OVERVIEW

Congress returned to their home districts for a month-long recess beginning on July 28th. The next few weeks offer a unique opportunity for you to contact your senators and representative or their staff about key pediatric and child health issues. Issues necessitating specific action are indicate below. Also provided is information on how to contact members of Congress and the White House. Members of the American Pediatric Society (APS), the Association of Medical School Pediatric Department Chairs (AMSPDC), and the Society for Pediatric Research (SPR) are urged to use this time to make their voices heard on the Hill.

This report includes legislative updates on the following issues:

w FY 2001 Appropriations
w Pediatric Research
w Pediatric Workforce
w Health Disparities
w Immunizations
w Managed Care
w Contacting your Member of Congress
w Contacting the White House

By a very narrow margin, the House of Representatives approved its version of the FY 2001 Labor/HHS/Education (L/HHS) appropriations bill on June 14, 2000. The House bill provided $99.5 billion in discretionary funding. The Senate amended and approved the House language on June 30, 2000, providing for $104.5 billion in discretionary funding for such agencies and health programs as NIH, AHRQ, community health centers, and Head Start. The House-Senate conference committee reconciled the two different versions of the bill and completed work on July 27, 2000. However, although the conference report includes $106.2 billion in discretionary funding, nearly the same amount as the Administration’s original request for Labor, Education and Health and Human Services programs, only the Republican members of the conference committee agreed with the outcome and signed the report. The conference report will be filed and voted on when Congress returns from its August recess and is expected to be vetoed by the President. Consequently, this sets up an inevitable showdown in September between the Administration and Congress over a number of policy priorities and funding levels.

Some of the details that are known at this time about the FY 2001 Labor/HHS/Education conference agreement are provided in the specific sections below.

National Institute of Health (NIH)/Appropriations: The President, as part of his FY 2001 budget recommendations to Congress, included an increase of $1 billion to $18.8 billion for the NIH in FY 2001, an increase of 5.6%. Throughout this session of Congress, the Public Policy Council (PPC) has worked with the medical research community, including the Ad Hoc Group for Medical Research Funding and Research!America, to advocate for $20.5 billion for NIH, a 15% increase. This increase represents the third step toward doubling the NIH budget by FY 2003.

It is our understanding that the FY 2001 Labor and Health and Human Service (L/HHS) appropriations bill will include the 15.2% increase recommended by the Senate, raising the NIH total budget for FY 2001 by $2.7 billion to $20.5 billion. However, at this time, it appears that the FY 2001 Labor/HHS/Education bill that includes this allocation will be vetoed by President Clinton due to concerns about unrelated policy priorities and funding levels.

Pediatric Research/Appropriations: Now it its fourth year, the Pediatric Research Initiative (PRI) provides money to fund new NIH extramural research devoted to illnesses and conditions of children. Currently, monies for the PRI are located in the Office of the NIH Director. While the House and Senate Committee Reports on the FY 2001 Labor/HHS/Education appropriations bill recognized the importance of the PRI and encouraged the NIH Director to continue to enhance pediatric research efforts, the conference agreement does not appear to include specific funding for the PRI at this time.

The pediatric academic societies will continue to work with congressional staff and the National Association of Children’s Hospitals (NACH), the March of Dimes, and the American Academy of Pediatrics (AAP) to implement and increase the federal investment in pediatric research. Staff has continued to advocate for a funding level of at least $50 million for the PRI in FY 2001.

Pediatric Research Initiative/Authorization: PPC staff continues to work with the NACH and with congressional staff to seek authorizing language for the PRI. During the first session of the 106^th Congress, Representative Jim Greenwood (R-PA) joined Senators Kit Bond (R-MO) and Mike DeWine (R-OH) by introducing H.R. 2621, a House companion bill to S. 592/S. 1091, the Health Kids Act of 1999. Senator Bill Frist (R-TN), together with 11 bipartisan cosponsors, introduced a comprehensive children’s public health bill, S. 2868, in July, that includes authorizing language for the PRI and a very important and much sought after provision on loan repayment for pediatric research scientists. Staff anticipates a continued commitment by several members of Congress to the creation of a PRI statutory provision at NIH.

Stem Cell Research/Federal Regulations: Following the Department of Health and Human Services’ General Counsel’s conclusion that federal funds can be used to support research with existing human embryonic pluripotent stem cells, the former Director of the NIH, Dr. Harold Varmus, asked a Working Group of the Advisory Committee to the Director to examine the issue. This Working Group subsequently proposed guidelines for funding research with existing lines of cells. In December 1999, these guidelines (available on-line at www.nih.gov/news/stemcell/draftguidelines.htm) were published in the Federal Register for public comment. Approximately 30,000 comments were received, including those submitted by the PPC.

To date, the NIH has not completed the final version of these guidelines although it is anticipated that the guidelines will be released before the end of August. Additional information about the issue is available on-line at www.nih.gov/news/stemcell/index.htm 

Stem Cell Research/Legislation: Representatives Carolyn Maloney (D-NY) and Connie Morella (R-MD) introduced H.Res. 414, a sense of the House that federal funds should be used to support research with human pluripotent stem cells without restrictions. While a sense of the House is not binding, H.Res. 414 currently has 31 cosponsors, and has been endorsed by the PPC.

In April, a hearing was held on S. 2015, The Stem Cell Research Act of 2000, which was introduced by Senators Arlen Specter (R-PA) and Tom Harkin (D-IA), with Senator Ernest Hollings (D-SC) as a cosponsor. This legislation would permit federal funds to be used for research with human pluripotent stem cells generated from early human embryos in excess of clinical need at IVF clinics, and with the informed consent of the donor. Research would be conducted in accordance with NIH guidelines and with the review of an Institutional Review Board. Testimony from the hearing is available on-line at www.senate.gov/~appropriations/labor/hrgtest.htm 

Fetal Tissue Research: Following a broadcast on ABC’s 20/20 news program in the early spring, the House Commerce Subcommittee on Health and the Environment held a hearing to investigate allegations of illegal profiteering from the sale of human fetal tissue material. The three witnesses supporting fetal tissue research emphasized the importance of such research and the complete and total adherence to federal law by every scientist in their experience. Representatives of the company under investigation failed to appear and were held in contempt of Congress with an ensuing investigation by the U.S. Department of Justice. Much of the testimony from this hearing is available on-line at www.house.gov/commerce

In a related matter, the General Accounting Office is currently conducting a study of the federal government’s involvement in the use of fetal tissue.

Gene Therapy/Federal Oversight: The Clinton Administration announced several new initiatives this year to ensure appropriate patient protections in gene therapy clinical trials with human subjects. These new oversight measures include requiring training in bioethics and human subjects research for clinical investigators receiving NIH funds; greater coordination between the Food and Drug Administration (FDA) and NIH to develop new conflict of interest policies; and an intent to seek legislation to allow the FDA to punish violations of research practices through fines on the institution and researcher. The full text of the HHS plan is available on-line at http://www.hhs.gov/news/press 

In addition, staff will continue to monitor this issue to ensure that if legislation is introduced, it contains appropriate patient protections without unreasonable restrictions on scientific advancements that gene therapy will produce.

Clinical Research: The Senate approved Senator Edward Kennedy’s (D-MA) Clinical Research Enhancement Act of 1999, S. 1813, at the conclusion of the first session of the 106^th Congress. This bill is designed to help reverse the pattern of "the clinical investigator as an endangered species" by authorizing funds to improve the peer review process of clinical research grants; establish general clinical research centers; make new training awards focused on clinical investigators; and expand the existing intramural loan repayment program. Representative Jim Greenwood (R-PA) reintroduced companion legislation, H.R. 1798, in the House last year. The bill, which currently has 51 cosponsors, remains in the House Commerce Committee with apparently little support from Committee Chairman, Thomas Bliley (R-VA). In August, the PPC joined with other advocates in signing a letter to Rep. Bliley urging passage of the bill in this session of Congress.

Agency for Healthcare Research and Quality (AHRQ)/Appropriations: The PPC is working with the Friends of AHRQ, a broad-based coalition of health services research supporters, to ensure a funding increase for AHRQ in FY 2001 of at least $270 million. The Friends of ARHQ, including the PPC, Ambulatory Pediatric Association (APA) and the AAP, recently sent a letter urging congressional conferees to support additional funding that would provide adequate funding in improving patient safety and reducing medical errors and expand investigator-initiated grants, private-public partnerships and clinical prevention research. At this time, the final bill reportedly will reflect the $270 million level with $50 million earmarked to reduce medical errors. However, as previously noted it appears that the FY 2001 Labor/HHS/Education bill may be vetoed by President Clinton due to concerns about unrelated policy priorities and funding levels.

Animal Research/Legislation: For the third time, Representative Charles Canady (R-FL) re-introduced the Pet Safety and Protection Act, H.R. 453, in the 106^th Congress. The bill, which currently has 73 cosponsors, remains in committee. Senator Daniel Akaka (D-HI) introduced a companion bill, S. 1522, in the Senate in August 1999. Senator Robert Smith (R-NH) joined as a cosponsor to the legislation in June 2000. Both bills are based on the erroneous notion that research institutions obtain stolen pets for use in research activities. If enacted, the legislation would have an adverse impact on the ability of medical schools to obtain random-source animals for research and testing.

Animal Research/Appropriations: In his FY 2001 budget proposal, President Clinton requested that the Animal Care Unit of the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service receive $15.2 million in FY 2001, a $5 million increase over FY 2000. The House- and Senate-passed versions of the Agriculture appropriations bills include $12.6 and $12.5 million, respectively, for the Animal Care Unit which is dedicated to requiring minimum standards of humane care and treatment for animals bred for commercial sale, used in research, transported commercially or exhibited to the public. The National Association for Biomedical Research and other members of the research community, including the PPC, supports the President’s request of $15.2 million and will continue to promote the much-needed increase.

Graduate Medical Education (GME) Financing in Children’s Hospitals/Federal Regulation: On June 19, 2000, the Health Resources and Services Administration issued a Federal Register notice and requested public comments on eligibility criteria, funding factors and methodology, and performance measure for hospitals participating in the children’s hospitals graduate medical education program. The AAP, in consultation with the APA, APS, AMSPDC, and SPR, responded to the notice, raising concerns about the notice’s language on the method of counting full-time equivalent residents for direct medical education and indirect medical education (IME) payments. Specifically, the pediatric community noted that:

w a mechanism that would provide funding only for training that occurs in the children’s hospital would constitute a great financial hardship to residency programs, as the majority of clinical training and care in pediatrics occurs in ambulatory settings;

w a case mix methodology for IME payments that includes both inpatient and outpatient care delivered by the hospital would prevent the perpetuation of financial incentives that reduce education in primary care pediatrics; and

w the calculation for IME payments should incorporate as a factor the costs associated with providing training opportunities in rural and underserved urban areas;

The NACH also submitted comments regarding HRSA’s proposal. The $40 million in funding for FY 2000 is expected to be released in mid-to-late September. For additional information see: http://www.hrsa.dhhs.gov/bhpr/childrenshospitalgme/docs.htm 

GME Financing in Children’s Hospitals/Legislation: The House of Representatives overwhelmingly passed an omnibus children’s research bill, H.R. 4365, introduced by Representative Michael Bilirakis (R-FL), in May 2000. This bill extends the children’s hospitals graduate medical education program’s authorization through FY 2005. A companion children’s health bill, S. 2868, that contains a similar provision, was introduced by Senators Bill Frist (R-TN) and Ted Kennedy (D-MA) in July, but to date has seen no further action.

GME Financing in Children’s Hospitals/Appropriations: The PPC has joined with the NACH and AAP to advocate for $285 million in FY 2001 for GME funding at independent children’s hospitals. This figure represents the fully authorized amount and is equal to GME financing provided to other hospitals through Medicare, according to a study conducted for NACH by the Lewin Group, an independent health policy firm. At this time, the House-Senate Labor/HHS/Education conference agreement includes a funding level of $125 million in FY 2001. However, it is possible that after the current L/HHS/Education appropriations bill is vetoed as anticipated additional funding may become available.

Of note, in July, AMSPDC members signed a letter to the chairmen of the House and Senate Appropriations Committees urging support for PPC/NACH/AAP-recommended $285 million funding level.

In supporting this important funding for children’s hospitals, the pediatric community will continue to encourage that GME funding does not come at the expense of other existing education and training programs for pediatrics and primary care, such as the primary care medicine and dentistry training grants included in Title VII of the Public Health Services Act.

GME/Medicare Reform: The solvency of the Medicare trust fund still remains an important issue in this election year. As part of his February 2000 budget proposal to Congress, President Clinton recommended a series of Medicare reforms, including $38.1 billion over five years for new prescription drug benefits for seniors; an opportunity for 55- to 65- year olds to buy into the Medicare program; and a plan to invest part of the surplus in Medicare. The debate surrounding the solvency of the Medicare program has caused GME financing to continue to be under increased scrutiny.

Medicare Payment Advisory Commission: The Medicare Payment Advisory Committee (MedPAC) submitted its report to Congress in June. The report reiterates its recommendation from August 1999, that IME payments be combined into a "teaching hospital adjustment." MedPAC also recommends that the IME portion of the teaching hospital adjustment remain at 5.5 percent. The PPC has joined with others in the medical education community to support an IME adjustment of 6.5 percent.

Council of Graduate Medical Education (COGME): COGME issued its draft 15^th report, Financing Graduate Medical Education Programs in a Changing Health Care Environment, in June. This report examines current funding mechanisms for GME and assesses their implications for developing community-based educational programs. It also evaluates alternative federal financing policies within the context of the COGME’s previous call for a stable funding mechanism that would provide adequate support for GME training, particularly in out-of-hospital settings. The 15^th report makes several specific recommendations, including:

w creating a GME fund that combines all federal funding support graduate medical education;
w establishing IME accounts to pay hospitals and other providers as appropriate for the indirect costs of educational activities;
w establishing direct GME accounts to pay program sponsors or their designees for the direct costs of graduate medical education;
w establishing a national average per resident payment for direct GME costs;
w continuing the Balance Budget Act limits on the numbers of residents with modifications;
w modifying the Medicare rules related to teaching physicians; and
w providing additional support for hospitals and community-based training sites that serve a disproportionate share of low-income patients.

GME/Legislation: As previously reported, several congressional proposals are still pending in Congress that would create all-payer systems to finance GME, although none appear likely to move forward at this time. These bills include: H.R. 1224, The All-Payer Graduate Medical Education Act, introduced by Representative Ben Cardin (D-MD), to fund GME through an all-payer fund; and S. 210, The Medical Education Trust Fund Act of 1999, introduced by Senator Daniel Moynihan (D-NY), to establish a Medical Education Trust Fund. Representative Nita Lowey (D-NY) introduced a companion bill to S. 210 in the House, H.R. 2771.

Balance Budget Act (BBA) Relief 2000 for Teaching Hospitals: Prior to the August congressional recess, Senate Democrats announced a 10-year, $80 billion BBA relief package for hospitals, home health agencies, nursing homes, Medicare+Choice plans and other providers. The plan, as outlined by Senate Minority Leader Tom Daschle (D-SD), includes adjusting inpatient payments to keep up with increases in hospital costs; preventing further reductions in payment rates for vital teaching hospitals; offering relief for rural hospitals; and providing additional support for hospitals with a disproportionate share of indigent patients. The plan also gives states the option to cover legal immigrant children and pregnant women under Medicaid; improves the eligibility and enrollment processes in the State Children’s Health Insurance and Medicaid programs; and extends the transitional medical assistance program under Medicaid for people who leave welfare for work.. The details will be finalized over the August recess.

On June 20, President Clinton joined the discussion by proposing $21 billion over 5 years ($40 billion over 10 years) in additional relief to providers from the Balanced Budget Act of 1997’s reimbursement cutbacks. Designed to "ensure adequate reimbursement" and "continue access to high-quality care," the package would designate $9 billion over 5 years in specific relief to hospitals, skilled nursing facilities, home health agencies, and Medicare +Choice plans. The $12 billion remaining would be negotiated with Congress.

Of the $9 billion in specified relief, $5 billion would be provided to hospitals. Teaching hospitals would benefit from the following provisions:

· full market basket update in FY 2001 to the Medicare inpatient service payment;
· one-year Medicare Indirect Medical Education freeze at 6.5 percent (FY 2000 levels);
· one-year Medicare Disproportionate Share Hospital payment freeze at FY 2000 levels; and
· one-year freeze in Medicaid Disproportionate Share Hospital allotments at FY 2000 levels.

The remaining $4 billion in specified relief would be invested in home health agencies ($2 billion), skilled nursing facilities ($1 billion), and managed care plans ($1 billion). In addition, the proposal eliminates savings associated with constraints in out-year provider payments in his FY 2001 budget.

In April, Rep. Charles Rangel (D-NY) introduced the Teaching Hospital Preservation Act of 2000, H.R. 4239, freezing the IME adjustment at 6.5 in FY 2001 and thereafter. The House bill currently has 72 bipartisan cosponsors. Senator Daniel P. Moynihan (D-NY) introduced the companion legislation, S.2394 on the same day. The Senate bill currently has 38 bipartisan cosponsors.

The pediatric community will continue its efforts to maintain the federal investment in graduate medical education, including freestanding children’s hospitals.

Title VII-Health Professions Training Grants/Appropriations: Through the activities of the Health Professions and Nursing Education Coalition (HPNEC) the PPC, APA and the AAP, supported a 10% increase ($335 million) above current level funding for the Title VII and Title VIII programs in FY 2001. Title VII provides grant funding for innovative general pediatrics residency and faculty development training programs through the primary care and dentistry grant program. The FY 2001 Labor/HHS/Education conference agreement includes a total of $456 million for health professions. Of that amount, $125 million is for the children’s hospital graduate medical education program and $331 million is for the Title VII and Title VIII programs. The vote on the conference agreement is expected to take place in early September.

The House Commerce Committee passed The Health Care Fairness Act of 1999, H.R. 3250, on July 26, 2000. Introduced by Representative Bennie Thompson (D-MS), this bill would extend the current field of research on health disparities; elevate the current Office of Research on Minority Health to a National Center for Research on Minority Health and Health Disparities at NIH; expand current research activities on health disparities at AHRQ; provide for Title VII grants for curricula development; and sponsor a national research conference in the field. Before approving the bill, the Commerce Committee agreed to an AAP-supported amendment by Representative Diane DeGette (D-CO) to include age-based and sex-based criteria in the development of research outcomes. On the same day, the Senate Health, Education, Labor and Pension, Subcommittee on Public Health and Safety, held a hearing on health disparities affecting minorities, women, and the medically underserved. The Subcommittee also discussed the Senate’s companion bill, S.1880, introduced by Senator Ted Kennedy (D-MA). The bill has not been acted upon.

The UCLA Center for Health Policy Research and the Kaiser Family Foundation recently produced a report entitled, Racial and Ethnic Disparities in Access to Health Insurance and Health Care. The report finds, among other things, that racial and ethnic minority groups are much more likely than non-Latino whites to be uninsured and are less likely to have job-based health insurance coverage. Furthermore, health disparities were found to be greater among children: "Latino, Asian American/Pacific Islander, and Native American children are nearly two to three times more likely than white children to not have a usual source of care." The full text of the report is available on-line at www.kff.org/kcmu or www.healthpolicy.ucla.edu 

Last January, Senator Patrick Moynihan (D-NY) introduced Amendments to the Maternal and Child Health Services Block Grant as S. 207. This bill would increase the authorization of appropriations for Title V, the Maternal and Child Health Block Grant (MCHB) program to $840 million in FY 2000. Under current law, Title V is permanently authorized at $705 million. It was last extended in FY 1993.

The PPC, together with the APA, AAP and other Title V advocates, continues to monitor the issue closely and to participate in efforts to increase the authorization level. The PPC also is supporting an increase in funding (appropriations) to $800 million for FY 2001. Current funding for the MCHB program is $709 million. The FY 2001 Labor/HHS/Education conference agreement recommends level funding for the MCH Block Grant.

Vaccine Safety/Congressional Hearings: Representative Dan Burton (R-IN), Chairman of the House Government Reform Committee, has continued to hold hearings on vaccines this session of Congress. In July, the most recent hearing, several parent-witnesses discussed the alleged link between thimerosal and autism. The CDC, FDA, and the NIH refuted this claim.

Prior to that hearing in June, using the rotavirus vaccine as an example, Chairman Burton held a hearing on alleged conflicts of interest and vaccine development. Specifically, Chairman Burton convened the hearing to investigation his concern that members of the FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) and the CDC’s Advisory Committee on Immunizations Practices (ACIP) are biased because of on-going relationships with vaccine manufacturers. At this hearing, four government witnesses testified, including representatives from General Services Administration, Office of Government Ethics, FDA and CDC.

These most recent actions follow three hearings held in 1999 by Chairman Burton’s full Government Reform Committee, as well as the Committee’s Subcommittee on Criminal Justice, Drug Policy and Human Resources, which is chaired by Representative John Mica (R-FL). This trio included a hearing on the Hepatitis B vaccine, vaccine safety and personal choice, and the vaccine injury compensation program. It is unclear at this time if future hearings will occur when Congress returns in the fall or what the new Congress next year will bring.

Selected testimony from each of these hearings is available on-line at http://www.house.gov/reform/hearings/index.htm 

Section 317 of the Public Health Services Act: The CDC’s National Immunization Program currently is funded at $510 million. The Administration’s FY 2001 budget proposed $530 million, including an additional $10 million for domestic vaccine purchases, $5 million for global polio eradication, $5 million for vaccine safety and no increase for state operations or infrastructure funding. It is the latter issue that triggered the Academy and the pediatric academic societies to join with several other immunization advocates, such as, Association of State and Territorial State Health Officials, the AMA, AAFP, APHA, Infectious Diseases Society of America, to support an increase - $615 million - in the Section 317 [Public Health Service Act] immunization program in FY 2001. This figure proposes additional funding above the Administration’s request for purchase of vaccines ($20 million) and for operations and infrastructure grant awards to states ($75 million). The FY 2001 Labor/HHS/Education conference agreement includes $542.3 million, of which $37.5 million if for state infrastructure grants and no funds were included for vaccine purchase. As noted previously final action has not yet taken place on the Labor/HHS appropriations bill.

Other immunization legislative activities include, The Comprehensive Insurance Coverage of Childhood Immunization Act of 2000, S. 2444. It would amend the Employee Retirement Income Security Act of 1974 (ERISA) to require that all health plans cover all childhood and adolescent immunizations. Sponsored by Senator Richard Durbin (D-IL), and cosponsored by Senators Jack Reed (D-RI), Dianne Feinstein (D-CA) and Paul Wellstone (D-MN), S. 2444 awaits committee action for the Senate Committee on Health, Education, Labor and Pensions. Representative Gene Green (D-TX) has a companion bill in the House. Representative Green also introduced H.Con.Res. 315, a non-binding, sense of Congress resolution stating that greater funding should be available for immunization infrastructure activities under Section 317.

Institute of Medicine Report: The IOM report – Calling the Shots – from the Immunization Finance Policies and Practices Committee was released in June. The report, originally requested by the Senate Appropriations Committee in 1998, addressed several key issues, including: an assessment of overall spending by all sources for immunization in the United States since the 1990s, how new federal immunization funds were spent by states and to what extent states maintained their own level of effort over the past five years, and current and future funding requirements for childhood immunization activities and how those requirements can be met through a combination of state funding, federal immunization funding and funding available through the State Child Health Insurance Program.

The IOM report noted that despite record high vaccination rates, pockets of under-immunized children still existed in the United States. The report recommended an increase of $75 million over current funding to address the pockets of need and to stabilize the current national immunization efforts.

MANAGED CARE/LEGISLATION

Despite the House passage of the bipartisan, AAP-supported Representative Charlie Norwood (R-GA)- Representative John Dingell (D-MI) Patients’ Bill of Rights last October, the Conference Committee charged with ironing out the differences between the House and Senate versions of the bill has failed to produce any agreement. Instead, conference proceedings – for the most part – have broken down.

Twice, the Senate has come within one vote of gaining a majority in support of the House bill, which is far more comprehensive than the Senate proposal. Specifically, the House bill guarantees access to pediatricians, pediatric medical subspecialists, and pediatric surgical specialists; preserves stronger state laws; ensures that medical experts, including those with pediatric expertise, make medical decisions; and holds managed care plans accountable for their medical decisions that injure patients where then Senate bill does not of these.

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How to Contact Your Members of Congress

The August congressional recess provides an excellent opportunity for you to contact your members of Congress. You can reach out to your legislators and their staff in Washington, D.C., as well as their home offices around the country. You may also wish to consider inviting your legislators and their staff to your facility, office or community-based pediatric program. Congress returns to Washington on September 5^th and its target adjournment date is October 6^th.

The Honorable (name)
United States Senate
Washington, D.C. 20510
Dear Senator (name):

The Honorable (name)
Washington, D.C. 20515
United States House of Representatives
Dear Representative (name):

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

Calling your Members of Congress: You can reach your Senators or Representative by calling the Capitol Hill switchboard at 202/224-3121. If you do not readily know who your Representative is, the switchboard operator can provide assistance. Once connect to your legislator’s office, ask to speak to this staff member who works on health care issues. Be prepared to leave a brief message, as well as your name, address and telephone number.

Faxing your Members of Congress: Most congressional offices have fax machines, so you may able to fax your letter, if desired. Some offices will not provide their fax numbers, however, preferring instead to rely on traditional mail.

Emailing your Members of Congress: While many congressional offices have email services, it is not a universally available for public correspondence. Moreover, given the volume of emails congressional offices receive, emailing your Senators or Representative may not be the most effective way to have your message heard. As such, we recommend your contact your legislators’ offices directly to determine their policies on email messages.

Calling: The phone number for the White House switchboard is 202/456-1111. You can enter by push-button your opinions on certain topics, or you can press 0 to speak with an operator.

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Additional information and resource material on these and other pediatric and child health issues are available from:

601 13^th Street, NW
Suite 400 North
Washington, D.C. 20005
ph: 800/336-5475
fax: 202/393-6137

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APS Myron Genel, MD; Jimmy Simon, MD
SPR Ora Pescovitz, MD; Christine Gleason, MD
AMSPDC Russell Chesney, MD; Jon Abramson, MD

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Report Submitted By:

Myron Genel, MD, Chairman
Karen M. Hendricks, JD, Washington Coordinator
Molly A. Hicks, MPA, Legislative Assistant

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