January 25, 2024

What Matters Now in Washington:

  • House and Senate congressional leaders have secured a topline spending agreement for the 2024 fiscal year, paving the way for appropriators in both chambers to begin hashing out differences over a dozen annual spending bills. More…
  • A consensus has emerged on a tax package that would pair corporate tax provisions with a three-year expansion of the Child Tax Credit (CTC). More…
  • Ohio Governor Mike DeWine rejected a bill that sought to effectively ban gender-affirming care in the state, but the state legislature recently overrode his veto. More…
  • Registration for the AAP’s Advocacy Conference has officially opened. More…
  • PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…
  • Find new funding opportunities, research findings, and more below. More…
  • See what other developments we’re tracking with implications for child health advocacy. More…

BIPARTISAN DEAL SIGNALS Renewed Hope for Spending Agreement BUT CHALLENGES REMAIN IN FINALIZING FY24 SPENDING BILLS. President Biden signed a short-term government funding patch Friday, buying extra time for the House and Senate to come to agreement on final spending bills after congressional leaders struck a bipartisan deal on topline discretionary spending earlier this month. Under the latest continuing resolution, federal agencies will continue operating at current spending levels through early March, with funding set to expire on March 1 for some agencies and March 8 for remaining parts of the Executive Branch like the Department of Health and Human Services.

Under the bipartisan agreement reached by House Speaker Mike Johnson (R-La) and Senate Majority Leader Chuck Schumer (D-NY), topline spending levels in FY 2024 are to be set at $1.7 trillion, with defense spending set at $886.3 billion and nondefense spending set at $772.7 billion. Leaders have stated that the deal adheres to the total level of spending laid out in last year’s debt ceiling package negotiated by President Biden and former House Speaker Kevin McCarthy.

Speaker Johnson was able to secure $16 billion in additional spending cuts beyond the terms of the debt ceiling agreement, which includes about $6.1 billion in further clawbacks of pandemic aid. Aides to Schumer have stated that these clawbacks would primarily come from unused funding recently recovered by the Department of Health and Human Services; development of new vaccines and treatments would not be affected by the cuts. Additionally, Schumer rejected Republican proposals to cut unspent housing aid provided from the 2021 American Rescue Plan and climate-related provisions in the Inflation Reduction Act.

—Challenges Remain in Finalizing FY24 Spending Bills. Despite reaching agreement on a topline spending amount, the House and Senate must still finalize all 12 appropriations bills for federal agencies for the 2024 Fiscal Year (FY) that runs through September 30, 2024, and several hurdles must still be resolved before these bills can be signed into law.

House and Senate appropriators remain far apart in their proposed funding levels for FY24 after the House advanced bills with dramatic cuts to federal discretionary spending while the Senate took a bipartisan approach that includes moderate spending increases. The work of hashing out specific funding levels for individual agencies and programs will be time consuming work for the House and Senate Appropriations Committees, and those negotiations cannot begin until congressional leaders carve up the $1.7 trillion topline spending figure into allocations for each of the 12 appropriations bills. Further complicating the negotiations, House Republicans are expected to fight to attach various policy riders to the House spending bills, such as those prohibiting the use of federal funds for abortion services, gender-affirming care, as well as Diversity, Equity, and Inclusion (DEI) initiatives. However, any such provisions would be dead on arrival in the Senate, as Schumer and House Minority Leader Hakeem Jeffries (D-NY) have released a joint statement affirming that they “will not support including poison pill policy changes in any of the twelve appropriations bills put before Congress.” How the demands of rank-and-file Republicans are reconciled with the position of congressional Democrats remains to be seen.

In the background of these FY24 spending bill efforts are the politically explosive negotiations to provide supplemental foreign aid to Ukraine, Israel, and Taiwan, which the Biden administration views as critical to bolstering democracy abroad. While support for overseas allies retains bipartisan support in Congress, the popularity of cash infusions for Ukraine in particular is waning among fiscal conservatives averse to continuing to send US tax dollars to the war effort. For months, Republicans have conditioned additional aid on significant policy changes to address the influx of migrants at the southern border, entangling the negotiations with what has long been an intractable political issue. Bipartisan negotiations over a potential package of foreign aid and border policy are ongoing in the Senate, and there are signs that Democrats are open to changes on issues that would previously have been a nonstarter. However these negotiations unfold, they may impact ongoing domestic spending legislation, particularly if additional spending on foreign aid reduces the appetite among House Republicans to include any spending increases in FY24.     

—Congressional Action Needed to Increase Funding for WIC. Congress will also need to act to provide additional funding for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, a vital support that provides nutritious foods, nutrition education, breastfeeding support, and referrals to health care and social services for millions of low-income women, their infants, and young children who are determined to be nutritionally at-risk. With WIC facing a funding shortfall of roughly $1 billion, nearly 2 million young children and pregnant and postpartum adults nationwide could be turned away by September without additional funding. 

Hope for expanded CTC emerges in a Bipartisan Tax Package. The House Ways and Means Committee overwhelmingly advanced a bill to extend corporate tax breaks and expand the Child Tax Credit (CTC) after senior congressional leaders secured a bipartisan $78 million tax agreement in recent weeks against the odds. The 40-3 vote breathes new life into the unexpected revival of a longstanding Biden administration priority.

Senator Ron Wyden (D-OR) and Representative Jason Smith (R-MO), chairs of the Senate Finance and House Ways and Means Committees respectively, have been negotiating a tax package that would address some Trump-era business tax provisions and expand the CTC. While work on this package has been ongoing behind the scenes for some time now, it still risks being crowded out by the funding issues challenging Congress’ bandwidth.

The Child Tax Credit (CTC) expansion provisions include:

  • A phased-in increase of the refundability cap to $1,800 in 2023, $1,900 in 2024, and $2,000 in 2025
  • Eliminating the penalty for larger families, allowing for low-income families with multiple children to receive more of the refundable credit
  • Adjusting the credit for inflation starting in 2024
  • A “lookback” provision that would allow families to use a prior year’s income to calculate their benefits in 2024 and 2025

If enacted, up to 16 million children in low-income families would benefit in the first year. The proposal could lift 400,000 children above the poverty line and reach children who have previously been excluded from the CTC. The deal would not, however, restore the monthly child cash payments that were a part of the American Rescue Plan. The Center on Budget and Policy Priorities (CBPP) reported that the package will be offset by ending new claims for the Employee Retention Credit, a credit enacted as a pandemic relief measure for certain businesses that has been faced with concerns about fraud and abuse. According to lawmakers, these changes are expected to save more than  and would have little or no impact on budget deficits.

While the components of the tax package may have been largely agreed upon, they need to be attached to must-pass legislation to receive timely consideration. Speaker Johnson has expressed support for the tax package but hasn’t committed to adding legislation to appropriations bills that are likely to be fragile given the complexity of the negotiation process thus far. Wyden said he wants to complete it by January 29 before tax filing season for 2023 begins. However, Congress would face an extremely tight deadline for doing so before then, and waiting until March for longer-term budget legislation may not be feasible given the need for the federal government to implement changes for the current tax filing season.

Ohio Governor Vetoes Ban on Gender-Affirming Care. On December 29, 2023, Ohio’s Republican governor Mike DeWine vetoed a bill that would have banned transgender children and teens from receiving gender-affirming health care, as well as restricting their participating on school sports teams. Governor DeWine said his veto of HB 68, “the SAFE Act,” was about “protecting human life” and that the decision about whether a minor should have access to gender-affirming care ought to be made by the child’s parents and doctors, not the government. “These are parents who have watched their children suffer for years and have real concerns their children would not survive without it,” DeWine said at a press conference following his veto. “Families are basing their decisions on the best medical advice they can get.”

The Ohio legislature officially overrode Governor DeWine’s veto on January 24, after both chambers surpassed the three-fifths majority vote needed to do so. HB 68 is expected to take effect in roughly 90 days.

Over 290 people signed up to speak in opposition to the bill during a December hearing, including several pediatricians. Dr. Christopher Bolling, a retired pediatrician and member of the Ohio American Academy of Pediatrics chapter, said that the bill would target a very small number of adolescents. Of the thousands of families that he saw before retiring, Dr. Bolling said he only worked with 20 to 30 that had persistent gender dysphoria. He referred most of them to Cincinnati Children’s Hospital, where he said they reported having positive experiences.

Despite the veto, Governor DeWine still signed an executive order one week later banning transition-related surgeries on minors. This executive order does not ban other forms of care, such as hormone therapies, that would’ve been banned under the bill. In addition, he directed the state Department of Health and Department of Mental Health and Addiction Services to develop rules that would take action against what he calls “fly-by-night” clinics that, in his view, could seek to influence patients’ decisions prior to seeking treatment.

REGISTRATION FOR AAP ADVOCACY CONFERENCE OPENS. Join us for the 2024 AAP Advocacy Conference! The conference will take place in Washington, DC, April 14 – 16, 2024. The conference brings together pediatricians, pediatric subspecialists and pediatric trainees who share a passion for child health advocacy.

During the conference, participants will hear from distinguished guest speakers, attend advocacy skills-building workshops and learn about timely policy issues impacting children, families, and pediatricians. On the final day, participants from each 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.

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:

Key Research Updates from NIH

WHAT WE’re Reading