• Pediatric Research

• Pediatric Drugs and Medical Devices

• Pediatric Workforce

• Access to Health Care

• FY 2008 Budget & Appropriations

• Pandemic Influenza

• Emergency Medical Services for Children

• Congressional Calendar

• How to Contact Congress and the President

• AAP- Federal Advocacy Action Network (FAAN) and Key Contact Program

 PEDIATRIC RESEARCH

 National Institutes of Heath (NIH)—Appropriations: The President requested $28.858 billion for
 the National Institutes of Health for FY 2008—a $511 million cut from the FY 2007 funding level. 
 The Ad Hoc Group for Medical Research, which includes APS, SPR, and AMSPDC as
 participating members, spearheaded an effort to increase NIH funding by 6.7% over FY 2007
 levels, totaling $30.8 billion for FY 2008.  However, When the House and Senate Appropriations
 Committees completed work on their chambers’ respective Appropriations bills, the results were
 mixed.  The House-passed bill allocated $29.650 billion, while its Senate Committee-passed
 counterpart dedicated $29.9 billion to the NIH for FY 2008.  The PPC will continue to support the
 highest level of funding for the NIH, including increased funding for pediatric research.   

 National Institute of Child Health and Human Development (NICHD)—Appropriations: The
 PPC, as part of the Friends of NICHD, supported an allocation of $1.337 billion for the National
 Institute of Child Health and Human Development (NICHD).  The House-passed Appropriations Bill
 included an allocation of $1.274 billion for NICHD, while the Senate Committee provided $1.282
 billion for NICHD in FY 2008. 

 National Children’s Study—Appropriations:  The funding picture for the NCS is much brighter
 this year, as both the House-passed Appropriations Bill and the Senate Appropriations Committee
 have provided the full $110.9 million necessary to continue funding the study in FY 2008, despite
 the President’s request that the study be zero-funded in his FY 2008 budget.  The $110.9 million
 allocation (new funds) matches the advocacy community’s request, which was made in a May 9
 sign-on letter, circulated by the pediatric community and the March of Dimes.  Over 50
 organizations joined the letter sent to House and Senate appropriators.  The next steps are to
 push for completion of the appropriations process with the inclusion of $110.9 million of new
 money for the NCS. 

 National Children’s Study— Research Plan: The National Children’s Study Research plan was
 made available for public review and comment in July.  The Research Plan describes the
 Study's background, design, measures, and the rationale for those selections in sufficient detail so
 that readers can understand the basis of the Study and how it will be carried out. The Plan is
 available online at: http://www.nationalchildrensstudy.gov/research/research_plan/index.cfm.  On
 July 26, an official request for public comments was published in the Federal Register. Comments
 are due by September 25.  In addition to seeking public comment, the NCS Program Office has
 sought review by the National Academy of Sciences (NAS).  The NAS had commenced their
 review of the plan, which was anticipated to take approximately 6-9 months.  The NCS Advisory
 Committee also commented on the Plan during their June meeting (see below). 

 National Children’s Study— June Advisory Committee Meeting: On June 26 and 27, Dr.
 Genel, Chair of the PPC, attended a meeting of the National Children’s Study (NCS) Advisory
 Committee, on which he serves as a member.  The majority of the meeting consisted of reviewing
 the NCS Research Plan.  During that review, committee members commented on a number of
 issues including human research subjects’ protections, retention of subjects over time and the
 need for community engagement in the Study.  The Committee also discussed issues associated
 with adjunct studies, successive waves of sampling and engaging health care providers in the
 NCS.   

 National Children’s Study— Request for Proposals: In March 2007, following passage of the FY
 2007 joint funding resolution providing $69 million for the NCS, NIH issued a Request for Proposals
 (RFP) to award contracts to up to 20 new NCS study centers. These centers will manage
 operations in up to a total of 30 communities across the United States. The NCS has identified a
 statistically representative group of 105 total communities across the United States where it will 
 recruit and enroll eligible participants. Contracts for the study centers will be awarded to interested
 medical research organizations based on the quality of their proposals and geographic proximity to
 the study communities over a three-year period (reaching the 105 total in year three).  These new
 study centers must successfully demonstrate such capabilities as collection and management of
 biological and environmental specimens; the capacity to develop community networks for
 identifying, recruiting, and retaining eligible mothers and infants; and the ability to secure the
 privacy of the data collected.  The contract awards are anticipated in September 2007. 

 Further information and updates on the NCS may be found at:
 http://www.nationalchildrensstudy.gov.

 NIH Consultation Meeting on Peer Review with Professional Societies: On July 30, 2007,
 the Peer Review Working Group of the Advisory Committee to the Director of the National
 Institutes of Health (NIH) hosted a consultation meeting with professional societies on the NIH peer
 review process.  Dr Elias Zerhouni, Director of the NIH, and Drs. Keith Yamamoto and Lawrence
 Tabak, Co-Chairs of the Peer Review Working Group, were the moderators.  Renée Jenkins, MD,
 President-Elect of AAP; Phyllis Dennery, MD, President of SPR; Tina Cheng, MD, President-Elect
 of APA; and Elizabeth Goodman, MD, liaison to the AAP’s Committee on Pediatric Research,
 representing the Society for Adolescent Medicine; and PPC Washington Office staff represented
 the pediatric and adolescent health community at the meeting.  Participants commented on a
 variety of topics, including who should serve on study sections, how the review process should be
 structured, how the burden on reviewers can be decreased, and how the plethora of NIH grant
 mechanisms can be consolidated or simplified to streamline the review process.  Individuals may
 submit comments on the peer review process via the web at:
 http://grants.nih.gov/grants/guide/rfi_files/rfi_peer_review_add.htm until September 7. In addition,
 three consultation meetings have been scheduled across the country - on September 12 in
 Chicago, October 8 in New York City and in San Francisco on October 25. Registration for these
 local meetings is available at http://enhancing-peer-review.nih.gov/.  PPC member societies are
 encouraged to participate in these local meetings. 

 Comments on NIH National Center for Research Resources (NCRR) Strategic Plan:  On July
 6, the National Institutes of Health (NIH) National Center for Research Resources (NCRR)
 published a notice in the Federal Register requesting comments and input as it develops a new
 Strategic Plan covering 2009 - 2013.  The purpose of the plan is to ensure that NCRR remains
 responsive to the emerging needs of biomedical researchers and provides them with the
 infrastructure, tools, and training they need to understand, detect, treat, and prevent a wide range
 of diseases. The NCRR requested input from biomedical scientists to define future needs for
 shared research resources and technologies that facilitate NIH-supported biomedical research. The
 PPC submitted written comments to the Director of the NCRR noting the importance of the
 opportunity to submit comments to the strategic plan while expressing concern that the current
 configuration and focus of the Clinical and Translational Science Award (CTSA) program on
 “institution-specific awards” may bring unintended consequences and potentially jeopardize
 pediatric clinical research. Individual members of the societies that comprise the PPC were
 encouraged to provide comments online at: http://www.ncrr.nih.gov/strategicplan.  The deadline for
 input is August 24. 

 Stem Cells: For the second time in two years, President Bush vetoed the Stem Cell Research
 Enhancement Act of 2007, S. 5, on June 20, 2007.  This legislation would expand the number of
 stem cell lines that are eligible for federal funding and allow federal funding for research using stem
 cells derived from embryos originally created for fertility treatments and willingly donated by
 patients. Currently, federal funding for embryonic stem cell research is allowed only for research
 using embryonic stem cell lines created on or before Aug. 9, 2001, under a policy announced by
 President Bush on that date.  

 On the day following the veto, June 21, the Senate Appropriations Subcommittee on Labor, Health
 and Human Services, Education, and Related Agencies, attached a stem cell provision to the L-
 HHS-E Appropriations bill that would allow federal funding for embryonic stem cell research if the
 embryos were derived before June 15, 2007, while adding ethical guidelines for such research.  No
 such provision was included in the House L-HHS-E Appropriations bill.  It is doubtful at the time of
 this writing, that this provision will remain in the final version of the FY 2008 L-HHS-E
 Appropriations Bill. 

 Genetic Information Nondiscrimination Act (GINA): H.R. 493/ S.358 The Genetic Information
 Nondiscrimination Act (GINA) was reintroduced in the House of Representatives and the Senate in
 January.  The House bill passed by a vote of 420-3 on April 25.  The Senate bill still awaits a vote
 on the Senate floor.  A vote had been scheduled to occur prior to adjournment for the August
 congressional recess; however, Senator Tom Coburn (R-OK) placed a hold on the legislation
 delaying such a vote from moving forward. 

 GINA prohibits discrimination on the basis of genetic information with respect to health insurance
 and employment. Its purpose is to establish basic legal protections that will enable and encourage
 individuals to take advantage of genetic screening, counseling, testing, and new therapies that will
 result from the scientific advances in the field of genetics. The legislation also prevents health
 insurers from denying coverage or adjusting premiums based on an individual's predisposition to a
 genetic condition, and prohibits employers from discriminating on the basis of predictive genetic
 information. Additionally, GINA would stop both employers and insurers from requiring applicants
 to submit to genetic tests, maintain strict use and disclosure requirements of genetic test
 information, and impose penalties against employers and insurers who violate these provisions. 
 The Public Policy Council continues to strongly support genetic nondiscrimination legislation. 

 Agency For Healthcare Research And Quality (AHRQ): The Friends of AHRQ, that includes
 APS, SPR, and AMSPDC as member organizations, urged the House and Senate Appropriations
 Committees to include $350 million for AHRQ in the FY 2008 spending bill.  AHRQ received $319
 million in FY 2007, while President Bush requested $329.6 million for the Agency in his FY 2008
 Budget.  Both the House-passed bill and the Senate Appropriations Committee followed the
 President’s lead, providing $329.6 million for AHRQ for FY 2008.  Out of this total, both the House
 and Senate Committees allocated $30 million for comparative effectiveness research and $78.9 
 million for patient safety initiatives.  At this time, the long overdue reauthorization of AHRQ is not
 on the agenda of either the House or Senate. 

 PEDIATRIC DRUGS AND MEDICAL DEVICES 

 The Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act
 (PREA): The PPC strongly supports the reauthorization of BPCA and PREA, which have been
 remarkably effective in generating important information on pediatric drugs.  Both laws will expire
 on September 30 unless reauthorized by Congress.  PREA gives FDA the authority to require
 pediatric studies of drugs for the on-label indication.  When PREA was codified in 2003, it for the 
 first time established the presumption that certain new drugs and biologics must be tested for
 children and be produced in formulations appropriate for children.  BPCA provides an incentive to
 drug manufacturers of an additional six months of marketing exclusivity for conducting pediatric
 studies of drugs that FDA determines may be useful to children.  Under BPCA, the FDA can issue
 requests for pediatric studies on both on- and off-label uses of drugs. 

 The pediatric community has been working closely with leaders in the House and Senate to
 improve and reauthorize these laws.  Rep. Eshoo (D-CA) championed BPCA and PREA in the
 House and Senators Dodd (D-CT) and Clinton (D-NY) championed BPCA and PREA, respectively,
 in the Senate.  The modifications the pediatric community advocated for improve the transparency
 of the programs while ensuring that BPCA and PREA work well together as an integrated package
 to improve pediatric drug information.  Working closely with the AAP, the PPC and other partners
 have also sought to enhance postmarket adverse event reporting as well as the speed and quality
 of label changes.  The PPC joins the Academy in supporting making PREA a permanent
 requirement by eliminating its sunset and is also on record supporting a BPCA exclusivity
 adjustment for blockbuster drugs that will reduce consumer costs without reducing the strength of
 the incentive. 

 BPCA and PREA were considered in the House and Senate in the context of a large FDA package
 that included the reauthorization of the Prescription Drug User Fee Act and drug safety legislation. 
 The House FDA bill, The Food and Drug Administration Amendments Act of 2007 (H.R. 2900),
 was sponsored by Rep. Dingell (D-MI), while the Senate FDA bill, The Food and Drug
 Administration Revitalization Act of 2007 (S. 1082) was introduced by Senators Kennedy (D-MA)
 and Enzi (R-WY).  The Senate passed its FDA bill on May 9 by a vote of 93-1, and the House
 passed its version on July 11, 403-16. 

 The House and Senate are currently trying to reach an agreement to reconcile the differences
 between the two versions of the bill.  The pediatric community is working to encourage Congress
 to keep the PREA permanency established in the House bill and eliminate a provision in the
 Senate bill that would put 3up roadblocks to using PREA for already marketed drugs.  Although
 Congress was not able to finish the reauthorizations before the August recess, it will almost
 certainly finish this work in September to avoid the expiration of the Prescription Drug User Fee 
 Act that would result in massive layoffs of drug approval personnel at FDA.

 Pediatric Medical Device Legislation: There are too few critical medical devices designed
 specifically with children’s needs in mind.  Like adults, children need medical devices that are
 safe, effective and designed for their needs.  The Pediatric Medical Device Safety and Improvement
 Act  (S. 830/H.R. 1494) provides assistance to device innovators, elevates pediatric device issues
 and improves incentives for devices for small markets while preserving the ability to ensure the
 safety of new products once on the market.  The legislation has been endorsed by APS, SPR, and
 AMPSDC.  Specifically, the legislation, sponsored in the Senate by Sen. Dodd (D-CT) and in the
 House by Reps. Markey (D-MA) and Rogers (R-MI), would provide incentives to the medical device
 industry to produce new pediatric devices by lifting restrictions on profit from the Humanitarian
 Device Exemption (HDE).  It would create new consortia to stimulate device development from idea
 to marketplace.  The bill would also give FDA additional regulatory mechanisms to track pediatric
 device needs as well as provide increased postmarket surveillance for adverse events in children as
 recommended by IOM. 

 APS, SPR, and AMSPDC, working in concert with the Academy, were successful in making sure
 that the pediatric device bill was considered alongside the must-pass medical device user fee
 reauthorization.  Both of these device provisions were included in the omnibus FDA reform bills (S.
 1082/H.R. 2900) passed this year by the House and Senate.  Negotiators in both chambers are
 currently working to reconcile differences between the House and Senate device portion of the FDA
 bill.  A conference report and final passage of the bill are expected in September before the
 expiration of the user fee bills. 

 PEDIATRIC WORKFORCE 

 GME Financing for Children’s Hospitals (CHGME)–Appropriations: Children’s Hospitals GME
 is currently funded at $297 million.  The President’s FY 2008 Budget request for CHGME was a
 mere $110 million—a 63% cut.  The PPC, working under the leadership of the National
 Association of Children’s Hospitals (NACH) in conjunction with the Academy and others, urged the
 House and Senate Appropriations Committees to increase funding for the CHGME program to
 $330 million for FY 2008. 

 However, despite these efforts, when the Senate Appropriations Committee approved their FY 2008
 Appropriations bill, they had cut CHGME by 33% - from $297 million to $200 million.  CHGME
 fared far better in the House, where the House Appropriations Committee allocated and the House
 approved $307 million for the program.  Members of the pediatric academic societies are urged to
 call members of the Senate and advocate for the higher House FY 2008 allocation--$307 million—
 for this vitally important program. 

 Title VII Health Professions Program and Title VIII Nursing Professions Program –
 Appropriations: The APS, SPR, and AMSPDC continue to participate in and support the
 advocacy efforts of the Health Professions and Nursing Education Coalition (HPNEC), led by the
 AAMC.  The coalition supports adequate funding for the Title VII Health Professions Training
 Programs and the Title VIII Nursing Programs.  This has been a particularly challenging task over
 the past several years as Title VII has received substantial funding cuts year after year.  In FY
 2005, Title VII received a final appropriation of $300 million. However, in FY 2006 and FY 2007
 funding was slashed.  Current funding stands at $185 million.   

 Congress has not been the only obstacle to fully funding Title VII.  President Bush’s Budget
 requests have repeatedly recommended funding only the Scholarships for Disadvantaged Students
 program (SDS)—at $10 million—with no funding whatsoever for the myriad of other programs,
 including primary care medicine, that make-up Title VII.  This pattern continued in the
 Administration’s FY 2008 budget proposal. 

 In its FY 2008 bill, the House-passed L-HHS-E Appropriations bill allocated $228.3 million to Title
 VII, while the Senate Appropriations Committee provided only $187.7 million.  Both allocated $48.9
 million to the “Primary Care Cluster,” Section 747.  The overall Title VII allocation in both    
 Committees fell far short of the $300 million request made by members of HPNEC to at least
 restore funding to FY 2005 levels.  In particular, the Senate allocation was disappointing, as 54
 Senators—a bipartisan majority—joined a June 20 “Dear Colleague” letter circulated by Senators
 Jack Reed (D-RI) and Pat Roberts (R-KS) calling for a restoration of Title VII funding to FY 2005
 levels of $300 million.  The FY 2008 letter included the signatures of 6 first time signers and 10
 Appropriations Committee members.  A similar letter was sent to House Appropriators in March. 
 Representatives Diana DeGette (D-CO) and Cathy McMorris Rodgers (R-WA) spearheaded the
 effort behind the House letter, which was signed by 98 representatives. 

 In light of these allocations, the pediatric community will continue to advocate for increased funding
 for Title VII throughout the FY 2008 appropriations process.  To that end, on September 12, a
 group of pediatric residents from Johns Hopkins will participate in HPNEC’s annual Capitol Hill
 Day.  During that event, the member organizations of HPNEC visit Capitol Hill offices to advocate
 for increased Title VII funding.   In addition, HPNEC is currently planning a February 2008 “Health
 Professions Open House” for Capitol Hill staff. 

 Title VII Health Professions Program—Reauthorization: It remains to be seen what action, if any, 
 will take place during the 110^th Congress on reauthorizing Title VII.  There has been some interest
 by members of the Senate to move various parts of the Title VII program forward, but other Senate
 offices has expressed concern that a “piecemeal” approach to reauthorization will further damage a
 program already struggling for funds. 

Physician Shortages: In February, both the Senate and House introduced the bipartisan Resident Physician Shortage Reduction Act, S. 588/H.R. 1093.  The legislation would increase the number of residency positions for which Medicare payments will be made to teaching hospitals in states with a shortage of resident physicians.  Specifically, the bill would allow teaching hospitals in states that have resident physicians to 100,000 population ratios below the national median, to be eligible to increase their resident caps, pending an allocation method determined by the Secretary of Health and Human Services. According to the bill's formula, teaching hospitals in 24 states would be eligible to receive additional resident cap slots.  The Secretary is required to take into account whether the hospital will be able to fill the positions over a 3-year period, as well as whether the filled positions will be in primary care, preventive medicine, or geriatrics. The total number of additional cap slots granted to teaching hospitals in each eligible state cannot exceed 25% of the number of residents needed to increase that state to the national median. Overall, approximately 1,200 additional cap slots would be added to the national resident limit. Increases in the number of positions eligible for federal funding would be phased in over a 5-year period.   The Senate bill has 8 cosponsors, while the House version has 46.

 

Student Loans: In March, Rep. Phil English (R-PA) introduced the Higher Education Affordability and Equity Act of 2007, H.R. 1407.  The bill would amend the Internal Revenue Code to expand certain tax incentives for education. Among other provisions, the bill:

• repeals the current $2,500 limitation on deductions of interest paid on qualified educational loans;
• increases the income levels that trigger an eligibility phase out to between $100,000-$115,000 ($200,000-$230,000 for joint returns); and
• excludes amounts received as part of a scholarship, fellowship or grant from taxable income if used for qualified higher education expenses for undergraduate and graduate students.

 Loan Deferment: Earlier this year, Senator Chris Dodd (D-CT) introduced S. 1066, the Medical 
 Education Affordability Act.  The bill would revise regulations regarding student loan repayment
 deferment with respect to borrowers who are in postgraduate medical or dental internship,
 residency, or fellowship programs.  Specifically, the legislation extends the Economic Hardship
 Deferment from 3 years to the length of a medical or dental residency.  

 The College Cost Reduction Act of 2007, H.R. 2669, which passed on the House floor on July 11
 by a vote of 273 to 149 eliminates the maximum length of time for Economic Hardship Deferment
 completely, allowing resident physicians to postpone federal loan repayments as long as they
 qualify.   

 On July 20, the Higher Education Access Act, also H.R. 2669, passed on the Senate floor by a
 vote of 78-18.  The Senate version increases the cap on the Economic Hardship Deferment from 3
 years to 6 years.

 Because of this and other differences between the versions of H.R. 2669 passed by the House and
 the Senate, the two bills must be reconciled and then approved again before going to the President
 for his signature.  This process will not begin until after the August congressional recess. 

 ACCESS TO HEALTH CARE 

 Reauthorization of the State Child Health Insurance Program (SCHIP): On August 1, the
 House voted 225-204 to approve legislation, H.R. 3162, the Children’s Health and Medicare
 Protection Act, which would reauthorize the State Child Health Insurance Program (SCHIP) and
 make changes to the Medicare program.  Five Republicans voted with 220 Democrats to pass the
 measure, while 10 Democrats and 194 Republics voted against.  SCHIP is set to expire on
 September 30.  The legislation would increase SCHIP funding by $50 billion over five years.  The
 House bill would reduce payments to Medicare Advantage plans and increase the federal cigarette
 tax by 45 cents per pack to boost funding.  In order to meet “Pay as you go” guidelines,
 Democrats agreed to reduce the amount of funding allotted for bonuses to states for enrolling
 children in the program.  Under the bill, states would have the option to cover children of
 documented immigrants and establish their own methods of verifying citizenship.  The PPC
 supports the House legislation, which has been endorsed by a number of organizations, including
 the Academy, Republican and democratic governors, the AAMC, AARP, and the AMA.  In a veto
 threat issued by the White House in response to the House bill, the Administration called the
 legislation a “wholesale, unapologetic move to government-run health care for large classes of
 children.” 

 On August 2, the Senate passed, by a vote of 68-31, the Children’s Health Insurance Program
 Reauthorization Act of 2007, S. 1893/ H.R. 976.  The 5-year, $35 billion reauthorization package
 preserves the enrollment of 1.9 million beneficiaries who would likely lose overage under current
 funding levels, enrolls 1.6 million SCHIP-eligible children not yet in the program, and expands
 SCHIP eligibility to 1.1 million more children.  The funding increase is offset by a 61 cents per
 pack increase in federal tobacco taxes and a series of SCHIP cuts beginning in FY 2014.  The
 package reconfigures the SCHIP allotment formula, reduces to 2 years the time states may
 access their allotments before redistribution, and establishes an “Incentive Bonus Pool” to fund
 state Medicaid and SCHIP expansions that exceed “a defined baseline.”  The bill also establishes
 a “Contingency Fund” for addressing state funding shortfalls, streamlines the enrollment process,
 permits coverage of prenatal care, and transitions SCHIP parents into new block grants with
 expenditures matched at the Medicaid level.  Childless adults will be transitioned out of the 
 program. 

 The House and Senate must now reconcile their disparate SCHIP packages.  This process is set
 to begin following the August congressional recess.  The pediatric community will be called upon
 to work with all members of Congress to pass a comprehensive and adequately funded SCHIP
 reauthorization bill by or before September 30, 2007. At this time, the key messages to convey to
 Congress remain:

• In the 10 years since it was enacted, SCHIP and Medicaid have reduced the number of uninsured children by more than one-third. Despite this, there are still 9 million uninsured children in America, the vast majority of who are in families with jobs that do not offer their children access to affordable coverage.
• Uninsured children are twice as likely as insured children to miss doctor visits and check-ups - and less likely to receive care for illnesses such as sore throats, earaches and asthma. When uninsured children go without needed care, small health problems can grow into bigger ones.
• Pass SCHIP legislation that contains the full $50 billion in new funding to reach millions of the children who are eligible for SCHIP or Medicaid but unenrolled.
• Any SCHIP legislation must also strengthen and improve health care for children by including a fair physician payment component, addressing citizenship and documentation issues, and strengthening pediatric quality measurement.

 FY 2008 BUDGET & APPROPRIATIONS 

 Following the release of the President’s FY 2008 Budget proposal in February, the House and
 Senate drafted, debated and then finally completed their work on the FY 2008 Congressional
 Budget Resolution (S. Con. Res. 21) in mid-May. 

 Congressional Budget Resolution: The Conference Agreement assumes $54.965 billion for
 Function 550 discretionary health spending, $2.9 billion (5.5%) above last year and $3 billion (5.8%
 ) above the President’s request.  It sets the overall non-defense discretionary spending cap at $450
 billion, which is $23 billion above the final FY 2007 level and $21 billion above the President’s
 request.  The House approved the Conference Agreement by a vote of 214-209, while the Senate
 cleared it 52-40.  The Budget Agreement includes several non-binding, deficit neutral reserve funds
 for FY 2007 through FY 2012 to support, among other programs, the State Children’s Health
 Insurance Program (SCHIP).  The Budget Resolution provides for “up to” $50 billion for SCHIP. 

 Senate L-HHS-E Appropriations Bill: On June 21, the Senate Appropriations Committee
 approved its version of the FY 2008 Labor-HHS-Education Appropriations Bill.  The bill, which had
 been approved by the Senate Labor-HHS-Education Appropriations Subcommittee on June 19,
 includes $29.9 billion for NIH, an amount that is described as an increase of $1 billion (3.5%) over
 the FY 2007 level.  However, once a $300 million transfer from NIH to the Global HIV/AIDS fund is
 taken into account, the increase over FY 2007 in the NIH program level in the Senate bill is $799
 million (2.8%).  This falls short of the projected 3,7% increase in the Biomedical Research and
 Development price Index (BRDPI) for FY 2008.  The Senate Committee bill also provides $329.6
  million for the Agency for the Healthcare Research and Quality (AHRQ), which is a $10.6 million
 (3.3%) increase over last year.  The bill cuts the Children’s Hospital Graduate Medical Education
 (CHGME) program by $97 million (3%) to $200 million.  The Title VII Health Professions Training
 Programs are level funded at the FY 2007 level of $184.7 million and the Title VIII Nursing  
 Programs are increased by $20 million to $169.7 million.  It is currently believed that the Senate
 Committee’s bill may be reconciled with the House-approved bill (see below) and may not be
 brought to the Senate floor for a vote by the entire chamber by the start of the new fiscal year –
 October 1, 2007. 

 House L-HHS-E Appropriations Bill: On July 18, the House of Representatives passed its 2008
 Labor-HHS-Education appropriations bill, H.R. 3043, by a vote of 276 to 140 following three days of
 rancorous debate and votes on dozens of amendments to modify funding for specific programs.  A
 total of 53 Republicans voted for the bill; the only Democrat to vote “no” was Rep. Melissa Bean 
 (IL). Prior to the final floor vote, the APS, SPR and AMSPDC signed a letter in support of the bill’s
 passage, joining nearly 1100 education, training, disability, public health, health and biomedical
 research, aging and child welfare organizations, elected officials and labor unions representing the
 full range of stakeholders in the programs of the Departments of Education, Health and Human
 Services, and Labor.  This was the culmination of an aggressive advocacy campaign that included
 the participation of the PPC to move the appropriations process forward to ensure funding
 increases in several programs.  For NIH, the bill includes 29.650 billion, an increase of $750 million
 (22.6%) above the current year’s funding level and $1.029 (3.6%) above the President’s request. 
 However, the bill also increase the amount of the transfer from NIH to the Global HIV/AIDS fund
 from $99 million in FY 2007 to $300 million in FY 2008, which means the net increase in the NIH
 budget is $549 million (1.9%) over FY 2007.  The House bill provides $228.3 million for the Title VII
 Health Professions Training Programs, a $43.6 million (23.6%) increase over FY 2007. 

 The House defeated (181-249) an amendment offered by Rep. Joe Barton (R-TX) to prevent funds
 from the bill from being transferred from NIH under the Secretary’s program evaluation authority.  A
 total of 19 Republicans, including most Republican members of the Labor-HHS-Education
 Appropriations Subcommittee, joined 230 Democrats to vote against the amendment; no
 Democrats voted for it.  Originally authorized in statute at 1.1 %, appropriators have increased the
 transfer authority in recent years to 2.4% of the budgets of NIH and other HHS agencies.  The
 transferred funds are used to support approximately two-thirds of the budget of the Agency for
 Healthcare Research and Quality (AHRQ) as well as the National Center for Health Statistics and
 other programs at CDC and the Department of Health and Human Services. 

 Prior to final passage, the House rejected by a vote of 206 to 213 a motion by Rep. Jerry Lewis (R-
 CA), the Ranking Member of the House Appropriations Committee, to recommit the bill to the
 Committee and a series of amendments offered by Republicans to cut the bill across-the-board by
 amounts ranging from 0.25% to 4.6%. 

 During House Appropriations Committee mark-up, Rep. Dave Weldon (R-FL) introduced the
 following amendment, which passed by voice vote and was included in the final bill: “None of the
 funds appropriated in this Act may be used to administer to any child under 3 years of age an
 influenza vaccine during the 2008-2009 influenza season for which thimerosal is listed on the
 labeling as an ingredient.”  The pediatric community joined the public health community in
 aggressively opposing this amendment. 

 In a Statement of Administration Policy (SAP) issued on July 17, the White House said it “strongly
 opposes H.R. 3043 because, in combination with the other FY 2008 appropriations bills, it
 includes an irresponsible and excessive level of spending and includes other objectionable
 provisions.”  The Administration noted that the House bill exceeds the President’s FY 2008 funding
 request by nearly $11 billion.  The SAP also included a statement opposing the Weldon
 amendment: “The Administration strongly opposes any restriction on the use of funds under
 section 317 and the Vaccines for Children program to deliver flu vaccine to children under three
 years of age if it contains thimerosol.  The provision could result in children not receiving any flu
 vaccine.”  The Senate Appropriations Committee Bill is also opposed by the Administration. 

 PANDEMIC INFLUENZA 

 One-Year Progress Report— National Strategy for Pandemic Influenza Implementation Plan:
 In July 2007, one year after the Bush Administration’s release of its federal pandemic influenza
 preparedness plan, the National Strategy for Pandemic Influenza Implementation Plan, the White
 House Homeland Security Council reported that 86% percent of the plan tasks that were to be
 completed by 2007 were finished.   The remaining 14% were expected to be completed by the end
 of the year.  The White House reported that the federal government still has limited capacity to
 detect a disease outbreak and track its progress across the country.  The nation also has little
 extra capacity in its hospitals and other health care facilities to deal with a huge surge in need that
 would accompany a mass disease outbreak. Further, the government has little ability to ensure
 that during an outbreak, when many workers would stay home, limited Internet capacity would go
 to essential work and not to children playing video games.  A White House spokesperson also
 said that a decision had been made to keep U.S. borders open if a pandemic flu outbreak occurs
 somewhere in the world.  The Administration noted that a significant remaining challenge is that
 the country has grown tired of pandemic flu warnings.  More information on the National Strategy
 for Pandemic Influenza can be found at: http://www.whitehouse.gov/homeland/pandemic-influenza- oneyear.html. 

 At-Risk Populations Listening Session: On July 26, 2007, the Interagency Committee on
 Pandemic Influenza’s Work Group on Pandemic Influenza and At-Risk Populations hosted a
 listening session for non-governmental organizations to seek information about gaps, barriers and
 best practices for addressing the needs of at-risk populations in State and local Pandemic
 Influenza plans.  The session was moderated by Dr. Daniel Dodgen, Human Services Policy
 Coordinator in the Office of the Assistant Secretary for Preparedness and Response.  Staff from
 the PPC Washington Office attended the meeting and relayed some of the pediatric community’s
 concerns regarding children and pandemic influenza, such as the need for further testing on the
 use of N95 masks by children and the ramifications of prolonged school closure on children’s
 emotional and physical health and well-being. 

 EMERGENCY MEDICAL SERVICES FOR CHILDREN 

 EMSC—Reauthorization: The EMSC program’s authorization expired in late 2005, but the
 program has yet to be reauthorized.  On the first day of the 110^th Congress, Senators Inouye (D-
 HI) and Hatch (R-UT) introduced an EMSC reauthorization bill, S. 60, the Wakefield Act. 
 Representatives Matheson (D-UT), Capps (D-CA) and King (R-NY) introduced a companion bill,
 H.R. 2464, in the House on May 23^rd, National Emergency Medical Services for Children Day.  No
 floor action has occurred in either chamber. 

 EMSC—Appropriations: The President’s FY 2008 Budget once again zeroed-out funding for the
 EMSC program.  In May, APS, SPR and AMSPDC joined a sign-on letter to Senate and House
 Appropriations Committee members urging that they provide $25 million for the EMSC program in
 FY 2008.  In July, the House Appropriations Committee voted to restore EMSC funding to the FY
 2007 level of $19.8 million in FY 2008.  Subsequently, during floor debate on the House bill, Rep.
 Reichert (R-WA) offered an amendment to add $2.5 million to the House Committee’s allocation,
 for a total of $22.3 million.  The amendment passed.  In June, the Senate Appropriations
 Committee allocated $20 million for EMSC in FY 2008.  The Appropriations Bill has not reached
 the Senate floor. 

 2007 CONGRESSIONAL CALENDAR (110^th Congress – First Session) 

 August 6 - Sept. 3:       August Congressional Recess
 October 1                    Fiscal Year 2008 begins
 October 26:                  Target Adjournment (House)
 November 16               Target Adjournment (Senate) 

 HOW TO CONTACT YOUR MEMBER OF CONGRESS: 

 Write: The letter remains the most popular choice of communication with congressional offices. 
 However, due to increased security on Capitol Hill, you must fax or e-mail your letter, in lieu of
 using traditional mail, in order to avoid extensive lag-time in the receipt of your correspondence.  If
 you decide to write a letter, remember to be courteous, to the point, and include key information
 and personal examples to support your position.  Address only one issue in each letter and, if
 possible, keep the length to one page. 

To a Senator:                             To a Representative:
            The Honorable (name)                 The Honorable (name)
            United States Senate                  United States House of Representatives
            Washington, DC 20510                Washington, DC 20515 

Dear Senator ________:          Dear Representative ____: 

 Fax:  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 Senators 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; if you are a member of the
 American Academy of Pediatrics, information about local offices is available on the AAP Member
 Center website, www.aap.org/moc. You can also go directly to www.senate.gov or www.house.gov
 for this information. 

 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
 www.senate.gov or www.house.gov for this information.  Be sure to identify, in the subject line, that
 you are a constituent along with the legislative topic of the email correspondence. 

 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
 E-mail: president@whitehouse.gov 

 AAP FEDERAL ADVOCACY ACTION NETWORK (FAAN) 

 The Federal Advocacy Action Network (FAAN) is comprised of all AAP members for which, the
 Academy has an email address.  FAAN alerts are sent when federal legislative efforts require
 large-scale advocacy efforts by the Academy’s entire membership. 

 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 needed to
 persuade their legislators. The Members Only Channel (http://www.aap.org/moc) has tools to
 make advocacy work easy.  Find the names of congressional representatives, contact legislators
 via e-mail, read about congressional activity, and register to become a Key Contact. 

 If you have questions about the FAAN or if you have not been receiving FAAN alerts, please
 contact Priscilla Ring, AAP Department of Federal Affairs, pring@aap.org, or (800) 336-5475, ext.
 3304.   

 AAP KEY CONTACT PROGRAM 

 If AAP members want to do more federal advocacy than responding to the FAAN alerts, we
 encourage pediatricians to join the AAP Key Contact program.  Key Contacts have an interest in
 developing a stronger working relationship with their congressional delegation, and usually work 
 on several AAP legislative issues.  Key Contacts are contacted on a regular basis (approximately
 once a month when Congress is in session).  Key contacts receive all the latest information and
 news, advocacy tips and tools, suggestions for improving relationships with members of Congress
 and more sophisticated advocacy assignments, such as media work and congressional visits (all
 with help from AAP staff).   

 To sign up to be an AAP Key Contact, log on to http://www.aap.org/moc (Member Login required,
 use your AAP member id, it can be found on the AAP News or Pediatrics mailing label) and click
 on “Federal Affairs."  For more information on the Key Contact program, contact Priscilla Ring,
 AAP Department of Federal Affairs, 800-336-5475, ext. 3304, or pring@aap.org. 

***

 PUBLIC POLICY COUNCIL MEMBERS 

 APS                 Myron Genel, MD; Jimmy Simon, MD
 SPR                 Thomas Green, MD; Elena Fuentes-Afflick, MD, MPH
 AMSPDC          Russell Chesney, MD; Jon Abramson, MD

***

 Report Submitted By:
 Myron Genel, MD, Chairman
 Karen M. Hendricks, JD, Washington Coordinator
 Stephanie Russell, JD, Legislative Assistant 

 Additional information and resource material on these and other pediatric and child health issues
 are available from: Washington Coordinator, Karen M. Hendricks, JD (KHendricks@aap.org) or
 Stephanie A. Russell, JD, (SRussell@aap.org). 

 Public Policy Council
 c/o American Academy of Pediatrics
 601 13^th Street, NW
 Suite 400 North
 Washington, D.C. 20005
 Phone: 800/336-5475 or 202/347-8600; Fax: 202/393-6137           

Please visit the Public Policy Council on the web at www.aps-spr.org

 August 22, 2007