Inside the Beltway – August 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.

August Recess: NAPNAP Policy Priorities for Advocacy at Home

Contributed by Health Policy Committee Chair Audra N. Rankin, DNP, APRN, CPNP and Co-chair Jennifer L. Helman, MSN, RN, CPNP-AC/PC

As we close out the end of summer, NAPNAP members have an exciting opportunity to connect with elected leaders in their communities during the August Congressional recess. Given the many policy changes impacting children and the nursing profession over the past few months, we must take advantage of the opportunity to advocate for a variety of health policy issues ranging from support of immunizations and nutritional programs to funding for nursing workforce and research programs. During the week of Aug. 25 – 29, NAPNAP will host a “Hill Day at Home” event that encourages members to set up meetings with their federal elected officials, attend town hall meetings, invite leaders to clinical practices and even collaborate with other pediatric health professionals in their advocacy efforts. A brief overview of our top priorities for these discussions are below.

Recent changes to the Advisory Committee on Immunization Practices (ACIP) include HHS Secretary Robert F. Kennedy, Jr.’s firing of 17 fully vetted voting members with significant medical/scientific experience and credentials and appointment of seven members critical of CDC and/or vaccines. Experts from NAPNAP and more than two dozen health care associations were barred from participating in ACIP workgroups; the administration said the change was intended to ensure ACIP workgroup activities are free from “special interest group” bias. (NAPNAP issued a statement disputing the agency’s claims of organizational bias.) As clinicians, we know ACIP’s peer-reviewed, evidence-based immunization recommendations have been critical to pediatric preventative health care. NAPNAP is closely monitoring H.R. 3701, the Family Vaccine Protection Act, which codifies the duties, procedures and authorities of ACIP and provides a framework for evidence-based protocols.

Our health policy team is also monitoring the appropriations process and asking elected leaders for continued fiscal support for immunizations, supplemental nutrition programs, Title VIII funding/programs and nursing research. Current authorization of Title VIII programs expires on Sept. 30, leaving nursing workforce programs vulnerable to consolidations and elimination. NAPNAP is asking for support H.R. 3593 and S. 1874, Title VIII Nursing Workforce Reauthorization Act to maintain these programs.

Creating awareness around the value of these programs and funding is necessary in both the U.S. House and Senate. Discussing the importance of preserved funding of immunization research and supplemental nutrition programs creates a unique opportunity to advocate with other pediatric focused health care professionals while nursing workforce and research funding create opportunities to advocate with our fellow nursing organizations. We are stronger together!

As we await the return of both chambers of Congress to Capitol Hill on Sept. 2, we can capitalize on advocacy efforts at “home” to elevate the voices of the children and communities we serve as well as the nursing profession.

Please join us as we work together to make positive policy change. Our team has developed all the resources you need to set up appointments with your federal elected leaders’ local offices, advocate for priority “asks”, write or call officials and more!

Key NAPNAP Advocacy Activities

NAPNAP issued calls to action for members to contact their U.S. senators and representatives to oppose cuts to Medicaid, nutrition, and other children’s programs in the “One Big Beautiful Bill Act” (H.R. 1) and to cosponsor and support passage of the “Title VIII Nursing Workforce Reauthorization Act of 2025” (S. 1874/H.R. 3593).
NAPNAP met with staff for the Department of Health and Human Services Office of Intergovernmental and External Affairs and the Office of the Secretary to discuss its policy priorities for children’s health and concerns about the impact of HHS reorganization, workforce reductions, and the administration’s proposed fiscal 2026 budget.
NAPNAP submitted a letter to Reps. Frank Pallone (D-NJ) and Kim Schrier (D-WA) supporting their introduction of the “Family Vaccine Protection Act” (H.R. 3701) to codify in federal statute the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices and its functions.
NAPNAP coordinated with staff for Rep. Kathy Castor (D-FL) on its endorsement of the “Keep Kids Covered Act” (H.R. 4641/S. 2496), which would provide continuous Medicaid and CHIP eligibility nationwide for children up to age 6 and for 24 months for children from ages 6 to 19.
NAPNAP participated in 35 in-person and virtual meetings with staff for House and Senate members and with Republican and Democratic committee staff regarding fiscal 2026 appropriations for nursing education and children’s health programs and support for the “Title VIII Nursing Workforce Reauthorization Act of 2025” (H.R. 3593/S. 1874).

Senate Appropriators Reject HHS Cuts, Preserve Nursing Workforce Funding

On a 26-3 bipartisan vote, the Senate Appropriations Committee approved its fiscal 2026 funding bill for the Department of Health and Human Services (HHS), ignoring President Donald Trump’s proposal to cut billions and consolidate programs. The Senate plan would preserve all current programs under Title VIII of the Public Health Service Act, providing a total of $303.47 million. Current funding levels would be maintained for all of the programs except the Nursing Workforce Diversity Program, which would see a $2 million reduction. By contrast, the president’s budget proposed to eliminate all of the Title VIII programs except for the Nurse Corps Program.

House appropriators have yet to release their version of the fiscal 2026 Labor-HHS-Education bill. Appropriations Committee Chair Tom Cole (R-OK) has said the panel plans to vote on it shortly after Congress returns from the August recess. However, there is little chance that Congress will finish all 12 annual spending bills before the Sept. 30 end of the fiscal year, meaning appropriators will have to shift to negotiating a stopgap continuing resolution to prevent a government shutdown.

Leaked MAHA Plan Calls for Vaccine Review

The Trump administration’s strategy on childhood chronic disease is expected to emphasize vaccine safety while avoiding tougher regulation of food production practices such as pesticide use, according to a draft of the Make America Healthy Again Commission recommendations leaked on Aug 15. White House officials dismissed the document as “speculative literature,” but industry representatives were privately told to expect a public release in September.

The draft directs the Department of Health and Human Service and the Domestic Policy Council to craft a framework for “ensuring America has the best childhood vaccine schedule” and addressing vaccine injuries. HHS Sec. Robert F. Kennedy Jr., echoing claims by anti-vaccine activists, has linked vaccines to chronic conditions such as autism and ADHD despite scientific evidence to the contrary. The National Institutes of Health would also expand research on alleged vaccine injuries. On infant health, the draft charges HHS, the Department of Agriculture, and the Food and Drug Administration with promoting breastfeeding, expanding access to safe donor milk, and modernizing infant formula nutrient requirements and testing standards.

Senate Confirms CDC Director, Other Nominations Await Action

The Senate confirmed Dr. Susan Monarez on July 29 as director of the Centers for Disease Control and Prevention (CDC), ending the agency’s four-month period without a leader. The 51–47 Senate vote fell along party lines. Monarez, a career government official with more than 20 years of health policy experience, is the first non-physician to lead the CDC since the early 1950s. She holds a doctorate in microbiology and immunology and previously served as deputy director of the Advanced Research Projects Agency for Health, as well as founding director of the Center for Innovation at the Health Resources and Services Administration, which supports safety-net health programs within HHS. She was President Trump’s second nominee for CDC director, following the withdrawal of former Florida Rep. Dr. Dave Weldon over concerns from key senators about his controversial views on vaccines.

Separately, the Senate Health, Education, Labor, and Pensions Committee is awaiting required paperwork from Dr. Casey Means before it can consider her nomination for surgeon general. The specific missing documents were not disclosed, but committee staff said the review cannot proceed until they are submitted. President Trump nominated Means in May after withdrawing the nomination of former Fox News contributor Janette Nesheiwat, who faced questions about misstating her academic credentials.

States Scramble After Congress Cuts Medicaid, Nutrition Funding

Nearly half of the states across the country are considering special sessions or other actions to prepare for implementing provisions of the “One Big Beautiful Bill Act” (H.R. 1) that cut nearly $1 trillion from Medicaid over 10 years and imposed new eligibility and enrollment restrictions. President Trump signed the budget reconciliation bill into law on July 4 after Republicans in both chambers of Congress set aside internal concerns to pass it. Some provisions affecting state programs went into effect immediately, while others require state action by Dec. 31. The Congressional Budget Office projected that the law will cause about 10 million people to lose health insurance by 2034, with another 5 million at risk if Congress fails to extend Affordable Care Act premium tax credits that expire at the end of 2025.

Meanwhile, congressional Republicans have floated ideas for a second bill using the budget reconciliation procedures to prevent Democrats from blocking the bill. Some conservatives are pushing for deeper cuts to Medicaid and other entitlements, while tax-writing committees have dozens of proposals that were ultimately not included in H.R. 1. However, party leaders are concerned that the approaching 2026 midterm elections could make passing a second reconciliation bill politically difficult.

White House Strengthens Control Over Research Funding

On Aug. 7, President Trump signed an executive order aimed at tightening White House control over billions of dollars in federal scientific and health research grants. The order requires agency heads to appoint a senior official responsible for creating a review process to ensure new funding opportunities align with the president’s policy agenda whenever possible. The order prohibits federal funding for research that uses race as a selection criterion, denies that sex is binary or suggests that sex can be changed, encourages or subsidizes illegal immigration, compromises public safety, or promotes “anti-American values” to be defined by agency officials.

It also addresses the administration’s ongoing dispute with universities over “indirect costs” – the administrative and facility expenses grantmaking agencies like the National Institutes of Health pay on top of direct project costs. The order states that, “all else being equal,” agencies should give preference for discretionary awards to institutions with lower indirect cost rates.

In Other News

White House Explores Funding Rescissions as Fiscal Year Ends
Last month, Congress passed the “Rescissions Act of 2025” (H.R. 4), canceling $9 billion in previously approved funding for foreign aid and public broadcasting. Now, the Trump administration is considering additional cuts to fiscal year 2025 funding that Congress had already authorized. The White House has signaled plans to send Congress a second rescission request targeting the Department of Education, an agency President Trump has vowed to dismantle. It is not yet clear how much funding would be rescinded or when the formal request will be made.

Separately, White House budget director Russ Vought has explored using “pocket rescissions” – a bid to cancel funding after Oct. 1 whether or not Congress acts on a rescission request since the 2025 fiscal year will have ended without some funds being obligated. The Government Accountability Office called “pocket rescissions” illegal, but Vought argued that Congress never amended the Impoundment Control Act to explicitly prohibit pocket rescissions. Lawmakers on both sides of the aisle are concerned that the fight could make it more difficult to advance the regular appropriations process for fiscal 2026 with just a few weeks until the deadline to avoid a shutdown.

CMS Proposed Boost in 2026 Medicare Part B Payments
The Centers for Medicare and Medicaid Services proposed a 3.8 percent pay increase for clinicians in its 2026 Part B Fee Schedule released last month, marking the first significant raise after five consecutive years of Medicare reimbursement cuts. The boost is driven largely by a 2.5 percent increase included in the “One Big Beautiful Bill Act” and would slightly outpace the projected 3.5 percent rise in the Medicare Economic Index (MEI), although physician groups continue to press Congress to tie future updates directly to MEI growth.

The proposed rule aims to curb the dramatic rise in Medicare spending on skin substitute products, which jumped from $256 million in 2019 to over $10 billion in 2024. CMS also proposes changes to how practice expenses are calculated, reflecting shifts in clinician employment trends. With more physicians working in hospital-owned settings, the agency wants to realign payments to better support office-based practices that carry their own overhead. To strengthen chronic disease and behavioral health care, the agency is introducing three new optional billing codes for services like collaborative care and behavioral health integration.

EPA Seeks to Repeal Key Greenhouse Gas Finding
The Environmental Protection Agency (EPA) last month proposed rescinding its 2009 “endangerment finding,” the legal foundation for nearly all federal regulations aimed at reducing greenhouse gas emissions. Eliminating the finding would end the agency’s regulation of greenhouse gases from all vehicles, from passenger cars to heavy-duty trucks, and weaken rules that limit emissions from power plants and control methane releases from the oil and gas industry. Speaking at a truck dealership in Indiana, EPA Administrator Lee Zeldin called the move “the largest deregulatory action in the history of the United States.”

The original endangerment finding determined that greenhouse gases threaten public health and welfare, allowing the EPA to regulate them as air pollutants under the Clean Air Act. The new proposal reinterprets the statute, claiming Congress never granted the agency the authority to regulate greenhouse gas emissions. If finalized, the change would almost certainly trigger immediate court challenges that could take years to resolve.