American Pediatric Society & Society for Pediatric Research

Public Policy Council

 2005–2006 Activities Report 

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This report, covering programmatic activities of the Public Policy Council from May 13, 2005 to April 28, 2006, is modified from a report provided to the joint APS/SPR Councils on April 28 during the meeting of the Pediatric Academic Societies and affiliated organizations in San Francisco. This report supplements the March-April legislative report prepared by the Public Policy Council's Washington-based staff. Queries or comments should be directed to the Public Policy Council chairman, myron.genel@yale.edu.

The Public Policy Council, now in its 22nd year, includes two representatives from each of the three constituent societies, the American Pediatric Society (APS), the Association of Medical School Pediatric Department Chairs (AMSPDC) and the Society for Pediatric Research (SPR). Members serve simultaneously as representatives to the AAMC Council of Academic Societies and as liaison and alternative representatives to the AAP Committee on Federal Government Affairs (COFGA).

The Public Policy Forum is a loosely knit assembly of designated representatives at each major academic institution represented in AMSPDC; it serves as a communication network with the membership of the three societies and with academic pediatrics in general. Materials are distributed regularly to the Forum, including periodic legislative updates as well as relevant items on time-specific issues. These are supplemented by the Public Policy Council’s home page on the APS/SPR web site, http://www.aps-spr.org/Public_Policy/index.htm, which also provides E-mail access to our Washington coordinators and to myself. The Forum also serves as a vehicle for the annual legislative briefing at the annual meeting. The annual legislative breakfast at the 2006 PAS meeting in San Francisco, the forum’s twentieth, was held on May 1, and featured U.S. Medicaid Commission member and immediate past president of the American Academy of Pediatrics, Carol Berkowitz, on "Medicaid 'reform': Can We Preserve Our Children's Safety Net?", a cogent review of Medicaid policy in an environment of deficit-driven efforts to reduce entitlement spending. Dr. Berkowitz called upon pediatricians and advocates for children to present their views at the public meetings of the Medicaid Commission, the next of which was to be held May 17-18 in Irvine, Texas.

The thirteenth annual Public Policy Plenary Symposium, conducted by the Public Policy Council in collaboration with the Public Policy and Advocacy Committee of the Ambulatory Pediatric Association, was held Sunday afternoon, April 30, and examined the impact of the new ACGME resident work hour limitations. Entitled "New Resident Work Hours and Quality Care—Synergistic or Antagonistic?", the symposium was moderated by Dr. Richard Behrman, executive chair of the Pediatric Education Steering Committee for the Federation of Pediatric Organizations. Panel members included David Leach, executive director of the Accreditation Council for Graduate Medical Education (ACGME), Doug Jones, representing the Residency Review Committee (RRC) for pediatrics, and Ted Sectish, immediate past president of the Association of Pediatric Program Directors. The session examined the impact of new work hours on patient care and safety as well as on resident education and quality of life and was followed by a vigorous interactive discussion between the panelists and the audience. Once again, a special symposium devoted to the National Children's Study was held on Monday, May 1 following the SPR presidential symposium. The study's current status and future plans were reviewed in light of the failure to provide continued funding in the president's proposed FY 2007 budget. The session was moderated by Public Policy Council member Elena Fuentes-Afflick and included panelists Peter Scheidt, director of the National Children's Study, Alan Fleischman, chair of the NCS Federal Advisory Committee and David Schonfeld, chair of the American Academy of Pediatrics' Committee on Research and a member of the NCS Advisory Committee. Formal presentations were followed by an extensive discussion of the study's progress, potential benefits, and costs. Strong support for continuation of a National Children's Study was voiced by those present.

The Public Policy Council's membership continued unchanged during the year with Christine Gleason and Elena Fuentes-Afflick representing the Society for Pediatric Research, Jimmy Simon and myself the American Pediatric Society and Russ Chesney and Jon Abramson representing AMSPDC. Karen Hendricks has continued her most effective service as the Public Policy Council’s Washington Coordinator, working out of the Academy of Pediatrics' Department of Federal and Government Affairs. For the past four years she has been ably assisted by Kristin Butterfield, who will be leaving shortly for another position. Our societies have been well represented by Ms. Hendricks over the past thirteen years. She is highly regarded and a central figure within most of Washington's most significant and relevant health and research advocacy groups. She continues to serve on the steering committee of the Ad Hoc Group for Medical Research Funding, and is past president of the Coalition of Health Funding, a consortium of voluntary health organizations, professional societies and advocacy groups. She is a significant figure in a number of other issue-specific coalitions. As noted previously, much of the Public Policy Council's effectiveness reflects the superb and energetic representation that Ms. Hendricks has provided on our behalf.

The council's activities continue to be conducted primarily through a monthly conference call supplemented by frequent mailings and e-mail communications from the Academy’s Washington office as well as from the AAMC Council of Academic Societies. Conference calls have frequently included Lisa Simpson, chair of the APA's Public Policy and Advocacy Committee and Lolita McDavid, past chair, in part to coordinate plans for the PAS annual meeting, but increasingly to coordinate policy initiatives, and Richard Behrman, executive chair of the Pediatric Education Steering Committee for the Federation of Pediatric Organizations, for input on pediatric workforce and other issues. John Lewy, chair of the Academy's Committee on Federal Government Affairs (COFGA) has participated in conference calls prior to COFGA meetings. Materials, including minutes of conference calls, are shared routinely with the leadership of the three societies and thus provide opportunity for input on specific issues. The periodic legislative reports prepared for the councils and AMSPDC executive committee and testimony by Public Policy Council members are routinely placed on the Public Policy Council web site. Programs of the Public Policy Council continue to be conducted from both the Academy's Department of Federal Affairs and my office at Yale's Child Health Research Center. A comprehensive legislative report, prepared in March, appears in the program booklet for the annual meeting.

Much of the Public Policy Council's efforts during the past year were devoted to budgetary issues. In short, it has been a dreadful year with federal funding for research and education constrained by ballooning budget deficits, the quagmire in Iraq and Katrina and its aftershocks. Full details on these items and others are provided in the accompanying April-May 2006 legislative report prepared by our Washington staff. With respect to the budget, the Public Policy Council mounted a vigorous grassroots effort during the first session of the 109th Congress in order to increase appropriations for federal research agencies, principally the National Institutes of Health, in concert with other professional organizations and coalitions such as the Ad Hoc Group for Medical Research Funding and Research!America but to no avail. The FY 2006 appropriations for the National Institutes of Health of $28.4 billion reflected a net decrease, negating the momentum developed by the doubling initiative completed in FY 2004. Other agencies of importance to the societies, such as the Centers for Disease Control and Prevention (CDC), Agency for Healthcare Research and Quality (AHRQ) fared similarly. The fiscal picture for FY 2007 is equally bleak with the President's budget proposing, at best, level funding for these agencies. Strenuous efforts were made to increase the health and education portions of the budget resolution, again through a grassroots campaign, which succeeded in $7 billion being added to the Senate resolution. However, as of this date, similar action in the House is uncertain with the prospect that no budget resolution may ensue and that funding decisions may not occur until after the fall elections. We continue to promote grassroots action by the societies' membership to secure an adequate budget resolution and a 5% increase for the NIH. A number of commentaries and editorials have appeared in recent months in prominent medical journals, among them Nature, Cell, and the Journal of Clinical Investigation, calling attention to the adverse consequence of level funding and there is a great risk that the biomedical research and advocacy communities will splinter along parochial lines as funding is squeezed further.

On a similar vein, the Public Policy Council in concert with the American Academy of Pediatrics worked assiduously to protect funding for pediatric health programs through the FY 2006 budget reconciliation process which was directed to achieve savings of $10 billion over five years. Again, details are provided in the legislative report but efforts centered on defeating the House version which in contrast to the Senate permitted states to impose cost sharing and to limit benefits to children on Medicaid. A vigorous grassroots effort was made and almost succeeded, the House version passing by a margin of two votes with a number of key GOP moderates voting in opposition.

With respect to the remainder of the legislative agenda, there appears to be vanishing time available for passage of legislation that would expand federal support for embryonic stem cell research, create a uniform clinical trial registry, or provide reauthorization for Title VII or the Children's Hospital Graduate Medical Education Fund and these items likely will be carried over to the 110th Congress.

AAP Committee on Federal Government Affairs: COFGA, formerly the AAP’s Council on Government Affairs, includes eight members appointed by the Academy plus liaison representatives from the three societies which form the Public Policy Council, the Ambulatory Pediatric Association, Society for Adolescent Medicine, the Academy’s Committee on State Government Affairs, and the Academy’s senior and resident sections. During the year, John Lewy, a member of all of the Public Policy Council societies, continued to serve as chair of COFGA, concluding with COFGA's January meeting. The incoming COFGA chair is Mary Ann Mcaffree, a neonatologist at the University of Oklahoma.

COFGA met on two occasions over the past year, July 24-25, 2005 and January 22-23, 2006, both in the Washington area. It is perhaps an oversimplification to state that COFGA's major activities during the past year were devoted to increasing access to health care for children on one hand and preserving access to the entitlement programs of Medicaid and S-CHIP on the other. For several years, COFGA has had a subcommittee on access whose mission has been to "achieve the goal of access to comprehensive, high quality health coverage and care for every child through age 21 in the United States". During the year the committee developed and COFGA approved four long-term goals: 1) to achieve 100% coverage of all infants, children, adolescents and young adults with comprehensive, quality, universal health insurance and appropriate access to care; 2) ensure that all children have appropriate access to pediatricians, pediatric medical subspecialists and pediatric surgical specialists in a medical home; 3) to ensure that payment for services is both adequate and appropriate so that qualified pediatric physicians are willing and financially able to provide care; and 4) to ensure that there is adequate funding of child health programs. The Academy has actively sponsored legislation promoting universal access such as the MediKids Health Insurance Act (Rockefeller/Stark) and Kids Come First Act of 2005, introduced by Sen. John Kerry and based on a proposal during his 2004 presidential campaign. Prospects for both for remain dim in the current political environment and thus COFGA's efforts have been increasingly focused on preserving the safety net programs provided through Medicaid and S-CHIP. A major aspect of COFGA's January meeting was to mount an all out last minute effort to defeat the House Budget Reconciliation Bill, an effort which failed by a 216-214 vote. This spring major emphasis has been to prevent passage of legislation (strongly supported by the Bush administration) to create insurance pools for small business - so-called Association Health Plans - which would override federal and state mandates for screening and other preventive pediatric services. A set of principles adopted by the Academy of Pediatrics, National Association of Children's Hospitals and AMSPDC were endorsed by the American College of Obstetrics & Gynecology (ACOG), the Academy of Family Physicians and the American College of Physicians: 1) preserving the entitlement, 2) preserving EPSDT,3) S-CHIP remaining separate from Medicaid, 4) reimbursement for Medicaid services at least on par with Medicare and 5) tax credits are not appropriate for all income groups. The AMA endorsed all of the principles save maintaining Medicaid as an entitlement.

Eileen Ouellette, a pediatric neurologist from Boston, succeeded Carol Berkowitz as Academy president at the Academy's annual meeting in October. She will be followed by Jay Berkelhamer, a past president of APA and an APS member.

AAMC Council of Academic Societies: The CAS is one of three principal components of the Association of American Medical Colleges (AAMC) together with the Council of Deans and the Council of Teaching Hospitals. The CAS now includes 96 academic and scientific societies with two additional societies accepted during the past year. Four of these societies represent pediatrics - the three parents of the Public Policy Council and the Ambulatory Pediatric Association. Cathy Nelson from the Ambulatory Pediatric Association now serves on the administrative board (Executive Council) of the CAS. The current chair is J. Lloyd Michener, chair of the Department of Family Medicine at Duke. The immediate past chair is Robert Desnick, an SPR/APS member who represents the Association of Professors of Human and Medical Genetics. The CAS provides an excellent opportunity for interaction of pediatric specialists with leaders of other professional societies as well as an opportunity for significant input into development of AAMC policies and activities. Regrettably, participation by our Societies remains limited.

The Council of Academic Societies, as usual, met on two occasions during the academic year—November 7, 2005 in Washington as part of the annual general meeting of the AAMC and March 16-18, 2006 in Miami. The overall theme for the AAMC's annual meeting was "The Globalization of Medical Education" led by retiring AAMC chair, Lyn Eckhert, director of academic programs for Harvard Medical International, and former chair of the Council of Academic Societies. A highlight was a plenary address by former Secretary of State Madeline Albright, who spoke of enduring humanitarian values in foreign relations and medical education. I was honored with a Distinguished Service Membership award from the AAMC. The spring meeting was built around the theme of "Increasing Physician Supply; Enhancing Quality Medical Education" with particular attention on a call from the AAMC for a 30% increase in medical school enrollment. As usual, the spring meeting provided an excellent opportunity for thoughtful interaction with leaders of other disciplines and for direct input into emerging AAMC policy. A highlight of the spring meeting was a reception honoring retiring AAMC president, Jordan Cohen, who will be succeeded in July by Darrell Kirch, until recently Dean at Penn State.

I continue to encourage PPC member societies to become more active within the affairs of the AAMC, and in particular the Council of Academic Societies. The AAMC provides a major voice for academic medicine and the CAS provides a significant vehicle for input by faculty and chairs. The fall annual meeting of the AAMC will be in Seattle October 27–November 1, 2006. Next year's CAS spring meeting will also be on the west coast, the Renaissance Long Beach, Long Beach, California.

Operations and Finances: Activities of the Public Policy Council continue to be managed through my office at Yale's Child Health Research Center with continued part-time support by Eleanore Miller. The Academy of Pediatrics' Washington Office continues to provide a Washington presence and support services as it has for the past twenty-two years.

Submitted by,

Myron Genel, M.D.
Chairman