The following is an update and summary of recent federal legislative and regulatory activities of interest to the pediatric academic community. At the time of this writing, the 106^th Congress is winding to a close and is expected to adjourn sine die by mid-October.

This report includes legislative updates on the following issues:

• Pediatric Research

• Pediatric Workforce

• Health Disparities

• FY 2001 Appropriations

• MCH Block Grant

• Immunizations

• Managed Care

• Election 2000

• PAS Annual meeting 2001

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 pediatric academic community 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. At the time of this writing, however, the Labor/HHS appropriations bill remains stalled on Capitol Hill as congressional leaders and the White House work to resolve various funding level and policy priority issues. It is anticipated that the final funding level for the NIH in FY 2001 will be $20.5 billion. PPC staff worked throughout the appropriations process to ensure adequate funding for NIH.

Pediatric Research Initiative: The Children’s Health Act passed by Congress in September as H.R. 4365, authorizes the NIH Director to establish a Pediatric Research Initiative to "conduct and support research that is directly related to diseases, disorders, and other conditions in children." The NIH Director in consultation with the Director of the NICHD and the Administrator of the Health Resources and Services Administration will head the initiative. It provides for increased training grants for pediatric training, additional career development awards for health professionals intending to build careers in pediatric basic and clinical research, and a pediatric research loan repayment program of up to $35,000 per year for qualified health professionals who "agree to conduct pediatric research." In its original format the loan repayment provision was specific to pediatrician research scientists. However, as the bill went through the legislative process, the language was broaden to "health professionals." In addition this title of the Child Health Act also includes a provision for a comprehensive review of regulations governing child participation in research studies and authorizes a $18 million long-term child development study. The PPC, the National Association of Children’s Hospitals, the APA and the American Academy of Pediatrics have been working on the passage of the overall Pediatric Research Initiative for the past five years and was very involved in the development of the loan repayment provision. While he has not done so yet, President Clinton is expected to sign this legislation into law.

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.

NIH published its final guidelines for research using human pluripotent stem cells on August 25, 2000. President Clinton and the medical research community, including the pediatric academic societies heralded the guidelines that allow the first federal funding of human embryonic stem cell lines. Some members of Congress have vowed to proactively oppose the implementation of the guidelines. They argue that the new guidelines violate a four-year old congressional ban on federal funding for research "in which a human embryo or embryos are destroyed, discarded or knowingly subjected to risk of injury or death." Additional information about the guidelines and the stem cell research issue generally is available on-line at www.nih.gov/news/stemcell/index.htm 

Stem Cell Research/Legislation: Legislation introduced by Senators Arlen Specter (R-PA) and Tom Harkin (D-IA), S. 2015 that goes beyond the scope of the NIH stem cell guidelines did not advance in this session of Congress but likely will be reintroduced in the 107^th Congress. The legislation, which was the subject of an April hearing, 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 

Additionally, 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. The resolution, which has been endorsed by the PPC, is not expected to be passed this Congress.

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 House Commerce Committee passed the bill, which currently has 51 cosponsors, in September. Final action is pending. The PPC joined other advocates in vigorously supporting this legislation.

Agency for Healthcare Research and Quality (AHRQ)/Appropriations: The PPC joined with the AAP, APA and 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. Throughout the appropriations process this group of AHRQ advocates sent several letters 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 the time of this writing, the final bill reportedly may reflect the $270 million level with $50 million earmarked to reduce medical errors.

Animal Research/ADRF v. Glickman: The USDA and the Alternatives Research and Development Foundation (ARDF) announced on September 29^th that they had reached a settlement agreement regarding ARDF’s lawsuit seeking to force USDA to include rats, mice and birds in the regulatory definition of animal under the Animal Welfare Act. The agreement calls on the USDA to grant ARDF's earlier petition to issue a rulemaking to amend the definition and "to initiate and complete" a rulemaking on changing the definition. The PPC sent a letter to Agriculture Secretary Glickman joined with hundreds of others in the research community to oppose the settlement and to urge the USDA to oppose the litigation. On October 6^th, the federal court ruled that it had no authority to stop the settlement and dismissed efforts to block it.

However, a House-Senate Agriculture Appropriations Conference Committee on October 3^rd added language to the FY2001 appropriations bill to prohibit the USDA from going ahead with the rulemaking. Specifically, the amendment bars the USDA from spending any federal funds to "issue a notice of proposed rulemaking, to promulgate a proposed rule, or to otherwise change or modify the definition of ‘animal’ in existing regulations pursuant to the Animal Welfare Act." On October 11, the House passed the Agriculture Appropriations bill. The Senate is scheduled to pass it shortly and send it to the President who is expected to sign the appropriations bill that includes this language.

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 Animal Care Unit 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 House and Senate passed bills included $12.6 million and $12.5 million respectively. The final FY 2001 appropriations for the Animal Care Unit, included in the Agriculture Appropriations conference agreement, is $12.565 million. The National Association for Biomedical Research and other members of the research community, including the PPC, worked throughout the appropriations process in support of the President’s request of $15.2 million.

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 PPC joined the comments prepared by the Academy in response 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:

• 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;

• 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

• 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 was released to 56 institutions in mid- September. For additional information see: http://www.hrsa.dhhs.gov/bhpr/childrenshospitalgme/docs.htm 

GME Financing in Children’s Hospitals Authorization Extension: Congress passed a comprehensive Children’s Health Act of 2000 in September as H.R. 4635. Among other things, this bill extends the authorization of the children’s hospital GME provision from 2001 to 2005. At the time of this writing, the bill awaits approval by President Clinton, who is expected to sign the legislation without delay.

GME Financing in Children’s Hospitals/Appropriations: The PPC, together with the National Association of Children’s Hospitals, the Ambulatory Pediatric Association and the Academy worked throughout the appropriations process to secure congressional support for independent children’s hospitals and to provide full funding – $285 million – in FY 2001. 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 (this is above the President’s budget request that was $80 million). The final funding outcome is still pending.

In supporting this important funding for children’s teaching hospitals, the pediatric community also worked to ensure that GME funding for independent children’s hospitals, as a discretionary program in HRSA, did not come at the expense of other existing HRSA 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 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.

GME/Legislation: As previously reported, several congressional proposals were introduced in the 106^th Congress that would have created an all-payer system to finance GME, although none appear likely to move forward before the 106^th Congress adjourns. 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.

Medicare Payment Advisory Commission: The Medicare Payment Advisory Committee (MedPAC) submitted a report to Congress in June 2000, reiterating MedPAC’s recommendation from August 1999, that IME payments be combined into a "teaching hospital adjustment." The report 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 legislation that includes an IME adjustment of 6.5 percent. At the most recent September meeting of MedPAC there was no discussion of payments to teaching hospitals.

COGME/NACNEP Conference on Patient Safety: COGME held a joint meeting with the National Advisory Council on Nurse Education and Practice (NACNEP) on September 13-14 to discuss the impact of physician-nurses relationships on patient safety. This meeting represented only the second time the two groups had met jointly in their 20-year history. The groups expect to issue a joint report and series of recommendations regarding patient safety by the end of the year. Key concepts identified by COGME/NACNEP to be addressed in the report include the creation of a new national agency or advisory board, or the strengthening of an existing organizations such as the Agency for Healthcare Research and Quality (AHRQ), to lead national patient safety efforts, and the development of new incentive programs, such as national awards or pilot centers, to recognize hospitals with outstanding patient safety records.

Balance Budget Refinement Act of 2000: On September 20, Senate Democrats introduced S.3077, a 10-year, $80 billion BBA relief package for hospitals, home health agencies, nursing homes, Medicare+Choice plans and other providers as S. 3077. The bill 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 bill 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. S.3077 also includes as a separate provision, Senator Bob Kerrey’s (D-NE) Children’s Hospitals GME bill that would among other things extend the GME provision through 2005. [NOTE: in another comprehensive child health bill approved in late September by the House and the Senate and at the time of this writing is awaiting the President’s signature, a provision is included to extend the children’s hospitals graduate medical education program’s authorization through 2005. It is safe to say that this extension will occur.]

The bill follows efforts undertaken by President Clinton in June. At that time, the President proposed $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.

Additionally, Rep. Charles Rangel (D-NY) introduced the Teaching Hospital Preservation Act of 2000, H.R. 4239, in April. This bill, which has 76 cosponsors, would freeze the IME adjustment at 6.5 percent in FY 2001 and thereafter. Senator Daniel P. Moynihan (D-NY) introduced the companion legislation, S.2394 on the same day. The Senate bill currently has 40 bipartisan cosponsors. Neither bill will be acted on as a freestanding proposal in this Congress although it is anticipated that several provisions may be included in the final Balanced Budget Refinement Act.

On October 11, the House Ways and Means, Commerce and Senate Finance Committee Chairmen and House and Senate Republican Leadership agreed to a $28 billion plan providing relief to hospitals, managed care plans, skilled nursing facilities, home health agencies and other providers. Unfortunately neither the White House nor House/Senate Democrats were involved in these negotiations. According to the information available, $8 billion would go to hospitals. In recent information provided from the AAMC, these provisions include:

The congressional leadership is considering attaching these provisions to the Labor, HHS appropriations bill or to other legislative vehicles that may be pending. President Clinton has expressed his concern over the amount of money the BBA proposal would give to Medicare Plus Choice plans.

The PPC 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 joined other organizations to support 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 independent children’s hospital graduate medical education program and $331 million is for the Title VII and Title VIII programs. However, at the time of the writing of this report no final actions have been taken on the FY 2001 Labor/HHS/Education bill that includes funding for the Title VII and VIII programs.

The pediatric community, including the PPC, worked throughout the appropriations process to secure adequate funding for the Title VII and VIII programs – at least the $331 million provided in the Conference report. This includes $18.3 million for general internal medicine/general pediatrics as provided in the House version of the bill and $125 million for GME funding for independent children’s hospitals.

HEALTH DISPARITIES

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 

By a very narrow margin, the House of Representatives approved its version of the FY 2001 Labor/HHS/Education (L/HHS) appropriations bill in June. The House bill provided $99.5 billion in discretionary funding. The Senate amended and approved the House language, providing for $104.5 billion in discretionary funding for such agencies and health programs as AHRQ, immunizations, GME for independent children’s hospitals, and the National Institutes of Health. The House-Senate conference committee reconciled the two different versions of the bill and completed work at the end of July. While 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 various allotments and signed the report. President Clinton has repeatedly indicated he would veto the bill in its current form because of concerns over non-health related policy priority and funding level determinations.

At this time of this writing it appears that the Republican-backed conference report may not be filed as freestanding measure. Rather, the Labor/HHS/Education provisions will be included in an end-of-session omnibus appropriations package. Staff worked throughout the final weeks of the 106^th Congress to ensure adequate funding for pediatric-backed initiatives. To date two short-term spending bills, Continuing Resolutions (CR), extending current level funding through October 14, 2000, have been passed by Congress and signed by the President. A third CR extending funding through October 20, has been passed by Congress and is awaiting presidential action.

MATERNAL AND CHILD HEALTH BLOCK GRANT

During the 106^th Congress, Senator Patrick Moynihan (D-NY) proposed an amendment to the Maternal and Child Health Services Block Grant that would extend the authorization level for Title V, the Maternal and Child Health Block Grant (MCHB) program to $1 billion in FY 2001 and beyond. Under current law, Title V is permanently authorized at $705 million. The authorization level was last extended in FY 1993. This provision was included in the Democratic proposed Balanced Budget Refinement Act of 2000, some provisions of which are winding their way through the final days of this Congress.

The PPC, together with other Title V advocates, continues to monitor the issue closely and to participate in efforts to increase the authorization level throughout this session of Congress. However, at this time, the FY 2001 Labor/HHS/Education conference report recommended level funding for the MCH Block Grant: current funding for the program is $709 million. Throughout this session of Congress, the PPC and other child health advocates have urged Congress to increase funding for the MCHB program to at least $800 million in FY 2001.

Vaccine Safety/Congressional Hearings: Representative Dan Burton (R-IN), Chairman of the House Government Reform Committee, continued to hold hearings on vaccines this session of the 106^th Congress. In July, the last hearing in this session of Congress, several parent-witnesses discussed the alleged link between thimerosal and autism. The CDC, FDA, and the NIH refuted this claim.

In June, a hearing was held alleged conflicts of interest and vaccine development, using the rotavirus vaccine as an example. Specifically, Chairman Burton convened the hearing to investigate 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. Chairman Burton issued a report in August, detailing the Committee’s examination of vaccine policy-making at HHS.

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 the new Congress convenes in January 2001.

Selected testimony from each of these hearings, as well as Chairman Burton’s report, is available on-line at http://www.house.gov/reform/hearings/index.htm 

Section 317 of the Public Health Services Act: In FY 2000 the CDC’s National Immunization Program was 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 immunization advocates, such as the members of the PPC, the AAP, AMA, AAFP, 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). At the time of this writing, it is believed that the FY 2001 Labor/HHS/Education conference agreement includes $542.3 million, of which $37.5 million is for state infrastructure grants and no funds were included for vaccine purchase. However, prior to the conclusion of this session of Congress, members of Congress are still hopeful that they may be able to get additional funding for state infrastructure and for vaccine purchase including Prevnar and influenza.

Vaccine-Related Programs in the Children’s Health Act: The Children’s Health Act passed by Congress in September as H.R. 4365 extends authorization for the Section 317, childhood immunizations program through 2005. It also amends the vaccine compensation program to include claims by on behalf of individuals who "suffered such illness, disability, injury or condition from the vaccine which resulted in inpatient hospitalization and surgical intervention." At the time of the writing of this report President Clinton is expected to sign this legislation into law.

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.

The pediatric academic societies joined with several other immunization advocates to sponsor a congressional briefing in September on the eight state case studies developed for the IOM report. The states that were discussed included: Maine, Michigan, North Carolina, Texas, Alabama, Washington, New Jersey and the counties of Los Angeles and San Diego, California.

On June 29, 2000, the Senate approved an amendment 51-47 (largely along party lines) to include a watered-down Patient’s Bill of Rights provision introduced by Sen. Don Nickles (R-OK) to the Labor/HHS Appropriations bill. The Amendment provides for a mix of protections from the Senate Republican legislation and additional provisions discussed in conference negotiations with the House. The liability provision in the Nickles amendment allows patients to sue their health plans in federal court, but only if they exhaust the plan’s independent appeals process and the plan still fails to abide by the independent reviewer’s decision. The provision would exempt employers from liability, bar class actions, and set as of yet unspecified limits on punitive and noneconomic damages. The Nickles amendment uses the same scope language as in the original Senate-passed bill, covering only those in self-insured plans governed by the Employee Retirement Income Security Act (ERISA).

Note: The Nickles language was dropped from the Labor/HHS appropriations bill in Conference. However, at this time the conference report has not been filed. As such, the Nickles amendment could be included in end-of-the year legislation, including the expected omnibus appropriations package. The PPC supports the original House-passed, bipartisan, Norwood-Dingell bill.

The 2000 elections are crucial to America’s children. The American Academy of Pediatrics has been active since last December in trying to elevate children’s health issues during this cycle and encourages the entire pediatric community to join in these nonpartisan efforts in the final weeks before the crucial November 7 election.

The presidential race is of the utmost importance and will draw most of the media attention, but the "down the ticket" races are crucial as well. There are slim majorities in both the US Senate and the US House of Representatives. Thirty-three seats in the US Senate and all 435 seats in the US House of Representatives are up for election this year. Slight swings either way could change the majority party in both chambers. On the state level, 11 states will hold gubernatorial races, 13 states will hold Supreme Court races, and 44 states will hold legislative elections. In 13 of these states, a one-seat switch could change the partisan control of the legislative chamber.

Get active - Above and beyond AAP national and chapter activity, individual pediatricians can play an active role in the elections as well. The Academy has materials available to guide and aid you in your efforts. It could be as simple as wearing an AAP vote button in your office, clinic or hospital to remind parents and others to vote with children’s needs in mind. Or you may attend a town forum to ask the candidates a child health related question. The AAP has the information and materials you need. Contact Marjorie Tharp, public affairs manager, Dept. of Federal Affairs, 800/336-5475, ext. 3003 or mtharp@aap.org 

Get informed - Interested in knowing where the presidential candidates stand on children’s issues before you cast your vote? Go to www.childrenshospitals.net (click on Campaign 2000). In partnership with the AAP and the Coalition for America’s Children, we surveyed the presidential candidates as well as some US congressional candidates (Missouri, Illinois, Texas, Pennsylvania, Washington and Virginia). Their unedited responses to 10 questions on children’s issues---ranging from health care and violence to pediatric research and public health, can be found at the web address above. Please spread the word!

• The Public Policy Plenary session sponsored by the PPC and the Ambulatory Pediatric Association on Sunday, April 29, 2001, at 2:00 p.m. will be an exciting two-hour panel presentation - "Entrepreneurism and Conflicts of Interest in Academic Medicine." This session will examine entrepreneurism, intellectual property and conflicts of interest in academia, particularly with relevance to pediatric education, research and the availability of appropriate tests and therapeutics. Presenters include: Marcia Angell, MD, Emeritus Editor New England Journal of Medicine, Robert P. Kelch, MD, Dean, College of Medicine, University of Iowa Hospital and Clinic, Stephen Spielberg, MD a pediatric pharmacologist, Johnson & Johnson and George Koski, PhD, MD, Director, Office for Human Research Protections, U.S. Department of Health and Human Services, Office of Public Health and Science (invited). Ora Pescovitz, MD, SPR President will moderate this session.

• The Public Policy Forum’s 15^th annual legislative breakfast will feature, AAP vice president Louis Cooper, MD who will discuss a variety of current and controversial immunization issues. This breakfast session is tentatively scheduled for Monday, April, 30, 2001 at 7:00 a.m.

October 2000

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