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.
Every Vote Counts
Contributed by Health Policy Committee chair Audra Rankin, DNP, APRN, CPNP and co-chair Ashleigh Bowman, DNP, RN, CRNP, CPNP-AC, SANE-A, SANE-P
As much of the nation’s attention turns to the upcoming November elections, health care providers are in a unique position to encourage voting in both their professional and personal settings. The 2023 National Report Findings of County Health Rankings found that civic participation influences one’s ability to improve health. (Stanicki, 2023) Individuals who are active voters often report better health than non-voters. (APHA, 2022) The link between voting and health equity makes NAPNAP members having open, nonpartisan dialogue regarding the importance of voting a necessary step while providing care.
Social determinants of health, factors that influence where we all live, work, and play, may impact between 30-50% of health outcomes. (APHA, 2022). Although relevant to everyone, voting is of particular interest to communities that are significantly impacted by government funding of programs that influence social services, housing, and child development and education. If a community loses their ability to influence the selection of elected officials, health inequities may occur. (Stanicki, 2023)
During the course of a typical encounter, pediatric-focused nurse practitioners (NPs) will engage in interactions with not only the child, but their entire family unit. These interactions provide critical opportunities to discuss civic engagement and provide education and resources to families. Interestingly, the concept of being an “informed voter” is not simply translated into better voting practices; Hannon (2022) discusses how strong partisanship can lead to bias in political thinking. Voters tend to focus much of their energy and effort into high-profile offices, such as governor or president; while candidates running for local offices, such as mayor, receive little attention from voters (Bernhard & Freeder, 2020). Bernard and Freeder (2020) additionally found that voters tended to ask candidates for local offices more general or “background” questions simply because they did not know enough about the policy issues at hand.
Pediatric-focused NPs are uniquely positioned to educate families on the importance of local and state elections and empower them to seek education on policy issues that will ultimately impact their child’s health, such as Medicaid expansion, among many others. Strategies as simple as encouraging parents and caregivers to register to vote can start the process of civic engagement (Vot-ER, n.d.).
Over the next few months, consider taking advantage of opportunities to inform your colleagues and the communities you serve about the importance of voting and the direct links to health outcomes. Share NAPNAP’s social media posts encouraging providers to be research candidates and vote for children’s health.
References:
- Advancing Health Equity Through Protecting and Promoting Access to Voting. (2022) American Public Health Association, Retrieved from https://www.apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2023/01/18/access-to-voting.
- Bernhard, R., & Freeder, S. (2020). The more you know: Voter heuristics and the information search. Political Behavior, 42,603-623. https://doi.org/10.1007s11109-018-9512-2
- Hannon, M. (2022). Are knowledgeable voters better voters? Politics, Philosophy, & Economics, 21(1), 29-54. https://doi.org/10.1177/147054X211065080
- Vot-ER. (n.d.). Healthy communities powered by a healthy democracy. Retrieved from https://vot-er.org/
- Stanicki, B., Grade, M., Pacheco, J., Dugan, L., Salerno, A., & Martin, A. (2023). Expanding voter registration to clinical settings to improve health equity. Health services research, 58(5), 970–975. https://doi.org/10.1111/1475-6773.14218
Key NAPNAP Advocacy Activities
NAPNAP’s Health Policy team, including our federal government affairs representative, committee chair and members, Executive Board members and staff, are working every day to advocate for federal legislation and regulations that positively impact child health and advanced practice nursing. A few recent highlights include:.
- Submitted a letter to the chair and ranking member of the House Energy and Commerce Committee supporting the “Accelerating Kids’ Access to Care Act” (H.R. 4758), creating a streamlined screening and enrollment process for out-of-state Medicaid and CHIP providers, sent in advance of the committee’s June 12 markup of the bill.
- Submitted a letter to the House and Senate sponsors of the “Strengthening Collective Resources for Encouraging Education Needed (SCREEN) for Type 1 Diabetes Act” (H.R. 8698/S. 4504) supporting the bill to authorize $5 million for the Centers for Disease Control and Prevention to carry out a national campaign to increase awareness and knowledge of type 1 diabetes detection, screening, and management, and met with staff for the bill’s sponsors, Sen. Jeanne Shaheen (D-NH) and Rep. Kim Schrier (D-WA).
- Met with Centers for Medicaid and CHIP Services senior officials for a detailed discussion about current children’s health issues in Medicaid and CHIP, including updates on recent regulations, upcoming policies, and states’ implementation of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefits. Met virtually with Health Resources and Services Administration (HRSA) Associate Administrator for Health Workforce Luis Padilla, MD, and with professional staff for the White House Office of Management and Budget regarding the administration’s fiscal 2026 budget and funding for Title VIII nursing workforce development programs and the National Institute of Nursing Research.
- Issued calls to action for NAPNAP members to urge Congress to provide adequate, sustained funding in the fiscal 2025 Labor-HHS-Education appropriations bill for nursing education and workforce development, the Vaccines for Children Program, tobacco cessation programs, and research on firearms injury prevention; urging the Senate to pass the “Kids Online Safety and Privacy Act” (S. 2073) to make social media platforms responsible for preventing the targeting of context and advertising harmful to children and the collection of personal data without consent; and calling on the Senate to pass the expansion of the child tax credit in the “Tax Relief for American Families and Workers Act” (H.R. 7024).
- Joined with 25 NAPNAP chapters in signing on to a Food Research and Action Center letter urging members of Congress to strengthen and protect the Supplemental Nutrition Assistance Program (SNAP) in the 2024 Farm Bill.
Decisions on Nursing Funding Unlikely Until After Election
Congress adjourned for its August recess without completing any of the 12 annual spending bills for fiscal 2025, ensuring that lawmakers will have to pass a short-term continuing resolution next month to avoid a government shutdown and fund agencies through the November election. The House was unable to hold a floor vote on its Labor-HHS-Education bill (H.R. 9029) that would eliminate the Nursing Workforce Diversity Program and cut overall funding for nursing workforce programs under Title VIII of the Public Health Service Act by $18.34 million. Senate appropriators advanced a bipartisan Labor-HHS bill (S. 4942) that would retain the diversity program and increase education funding, but the full Senate is unlikely to vote on that measure. Aside from the diversity program, the two chambers are not far apart on Title VIII funding plans – both chambers would give a $5 million to the Nurse Education, Practice, Quality and Retention Program and retain current funding levels for the other Title VIII programs.
When lawmakers reconvene after Labor Day, leaders will have to agree on how long they should extend current agency funding. House Speaker Mike Johnson is weighing a six-month continuing resolution that would kick final negotiations on the fiscal 2025 budget into the next Congress, which could appease conservatives but put the Speaker at odds with appropriators. Johnson is looking at extending funding into March, avoiding a Christmas pileup of unfinished legislation and potentially giving Republicans more leverage over the final outcome. But House Appropriations Committee Chair Tom Cole (R-OK) and Senate and House Democrats prefer to wrap up the fiscal 2025 process during the post-election lame-duck session. Appropriators are thinking about extending funding through either Nov. 15, Dec. 6 or Dec. 13.
Back to School with CHPLC
This is your chance to learn more about policy and advocacy related to child health and advanced practice nursing. Join us on Sept. 4 for our first Child Health Policy Learning Collaborative webinar of the 2024-2025 season. The meeting will focus on immunization policy. Members of our CHPLC will receive their invitation email with registration info by Aug. 28. You will not receive the email if you have opted out of NAPNAP email communications. If you would like to join our CHPLC, email [email protected].
Senate Passes Online Protections for Kids, but House Vote Is Unclear
The Senate overwhelmingly passed the “Kids Online Safety and Privacy Act” (S. 2073) last month, merging two bill that expand online privacy and safety protections for children. The measures combines the “Kids Online Safety Act,” or KOSA, and the “Children and Teens’ Online Privacy Protection Act,” referred to as COPPA 2.0, and would require digital platforms to take “reasonable” steps to prevent harms to children such as bullying, drug addiction and sexual exploitation, and would broaden existing federal privacy protections to include kids and teens 16 years old and younger.
Proponents hope that Senate passage will amplify calls for the package to be considered in the House, where the bills have garnered bipartisan support but negotiations have unraveled over disagreements between Republican leaders. While KOSA has drawn broad bipartisan support in Congress, it has faced persistent opposition from tech industry and digital rights groups, who say it will chill speech online and force companies to collect even more data from users to comply with its obligations. Some advocates are concerned that the policies could be used to obstruct legal and essential information to young users and undermine privacy features like encryption.
Child Tax Credit Boost Stalls Amid Election-Year Debates
Senate Republicans blocked consideration of a House-passed tax package that would boost the child tax credit last month, effectively killing the bill until after the November election. The “Tax Relief for American Families and Workers Act of 2024” (H.R. 7024) would reinstate business tax credits in addition to expanding the child tax credit to reach 80 percent of the families that don’t receive the full credit because their household incomes are too low. Republicans objected that those provisions fail to impose strong enough work requirements on recipients – and some worried that the bill’s passage would be a win for politically vulnerable Democrats. The bill could be voted on again later this year, but Republicans are planning a larger bill to extend expiring Trump-era tax cuts in the next Congress.
Meanwhile, Vice President and Democratic presidential nominee Kamala Harris unveiled a set of economic policy proposals this month including provisions that would provide a $6,000 child tax credit for families within a newborn child’s first year and bring back the broader child tax credit from the 2021 pandemic relief law that applied to older kids but lapsed at the end of that year. Republican vice-presidential nominee Sen. JD Vance (R-OH) has also floated the idea of raising the credit to $5,000 per child and applying it to all families to avoid cutting out lower-income households.
NAPNAP Raises Concerns About House NIH Reform Proposal
A proposal by House Republicans to significantly restructure the National Institutes of Health requires thoughtful bipartisan examination and comprehensive public hearings, NAPNAP told leaders of the House Energy and Commerce Committee this month in response to Republicans’ “Reforming the National Institutes of Health: Framework for Discussion” released in June. The association strongly urged the panel to rescind proposed mergers of the National Institute of Nursing Research (NINR) and the National Institute of Child Health and Human Development (NICHD) with other research centers and to consider elevating the role of pediatric nursing research by providing adequate, sustained funding and by engaging pediatric nurse educators and scientists in leadership and policy development in modernizing and strengthening the National Institutes of Health.
House appropriators included provisions of the framework in their fiscal 2025 Labor-HHS-Education spending bill that would reduce the number of NIH institutes and centers from 27 to 15 and eliminate dedicated funding for NINR and NICHD, even though no hearings had been held on the plan. Senate appropriators did not include the House restructuring plan in their HHS funding bill, although Sen. Bill Cassidy (LA), the ranking Republican on the Senate Health, Education, Labor, and Pensions Committee has also called for changes to the NIH.
Supreme Court Blocks Transgender Student Protections
The Supreme Court this month temporarily continued to block Education Department rules intended to protect transgender students from discrimination based on their gender identity in several Republican states that mounted challenges. The emergency order allowed rulings by lower courts in Louisiana and Kentucky to remain in effect in about 10 states as litigation moves forward, maintaining a pause on new federal guidelines expanding protections for transgender students that had been enacted in nearly half the country on Aug. 1. The decision handed a victory to the Republican-led states that had challenged the rules. A patchwork of lower court decisions means that the rules are temporarily paused in about 26 states.
In Other News
Proposed Medicare Pay Cuts Spark Calls For Congress To Intervene
The Centers for Medicare and Medicaid Services proposed regulations last month to reduce Medicare payments to clinicians under the Part B fee schedule by 2.8 percent in 2025, reigniting calls for Congress to overrule the agency and reform Medicare payment policies. The new rule proposes no adjustment in 2025 payments to nurse practitioners, keeping reimbursements flat at their 2024 levels. The rule also proposes a new advanced primary care management bundle and extending flexibilities in supervision of telehealth services, although congressional action is needed to extend geographic and site-of-service flexibilities. The rule would also expand coverage of hepatitis B vaccines, Pre-Exposure Prophylaxis (PrEP) for HIV infection prevention, colorectal cancer screening, and caregiver training services. Public comments on the proposed rule are due by Sept. 9, with a final rule expected to be published around Nov. 1 and most provisions effective Jan. 1, 2025.
CMS Releases First Negotiated Medicare Drug Prices
The Centers for Medicare and Medicaid Services this month released the results of the first Medicare drug price negotiations, a milestone in Democrats’ longstanding quest to have the nation’s largest payer use its leverage to lower prescription drug prices. The result was a $6 billion savings across 10 drugs when new prices take effect in 2026, according to the White House, and beneficiaries could save roughly $1.5 billion in out-of-pocket costs. The first 10 drugs the Biden administration selected for negotiations cost nearly 8 million Medicare recipients $3.4 billion in out-of-pocket costs in 2022, treating common ailments like blood clots, diabetes and rarer conditions like blood cancers.
However, most of the drug companies subject to the inaugural price negotiations have sued the administration over the program in multiple federal courts in a strategy that could lead to split decisions that make it more likely that the Supreme Court will hear the issue. So far, CMS has won the suits heard in federal district courts, but that could change as cases are appealed. The lawsuits pursue a handful of constitutional arguments from claiming free speech violations to alleging the end-result prices will amount to illegal “takings” of private property for public gain without fair compensation. Drug makers argue that the Medicare market is important that it is practically impossible for them to pull out of the program to avoid price negotiations.
Feds Take Emergency Action to Ban Pesticide
For the first time in 40 years, the Environmental Protection Agency took emergency action this month to stop the use of a pesticide linked to serious health risks for fetuses. The emergency order applies to dimethyl tetrachloroterephthalate, also known as DCPA, a weedkiller used on crops such as broccoli, Brussels sprouts, cabbage and onions. When pregnant farmworkers and others are exposed to the pesticide, studies showed that their babies can experience changes to fetal thyroid hormone levels, which are linked to low birth weight, impaired brain development, decreased IQ and impaired motor skills later in life. In a statement, the EPA said, “DCPA is so dangerous that it needs to be removed from the market immediately…pregnant women who may never even know they were exposed could give birth to babies that experience irreversible lifelong health problems.”
Immunization Advocacy Resources for APRNs Caring for Children
State of the ImmUNION 2024 – presented by Vaccinate Your Family
State Laws and Requirements by Vaccine as of May 2024 and State Immunization Websites – presented by Immunize.org
Legislative Round-up, June 2024 – presented by Association of Immunization Managers
Patient-led Advocacy – presented by Voices for Vaccines
