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
January 22, 2021
What Matters Now in Washington:
- Democrats will have unified control of Washington following unexpected victories in a pair of Georgia Senate runoff contests, but they face steep challenges unifying the nation and combatting the pandemic following the January 6 riots at the Capitol. More…
- Congress passed a massive pandemic relief and government funding bill in late December, and President Biden has now proposed additional federal legislation to address COVID-19. More…
- President Biden has named pediatricians to several key positions, and Francis Collins will stay on as Director of the National Institutes of Health. More…
- The Census Bureau missed a key deadline for reporting data from the 2020 count, but the delay means that the Biden administration, not the Trump administration, will oversee the finalizing of the numbers. More…
Trump Era Comes to A Close Amid Failed Insurrection, Unified Democratic Control of Washington. In a near-split-screen moment, Georgia voters handed two Democratic Senate candidates unexpected victories over Republican incumbents while violent rioters stormed the United States Capitol just hours later. As has proven to be the case often over the last four years, former President Donald Trump was the common denominator between these two shocking events that are certain to dramatically reshape the political landscape for years to come.
The storming of the Capitol building by a mob of rightwing extremists during the counting of Electoral College ballots stunned a nation already rocked by a year of viral pandemic, outcries over racial injustice, and a divisive presidential election. After the loss of President Trump during the November election, aggrieved supporters of the President used the normally staid process of finalizing the presidential election results as a rallying point, descending on the capital to express their frustrations. In a speech to his supporters shortly before the violence, Trump reiterated falsehoods about the veracity of the election and urged them to march on the Capitol. A growing bipartisan consensus has emerged that the President’s words effectively incited the violence and amounted to a failed coup attempt, though a sizable number of Republicans have continued to back the former President. Following the riots, Washington locked down for the inauguration of newly sworn-in President Joe Biden amid reports of additional domestic terrorism threats.
Meanwhile, the ouster of Republican Senators David Perdue and Kelly Loeffler in the January 5 runoff election in Georgia came after months of baseless allegations of widespread voter fraud from the former President and his allies. The falsehoods appear to have played a critical role in depressing Republican turnout and potentially in driving others out to support Perdue and Loeffler’s opponents. Newly sworn-in Democratic Senators Raphael Warnock and Jon Ossoff both succeeded in boosting turnout among their base to flip a state that had long been reliably red until President Biden bested Donald Trump there in November. Warnock and Ossoff won their races by relatively narrow but clear margins.
—Biden’s Prospects See Boost with Control of Congress, But His Toughest Task Lies in Uniting Divided Nation. President Biden takes office against the backdrop of a charged political landscape that has only become more complicated in recent weeks. The outcome of the November election provided a less than clear electoral mandate for Biden. Despite a resounding win in the popular vote with over 80 million ballots cast in his favor, former President Trump earned 75 million votes, a record number of ballots cast for any American presidential candidate surpassed only by Biden himself. A sizable minority question the integrity of the election outcome. Trump’s continued support from voters, anger among his core base over his loss, and doubts about Biden’s victory, baseless though they may be, will challenge Biden in his task to unify the country.
This major hurdle notwithstanding, it is clear that Democratic control of the Senate will be essential to helping Biden enact major parts of his agenda, from additional pandemic relief to economic recovery, infrastructure, and climate change legislation. Democrats will determine which bills get a vote on the Senate floor, allowing them to set the legislative agenda in Congress. It will also provide a much easier path for confirmation of Biden’s executive branch and judicial nominees, a task that would have been significantly more difficult had Republicans retained control of the Senate.
The Democratic Senate majority has also unlocked the powerful budget reconciliation process, which allows the Senate to bypass the filibuster and pass legislation that has direct implications for government revenue and spending with a simple majority vote. Though Congress is limited to one budget reconciliation per fiscal year and must abide by other legislative limitations, the procedure has been used to enact priority agenda items in the past, including tax cuts under Presidents Bush and Trump. Much of the Affordable Care Act was also passed through budget reconciliation.
—Impeached A Second Time, Trump’s Future in the Republican Party Less Certain Than Ever. Former President Trump made history just one week after the armed insurrection at the Capitol, becoming the first president in U.S. history to be impeached twice during his tenure. The impeachment exposed rifts in the Republican Party that have been growing since the November election. Ten Republican members of the House joined Democrats to support impeachment, and additional House Republicans have condemned his role in the insurrection. Other high-profile Republicans, including several top Trump administration appointees, resigned in protest or registered their disapproval publicly.
At least a handful of Republicans are expected to join Senate Democrats in voting to convict Trump, though whether he is ultimately convicted by the Senate and barred from holding public office again remains to be seen. Senate Republican Leader Mitch McConnell is expected to be pivotal in determining whether Republicans defect from Trump in sufficient numbers to secure the conviction. McConnell has not said definitively which way he will vote, though reporting indicates that he is pleased that Democrats moved to impeach Trump and is said to be furious with the President. In remarks on the Senate floor just a day before Joe Biden’s inauguration, he made clear his belief that the Capitol riots were provoked by the President.
Despite the chorus of anger from many Republicans, a wide base of support for the Trump remains, beginning with the majority of House Republicans who voted against impeachment. Two schools of thought have emerged about Trump’s future role in the party, with some believing that support for Trump forms the base of the Republican Party. Others, however, would like to excise Trump from the party and move past his tumultuous tenure. The ultimate outcome of this internecine battle will have dramatic implications for the party’s future direction, from policy platform to philosophical approach.
Congress Provides Another $900B in Pandemic Relief to End the Year, But Additional Spending Is Expected Under Biden. After months of stalemate, Congress finally struck a bipartisan deal on COVID-19 relief legislation in a massive year-end package. The legislation, which also included annual spending legislation to fund the government through September, passed by wide bipartisan margins in late December. Despite a threatened veto from former President Trump over the bill’s failure to include larger direct payments to Americans, it was ultimately signed into law shortly before the new year.
The legislation injected funding into the health care system, which continues to face financial pressures from responding to the pandemic. Major provisions of note to the academic pediatric community include:
- $3 billion in additional funding for the Provider Relief Fund
- $8.75 billion to the Centers for Disease Control and Prevention for COVID-19 vaccine distribution
- $19.695 billion for the Biomedical Advanced Research and Development Authority (BARDA) for manufacturing and procurement of vaccines and therapeutics
- Vaccine confidence provisions (More below)
- $1.25 billion for the National Institutes of Health (NIH) to support additional COVID-19 research
- This emergency NIH funding in the pandemic relief legislation is on top of the $1.25 billion funding increase the agency received in the annual spending legislation, bringing NIH’s base budget to $42.9 billion
- $22.4 billion for testing and contact tracing
- $3.25 billion for the National Strategic Stockpile
A summary of additional provisions relevant to pediatrics is available online.
Congress also included the PPC-endorsed VACCINES Act, which authorizes a national campaign to increase awareness and knowledge of the safety and effectiveness of vaccines for the prevention and control of diseases, to combat misinformation, and to disseminate scientific and evidence-based vaccine-related information. PPC had previously called on Congress to include this legislation in the next round of pandemic relief legislation. Congress authorized the VACCINES Act programs at $15 million annually for five years.
Economic relief and support for families also comprised a significant portion of the package. The legislation extends unemployment insurance benefits through March 14, 2021 and provides $300 per week in enhanced federal payments to beneficiaries, which are in addition to state financed unemployment benefits. It also includes $600 direct payments to adults and children with annual incomes of $75,000 or less for individuals and $150,000 or less for married couples filing jointly. The bill also increases SNAP monthly benefits by 15% for 6 months.
Finally, Congress provided $54.3 billion for an Elementary and Secondary School Emergency Relief Fund, which schools can use to improve ventilation in classrooms and other facilities repairs and maintenance. The money can also be used to address learning loss among students, including low-income students, children with disabilities, English learners, racial and ethnic minorities, students experiencing homelessness, and children and youth in foster care.
—Biden Proposes Ambitious Pandemic Relief Legislation As First Priority. President Biden promised bold, urgent action to address the COVID-19 pandemic throughout his campaign and called on Congress to act in the first days of his presidency to pass additional pandemic relief legislation.
The $1.9 trillion American Rescue Plan proposes major infusions of cash to bolster the American public health infrastructure and struggling families, while extending policy supports from prior round of coronavirus legislation. The package envisions a $20 billion national vaccination program, $50 billion to scale up testing and reopen schools, and a public health jobs program to fund 100,000 public health workers in community health roles. Biden has also called for investments in COVID-19 treatments, improved disease surveillance, and an explicit focus in the federal response on COVID-19-related health disparities. From an economic perspective, the American Rescue Plan would send most Americans an additional $1,400 direct payment, extend unemployment benefits and paid sick leave through September, and increase the federal supplement for unemployment insurance by $100 per week.
The President has made clear that he would like to pass this legislation on a bipartisan basis, though it is not clear whether Republicans will support such massive spending after spending trillions on the pandemic last year. As such, some Democrats are preparing to use budget reconciliation to pass pandemic relief legislation should Republicans refuse to cooperate.
Kessler, Levine Named to Top Biden Administration Positions While Francis Collins to Remain NIH Director. Pediatrician and former Food and Drug Administration (FDA) Commissioner David Kessler is President Biden’s choice to lead the federal government’s vaccine initiative, known as Operation Warp Speed under the Trump administration. In this role, he will oversee the effort to accelerate the development, manufacture, and distribution of coronavirus vaccines at a time when the initiative’s early successes have been clouded by a shaky vaccine rollout.
Biden also announced Dr. Rachel Levine as his nominee for Assistant Secretary for Health. Dr. Levine is a pediatrician and currently serves as the Pennsylvania health secretary, where she has led the state’s response to the pandemic. She would oversee a portfolio of public health issues that includes infectious disease policy, human research protections, minority health, and population affairs. Dr. Levine would also become the first transgender Senate-confirmed federal official.
Dr. Francis Collins will also continue as Director of the National Institutes of Health during the Biden administration, a role he has held since 2009.
Trump Administration Efforts to Exclude Undocumented Immigrants from Census Data Officially Dead. President Biden signed an executive order on the first day of his presidency to ensure that all inhabitants of a state, regardless of lawful status, are included in the final 2020 Census data. The move came days after the Census Bureau had stopped all work on a presidential directive signed by former President Trump to identify the number of undocumented immigrants in states and congressional districts across the country. Trump had planned to use the data to remove undocumented immigrants from the population counts used to apportion seats in the House of Representatives among states, effectively diluting the power of immigrant-heavy states in Congress. Instead, President Biden will now oversee the finalizing of the 2020 Census data, which is expected to give advocates more certainty after a year in which the decennial count was politicized by the Trump administration. In a sign of the backlash facing the Census Bureau over these issues, the Director of the agency will step down a year before his term expires.