September 14, 2022
What Matters Now in Washington:
- With passage of Inflation Reduction Act, major pieces of Biden’s agenda on climate and health care become law. More…
- While some progress has been made to develop spending bills for Fiscal Year (FY) 2023, a short-term stopgap is likely needed to prevent a government shutdown. More…
- Earlier this summer, Congress passed the most significant bipartisan legislation to combat gun violence in more than 20 years. 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…
- See articles we’re reading. More…
Biden Signs Inflation Reduction Act, Notching Key Victory on Drug Pricing, Climate Change Ahead of Midterms. After months of failed attempts, congressional Democrats finally passed ambitious budget reconciliation legislation making good on long-held campaign promises to take action on climate change and lower prescription drug prices in early August. The party-line vote came after Senate Majority Leader Chuck Schumer (D-N.Y.) reached a surprise deal in late July with Sen. Joe Manchin (D-W.Va.), a key holdout whose support was necessary to pass the legislation, long after many had assumed a package was dead.
The Inflation Reduction Act (IRA), as the legislation is known, consists primarily of three major components to reduce health care costs, combat climate change, and reduce the federal budget deficit. Most prominently, the legislation allows Medicare to negotiate the cost of certain high-cost prescription drugs beginning in 2026, though the federal government would be limited to negotiating the cost of 20 drugs in total by the year 2029. The provision is expected to save the federal government more than $100 billion over a decade. Negotiated prices will not apply to those on private health insurance, despite attempts by Democrats to do so. Furthermore, out-of-pocket prescription drug costs for Medicare enrollees will also be capped at $2,000 per year, and the legislation extends enhanced premium tax credits for health insurance coverage purchased through the Affordable Care Act marketplaces, originally provided by the American Rescue Plan, for three years.
The IRA also includes historic investments in carbon emissions reduction, investing more than $300 billion in efforts to address climate change by decarbonizing the electric grid and transportation. This includes expanded electric vehicle tax credits for lower- and middle-income individuals to switch away from internal combustion engine vehicles and other incentives like an annual $1,200 tax credit to lower energy costs and encourage consumers to make their homes more energy efficient; investments in advanced clean energy manufacturing; and investments in climate justice to help communities that have been disproportionately impacted by climate change. The legislation would also impose a new fee on excess methane emissions in an effort to reduce a potent greenhouse gas. Investments in the IRA are paid for primarily by closing loopholes in the federal tax code, including the imposition of a 15 percent minimum tax on billion-dollar corporations that pay very little in corporate income tax, and boosting Internal Revenue Service (IRS) enforcement to crack down on tax evasion.
President Biden signed the IRA into law on August 16, heralding it as “one of the most significant laws in our history.”
Congressional Appropriators Develop FY23 Spending Bills but Stopgap measure Likely to Keep Government Open. With the fiscal year coming to a close at the end of the month, congressional appropriators have made progress developing spending bills for Fiscal Year (FY) 2023, but they are almost certain to pass a short-term continuing resolution (CR) to keep the government open after September 30 and buy themselves time to negotiate bipartisan compromise spending legislation. Recent reporting indicate the CR may run through December 16.
The House of Representatives has made the most significant progress on its FY23 spending bills. In June, the Appropriations Committee approved a spending bill funding the Department of Health and Human Services (HHS) with increased investments in several pediatric research and child health priorities. Under the legislation, the National Institutes of Health would receive $47.5 billion, a $2.5 billion increase over current year funding, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) would receive $1.756 billion, or $73 million of the total funding increase for NIH. Gun violence prevention research at the NIH and the Centers for Disease Control and Prevention (CDC) would receive $60 million, $35 million at CDC and $25 million at NIH, more than double the current funding level. Significantly, the House Appropriations Committee provided $15 million—a $10 million increase—for the Pediatric Subspecialty Loan Repayment Program (PSLRP); separately, the PPC has written to the Health Resources and Services Administration outlining priorities for the implementation of PSLRP as the agency prepares to stand up the program.
Other items of note in the House bill include a proposed $1.75 billion increase for the Advanced Research Projects Agency for Health (ARPA-H), President Biden’s signature biomedical research initiative which was created earlier this year with $1 billion in initial funding, and a $35 million increase for the Agency for Health Care Research and Quality (AHRQ) for a total funding level of $385 million. The Children’s Hospitals Graduate Medical Education Program (CHGME) would receive $385 million, a $10 million funding increase.
While the Senate Appropriations Committee has yet to formally approve any spending legislation, Committee Chair Patrick Leahy (D-Vt.) published Senate Democrats’ proposed spending bills for FY23 in late July. Under the proposal, the NIH would receive a similar funding level as that proposed by the House—$47.459 billion—while the NICHD would receive $1.745 billion, roughly $10 million below the House’s proposal. In significant news, Senate Democrats have also proposed a $10 million increase for PSLRP, which will be helpful in securing a $15 million appropriation for the program in a final negotiated package. The Senate has also proposed the same $60 million funding for gun violence prevention research as the House. While the Senate has proposed the same funding increases for CHGME and AHRQ as the House—$10 million ($385 million total) and $35 million ($385 million total) respectively—the Senate would provide flat funding for ARPA-H in the coming year.
Despite the progress, Democrats and Republicans will need to agree on top-level dollar figures for each spending bill and negotiate a bipartisan agreement that can withstand the Senate’s 60-vote threshold. With a limited number of legislative days before the end of the month, the clock is not on their side to pass full-year spending bills that avert a government shutdown, and Republicans are in no mood to cooperate after Democrats forced through the Inflation Reduction Act on a party-line vote. It appears more likely that Congress will punt the issue of FY23 spending until after the November midterm elections, potentially not resolving the issue until a new Congress is seated in January.
Bipartisan Gun Violence Legislation Signed into Law After Tragic Mass Shootings. In late June, Congress passed and President Biden signed into law bipartisan legislation to address gun violence. The Bipartisan Safer Communities Act represents the most significant legislation to address gun violence in more than two decades. Although the legislation does not reflect all that is needed to protect children, families, and communities from gun violence, it does include several wins for child health and is the result of lawmakers working across the aisle to advance needed policy solutions.
Key gun safety provisions include enhanced firearm purchase background checks for buyers between the ages of 18 and 21; funding to incentivize implementation of state red flag laws to temporarily remove weapons from those who pose an imminent risk of injury to themselves or other; and improvements to the federal background check system. The legislation also included important investments in mental health, including the reauthorization of the Health Resources and Services Administration (HRSA) Pediatric Mental Health Care Access Program, which supports the integration of behavioral health into pediatric primary care practices, and an additional $80 million in funding for the program over the next four years. Congress also provided greater integration and resources for mental health in schools.
Key Research Updates
- Fauci is set to step down after decades as top US infection expert.
- President Biden picked Dr. Renee Wegrzyn to run the Advanced Research Projects Agency for Health, the country’s newest biomedical research funder.
- National Academies of Sciences, Engineering, and Medicine: Call for Perspectives on the Pediatric Subspecialty Workforce
- NIH Director: Letter: The NIH Has Responded Forcefully to COVID-19
- Environmental influences on Child Health Outcomes (ECHO) FOAs
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:
- Reducing infant mortality: maternal health is infant health by Drs Kristen Shanahan, Kendall Burdick, and Lois Lee
- Health and access to care for refugees, asylees, and unaccompanied children by Drs Susan Baker and David Keller
- The politicization of children: implications for child health and public policy by Drs Christian Pulcini, Rachel Berman, Jean Raphael, and Mona Patel
What We’re Reading
- NICHD Director: Preventing Gun Violence, the Leading Cause of Childhood Death