July 25, 2014
Federal Legislative Update
In this update:
- Senate Committee and House Working Group Unveil Proposals on Unaccompanied Children Humanitarian Crisis
- House Budget Committee Chairman Unveils Poverty Proposal
- Save the Dates: Upcoming AAP Advocacy Training Opportunities
- Key Child Health Bills Move Through House and Senate
- Global Health Update
- Senate Committees Hold Hearings on Issues Important to Children’s Health
- Health Reform Implementation Update
- Defense Health Agency Releases TRICARE Report
- AAP Prepares for August Recess Advocacy Opportunities
- What We’re Reading
- This Week in Washington: Rhyming Recap
Senate Committee and House Working Group Unveil Proposals on Unaccompanied Children Humanitarian Crisis
This week, Senate Appropriations Committee Chairwoman Barbara Mikulski (D-Md.) released a draft of the emergency supplemental funding bill that would provide $2.7 billion in resources to address the humanitarian crisis on the southwestern border, approximately $1 billion less than President Obama’s request. Chairwoman Mikulski’s proposal includes $1.2 billion for the Department of Health and Human Services (HHS) for the unaccompanied children program. The proposal seeks to allow HHS to continue to expand shelter capacity and provide critical service for unaccompanied children through the end of 2014. It also contains $1.1 billion for the Department of Homeland Security for Immigration and Customs Enforcement and Customs and Border Protection (CBP) operations including transportation for unaccompanied minors; the Alternatives to Detention program; improvements at CBP facilities for children (e.g. meals, clothing, child care supplies, laundry and shower facilities and medical supplies and support); enforcement and disruption activities to break up smuggling and trafficking rings; and Office of Inspector General site visits to detention facilities.
The proposal contains $124.5 million for the Department of Justice for new immigration judge teams, legal representation services and other legal protection programs. Lastly, the proposal includes $300 million for the Department of State and U.S. Agency for International Development to address the contributing causes of migration from Central America, inform Central Americans of the dangers of the journey and support the safe repatriation and reintegration of migrants from Central America. The proposal only contains funding. It does not include any immigration-related legislative proposals.
In the House, a Republican working group on the border, chaired by Representative Kay Granger (R-Texas) and supported by House Republican leadership, unveiled its recommendations for dealing with current crisis. While the proposal and its path forward were not immediately clear, House Appropriations Committee Chairman Harold Rogers (R-Kent.) told his caucus that about $1.5 billion is what can “feasibly and sensibly be spent before the end of the calendar year.” The working group’s recommendations include but are not limited to the following:
- Deploy the National Guard to the border to assist border patrol agents.
- Require the Homeland Security Department to craft and implement a plan to "gain operational control" of the southwest border.
- Create repatriation centers to help families and unaccompanied minors once they return to their home country.
- Implement messaging campaigns, which are already underway in Honduras, Guatemala, and El Salvador, aimed at exposing the dangers of the journey to the United States and dispelling the myth that children will be permitted to enter the country.
- Process family units within five to seven days. Children should have a fast-tracked immigration-court hearing within seven days after a child welfare official's screening. Additional judge teams and temporary judges would be added.
- Create tough penalties for smugglers and disassemble transnational criminal organizations.
It is not clear whether the proposal will include any additional resources for HHS.
One of the major sticking points for action on a supplemental funding request in both the House and Senate is whether or not changes should be made to the 2008 Trafficking Victims Protection Reauthorization Act to treat unaccompanied minors from non-contiguous countries the same as unaccompanied minors from Mexico for purposes of expedited deportation.
Bicameral action on a supplemental funding request that would provide additional resources to the Administration to address the current humanitarian crisis appears unlikely before August recess.
House Budget Committee Chairman Unveils Poverty Proposal
On Thursday, House Budget Committee Chairman Paul Ryan (R-Wis.) unveiled his plan to address poverty at a speech during the American Enterprise Institute. In conjunction with the speech, he also published an op-ed in USA Today. Chairman Ryan proposed a budget neutral Opportunity Grant pilot program, which would consolidate 11 federal programs including the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps), the Child Care Development Fund, housing assistance and the Temporary Assistance for Needy Families into one block grant to the states.
While the proposal would expand the earned income tax credit by increasing the maximum credit for childless workers and lowering the eligibility age, it would pay for those changes by eliminating the Fresh Fruits and Vegetables Program, the Social Services Block Grant, the Farmers’ Market Nutrition Program and other programs. The proposal would turn Head Start into a block grant and permit states to modify their assessments for students with significant developmental disabilities.
Chairman Ryan’s proposal has not been introduced as legislation. AAP staff will continue to monitor the proposal and keep AAP members informed of any updates.
Save the Dates: Upcoming AAP Advocacy Training Opportunities
2015 AAP Legislative Conference
Mark your calendar! The AAP Legislative Conference will be held April 12-14, 2015, in Washington, DC. Participants will have the opportunity to develop their federal advocacy skills through interactive workshops, learn about timely child health policy topics, hear from several guest speakers from Congress and the Administration and visit with their legislators on Capitol Hill. If you are interested in attending and would like to be notified when registration opens, please email LegislativeConference@aap.org. For more information, please visit aap.org/legcon.
Advocacy Day Trainings
The AAP will also be hosting two Advocacy Day trainings in Washington, DC, on Monday, October 27, 2014, and Monday, February, 9, 2015. Beginning with an in-depth training session on how to advocate to members of Congress led by pediatrician federal policy experts and AAP staff, the day will culminate with in-person visits to federal legislators on Capitol Hill. If you are interested in attending either of the trainings, please email kids1st@aap.org.
Key Child Health Bills Move Through House and Senate
Emergency Medical Services for Children Reauthorization Act
On Wednesday, the Senate Health, Education, Labor and Pensions (HELP) Committee marked up and passed the Emergency Medical Services for Children(EMSC) Reauthorization Act (S. 2154). Following the committee’s passage, AAP President James M. Perrin, MD, FAAP, issued a press statement supporting the legislation. Unfortunately, due to Senate Republicans’ opposition to bills that authorize levels of funding that are higher than the most recent appropriated amount, a change was made to S. 2154 to reduce the authorization level over the next five fiscal years from $30.4 million to $20.2 million, the most recent funding level for EMSC. The legislation now heads to the Senate floor.
AAP staff are working closely with Senate and House staff to determine the most expeditious path forward to ensure that an EMSC reauthorization bill can reach the president’s desk by September 30.
Promoting Physical Activity for Americans Act
Also on Wednesday, the Senate HELP Committee approved the Promoting Physical Activity for Americans Act (S.531) in an executive session. The legislation requires HHS to develop and disseminate science-based physical activity guidelines at least every 10 years. The bill would also establish an approval process for other federal agencies to submit any physical activity proposal to HHS before disseminating it to the general public.
The House has not yet taken up its version of the bill (H.R. 2179), which the AAP has endorsed.
Preventing Sex Trafficking and Strengthening Families Act
The House approved the bipartisan and AAP-endorsed Preventing Sex Trafficking and Strengthening Families Act (H.R. 4980) by voice vote on Wednesday. The bill's sponsors include Sens. Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah) and Reps. Dave Camp (R-Mich.) and Sander Levin (D-Mich.), the chairmen and ranking members for the Senate Finance Committee and the House Ways and Means Committee, respectively. The bill combines several major initiatives related to the child welfare system, including efforts to address sex trafficking of children, improvements to the foster care system and reauthorization of the adoption incentives program.
The bill would require state child welfare agencies to identify, document and determine appropriate services for children who are, or who are at-risk of becoming, victims of sex trafficking. The legislation would also expand involvement of adolescents ages 14 and older in their foster care case planning, and also require provision of important documents to youth aging out of foster care, including their health records and insurance information. In addition, the bill would eliminate legal barriers to facilitating increased participation in age-appropriate extracurricular activities by foster youth, and includes provisions to reduce reliance on long-term foster care for children under 16 years old. Additionally, the bill would reauthorize the adoption incentives program and update its terms to provide incentive payments for increased adoption rates, rather than total numbers.
The Congressional Budget Office has reported that the bill will save $19 million over 10 years. The bill now moves to the Senate, which is expected to vote on the bill before adjourning for August recess.
Pediatricians head to Capitol Hill to defend global immunization
On Wednesday, James H. Conway, MD, FAAP, professor of pediatrics at the University of Wisconsin School of Medicine & Public Health, and Dean A. Blumberg, MD, FAAP, associate professor and chief of pediatric infectious diseases at UC Davis Children’s Hospital, visited 12 congressional offices to urge support for a new bipartisan House resolution supporting the role of the United States in ensuring that children in poor countries have access to vaccines and immunization through the GAVI Alliance. The AAP partnered on the Hill advocacy day with the Global Poverty Project, a nonprofit grassroots mobilization organization.
Pictured left to right: Dr. Conway and Dr. Blumberg after their meeting with the office of Representative André Carson (D-Ind.).
Senate Committees Hold Hearings on Issues Important to Children’s Health
School meal programs
On Wednesday, the Senate Agriculture Committee held its second hearing related to child nutrition reauthorization. The hearing, “Meeting the Challenges of Feeding America’s School Children,” examined school meal programs across the country – from purchasing and procurement to planning and preparation – and discussed opportunities to continue strengthening these programs to better support America’s school children. Witnesses described the success of the new nutritional standards for school meals that were passed as part of theHealthy, Hunger-Free Kids Act, and addressed new findings from the Robert Wood Johnson Foundation showing that 70% of elementary school leaders nationwide reported that students like the healthier school lunches implemented in fall 2012. A witness from the School Nutrition Association pressed Congress to provide more flexibility for schools and delays in implementing the new nutritional standards.
The Academy is in close contact with congressional staff and partner organizations as lawmakers and advocates prepare for child nutrition reauthorization in 2015.
Achieving a Better Life Experience Act
The Senate Finance Committee held a hearing on Wednesday on the Achieving a Better Life Experience (ABLE) Act (S. 313/H.R. 647). The bill, which AAP has endorsed, would amend Section 529 of the Internal Revenue Code so that families could create tax-free savings accounts that help pay for education, medical bills, and other expenses for their disabled children. The accounts would be structured so that beneficiaries would still be eligible for Medicaid and Supplemental Security Income benefits if the balance remains below $100,000. Currently, the legislation has 74 sponsors in the Senate and 367 in the House.
During the hearing, Sens. Bob Casey (D-Pa.), Richard Burr (R-N.C.) and Mike Enzi (R-Wyo.) expressed their strong support and optimism for passage of this legislation. Each of the panelists at the hearing attested to the importance of the bill for allowing families to better save and plan for their special needs children.
The bill is expected to be taken up in the Senate and House this fall.
Health Reform Implementation Update
Appellate decisions split on tax credits in ACA federal exchanges
On Tuesday morning, the U.S. Court of Appeals for the District of Columbia Circuit handed down a decision in Halbig v. Burwell. Two judges ruled that Affordable Care Act (ACA) provision allowing federally-facilitated exchanges to issue premium tax credits to individuals with household incomes between 100 and 400% of the federal poverty level was invalid. Approximately two hours later, the Fourth Circuit Court of Appeals in Richmond, Virginia, unanimously upheld the IRS rule in King v. Burwell.
The Halbig decision is automatically put on hold until seven days after the expiration of the 45-day period the government has to request a rehearing by all 11 judges of the DC Circuit, in addition to the two senior judges who were on the panel. If the government requests such “en banc” review (as it has said that it will), the entire court will likely set aside the three judge panel decision and rehear the case itself; this will likely take several months. Depending on the decision issued by the full DC Circuit Court, the case could go to the Supreme Court.
Alliance for Health Reform briefing on network adequacy
On Monday, the Alliance for Health Reform held a briefing on Capitol Hill focused on the network adequacy issues that have increased since coverage began in the health insurance marketplaces on January 1, 2014. Some new health plans sold in the insurance marketplaces are offering consumers networks that exclude certain doctors, hospitals and other medical providers. While some claim that these networks hamper provider access and choice, others contend that this approach, if done correctly, helps consumers by creating competition and controlling costs. A transcript, materials and full archived webcast of the briefing are available here.
Defense Health Agency Releases TRICARE Report
Last week, the Office of the Secretary of Defense submitted a report analyzing pediatric health care coverage under TRICARE to the House and Senate Armed Services Committees. The report titled, “Study on Health Care and Related Support for Children of Members of the Armed Forces,” was a requirement of Section 735 of the Fiscal Year (FY) 2013 National Defense Authorization Act (NDAA), which directed the Secretary of Defense to conduct a study on the health care provided to dependent children of members of the armed forces. AAP endorsed the original legislation that contained the idea for the study.
The report largely concluded that the Military Health System is meeting the needs of children, but acknowledges that there were certain data limitations in many of the areas examined. In addition, the report also lists several “gaps” or “areas for clarification” that require further analysis.
Among its findings, the report establishes that although early child care under TRICARE aligns with the basic tenets of Bright Futures, there is a gap for children ages 6 to 21 for preventative services. It also acknowledges that the TRICARE definition of medical necessity may differ from the broader healthcare system, and that a review of the TRICARE medical necessity criteria compared with standards used in the larger community could be warranted. Additionally, while the report found that TRICARE’s payment for pediatric care was adequate, it does acknowledge concerns raised by the AAP, and affirms the department’s commitment to “modifications and/or exemptions” to existing reimbursement systems.
AAP and its partner organizations in the TRICARE for Kids working group will draft a unified response to this report and plan to meet with staff from the House and Senate Armed Services committees to discuss possible legislative responses to some of the “gaps” and “areas of clarification” included in the report. The coalition also plans to meet with the Defense Health Agency (DHA) to review the Unified Legislation and Budgeting Process, and changes DHA might propose in this process that would not require additional legislation.
AAP Prepares for August Recess Advocacy Opportunities
The AAP Department of Federal Affairs is gearing up for August congressional recess. Members of the House and Senate will be leaving Washington, DC, and heading to their home states and districts from August 4 through September 5. Please look out for a Key Contact advocacy action alert on how you can engage your federal legislators on key child health access issues during the recess.
- A Huffington Post article by Claire McCarthy, MD, FAAP, “The Children at the Border Are…Children”
- A New York Times article, “Obama to Urge Central American Leaders to Slow Wave of Immigrants”
- A letter to the editor published in the San Antonio Express-News by Ryan Van Ramshorst, MD, about unaccompanied children crossing the U.S. border
- A Reuters piece featuring an article published by Aimee Grace, MD, MPH FAAP, Wendy Macias Konstantopoulos, MD, MPH and Roy Ahn, MPH, ScD, titled, “Integrating Curricula on Human Trafficking Into Medical Education and Residency Training”
- New public service announcements from the Centers for Medicare & Medicaid Services as part of the Connecting Kids to Coverage National Campaign
- A new study from the New England Journal of Medicine showing that 10.3 million people gained coverage under the ACA
- Friday Funny: an article from The Onion, “Obama To Cut Costs By Packing Lunch Every Day for U.S.
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