Inside the Beltway - April 2025

Inside the Beltway is a member-only benefit developed by NAPNAP’s Health Policy Team to keep members up to date on key policy issues at the federal level.

Child Health Equity at Risk: Advocacy in Response to Potential Medicaid Cuts

Contributed by Health Policy Committee Members Allison Clark Young, MS, APRN-FPA, CPNP, IBCLC and Noelia MaGowan, MSN, CPNP

Access to high-quality, affordable health care and non-medical drivers of health, such as historical racism, poverty, nutritious food access, educational support, safety, and more, continue to impact disparities in health outcomes for children. Programs such as Medicaid and the Children’s Health Insurance Program (CHIP) insure over 37 million children in the United States and provide vital health care services to counter health disparities. Potential policy and funding changes will drastically impact health care access for children and families.

Proposed Budget Cuts and Their Implications
In early 2025, the U.S. House of Representatives passed a budget resolution directing the Energy and Commerce Committee to identify $880 billion in spending reductions over the next decade. While the resolution does not explicitly mandate cuts to Medicaid, the magnitude of the proposed savings suggests to policy experts that substantial reductions to the program are likely.

These potential cuts have raised concerns among NAPNAP’s leaders and our fellow health care professionals and child advocates. The Children’s Hospital Association warns that such reductions could adversely affect the 37 million children enrolled in Medicaid, including nearly 50 percent of children with complex and special health needs, 3 million children in military-connected families, and over 40 percent of children residing in rural areas and small towns.

Impact on Pediatric Health Care
Medicaid is the largest payor for pediatric health services, ensuring that children receive preventive care, vaccinations and treatments for acute and chronic conditions. Significant funding cuts will likely lead to:

Reduced Access to Care: Decreased funding may result in longer wait times and limited availability of pediatric specialists, particularly in underserved areas.
Financial Strain on Families: Cuts could increase out-of-pocket expenses for families, potentially causing some to forgo necessary medical care for their children.
Worsening Health Outcomes: Limited access to timely and appropriate pediatric health care services can lead to undiagnosed developmental delays, progression of untreated conditions and/or missed opportunities for mental health and other important screenings adversely affecting children’s short- and long-term health and development.

Call to Action for Pediatric Health Care Providers
Pediatric nurse practitioners, family nurse practitioners and other pediatric providers play a crucial role in advocating for children’s health and well-being. To address the potential threats to Medicaid, providers are encouraged to:

Engage in advocacy: Communicate with elected officials to share firsthand accounts of how Medicaid cuts could harm children and families. Ask for support for high-quality, affordable health care for children and families and policies that promote child health equity.
Educate communities: Inform patients, families, and your own community about the potential changes and guide them on how to voice their concerns to policymakers.
Collaborate with professional organizations: Work with local-level groups, including your NAPNAP chapter, state American Academy of Pediatrics chapter and other state-based child health and nursing organizations to strengthen collective advocacy efforts.

By proactively addressing these challenges, pediatric health care providers can help safeguard Medicaid and CHIP and ensure that all children continue to receive the essential health services they need to thrive.

References

FactCheck.org. (2025, March). The War of Words Over Medicaid Cuts. Retrieved from https://www.factcheck.org/2025/03/the-war-of-words-over-medicaid-cuts/
Children’s Hospital Association. (2025, February). Children’s Hospital Association Opposes Cuts to Medicaid, Urges Congress to Protect Patient Care. Retrieved from https://www.childrenshospitals.org/news/newsroom/2025/02/childrens-hospital-association-opposes-cuts-to-medicaid-urges-congress-to-protect-patient-care
Center for Medicare and Medicaid Services (2024, November). Medicaid and CHIP Eligibility Operations and Enrollment Snapshot. Retrieved from https://www.medicaid.gov/resources-for-states/downloads/eligib-oper-and-enrol-snap-november2024.pdf
Kellermann, A. L. (2025, February 24). Trump’s Medicaid cuts, if enacted, will affect you. Forbes. Retrieved from https://www.forbes.com/sites/arthurkellermann/2025/02/24/trumps-medicaid-cuts-if-enacted-will-affect-you/
Center for Children and Families at the McCourt School of Public Policy at Georgetown University. (2025). How Medicaid supports student success. Retrieved from https://ccf.georgetown.edu/2025/01/09/how-medicaid-supports-student-success/

Key NAPNAP Advocacy Activities

Joined the Congressional Children’s Health Care Caucus in hosting a Capitol Hill briefing, “From Medicaid to Private Plans: How Kids Get Care,” for congressional staffers, with NAPNAP members from Maryland, Virginia, and the District of Columbia participating.
Coordinated with United States of Care and the National Health Law Program to join an amicus brief filed with the U.S. Supreme Court in the Kennedy v. Braidwood Management lawsuit challenging the Affordable Care Act requirement that health plans must cover services recommended by the U.S. Preventive Health Services Task Force at no cost to enrollees.
Issued calls to action for NAPNAP members to contact U.S. Representatives to oppose the House’s proposed fiscal 2025 budget resolution instructing the Energy and Commerce Committee to reduce spending on programs under its jurisdiction, including Medicaid and the Children’s Health Insurance Program, by at least $880 billion as part of a budget reconciliation bill to extend expiring tax cuts and address border security, energy, and defense policies, and to contact their members of Congress to cosponsor the “Improving Care and Access to Nurses (I CAN) Act” (H.R. 1317/S. 575), removing federal barriers to APRN practice.
Coordinated with staff for Rep. August Pfluger (R-TX) and Sen. Alex Padilla (D-CA) on NAPNAP’s endorsement of the “Early Action and Responsiveness Lifts Youth Minds (EARLY Minds) Act” (H.R. 1735/S. 779), allowing states to allocate up to five percent of their Mental Health Block Grant funding toward prevention and early intervention programs.
Coordinated with staff for Sen. Brian Schatz (D-HI) on NAPNAP’s endorsement of the reintroduction of the “Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act” (S. 1261), permanently removing geographic restrictions on telehealth services, expanding originating sites to the location of the patient, and enabling eligible APRNs and health care professionals to utilize telehealth services.

HHS Faces Major Reorganization As Kennedy Takes Charge

The Department of Health and Human Services will eliminate nearly a quarter of its workforce and consolidate some of its major departments and agencies under a plan announced last month by Sec. Robert F. Kennedy Jr. The proposal would reduce the department’s 28 divisions to 15 and create a new “Administration for a Healthy America” that will include the Health Resources and Services Administration, which oversees nursing education and workforce development programs. Along with HRSA, the new subdivision would include the Substance Abuse and Mental Health Services Administration, the Office of the Assistant Secretary for Health, the Agency for Toxic Substances and Disease Registry, and the National Institute for Occupational Safety and Health. The Agency for Healthcare Research and Quality would merge with the Assistant Secretary for Planning and Evaluation to form a new Office of Strategy. HHS will close its Office of Minority Health and the CMS Office of Minority Health, as well as the Office of Infectious Disease and HIV/AIDS Policy.

The moves are projected to save the department about $1.8 billion annually, the agency said, by reducing staff from 82,000 to 62,000. Half of those 20,000 employees took buyouts and early retirement, while 10,000 will lose their jobs. The number of regional offices will drop from 10 to five, and the focus will be on “safe, wholesome food, clean water, and the elimination of environmental toxins” in an effort to “Make America Healthy Again,” according to an agency statement. The Atlanta-based Centers for Disease Control and Prevention will lose 2,400 employees, while the Food and Drug Administration will have its staff cut by 3,500. The National Institutes of Health workforce will be reduced by about 1,200 employees.

The workforce reductions included several top agency officials, including Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research and its top vaccine regulator. Marks resigned after clashing with Kennedy on his policies and statements on vaccination, saying in his resignation letter that the ongoing measles outbreak in the southwest “reminds us of what happens when confidence in well-established science underlying public health and well-being is undermined.” Other departing senior leaders included National Institute of Nursing Research director Dr. Shannon Zenk, HRSA Bureau of Nursing and Public Health chief Dr. Leah Fitzgerald, and FDA Center for Tobacco Products head Brian King.

Senate Confirms HHS Officials, Awaiting CDC Nomination Hearing

Following the confirmation of Robert F. Kennedy, Jr., to head the Department of Health and Human Services, the Senate voted to confirm several of the department’s agency chiefs, including Dr. Mehmet Oz to run the Centers for Medicare and Medicaid Services, Dr. Marty Makary as commissioner of the Food and Drug Administration, and Dr. Jay Bhattacharya to direct the National Institutes of Health. President Trump appointed the CDC’s acting director, Susan Monarez, to permanently lead the agency. Monarez was named acting director and acting administrator for the Agency for Toxic Substances and Disease Registry in January after previously serving as the deputy director of the Advanced Research Projects Agency for Health since 2023. A confirmation hearing for Monarez has not yet been scheduled.

Congress Adopts Budget for Tax Breaks and Spending Cuts

Before adjourning for a two-week Easter and Passover recess, the House of Representatives votes 216 to 214 on April 10 to pass a budget resolution (H. Con. Res. 14) that sets the stage for drafting the bill to enact most of President Donald Trump’s legislative agenda, paid for with what is likely to be deep cuts in Medicaid and other health care programs. Only two Republicans, Reps. Thomas Massie of Kentucky and Victoria Spartz of Indiana, voted against the budget blueprint after more than a dozen conservatives threatened to oppose it, forcing House Speaker Mike Johnson to delay a final vote. The Senate approved the resolution on April 5 on a 51 to 48 vote after amending the House’s earlier version, providing different instructions to House and Senate committees for drafting a reconciliation bill that can avoid a filibuster by Senate Democrats and pass with only Republican votes.

Republicans intend to advance legislation that will extend tax breaks from Trump’s first term, create new tax breaks, boost funding for border security and defense programs, and reform energy policies. To offset some of the costs, the budget instructs the House Energy and Commerce Committee, which has jurisdiction over Medicaid and Medicare, to cut spending by $880 billion. But the Senate Finance Committee, which oversees the same programs, is not required to hit the same target. Committees are expected to spend most of May drafting the specific policies, and the two chambers will have to reconcile the differences before sending a bill to the White House.

Cuts in Medical Research Funds Face Legal Fights

Sixteen state attorneys general filed a lawsuit in federal district court in Boston earlier this month challenging the Trump administration’s cancellation of millions of dollars in medical research grants. The lawsuit alleges that since March, the National Institutes of Health has sent hundreds of letters to researchers informing them that their research projects “no longer effectuate agency priorities.” The only explanation given was that their previously approved projects were related to diversity, equity, and inclusion; transgender issues; vaccine hesitancy; or other topics that don’t align with the administration’s priorities, the lawsuit says. In addition to Massachusetts Attorney General Andrea Joy Campbell, the attorneys general of Arizona, California, Colorado, Delaware, Hawaii, Maryland, Minnesota, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Washington, and Wisconsin, all Democrats, joined the suit.

The American Civil Liberties Union filed a separate lawsuit in the Boston federal district court seeking to force the National Institutes of Health to restore canceled grants and to block the agency from cutting more. The plaintiffs include four individual researchers and organizations whose members were hit by the Trump administration’s recent grant cancellations that initially targeted research on LGBTQ+ health and have since hit grants on vaccine hesitancy and COVID-19. Roughly $17 billion in recently canceled grants is at stake, according to the lawsuit. The challenge followed action by Colorado Attorney General Phil Weiser contesting the termination of $11.4 billion in Centers for Disease Control and Prevention funding allocated to state and community health departments in response to the COVID-19 pandemic.

Funding Extension Ends Fiscal 2025 Appropriations Debate

President Trump signed the final spending bill (H.R. 1968) for fiscal 2025 last month, narrowly heading off a partial government shutdown. The six-and-a-half-month continuing resolution, extending agency funding through Sept. 30, passed the Senate after ten Democrats, including Minority Leader Chuck Schumer, crossed the aisle on a 62 to 38 procedural vote to end debate, defying objections from party progressives. The final bill largely kept spending flat at fiscal 2024 levels, including funding for nursing workforce programs under Title VIII of the Public Health Service Act. But the measure also included “anomalies” that increased spending for the military by $6 billion and slightly decreased overall spending by dropping earmarked funding for projects in lawmakers’ districts or states. The resolution also failed to extend guidance to agencies on how allocated funds should be prioritized, giving the administration greater latitude on spending.

The final resolution also extended Medicare authority to cover telehealth services, delayed cuts in Medicaid payments to safety net hospitals, and funded community health centers, the National Health Service Corps, and several lapsing Medicare programs through Sept. 30. However, lawmakers angered many health care providers by failing to include provisions reversing the 2.83-percent cut to Medicare Part B fee-for-service payments that went into effect Jan. 1, leaving clinicians with a promise from House Republicans to include a fix in the upcoming budget reconciliation bill.

In Other NAPNAP News

Supreme Court Upholds Ban of Flavored Vapes
The Supreme Court ruled unanimously earlier this month that the Food and Drug Administration properly refused to approve flavored vape products by two e-cigarette companies because regulators determined they were too great a risk to public health. The ruling overturned a decision by the 5th Circuit Court of Appeals that found that the FDA unfairly changed its standards while assessing products made by Triton Distribution and Vapetasia. Justice Samuel Alito wrote that the FDA’s denial orders were “sufficiently consistent with its pre-decisional guidance,” adding, “…in the end, we cannot say that the FDA improperly changed its position with respect to scientific evidence, comparative efficacy, or device type.”

The e-liquid flavor products marketed by Triton and Vapetasia include dessert, candy, and fruit flavors such as “Killer Kustard Blueberry,” “Rainbow Road,” and “Pineapple Express.” They were among millions of other flavored e-cigarette products that the FDA barred in 2021 due to their attractiveness to young people and addictive nature, the court said.

Administration Moves to Roll Back Environmental Rules
The Environmental Protection Agency announced last month that it would dismantle dozens of Biden-era rules touching issues as varied as electric vehicles, coal plants, and clean water. EPA Administrator Lee Zeldin said the agency will roll back some of President Biden’s most significant climate and environmental regulations, calling it “the most consequential day of deregulation in American history.” He specifically cited rules aimed at speeding the nation’s shift to electric vehicles, slashing planet-warming emissions from power plants, and safeguarding waterways from harmful pollution.

Taken together, the announcements mark a dramatic shift in U.S. environmental policy, easing rules on nearly every sector of the economy, although issuing regulations that officially rewrite many of the rules could take the agency months or even years. Zeldin also confirmed that the administration will repeal the “endangerment finding,” a scientific determination that underpins much of the federal government’s push to combat climate change and that cleared the way for regulating greenhouse gases under the Clean Air Act by concluding that the planet-warming gases pose a threat to public health and welfare.

Justice Department Launches Task Force on Anticompetitive Policies
The Justice Department last month announced the formation of an Anticompetitive Regulations Task Force that will “advocate for the elimination of anticompetitive state and federal laws and regulations that undermine free market competition and harm consumers, workers, and businesses.” As a first step, the department’s Antitrust Division initiated a public inquiry “to identify unnecessary laws and regulations that raise the highest barriers to competition,” including those in health care markets that discourage providers from providing low-cost, high-quality care and encourage overbilling and consolidation. The agency is seeking comments from the public by May 26. NAPNAP and other national nursing organizations will use the opportunity to renew efforts to urge the administration to eliminate barriers to practice and prevent discrimination against APRNs in the formation of provider networks.