American Pediatric Society & Society for Pediatric Research

Public Policy Council

 2006–2007 Activities Report 

Return to APS/SPR Homepage

The Public Policy Council, now in its 23rd year, is comprised of 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 liaison 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 communications 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 breakfast forum at the PAS meeting. The legislative breakfast for this year=s PAS meeting in Toronto, the twenty-first annual, was held May 7, featuring  Dr. James James, director of the American Medical Association’s Center for Public Health Preparedness and Disaster Response.  Dr. James described the AMA’s efforts to educate physicians and first responders in responding to disasters, man-made and natural, and to epidemics.

 The fourteenth 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 May 6 and examined the numerous issues entailed in addressing the health needs of immigrant children and youth in the United States and Canada.  Dr. Lisa Simpson of Cincinnati Children’s Hospital, chair of the APA Public Policy and Advocacy Committee moderated the Symposium, entitled “Health Care for Immigrant Children”.  Panel members included Sara McDermott, Public Health Agency of Canada Centre for Chronic Disease Prevention and Control, Glen Flores, Center for the Advancement of Underserved Children, Medical College of Wisconsin, and Maria Youdelman, U.S. National Health Law Program.  The panel reviewed the current state of knowledge regarding the health of immigrant children, the barriers to care experienced by these children and their families, including issues of language, culture and race, and strategies to address these barriers and improve the health of these children and their families. 

 For the third successive year there was a special plenary session devoted to “The National Children’s Study: Data and Future Plans” on Monday, May 7, following the SPR presidential symposium.  With funding now provided in the FY ’07 budget, the NCS has issued an RFA for an additional 15-20 centers and the seven previously selected “vanguard” centers are beginning enrollment.  Panelists included Duane Alexander, director, NICHD, Peter Scheidt, study director and Marion Balsam, research partnerships program director.  Public Policy Council member Elena Fuentes-Afflick moderated the session.

 There was one change in the Public Policy Council’s membership during the past year.  After an open solicitation to SPR membership elicited  more than 130 responses, Tom Green, chair of pediatrics at Northwestern University School of Medicine, was selected in March to replace Christine Gleason who had served as one of the SPR representatives to the Public Policy Council for seven years before being elected to the APS Council  The overwhelming response to the SPR solicitation is certainly evidence of widespread interest in our activities, as well as recognition of their importance to the missions of academic pediatrics.

 Elena Fuentes-Afflick, vice president of the Society for Pediatric Research, continued to represent the Society for Pediatric Research, as has Jimmy Simon and myself for the American Pediatric Society and Russ Chesney and Jon Abramson for AMSPDC.  Karen Hendricks continues her most effective service as the Public Policy Council=s Washington Coordinator, ably assisted by Stephanie Russell, working out of the Academy of Pediatrics’ Department of Federal and Government Affairs.  As noted previously, our societies have been well served by Ms. Hendricks over the past fourteen years.  She is well regarded and a central figure within most of Washington’s most significant and relevant health and research advocacy groups.  For example, Ms. Hendricks 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, as well as an active member of multiple issue-specific coalitions.  Without doubt, much of the Public Policy Council’s effectiveness reflects outstanding representation which 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 correspondence from the Academy=s Washington office as well as from the AAMC Council of Academic Societies.  Conference calls generally include Lisa Simpson, chair of the APA's Public Policy and Advocacy Committee and Lolita McDavid, past chair, primarily to coordinate plans for the PAS annual meeting, as well as to coordinate policy activities, and the executive chair of the Pediatric Education Steering Committee for the Federation of Pediatric Organizations (FOPO), previously Richard Behrman, and since January 2007, Ted Sectish.  Mary Anne McCaffree, chair of the AAP’s Committee on Federal Government Affairs (COFGA) participates in conference calls prior to COFGA meetings and on specific issues, we have been joined by the lead Academy staff.  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, is posted on the web site and will appear in the program booklet for the annual meeting.

 Once again a considerable proportion of the Public Policy Council’s efforts during the year were devoted to securing adequate funding for the National Institutes of Health and other agencies, such as Centers for Disease Control and Prevention (CDC) and Agency for Healthcare Research and Quality (AHRQ) of importance to members of the societies.  Over the course of the year, a number of alerts were sent to the APS/SPR membership requesting grassroots action on the FY ’07 budget resolution and appropriations measures in both the House of Representatives and Senate, though the FY ’07 budget was not resolved until after the 100^th Congress convened in early 2007.  Though the original budget submitted by the President did not provide any increase, the FY ’07 joint resolution included a $620 million increase for NIH.  Nonetheless, the President’s proposed budget for FY ’08 remains level, in fact less than the final FY ’07 budget.  Allowing for inflation, the NIH budget, after a five-year doubling, has actually lost 15% in purchasing power.  The effect of this, coming after a period of expansion fueled by the NIH doubling, has been well chronicled in the literature and lay press.  Noteworthy was a recent hearing before the Senate Appropriations Subcommittee which featured release of a status report “Within Our Grasp – or Slipping Away?” by a coalition of eight research-intensive medical schools.  According to FASEB, success rates for R01 applications have fallen from 31% in 2002 to 20% in 2006, though it should be noted that applications have also increased by 50% from 30,000 to over 45,000. 

 Earlier this year after release of the President’s FY ’08 budget, the Public Policy Council joined other Washington advocacy groups in calling for a $2.2 billion increase in the 550 health function.  Further details are provided in the updated Public Policy Council legislative report.

 A bill reauthorizing the Institutes of Health was enacted during lame duck session of the 109^th Congress authorizing increases to $32.8 billion in FY ’08 and “sums as may be necessary” in succeeding years.  Although signed by the President, the authorized FY ’08 level is well in excess of the President’s budget request of just over $28 billion.  The NIH reauthorization codifies a central planning Office of Portfolio Analysis and Strategic Initiatives (OPASI) to which APS/SPR member and former SPR president Alan Krensky was named to head in January.

 The Public Policy Council continued to advocate for full funding of The National Children’s Study which was omitted in the President’s FY ’07 budget proposal.  In concert with a coalition of professional societies and advocacy groups, the Public Policy Council called for appropriation of specific funds outside of the regular NIH budget to continue the study, which was not accomplished until passage of FY ’07 joint funding resolution early in the 110^th Congress.  Subsequently the NCS leadership announced plans to begin enrollment in the seven previously selected “vanguard” sites and to fund 15-20 additional centers.  The full study calls for enrollment of 100,000 children at 105 selected sites.  Funding for The National Children’s Study was again omitted in the President’s FY ’08 budget, but from statements made already by the Democratic Congressional leadership, it is expected that the funding will be restored once more.

 The Public Policy Council worked with the American Academy of Pediatrics and the National Association of Children’s Hospitals (NACH) to achieve reauthorization of the program providing financing for graduate medical education at children’s hospitals which was secured through FY 2001 at a ceiling of $330 million.  Funding of $297 million was provided in FY ’06 and FY ’07.  We are advocating for full funding in FY ’08.

Public Policy Council member Jon Abramson continued to lead efforts to improve the safety and monitoring of medical devices used in children.  Legislation, the Pediatric Medical Device Safety and Improvement Act of 2006 was introduced at the end of the 109^th Congress by Senators Christopher Dodd and Mike DeWine and was reintroduced at the beginning of the 110^th Congress.  Reauthorization of the Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) will also be required during this session.  It is likely that an omnibus bill will emerge.  In addition, the Public Policy Council has been considering how a proposal to create a “Pediatric Centers of Excellence” program can be moved forward in the current fiscal climate.  Options have been discussed at two monthly PPC conference calls, most recently at the April 10 conference call preceding the PAS meeting.

AAP Committee on Federal Government Affairs: COFGA, previously 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. COFGA chair is Mary Ann McCaffree, a neonatologist at the University of Oklahoma, and chair-elect of the AMA’s Council on Scientific Affairs and Public Health.

COFGA met on two occasions over the past year September 10-11, 2006 and March 11-12, 2007, as always in the Washington, DC area.  Much of the September meeting was devoted to efforts to limit impact of the FY ’06 Deficit Reduction Act.  A interim final rule promulgated by the Centers for Medicare and Medicaid Service (CMS) required that applicants for Medicaid demonstrate proof of US citizenship.  This was thought to be particularly problematic for infants born of mothers with undocumented status, especially as these infants were regarded as US citizens by virtue of their birth.  Documentation of citizenship was also felt to be a problem for children in foster care and for many families where Medicaid status was sought distant from their place of birth.  In support of the Academy’s position the Public Policy Council sent a letter to CMS on August 7 and subsequent aspects of the final rule were modified.  There also was extensive discussion at the September meeting regarding the Academy’s initiatives to improve the quality of pediatric care.  An Alliance for Pediatric Quality (APQ) has been formed including the National Association of Children’s Hospitals and Related Institutions (NACHRI), the American Board of Pediatrics and the Child Health Corporation of America (CHCA) together with the American Academy of Pediatrics, thus allowing the pediatric community to speak with a unified national voice.  Most of the March 2007 meeting was devoted to the Academy’s efforts to reauthorize and expand the State Children’s Health Insurance Program (SCHIP) which requires renewal this year.  Together with other advocacy groups, the Academy is supporting expansion of SCHIP with provision of $60 billion in new federal funding.  Budget resolutions passed by both the House and the Senate include $50 billion for SCHIP.  Emergency funding of $750 million was included in the FY ’07 emergency supplemental appropriation to address SCHIP shortfalls in a number of states, though this is part of a contentious measure providing additional funds for the military campaigns in the Middle East which the President has yet to sign as of the drafting of this report.

There was extensive discussion at the March meeting regarding various proposals to increase coverage and access to health care for children beyond expansion of SCHIP.  The Academy continues to support legislation previously introduced promoting universal access such as the MediKids Health Insurance Act (Rockefeller/Stark) and the Kids Come First Act, initially introduced by Sen. John Kerry in the 109^th Congress based on his 2004 presidential campaign.  These and other proposals, including one being developed by Sen. Hillary Clinton and Rep. John Dingell, which would expand SCHIP to 400% of the poverty level, were discussed extensively at the March COFGA meeting.  During the meeting a set of principles that has been developed by the Subcommittee on Access was modified to state that: 1) every child must have quality health insurance; 2) health insurance should be a right, regardless of income, for all children, pregnant women and families and ultimately all individuals; 3) all health insurance plans should have a comprehensive age-appropriate benefits package such as that of the American Academy of Pediatrics (AAP); 4) all children should have access to primary care pediatricians, pediatric medical subspecialists, pediatric mental and dental professionals and hospitals with appropriate pediatric expertise; 5) all health plans should have payment rates that assure that children receive all recommended and needed health services; 6) health insurance should be fully portable and provide continuous coverage; 7) administrative aspects should be streamlined and simplified; 8) families should have a choice of clinicians; and 9) health plans should compliment and coordinate with existing maternal and child health programs to ensure excellent health benefits to families.

Jay Berkelhamer, an APS member and a past president of the Ambulatory Pediatric Association, succeeded Eileen Ouellette as the Academy President at the Academy’s annual meeting in October held in Atlanta.  He will be followed by Renee Jenkins, chair of the department of pediatrics at Howard University 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 and Health Systems.  The CAS is presently comprised of 94 academic societies devoted to behavioral research, medical education and patient care.  Four of these societies represent pediatrics – the three parents of the Public Policy Council together with the Ambulatory Pediatric Association. Cathy Nelson from the Ambulatory Pediatric Association continues serves on the administrative board (executive council) of the CAS.  The current chair is Michael Friedlander, who is Wilhelmina Robertson Professor and Chair of Neuroscience at Baylor College of Medicine.  Richard Krugman, Dean of the University of Colorado School of Medicine and an APS member is the current chair of the AAMC, while Robert Desnick, an APS and SPR member who was chair of the CAS two years ago and represents the Association of Professors of Human and Medical Genetics, is the Association’s chair-elect.   Darrell Kirch, previously dean of the Pennsylvania State University School of Medicine, was installed as the new AAMC president in July, succeeding Jordan Cohen.  While the CAS provides an unparalleled 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 – October 28-31 in Seattle, Washington, as part of the annual general meeting of the AAMC and March 15-17, 2007 in Long Beach, California.  The overall theme for the AAMC’s annual meeting was “Pursuing Excellence, Creating Value” which explored how medical schools and teaching hospitals provide value to society under the highest standards of quality – and how that value can be maximized now and in the future.  In his inaugural address, AAMC Darrell Kirch called on the Association “to take the risk and leap together into a new national discussion, not a partisan debate” regarding how to best support education, scientific discovery and health care for all Americans.  The meeting’s keynote speaker, business author Jim Collins, emphasized that medical schools and teaching hospitals must stay true to their core values in order to thrive in an environment of high expectation and stressed the importance of maintaining medical education as the core value of academic health centers.  The CAS sessions at the annual meeting were devoted to clinical research and included an extensive discussion of the Clinical and Translational Science Award (CTSA) program and creating an “academic home” for clinical translational research.  The CAS plenary session was devoted to how to accelerate research advances into practice and education.

The CAS spring meeting, which I attended, was built around a theme of “The Role of Research and Training the Next Generation of Physicians” with a series of interactive sessions devoted to exploring how training in research can best be integrated in medical education and residency.  There was also discussion and opportunity for input into the AAMC’s “strategic thinking and positioning” process that has been initiated by Dr. Kirch upon his assumption of the Association’s presidency.  The spring meeting, as usual, provided an excellent opportunity for ongoing interaction with leaders of other disciplines and for direct input into emerging AAMC policy.  The AAMC provides the major voice for academic medicine nationally and the CAS provides a direct vehicle for input by faculty and chairs.  The fall annual meeting of the AAMC will be in Washington,. DC, November 2-7, 2007.  Next year’s spring meeting will be at the Hotel Monteleone in New Orleans, March 6-9.

Submitted by,

Myron Genel, M.D.
Chairman