Pediatric Policy Council Update
The APS and SPR are members of the Pediatric Policy Council (PPC) which actively advocates for children and academic pediatrics at the federal level. APS representatives to the PPC are Drs. DeWayne Pursley and Jonathan M. Davis; Drs. Joyce Javier and Shetal Shah represent the SPR.
The PPC also includes representatives from the Academic Pediatric Association (APA) and the Association of Medical School Pediatric Department Chairs (AMSPDC). The PPC is based in the Washington DC office of the American Academy of Pediatrics (AAP), who supplies staff and other support.
The latest advocacy developments are summarized by the PPC below
PPC CAPITOL CONNECTION
December 2, 2021
What Matters Now in Washington:
- Congress approved a $1 trillion bipartisan infrastructure package, but the fate of President Biden’s proposed social spending package remains uncertain. More…
- Under a proposal released by the Senate appropriations committee, pediatric research priorities would see major funding increases. More…
- Younger children have started getting vaccinated for COVID-19 following the Pfizer-BioNTech vaccine’s authorization for children ages 5 to 11. More…
- President Biden announced Robert Califf as his nominee for Food and Drug Administration commissioner. More…
- Find new funding opportunities, research findings, and more below. More…
- PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…
ONE STEP FORWARD AND TWO STEPS BACK AS CONGRESS PASSES BIPARTISAN INFRASTRUCTURE BILL, PAUSES ON SOCIAL SPENDING PACKAGE. With the passage of the bipartisan Infrastructure Investment and Jobs Act—commonly referred to as BIF—the House handed President Biden the most significant accomplishment of his presidency, bringing him one step closer to enacting his ambitious domestic agenda. The bill, which passed the Senate in August, provides over $1 trillion in funding for public works projects. This includes money to prevent lead exposure in drinking water by replacing outdated lead service lines, build additional electric vehicle charging infrastructure, and expand broadband networks. After months of squabbling, the Democrats’ poor showing in November’s off-year elections in Virginia and New Jersey finally created the urgency to pass the bill.
In another major development, the House passed the Build Back Better Act (BBB) on November 19 by narrow margins. The BBB encompasses the Biden administration’s social safety net and climate change priorities that Democrats are passing through the budget reconciliation process, which allows them to advance the bill on a party-line vote.
Despite this progress, the road ahead remains perilous as Democratic leaders in Congress work to strike a deal on a final BBB that can satisfy moderates and progressives in both the House and Senate. This effort will require near lockstep unity among congressional Democrats. On the other side of the Capitol, internal dynamics within the Senate Democratic caucus have been challenging. Senators Kyrsten Sinema (D-Ariz.) and Joe Manchin (D-W.Va.), moderate holdouts who are key to passing the social spending package in the evenly divided chamber, continue to present roadblocks. In recent weeks, the two seemed serious about striking a deal, as Sen. Manchin agreed to $500 billion in spending to address climate change. For her part, Sen. Sinema proposed tax increases she found palatable and struck a deal giving Medicare the authority to negotiate prices for certain prescription drugs. However, their tone has changed in recent days, with Sen. Manchin in particular calling for a pause in the process based on concerns over increasing inflation. Whether these concerns are a temporary blip in the drawn-out negotiating process or more fatal to the effort remains to be seen.
All the while, key child health priorities hang in the balance. Under consideration are policies like a permanent extension of the Children’s Health Insurance Program (CHIP), mandatory 12-month continuous eligibility for children in Medicaid, Medicaid coverage for post-partum individuals, a monthly child allowance, and expanded child nutrition support. Bold investments to counter climate change also have dramatic implications for child health. And funding for child care, universal pre-K, and 4 weeks of paid family and medical leave all have a shot at being included—with the first two looking particularly likely. Some of these policies, like a permanent CHIP extension and extending Medicaid coverage to post-partum individuals, are less controversial, increasing the likelihood that they’ll make it into a final package. Others, like paid family and medical leave, have been more fraught during negotiations, and their fate remains anything but certain. In the meantime, advocates for child health are left waiting for Democratic negotiators to show their cards.
SENATE APPROPRIATIONS BILLS CONTAIN MAJOR WINS FOR PEDIATRIC RESEARCH BUT FINAL DEAL REMAINS ELUSIVE. Senate appropriators released draft spending bills for Fiscal Year (FY) 2022 late last month, a small step forward after Congress failed to pass full-year spending legislation before the start of the fiscal year on October 1. In a major victory, the proposal would provide $30 million in initial funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP), $5 million more than the amount included in the House’s bill. Inclusion of this funding by both the House and Senate increases the likelihood that funding for the program will make it into a final spending package.
In another key victory, the Senate bill has proposed doubling funding for gun violence prevention research at the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to $50 million in total. The legislation would also boost overall funding for the NIH by $2.6 billion over current funding to $45.5 billion in total, $900 million less than the funding increase proposed by the House. This includes $1.678 billion for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), similar to the amount proposed by the House. The Children’s Hospitals Graduate Medical Education (CHGME) program, which funds training for half of the nation’s pediatric physicians, would receive a $25 million increase to $375 million in total funding. Also of note are a $10 million funding increase for the Pediatric Mental Health Care Access Program and a $5.8 million increase for the Emergency Medical Services for Children Program.
Hurdles remain to realizing these proposed funding increases for the remainder of FY 2022 by passing final spending legislation. Most significantly, congressional leaders have yet to strike a bipartisan deal on top-line spending numbers that will determine the total pot of money allocated to each agency. Without these numbers, congressional appropriators cannot begin to reconcile the differences between the House and Senate proposals and develop final legislation. Displeasure among Republicans over Democrats’ plans to enact trillions in new spending on a party-line vote, a tense political environment on Capitol Hill, and a chaotic year-end schedule during which Congress will need to raise the nation’s borrowing limit present numerous difficulties. All of this has Republicans suggesting a full-year continuing resolution that would freeze government funding at current levels. Others remain hopeful that the desire for members of Congress to secure increases for their key funding priorities will force Congress to cut a deal.
CDC RECOMMENDS COVID-19 VACCINE FOR 5 TO 11 YEAR OLDS, A MAJOR CHILD HEALTH LANDMARK. Earlier this month, the CDC recommended the Pfizer-BioNTech COVID-19 vaccine for use in children ages 5 to 11 following its recent authorization in this age group by the Food and Drug Administration (FDA). The move, touted by pediatricians, marks a major child health milestone in the pandemic, allowing younger children to begin getting vaccinated against the coronavirus. Many families began vaccinating their newly eligible children almost immediately, and White House data indicate nearly 1 million children ages 5 to 11 were vaccinated in a little over a week. However, work remains to reach millions of eligible but unvaccinated children, and polling from the Kaiser Family Foundation suggests some parents do not intend to have their children vaccinated against COVID-19. Efforts to educate families about the safety and efficacy of the COVID-19 vaccine will be crucial, and the continued need for a vaccine authorized for use in children under 5 is an ongoing imperative.
BIDEN NOMINATES ROBERT CALIFF FOR FDA COMMISSIONER. The Biden administration announced it has selected Robert Califf, MD, as its nominee for commissioner of the U.S. Food and Drug Administration, a role that has been filled by an acting commissioner since the beginning of Biden’s presidency. Dr. Califf, who served as FDA commissioner at the end of the Obama administration, would join the agency at a time of enormous public attention over its role shepherding new vaccines and therapeutics through the regulatory process during the COVID-19 pandemic. He will also take the helm at a critical moment for tobacco product regulation, as the agency takes steps to regulate flavored e-cigarettes and considers a ban on menthol flavoring in traditional cigarettes. The Senate must now evaluate Dr. Califf’s nomination and must ultimately vote to confirm him by a simple majority before he can move into the role.
KEY RESEARCH UPDATES
- The Centers for Disease Control and Prevention (CDC) is currently accepting applications for grants to support new investigators in conducting research related to preventing interpersonal violence impacting children and youth. The deadline is January 5, 2022.
- The CDC is currently accepting applications for research grants to prevent firearm-related violence and injuries. The deadline is February 4, 2022.
- NICHD Deputy Director Alison Cernich, PhD, writes in Pediatrics about the importance of building the evidence base for safe return to school, particularly for underserved communities.
PPC POLICY COMMENTARIES. Members of the PPC have authored commentaries detailing the policy implications of research published in Pediatric Research. You can read these PPC-authored commentaries online:
- Advocating for donor milk access in Medicaid: bringing equity to the neonatal intensive care unit by Shetal Shah, MD, and Emily Miller, MD