July 25, 2023 

What Matters Now in Washington:

  • The House proposed dramatic cuts to health care spending, but those reductions are unlikely to ever make it into law. More…
  • The Pediatric Subspecialty Loan Repayment Program is accepting applications for its initial round of funding through July 25, and the PPC is working to ensure that program implementation best supports pediatric subspecialists. More…
  • The Children’s Hospitals Graduate Medical Education Program is up for reauthorization, but gender-affirming care provided by recipient institutions has become a major flashpoint in these efforts. More…
  • President Biden nominated Dr Monica Bertagnolli to head the National Institutes of Health, but the Senate has yet to act on her nomination. 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…

Long Road Ahead As Congress Navigates Difficult Fiscal Environment to Prepare Federal Spending Bills. Advocates for child health and pediatric research are facing a markedly different political environment as Congress gears up to pass federal spending legislation for the fast-approaching 2024 fiscal year (FY), driven by an empowered conservative wing among the House Republican majority and a recent debt ceiling agreement. After several years of generous spending increases for many federal programs, Washington has entered a decidedly more conservative era for federal expenditures. While the most extreme proposals on the table are ultimately not likely to be signed into law, the voice of academic pediatricians will be all the more important for protecting programs of critical importance to pediatric research and child well-being.

The challenging spending environment can be traced back to January, when House Speaker Kevin McCarthy (R-Calif.) was struggling to unite the Republican conference around his Speaker candidacy. After 15 rounds of votes, McCarthy finally secured the House’s top position after striking an agreement with holdout conservatives that he would pursue drastic spending cuts. Later in the spring as the nation approached its borrowing limit—an outcome with potentially catastrophic consequences—the Biden administration agreed to a deal that raised the debt ceiling in exchange for discretionary spending caps in FY 2024 and 2025. Under the deal, domestic spending is to remain flat in 2024 and increase by 1 percent in 2025.

—House Republicans Propose Major Cuts to Federal Spending. The sharp break from prior years is nowhere more evident than in the House Appropriations Committee. Earlier this month, the Republican-led subcommittee advanced FY 2024 health care spending legislation with more than $60 billion in cuts over current funding levels, dramatically higher than those agreed to in the debt ceiling deal. The legislation proposes a $2.8 billion cut for the National Institutes of Health (NIH) compared to the current program level funding, or $44.6 billion overall. While the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) would be level funded in the coming year, other institutes would see major cuts, including the National Institute of Allergy and Infectious Diseases with a cut of $1.5 billion and the National Institute of Mental Health with a $139 million cut. Roughly 80 percent of NIH’s child health research portfolio is funded by institutes other than NICHD, making these cuts elsewhere at NIH harmful to pediatric research. The NIH’s Advanced Research Projects Agency for Health (ARPA-H), a Biden administration priority that was just established by Congress in the last year, would receive a $1 billion reduction to a program funding level of $500 million.

House Republicans have also proposed eliminating a number of programs of vital importance to academic pediatricians. This includes the Agency for Healthcare Research and Quality (AHRQ), funding for gun violence prevention research at the NIH and the Centers for Disease Control and Prevention (CDC), and workforce development programs. More broadly, the bill would do away with major longstanding programs like the Title X Family Planning Program, the Teen Pregnancy Prevention Program, and tobacco control activities at the CDC. The bill also adopted a number of concerning policy riders, or amendments to funding bills intended to restrict how the federal government may spend monies appropriated by Congress, including a prohibition on gender-affirming care, a prohibition on fetal tissue research, and policies targeting critical race theory and other diversity, equity, and inclusion initiatives.

—Compromise Will Be Needed to Get Final Spending Legislation Across the Finish Line. These cuts, if they were ever to become law, would be devastating, but the proposal is best understood in the context of the congressional appropriations process. The House bill is simply an opening bid in the lengthy process by which Congress develops spending legislation every year. The House Appropriations Committee can advance these bills by a party-line vote, but they will need enough support to pass on the House floor. Moderate House Republicans from swing districts are likely to be skittish about supporting cuts that would be highly unpopular with their constituents and will never ultimately become law; with a slim 5-seat majority, House Speaker Kevin McCarthy (R-Calif.) may have trouble convincing enough of his members to vote in favor of the bill.

More critically, any spending legislation needs bipartisan support in the Senate to clear the chamber’s 60-vote threshold, meaning Senate appropriators are likely to advance consensus legislation that can garner support from both sides of the aisle. At the very least, the Senate’s bills will adhere to the flat funding agreed to in the debt ceiling deal, and a recent deal by the top Democrat and Republican on the Senate Appropriations Committee has proposed adding an additional $14 billion to the FY 2024 spending bill through emergency spending not subject to the budget caps. Any final spending deal will need to balance the House’s desire to cut spending with the recognition among other members of Congress that significant cuts to a wide variety of programs would be deeply harmful to the work of the federal government.

Pediatric Subspecialty Loan Repayment Program Launches Thanks to PPC Advocacy. After over a decade of advocacy from the American Academy of Pediatrics, applications are now open for the first awards from the Pediatric Subspecialty Loan Repayment Program (PSLRP). Pediatric medical subspecialists and pediatric surgical specialists are eligible to apply for $100,000 in loan repayment. The deadline to apply is July 25.

Awardees must commit to serving an underserved area for three years. The program is available for both fellowship trainees and those who have completed fellowship. The Health Resources and Services Administration (HRSA) will fund 150 awardees this year. Visit HRSA’s website to learn more, including details about upcoming live Q&A sessions.

The PPC is monitoring the implementation of PSLRP closely and is aware of challenges that are making it difficult for pediatric subspecialists to qualify for the program. Specifically, HRSA’s requirement that PSLRP recipients provide 36 hours of direct patient care per week is a significant barrier that will make it very difficult for most pediatric subspecialty fellows and practicing subspecialists to qualify. This HRSA-imposed requirement is not required by the law for which the PPC long advocated and is incompatible with the nature of pediatric subspecialty training and practice at large academic medical centers. The PPC will be advocating to ensure that this and other implementation issues are addressed so that as many pediatric subspecialists as possible can qualify.

The launch of PSLRP was made possible by the advocacy of pediatric subspecialists and academicians, which resulted in Congress providing funding for the program in the two most recent annual spending bills. In FY 2022, the AAP secured $5 million for PSLRP and subsequently secured an additional $10 million in the FY 2023 spending bill. Together, this funding gave HRSA $15 million, which allowed it to fund more slots than initially anticipated with the original $5 million investment. The AAP is calling on Congress to increase funding for PSLRP in FY 2024. While the pr and will be in touch with additional opportunities for advocacy as they arise.

CHGME Reauthorization in Question After Partisan Divergence on Gender-Affirming Care. The Children’s Hospitals Graduate Medical Education (CHGME) program is due to be reauthorized this year, but the path forward for extending the program is unclear after the effort to renew it became ensnared in political controversy about gender-affirming care (GAC) provided by CHGME-recipient institutions. Typically reauthorized by Congress every five years with broad bipartisan support, the current House Republican majority is pursuing legislation that would restrict CHGME programs from providing GAC to transgender and gender-diverse youth, while Democrats push for the program to be extended with no policy changes. A Republican-only reauthorization bill led by Rep. Dan Crenshaw (R-Texas) with a GAC prohibition advanced out of the House Energy and Commerce Committee last week. Pediatrician Rep. Kim Schrier (D-Wash.) is championing a clean reauthorization of the program that would make no changes to CHGME. The divergence is deeply concerning, given the program’s longstanding history of bipartisan cooperation and support.

The disagreement may ultimately prevent Congress from reauthorizing the program before it expires in September. However, a lapsed authorization does not mean funds will necessarily stop flowing to children’s hospitals, since programs like CHGME do not need to have a current authorization for Congress to continue being funded through the annual appropriations process. Ultimately, the fate of CHGME funding in FY 2024, which is currently funded at $385 million in FY 2023, will come down to how Congress resolves broader discussions around federal spending levels.

Biden’s NIH Nominee Stalled in Senate. A year and a half after Francis Collins, MD, PhD, stepped down as director of the NIH, the Biden administration has yet to successfully install a new head for the nation’s largest biomedical research funder. In May, President Biden nominated Dr Monica Bertagnolli to head the NIH, a position requiring confirmation by the Senate. Dr Bertagnolli is a world-renowned oncologist and former head of the National Cancer Institute, and her nomination was praised widely by members of the biomedical research community, including former NIH directors. However, Senate consideration of her nomination is being held up over disagreements between Sen. Bernie Sanders (D-Vt.), the chair of the Senate Health, Education, Labor & Pensions Committee responsible for vetting her, and the White House about drug pricing efforts. Sen. Sanders is pushing for aggressive unilateral action from the Biden administration to lower the cost of prescription drugs and is refusing to consider any of Biden’s health nominees until he is satisfied that they are doing so. Until the impasse is resolved, the NIH will remain without a director.

What We’re Reading

Key Research Updates FROM NIH

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: