January 25, 2023 

What Matters Now in Washington:

  • Republican Rep. Kevin McCarthy was elected speaker of the House earlier this month after a protracted struggle with conservatives. More…
  • Congress passed a spending bill for Fiscal Year (FY) 2023 that included a number of child health priorities before leaving town for the holidays. More…
  • Registration for the AAP’s Advocacy Conference has officially opened. More…
  • See what other developments we’re tracking with implications for child health advocacy. 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…

McCarthy Strikes Tenuous Accord to Land the Speaker’s Gavel As 118th Congress Kicks Off. The new Congress was off to a rocky start after a narrow margin left House Republicans scrambling to strike a deal to secure Rep. Kevin McCarthy (R-Calif.) the votes to win the Speaker election on the floor of the House. While McCarthy was ultimately elected Speaker, the saga delayed the start of the new Congress and raised serious questions about the California Republican’s ability to govern over the next two years.

When the House of Representatives first convened last Tuesday to swear in members of Congress, McCarthy, selected late last year by the Republican conference to run for House Speaker, had failed to reach an accord with far-right members of his party whose votes he needed to become Speaker. While the majority of House Republicans have consistently supported McCarthy, a small faction of roughly 20 members was distrustful of McCarthy’s conservative bona fides, seeking concessions in the rules that govern House proceedings to empower conservatives and limit government spending in exchange for their votes. With all 212 House Democrats voting for Democratic Minority Leader Hakeem Jeffries (D-N.Y.) for Speaker, McCarthy had just four Republican votes to spare, forcing him to walk a tightrope between the conservative and moderate members of his conference. The disagreement turned the Speaker election, a typically sedate proceeding to rubber stamp the majority party’s Speaker nominee, into a dayslong political drama not seen in a century.

It took 15 ballots and 4 days of House convenings, but McCarthy ultimately did lock down the votes he needed to win early Saturday morning. Among the concessions made by McCarthy to conservatives to win are a number of rules that will shift the balance of power away from the Speaker and towards conservatives, with dramatic implications for the functioning of the House over the coming two years. Under the agreement, any member of Congress will be able to call a vote to remove the sitting Speaker, a tool used in 2015 to pressure former Speaker John Boehner (R-Ohio) to resign. The conservative House Freedom Caucus will also be given seats on the House Rules Committee, the powerful committee that determines which legislation gets a vote on the House floor and what types of amendments can be offered during that process; historically, the Speaker has selected members for the Rules Committee who will help them accomplish their goals, so the inclusion of conservative members on this committee who may be at odds with McCarthy’s agenda has the potential to hamstring him in efforts to advance his priorities. Among other major changes, McCarthy has committed to limiting discretionary spending at Fiscal Year (FY) 2022 spending levels—in other words, a cut as compared to the funding increases just provided in December by the FY 2023 omnibus spending package.

The dynamics in the House are likely to make this Congress far less productive than the last one, with an empowered conservative Republican wing and far fewer areas of bipartisan consensus that would otherwise allow for legislation to advance. The agreement to cap discretionary spending will also create an extremely challenging budget environment for pediatric research advocates. While the House of Representatives does not have unilateral control over federal appropriations, Senate Democrats and the White House may be forced to make major compromises during budget negotiations or risk a government shutdown. This environment also creates the risk of year-long continuing resolutions that freeze government funding at current levels, amounting to cuts once inflation is taken into account.

Analysts are also predicting a showdown over the debt ceiling, which has officially been reached and will need to be raised this year. While the Treasury Department is using extraordinary measures to stave off a credit default for the time being, that will only buy the government months before congressional action is absolutely necessary. As congressional leaders and the White House work to reach a deal, Republicans in Congress are expected to push for major budget concessions in mandatory and discretionary spending in exchange for a debt ceiling increase, and it is unclear how Democrats will respond. Failure to raise the debt ceiling could have catastrophic consequences for the ability of the U.S. government to borrow money.

McCarthy’s shaky grip on power and a newly emboldened House conservative bloc are almost certain to lead to additional trouble in terms of Congress’s ability to govern this year, making it essential that child health advocates prepare to defend programs essential to helping children and families thrive.

Congress Finishes FY23 Spending Bills in Final Days of 2022. Before leaving Washington for the holidays, Congress passed a sweeping $1.7 trillion federal government funding package, and President Biden signed it into law. The deal funds the federal government for fiscal year 2023 and includes several key child health funding and policy priorities.

Notably, Congress doubled funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP) in FY 2023 to $10 million total. The funding increase comes on top of the $5 million awarded to the Health Resources and Services Administration (HRSA) in FY 2022 and infuses additional resources in the program as the agency continues work to implement the program.

Biomedical research funding also saw a boost in the omnibus spending package. The top-line funding level for the National Institutes of Health (NIH) got a $2.5 billion funding increase for a total of $47.5 billion. The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) received $1.749 billion, a $66 million increase over current funding. The Advanced Research Projects Agency for Health (ARPA-H) has received a half billion dollar increase this year, bringing its total funding to $1.5 billion, while the Agency for Healthcare Research and Quality (AHRQ) saw an increase of $23.5 million to $373.5 million.

While gun violence prevention research saw continued funding this year, the total funding level stayed flat, despite a request by the Biden administration to more than double its funding. The Centers for Disease Control and Prevention (CDC) and the NIH will each receive $12.5 million to fund investigations into ways to reduce the morbidity and mortality caused by firearms.

The Children’s Hospitals Graduate Medical Education Program (CHGME) received a $10 million funding increase in FY 2023. CHGME funds training for roughly half of pediatric residents and fellows and plays a critical role in strengthening the pipeline of pediatric researchers and clinicians.

The package also included a number of child health policy victories. Under the omnibus spending legislation, all state Medicaid and Children’s Health Insurance Program (CHIP) programs will be required to provide 12-month continuous coverage for child enrollees, a significant step toward keeping children and adolescents enrolled in coverage so they can get the care they need. The state option to expand Medicaid coverage to individuals 12 months postpartum, originally provided to states for 5 years through the American Rescue Plan, is now a permanent option. Finally, CHIP funding was extended by 2 years, from 2027 to 2029.

Congress also extended and expanded the bipartisan Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) for five years. Under the legislation, Congress has doubled MIECHV’s funding, the first funding increase for the program since its inception over a decade ago. These additional resources will help MIEHCV reach additional families with evidence-based home visiting programs.

Among the other policy victories are passage of the PPC-supported Pregnant Workers Fairness Act, which ensures workplace accommodations for pregnant and postpartum employees and the reauthorization of several key child mental health programs.

While important child health priorities, such as new online protections for children, were left on the cutting room floor, the omnibus bill helped move several priorities across the finish line before the tumult of the new Congress.

Registration for AAP Advocacy Conference Opens. Join us for the 2023 AAP Advocacy Conference! For the first time since 2019, the conference will return to Washington, DC, March 26 – 28. Join pediatricians, pediatric subspecialists, and pediatric trainees from across the country and speak up for children in our nation’s capital.

The conference will feature distinguished guest speakers, advocacy skills-building and child health policy issue sessions and opportunities to learn how to be a strong voice for children. On the final day, participants and other attendees from their state will attend meetings with their congressional offices to discuss a timely child health issue.

To learn more and to register for the conference, please visit AAP.org/AdCon.

What We’re Reading

Key Research Updates

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: