Children's Study
Federal Advisory Committee. Elena Fuentes-Afflick, University of
California, San Francisco, a member of the Public Policy Council
will chair this session. Please
note that the APS-SPR website (www.aps-spr.org)
has posted the PowerPoint presentations from the 2005 Public
Policy Council/APA State of the Art Public Policy Plenary
session, "Clinical Trial Registries: Challenges and
Opportunities as well as the Legislative Breakfast on Stem Cell
Research." 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 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: The letter remains the most popular choice of communication with a congressional office. If you decide to write a letter, remember to be courteous, to the point, and include key information and examples to support your position. Address only one issue in each letter and, if possible, keep the length to one page.
Fax: Currently it is best to fax your letter to Congress. Fax numbers are available through the Capitol Hill Switchboard (202) 224-3121, or you can look up your members of Congress on "Thomas" the official website for Congress, available at http://thomas.loc.gov/, by going to "House Directory" or "Senate Directory" from the front page. Call: You can contact your Senator's and Representative's offices by calling the U.S. 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 American Academy of Pediatrics' Members Only website, www.aap.org/moc. E-mail: All of members of Congress now have e-mail addresses, but there is no set format for them. On some members web sites there is a mechanism to directly email most notably if you are a constituent. We suggest calling the congressional office to get an accurate e-mail address or visit www.aap.org/moc the Members Only website of the AAP. HOW TO CONTACT THE PRESIDENT: Write: Call: 202-456-1414
Additional information and resource material on these and other pediatric and child health issues are available from:
Public Policy Council Members:
Report Submitted By:
March 1, 2006 |
||||||||||||||||||||||||||||||||||||||
| Copyright:
All information contained
in this Website is the property of the American Pediatric Society and
the Society for Pediatric Research unless otherwise noted. Duplication of any information contained herein for reasons other than personal use requires the expressed written permission of APS / SPR. Last Updated: 10/02/2006 Staff only: Click here to logon to webmail. |
|||||||||||||||||||||||||||||||||||||||
