Inside the Beltway – August 2022

You are the Key to Child Health Advocacy

Contributed by Health Policy Committee chair Audra Rankin, DNP, APRN, CPNP

Many recent issues including, mental health, reproductive health, firearm violence and vaccinations have highlighted the need for thoughtful approaches to child health policy and advocacy efforts.  Pediatric health care providers, through our evidence-based work and commitment to the overall well-being of the children and families we serve, have a unique lens to discuss these topics and subsequently influence change. Although guiding principles of the NAPNAP Health Policy Agenda include a commitment to national and grassroots advocacy, advocacy efforts may seem like a daunting task for many members. As midterm elections draw near, we must all think about how we can advance our development as advocates and leaders in pediatric health policy, whether it be at the individual, community, state or federal level.

The first, and most important, action is to VOTE. November midterm elections have the potential to greatly impact policies that influence children’s health. At the federal level, all 435 U.S. House seats as well as 35 U.S. Senate seats are up for election. While at the state level, 80% of legislative seats and 36 gubernatorial elections are up for election. Voting is the first step in putting officials into office that can effectively influence child health policy.

Goals of the NAPNAP Health Policy Agenda include improving health care access and quality, optimizing child and adolescent health, removing barriers to pediatric-focused APRN practice, and positioning pediatric-focused APRNs as leading advocates. (NAPNAP, 2022). When communicating with elected officials, consider framing conversations around a mutual commitment to healthy children and families. As we reflect on the many, often polarizing, issues grappling our communities today, it may be helpful to use this bipartisan, child- and family-focused framework when engaging with leaders on both sides of the aisle.

Engaging with elected officials may include sharing your professional expertise through calls, meetings, letters, and op-eds. NAPNAP’s Advocacy Center is also a great tool to send pre-formatted communication directly to elected officials at the federal level or contacting any of your federal and state elected leaders. Additionally, participating in local, state, and federal advocacy events and identifying policy partners, often outside of the nursing profession, that share a mutual commitment to child health are ways to strengthen our collective advocacy voice.

NAPNAP members serve as a critical link between practice and policy. Our advocacy efforts, ranging from heading to the midterm election polls to establishing powerful political partnerships, have the potential to create a lasting impact on children and families.

For more information on the best ways to engage with elected officials this fall, join us for our Child Health Policy Learning Collaborative meeting on Sept. 7, open to all current NAPNAP members.


Democrats Pass Key Health and Climate Policies

More than a year after President Biden proposed a sweeping “Build Back Better” domestic policy agenda, congressional Democrats finally reached agreement on a trimmed-down $740 billion package of health care, climate change, and tax policies passed without Republican input or support. House Democrats narrowly adopted the “Inflation Reduction Act” (H.R. 5376) Aug. 12, sending the measure to the White House for the President’s signature. House passage followed the Senate’s Aug. 7 approval of the bill on a straight party-line 50 to 50 vote with Vice President Kamala Harris delivering the tie-breaking vote after a 15-hour marathon “vote-a-rama” on dozens of amendments.

The measure, which appeared dead just weeks ago, was revived after Sen. Joe Manchin (D-WV) – whose opposition killed the House-passed $1.75 trillion “Build Back Better Act” last year – reached agreement with Senate Majority Leader Chuck Schumer, allowing Democrats to use the chamber’s budget reconciliation process to prevent a Republican filibuster. The bill extends increased premium subsidies for three years to help consumer purchase Affordable Care Act coverage, allows Medicare to directly negotiate prescription drug prices for the first time, and pumps nearly $400 billion into a range of climate change and energy programs. However, it fails to include a host of “Build Back Better” health policies including extending Medicaid postpartum coverage to 12 months and permanently authorizing the Children’s Health Insurance Program – priorities that advocates hope to attach to a year-end omnibus measure.


Welcome to our New Committee Members

We are pleased to welcome Allison Grady, MSN and Jennifer Flippo, DNP, CPNP, to the national Health Policy Committee, lead by new chair Audra Rankin, DNP, APRN, CPNP. Sarah Green, DNP, CPNP-AC, begins her second term on the committee. We also congratulate new chapter legislative chairs starting their terms to guide advocacy efforts at the state level.


Appropriators Propose Increases for Nursing Workforce Programs

Although a final agreement on funding government programs for fiscal 2023 isn’t likely until a post-election “lame duck” session, appropriators in both chambers of Congress have staked out their negotiating positions in proposed spending bills – including increasing funding for nursing workforce development and research programs. Democrats on the Senate Appropriations Committee issued spending plans July 28 that included a $38 million funding increase for nursing workforce programs under Title VIII of the Public Health Service Act, for a total of $318.47 million. The Senate boost is $6 million less than House appropriators proposed for the programs in their funding measure, but both proposals are subject to negotiation with Republicans.

The Senate’s $38 million increase for Title VIII programs includes a $26 million increase for the Advanced Nursing Education program – the same increase as proposed by the House. However, the Senate proposal would allocate $25 million “to grow and diversify the maternal and perinatal health nursing workforce by increasing and diversifying the number of Certified Nurse Midwives with a focus on practitioners working in rural and underserved communities.”  The House proposal allocates $20 million for that purpose, and both proposals are similar to a request in the President’s budget.

The Senate bill also proposed an increase of $15.6 million for the National Institute of Nursing Research for a total of $196.5 million, short of the $27.7 million increase offered by the House. The Senate allocates $10 million of the proposed increase “to support research related to identifying and reducing health disparities” while the House allocated $22 million for that purpose.


Administration Sends $300 Million To Boost School Mental Health

The Biden administration unveiled plans on July 29 to distribute the first of nearly $300 million for schools to hire more counselors, social workers and other mental health professionals for the coming school year, as well as plans to issue new guidance to states in the coming months on how to make it easier for schools to receive Medicaid reimbursements for providing mental health services. HHS estimates that the “Bipartisan Safer Communities Act” will invest $1 billion over the next five years in school mental health services, and the administration is allocating $140 million each to the Mental Health Service Professional Demonstration Grant Program and the School-Based Mental Health Services Grant Program, which is meant to increase the number of qualified mental health providers in schools with a demonstrated need.

The Biden administration also mentioned it plans to issue new guidance on how schools can leverage Medicaid funding to pay for the mental health services they’re providing their students. Children’s health advocates have encouraged the administration for years to give states additional guidance on the Medicaid in Schools program, which lets schools be reimbursed for treating Medicaid-enrolled students.


Monkeypox Outbreak Declared Public Health Emergency

HHS Sec. Xavier Becerra issued a declaration Aug. 9 authorizing emergency use of the existing monkeypox vaccine, five days after he initially declared the outbreak of the virus that has infected nearly 9,500 people in the U.S. a public health emergency. Becerra’s action was swiftly followed by the Food and Drug Administration granting emergency authorization for public health officials to alter the administration of the vaccine and to allow minors deemed at high risk of infection to receive it, although it was previously approved only for adults. Rather than injecting doses of Jynneos – the only FDA-approved vaccine for monkeypox – subcutaneously, the new strategy allows intradermal injections of a smaller amount of the vaccine under the top layer of skin. The change would allow the administration of only one-fifth of the original dose, officials said, stressing that the approach would not compromise safety or efficacy.

On Aug. 2, the White House named Robert Fenton as coordinator of the nation’s monkeypox response amid a surging epidemic that has prompted three states to declare health emergencies. A regional administrator for the Federal Emergency Management Agency, where he has worked since 1996 and previously served as acting administrator, Fenton helped oversee the Biden administration’s efforts to set up coronavirus vaccination sites.


Child Health Policy Learning Collaborative – Sept. 7

NAPNAP’s Child Health Policy Learning Collaborative (CHPLC) returns from summer hiatus on Wednesday, Sept. 7 at 8 p.m. ET. Join us to learn more about how pediatric advanced practice providers can better engage with state elected leaders and build relationships that can lead to more productive advocacy efforts. CHPLC is an exclusive member-only benefit free to all NAPNAP members. To receive links to our monthly calls, email healthpolicy@napnap.org. Members can login to access archived meetings.


Biden Administration Responds to Reproductive Restrictions

In the wake of the Supreme Court ruling overturning Roe v. Wade, President Biden issued an executive order Aug. 3 aimed at protecting people’s ability to travel out of state to access abortion. Biden is also asking HHS Sec. Xavier Becerra to consider “all appropriate actions” to ensure that health providers follow federal nondiscrimination laws so that people can “receive medically necessary care without delay” and to improve research, data collection, and data analysis efforts on maternal health. At the end of July, the departments of Health and Human Services, Treasury and Labor sent additional guidance to health insurers reminding them that federal law requires them to cover all FDA-approved forms of birth control with no copays – and threatening stepped up enforcement if they

On Aug. 2, the Department of Justice filed its first lawsuit challenging state restrictions, arguing that a new Idaho law that would impose a near-total ban on the procedure violates a federal requirement to provide medical care when a pregnant person’s life or health is at stake. The Idaho ban, set to take effect Aug. 25, allows clinicians to be criminally prosecuted for providing abortions and, the Justice Department said, could conflict with federal law protecting patients seeking emergency hospital care. Attorney General Merrick Garland earlier threatened to sue states that have outlawed or restricted abortion, adding that the agency would ask a judge to dismiss a Texas lawsuit seeking to block federal rules requiring doctors to perform abortions in emergency situations.

Meanwhile, the House passed legislation in July that would codify the federal right to contraception, although the measure faces slim odds in the Senate with Republicans objecting to the broadness of the bill. Supporters say the “Right to Contraception Act” (H.R. 8373), which passed on a 228 to 195 vote largely along party lines, would enshrine the right to access contraception and the right of providers to prescribe and provide information about contraception into federal law.


In Other News

HHS Signals Extension of COVID-19 Health Emergency
The Biden administration appears ready to extend the federal COVID-19 public health emergency into a third year after not giving states notice that it would let the emergency designation lapse in October. HHS Sec. Xavier Becerra has promise to warn states and stakeholders at least 60 days before the emergency declaration, first issued in January 2020, will end in an effort to help them prepare for the removal of pandemic-related policies and the resumption of Medicaid eligibility redeterminations. Having extended the emergency July 15 for another 90 days, Becerra’s 60-day deadline would have been August 15.

The Centers for Medicare and Medicaid Services (CMS) has created a website for the unwinding of the COVID-19 Public Health Emergency for individuals who need to renew their Medicaid or CHIP coverage or apply for another type of health care coverage. The CMS site has state-by-state information and resources for impacted individuals.

Following the approval of COVID-19 vaccines for children six months to five years old, CMS also announced that children with Medicaid and Children’s Health Insurance Program (CHIP) coverage are eligible for COVID-19 vaccinations without cost-sharing. Nearly all people with Medicaid, CHIP, Basic Health Program coverage, self-insured employer-sponsored coverage, and group and individual health insurance coverage can get COVID-19 vaccinations, including boosters, at no cost. People with Medicare pay nothing to receive a COVID-19 vaccination, and there is no applicable copayment, coinsurance or deductible. The Centers for Disease Control and Prevention provides resources for providers at its COVID-19 Vaccination Provider Requirements and Support webpage.

Meanwhile, Biden administration officials are developing a plan to allow all adults to receive a second coronavirus booster shot, pending federal agency sign-offs, as the White House and health experts seek to prepare for a possible fall surge. Currently, a second booster shot is available only to those 50 and older, as well as to those 12 and older who are immunocompromised. The White House held an all-day summit July 26 to discuss the future of COVID-19 vaccines, focusing on development of a vaccine that would offer universal protection against all strains of the coronavirus.

House Votes to Extend Telehealth Flexibilities
The House overwhelmingly passed legislation July 27 to extend eased telehealth rules through the end of 2024. The 416 to 12 vote to pass the “Advancing Telehealth Beyond COVID–19 Act of 2021” (H.R. 4040) was a significant win for telehealth advocates. The bill would allow Medicare and federally qualified health centers and rural health clinics to continue covering telehealth visits from patients’ homes, as well as audio-only telehealth under Medicare. The measure would also extend a waiver permitting mental health patients to avoid having to go to in-person visits.

Initially permitted by the Trump administration at the outset of the pandemic and reinforced by Congress in a March 2020 COVID-19 relief law, the expanded telehealth rules are now set to expire five months after the end of the public health emergency. The legislation heads to the Senate, where it is also expected to have the votes to pass, although it faces a packed legislative calendar.

House Panel Introduces Child Nutrition Reauthorization
House Education and Labor Committee Chairman Bobby Scott (D-VA) released the “Healthy Meals, Healthy Kids Act,” the committee’s Child Nutrition Reauthorization bill, July 20. The legislation includes provisions to increase access to school meals, summer meals, and child care meals and to continue improving the nutritional quality of the meals served. The measure would expand community eligibility for free school meals to allow more high-need schools to offer free meals to all students at no charge, expand access to summer meals and create a nationwide Summer electronic benefit transfer program. The panel plans to mark up the bill in September, but it’s unclear when it might move to the House floor.

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