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
November 20, 2020
What Matters Now in Washington:
- The 2020 election will bring a new presidential administration to Washington, but divided government looks likely to remain with two Senate races yet to be decided. More…
- With the balance of power set to shift in Washington, a lame duck Congress returns to slate of year-end priorities. More…
- PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…
President-elect Joe Biden and Vice President-elect Kamala Harris win White House amid split electorate. After a hotly contested election and a protracted vote count, Americans have chosen former Vice President Joe Biden and Senator Kamala Harris as the next President and Vice President of the United States. The election marks the first time that voters have ousted a sitting President since 1992. In Congress, Democrats will retain control of the U.S. House of Representatives with a narrowed majority. On the other side of the Capitol, Republicans have retained 50 of the Senate’s 100 seats, and control of the chamber will ultimately be determined by simultaneous runoff elections in Georgia for the state’s two contested Senate seats. Regardless of the outcome, whichever party wins the Senate majority will face razor thin margins.
With nearly two-thirds of eligible voters casting ballots this year, voter turnout reached levels not seen in a century, a sign of the passion Americans on both sides of the aisle felt about the issues at stake in the election. At nearly 80 million votes, President-Elect Biden won a strong victory in the national popular vote, surpassing President Trump’s total votes by more than 6 million or a roughly 3.5 percentage point margin; additional ballots remain to be counted. Indeed, Biden and Trump each garnered more votes than any presidential nominees in U.S. history.
Despite the sheer number of ballots cast, the outcome of the presidential race came down to contests in a handful of swing states: Pennsylvania, Michigan, Wisconsin, Arizona, Nevada, Georgia, and North Carolina. All of those states have been called for President-Elect Biden with the exception of North Carolina, which President Trump secured with a comfortable margin. Five of those states flipped from the Republican to the Democratic column, including Georgia and Arizona which have not voted for a Democratic presidential nominee in decades. President-Elect Biden will ultimately take the White House with 306 Electoral College votes.
—Voters Send A Message to Elected Officials on Both Sides of the Aisle. The election offered critical lessons for both parties. For Democrats, the sweeping repudiation of Trumpism that many had hoped for never materialized. Pollsters and pundits anticipated a so-called blue wave election in which distaste for President Trump’s divisive rhetoric and mismanagement of the COVID-19 pandemic would drive major gains in the House and Senate, bringing unified Democratic control to Washington for the first time since 2010 and ushering in an era of progressive policymaking. Democratic losses in the House and the failure of Democrats to take an outright majority in the Senate rendered a split verdict that is certain to shape policymaking and will limit the scope of legislative change at the federal level. To many, the result suggests an appetite for moderation and compromise from voters across the country. Down ballot losses in state legislative contests reinforced that conclusion and may once again lock Democrats out of the once-in-a-decade legislative redistricting process in critical swing states that Republicans dominated in the early 2010s.
The Republican Party faces its own reckoning in the aftermath of the election despite a stronger than expected showing in congressional and state-level contests. After President Trump’s shock victory in 2016, the Republican Party appears to finally have found the limits of his divisive approach to governing. His defeat highlights several trends and tactical errors. For instance, the President spent months bashing mail-in voting, urging his supporters to vote in person on Election Day despite efforts by state officials to encourage voters to cast ballots early. As became clear in the days following the election, his campaign to cast doubt on the legitimacy of mail-in voting cost him dearly as those ballots broke overwhelmingly for Joe Biden.
Perhaps most critical to Trump’s loss was the overwhelming turnout from voters of color in support of Joe Biden. Despite underperforming Hillary Clinton among Black and Latinx men, Black and brown voters in urban and suburban centers powered Biden’s victory nationwide, particularly in several key swing states like Arizona and Georgia. Separately, discomfort among moderate Republicans with the President’s crude rhetoric, rejection of expertise, and chaotic leadership style pushed many to pull the lever for Joe Biden. The loss of longtime Republican stronghold Arizona is instructive on this front: some Republican voters rejected Trump, who openly maligned the widely respected late Senator John McCain, and Trump-aligned Republican Senator Martha McSally. Examples abound nationwide of voters who split their tickets in places like Nebraska, where Biden-Bacon voters, so called for their willingness to reelect incumbent Republican Congressman Don Bacon, handed Joe Biden the Omaha area’s one Electoral College vote. Similar trends were seen in Pennsylvania, Minnesota, and elsewhere.
—Pediatricians Prepare for A New Administration. Last week, the AAP released Transition Plan: Advancing Child Health in the Biden-Harris Administration, which outlines specific policy recommendations to support our nation’s children and their futures. The recommendations build on the Academy’s Blueprint for Children, released in October, which focused on how our government leaders can support healthy children, secure families, and strong communities and ensure our role as a leading nation for youth. The plan outlines how the Biden-Harris administration can address the critical issues facing children and adolescents today. The PPC is preparing its own advocacy priorities for the coming year to advance pediatric research and child health in the new administration.
Congress Returns to Negotiate Year-End Package in Lame Duck Session. With the election largely in the rearview mirror, Congress has returned to Washington to close out the 116th Congress, but major outstanding issues remain for the lame duck session. Chief among Congress’s concerns will be funding the federal government for the remainder of the fiscal year, which began on October 1. The federal government is currently operating under a continuing resolution that runs through December 11 after the House and Senate failed to reach a bipartisan agreement on spending levels for Fiscal Year (FY) 2021. House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Mitch McConnell (R-Ky.) have both publicly stated their interest in finishing the FY 2021 appropriations process before the end of the year, and Congress will need to act to avoid a government shutdown.
—Senate Releases FY21 Spending Bills After Months of Delay. The Senate Appropriations Committee released its FY 2021 spending proposal following the election, a significant sign of progress that Congress is moving toward a negotiation. The Department of Health and Human Services spending bill included a number of key pediatric research priorities.
The National Institutes of Health (NIH) would receive another $2 billion increase under the Senate proposal for a total funding level of $43.68 billion; the proposed $2 billion increase is significantly higher than the House proposal to increase funding by $500 million, though it does not include the $5 billion in emergency COVID-19 relief funding—which would be available to the NIH for five years—that the House bill includes. Level funding of $25 million split between the NIH and Centers for Disease Control and Prevention (CDC) for gun violence prevention research is also a part of the Senate’s proposal. Finally, the Senate bill funds the Children’s Hospital Graduate Medical Education (CHGME) program at $355 million, a $15 million increase over current funding. Unfortunately, the Senate proposal does not include initial funding for the Pediatric Subspecialty Loan Repayment Program (PSLRP), a top priority of the PPC.
House and Senate appropriators will have to reach agreement on final funding levels before a bill can be signed into law.
—Promising Signs Emerge That COVID Relief May Be Near But Hurdles Remain. Congress also faces pressure to pass another COVID-19 relief package as the country continues to reel from the pandemic. Progress on a deal has eluded top lawmakers for over six months, and Republicans and Democrats remain hundreds of billions of dollars apart in their proposals.
However, the political landscape has shifted. Majority Leader McConnell voiced his support for a bipartisan COVID bill before the end of the year just one day after the election, a shift from his earlier suggestions that COVID relief could wait until next year. He also signaled his willingness to include aid for state and local governments hit hard by the pandemic in a legislative package, dropping Republican opposition to a key Democratic priority that has been one of several sticking points in recent months. Separately, President-Elect Joe Biden’s transition team has begun engaging congressional Democrats to move COVID relief forward during the lame duck session, another new dynamic in long stagnant negotiations.
It is possible that Congress will attempt to combine year-end spending bills with supplemental COVID relief and other outstanding priorities ahead of the December 11 government funding deadline. For that to happen, though, House Democrats and Senate Republicans will need to compromise on outstanding priorities, including top-level dollar figures and key policy provisions like liability protections for businesses. Until then, Americans will be left waiting for much needed COVID relief.
—Anomalies in Census Data Emerge As December 31 Reporting Deadline Approaches. Census officials have hit a roadblock in their efforts to meet a December 31 deadline for the reporting of key Census data. As a result, routine “processing anomalies” identified during the agency’s data validation and analysis activities now look likely to delay the delivery of Census data until January 26 or later.
This timeline delay is a key development as advocates continue to grapple with efforts by President Trump to exclude undocumented immigrants from the state population counts used to apportion seats in the House of Representatives among the states. Such a move threatens to diminish the representation of states with large immigrant communities, potentially shifting House seats to states with fewer people, but has also been struck down as illegal by multiple federal courts. The Supreme Court is set to consider the legality of excluding undocumented immigrants from the decennial count in the coming weeks. If the data is ultimately not ready until late January or after, it would be finalized by the incoming Biden administration instead, which is certain to dismiss the Trump administration’s efforts.
Beyond these efforts to exclude undocumented immigrants from Census data, other major concerns about the quality of the Census remain. For instance, one recent report interviews several Census takers who logged false data to finish the count on the shortened timeline under pressure from supervisors. Experts are urging transparency in the process to bolster public confidence.
There has been bipartisan interest in Congress to extend the statutory reporting deadlines by four months to sidestep these difficult issues and to ensure that the federal government has sufficient time to product high-quality data. The PPC has endorsed this proposal. If Congress does intend to act on this issue, it will need to do so during the lame duck session.
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:
- Rigorous and consistent evaluation of diagnostic tests in children: another unmet need by Scott Denne, MD, and Christine Caldwell, MD
- Acute-on-chronic stress in the time of COVID-19: assessment considerations for vulnerable youth populations by Mona Patel, MD, and Jean Raphael, MD, MPH