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.
APRNs: Voting in the Midterm Election
Contributed by Health Policy Committee Chair Jennifer Helman, DNP, MSN, RN, CPNP-AC/PC
Nov. 3, 2026, is quickly approaching, when United States citizens will have the opportunity to vote in the midterm elections. These midterm general elections have earned their name because they fall halfway through the presidential term and affect members of Congress, as well as many state governor and legislature races and local district elections. This year, the U.S. Senate will have 35 of its 100 seats up for election, each with six-year terms. All 435 seats in the House of Representatives will also be on the ballot, with members serving two-year terms. This provides a unique opportunity for voters to share their impressions of current policies, either to stay the course or to express an interest in change.
Legislative activity is greatly influenced by election results. Which political party holds a majority in the House of Representatives and the Senate for the next two years will set the national legislative agenda of what makes it through committees and to full chamber votes. A party requires 51 seats in the U.S. Senate and 218 seats in the U.S. House of Representatives to have the majority in their respective chambers. Similarly, state houses and city/county/town councils are also driven by those elected to lead.
Voter registration and turnout are also closely followed in midterm elections. According to the U.S. Census, voter registration reached an all-time high at 69.1 percent in the last midterm congressional election in 2022; however, the actual voter turnout rate was 52.5 percent (United States Census Bureau, 2024). In the 2024 presidential election, voter registration reached 73.6 percent, with voter turnout at 65.3 percent. Historically, midterm national races can bolster turnout and impact state and local elections, too. Voter registration deadlines can vary by state, with some states having deadlines even on Election Day. Check your voter registration status and encourage your colleagues to do so in order to cast a ballot on Nov. 3.
PNPs and our fellow APRNs are an important contingent of our nation’s voting population, and we must use our ballots and voices to influence policy on children’s health issues at the local, state and national levels, including local school board and city government policies, state-based programs and federal regulations. Our votes can make a difference for future child health outcomes and/or advanced nursing practice.
On the national candidate ballot, please take time to research candidates’ views on issues that impact children such as Medicaid, the Children’s Health Insurance Program, nutrition benefits, mental health services and online safety. For state and local elections, look at candidates’ positions on school health and/or school-based services, immunization policies, child care, environmental hazards and housing. If you have the opportunity to speak with a candidate, ask their thoughts on issues that are important to you, as a pediatric-focused APRN, and your patients and families. APRNs have a voice to share, and children depend on us to speak for them.
References
- United States Census Bureau. (2024, April 23). Census Bureau releases 2022 Congressional election voting report. United States Census Bureau. https://www.census.gov/newsroom/press-releases/2024/congressional-election-voting-report.html
- United States Census Bureau. (2025, April 30). 2024 presidental election voting and registration tables now available. United States Census Bureau. https://www.census.gov/newsroom/press-releases/2025/2024-presidential-election-voting-registration-tables.htmlÂ
- USA.Gov. (2026, February 12). Congressional elections and midterm elections. USA.Gov. https://www.usa.gov/midterm-elections
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Key NAPNAP Advocacy Activities
- NAPNAP submitted comments to the Office of Management and Budget on its proposed regulation, “Regulation for Federal Financial Assistance” (Docket OMB-2026-0034), urging the agency to withdraw the proposed rule and preserve a federal grant system that supports a stable, well-trained pediatric health care workforce and the research that improves outcomes for children, and warning that the rule, if finalized, would make the grant process less predictable, more susceptible to political interference, and more burdensome.
- NAPNAP submitted comments to the Centers for Medicare and Medicaid Services on the proposed rule, “Medicaid Managed Care State Directed Payments and Medicaid Fee-for-Service Targeted Medicaid Practitioner Payments” (CMS-2449-P), warning that proposed limits on provider payments would harm pediatric APRNs and the children they serve. NAPNAP also submitted comments to CMS on the interim final rule, “Community Engagement Requirement for Certain Individuals” (CMS-2454-IFC), raising concerns that it would cause children and families to lose coverage and impose unworkable requirements on pediatric APRNs.
- NAPNAP member Kristin Hittle Gigli, PhD, APRN, CPNP-AC, CCRN, participated as a panelist in a July 15 congressional briefing, “Kids’ Care At Risk: The Pediatric Workforce Shortage,” that NAPNAP sponsored with the congressional Children’s Health Care Caucus and the Children’s Hospital Association.
- NAPNAP coordinated with staff for Rep. Mike Lawler (R-NY) on its support for the “Professional Student Degree Act” (H.R. 6718), codifying and expanding the definition of “professional degrees” under the Department of Education’s student loan regulations to include post-baccalaureate nursing degrees and the advanced degrees of other health care professions.
- NAPNAP participated in discussions with the professional staff of the Senate Health, Education, Labor, and Pensions Committee on its markup of the “Title VIII Nursing Workforce Reauthorization Act of 2025” (S. 1874) and with professional staff of the House Republican and Democratic Doctors Caucuses on discussion draft legislation to reform Medicare Part B fee-for-service reimbursement and quality measures.
Executive Order Seeks to Reduce Childhood Vaccines
President Donald Trump renewed his effort to rewrite the childhood vaccine schedule on Aug. 10, signing an executive order that called for cutting the number of recommended childhood vaccines, spacing out inoculations, and making other changes that would upend decades of federal guidance. Speaking in the Oval Office, the president reiterated his long-held claim that childhood vaccines have led to a rise in U.S. autism cases, an idea that outside researchers have largely debunked. Under Trump’s plan, vaccines against 11 diseases – including measles, mumps, rubella, polio and whooping cough – would be recommended for all children, down from 18 diseases under the current schedule. His order also called for breaking up the combined measles, mumps and rubella vaccine into three separate doses, among other changes intended to space out immunizations. NAPNAP issued an official statement and joined other children’s health providers, scientists, and members of Congress in immediately opposing the plan, warning that it “could leave children vulnerable to vaccine-preventable diseases while waiting to complete the recommended immunizations and doses.”
The executive order came less than a week after the Senate confirmed Trump’s nominee to head the Centers for Disease Control and Prevention. Erica Schwartz, the deputy surgeon general in the first Trump administration and a top Coast Guard health official, was approved on a mostly party-line 51-44 vote despite concerns about her willingness to push back against anti-vaccine policies promoted by HHS Sec. Robert F. Kennedy, Jr. She is the agency’s first confirmed leader since Trump fired previous director Susan Monarez after she refused to resign amid pressure from Kennedy to change vaccine policy.
Senate Panel Advances Title VIII Funding Reauthorization
The Senate Health, Education, Labor and Pensions Committee overwhelmingly endorsed the “Title VIII Nursing Workforce Reauthorization Act of 2026” (S. 1874) last month on a 21-1 vote, sending it to the full Senate for action. The panel amended the Title VIII bill to extend the funding authorization through fiscal 2031 and added Sen. Lisa Blunt Rochester’s (D-DE) amendment to create a three-year pilot program to expand the nursing workforce center program, similar to the “National Nursing Workforce Center Act of 2025” (S. 1482). Senators also included Sen. Lisa Murkowski’s (R-AK) amendment to include a three-year, $15 million demonstration program to provide grants to supplement the salaries of eligible nursing faculty members, similar to the “Nurse Faculty Shortage Reduction Act of 2026” (S. 3707). The committee also approved the “Educating Medical Professionals and Optimizing Workforce Efficiency and Readiness (EMPOWER) for Health Act” (S. 4110), reauthorizing the Title VII health professions education programs.
Given the committee’s strong support and the bill’s bipartisan sponsorship (11 Democrats and four Republicans), the measure could be “hotlined” for a quick vote in the full Senate in September. However, the House version of the bill (H.R. 3593) remains stalled in the House Energy and Commerce Committee after its Health Subcommittee approved the measure nearly a year ago. The programs’ funding authorization expired last year, although Congress can continue to appropriate money for them.
Fate of Online Safety Bills Uncertain After Senate Committee Action
Legislation to strengthen online protections for children is gaining momentum in Congress, but disagreements on key provisions between the two chambers could still derail the measures. The Senate Commerce, Science, and Transportation Committee took the latest step on Aug. 5, advancing several measures aimed at protecting children from harmful online content. The panel approved the “Kids Online Safety Act (KOSA)” (S. 1748), which would impose a duty of care on platforms, require defaults and parental tools, and curb addictive design features. The advancement of the Senate bill represents a win for children’s advocates who have insisted on a crucial “duty of care” provision.
However, the Senate bill differs significantly from a bipartisan package of protections approved in June by the House Energy and Commerce Committee. The “Kids Internet and Digital Safety Act,” or the “KIDS Act” (H.R. 7757), a package of more than a dozen bills that includes a version of the “Kids Online Safety Act” that did not include a “duty of care” requirement that social media platforms demonstrate reasonable care to prevent harms to young users. The House passed H.R. 7757 before adjourning on a bipartisan 267-117 vote.
Administration Seeks to Tighten Rules Affecting Immigrant Children
The Trump administration is seeking to tighten two policies affecting immigrants’ access to benefits and the detention of migrant children. The Department of Homeland Security finalized its rescission of the 2022 “public charge” rule but has not yet implemented the policy change. Beginning in mid-September, immigration officers may consider receipt of any means-tested public benefits, along with health, age, income, education, family support and other factors, when deciding whether applicants for admission or permanent residence are likely to become dependent on government assistance. The change replaces the 2022 rule’s narrower focus on cash assistance and government-funded long-term institutionalization with broader case-by-case discretion. While the policy doesn’t directly affect most immigrant children’s access to benefits, advocates warn that uncertainty could discourage immigrant families, including those that are exempt from the policy, from seeking health and nutrition benefits.
Separately, HHS’s Office of Refugee Resettlement has proposed stricter screening of adults seeking to sponsor unaccompanied immigrant children. Sponsors and adult household members would face expanded identity, income and fingerprint-based background-check requirements, interviews and residence verification. The agency could also examine children for gang-related tattoos or markings when assessing dangerousness. Immigrant-rights groups fear that the requirements could disqualify otherwise suitable relatives and prolong children’s detention in federal custody.
In Other News
Lawmakers Advance Competing Government Funding Stopgaps
With campaigns for the approaching midterm elections shrinking the legislative calendar and none of the 12 annual appropriations bills completed, bipartisan majorities in both the House and the Senate approved stopgap resolutions to continue funding for most government agencies through the election and into December. However, the chambers disagreed on how long the funding patch should extend and what policies should be attached to it. Those differences will have to be resolved before the Sept. 30 end of the current fiscal year to avoid another partial government shutdown.
Before adjourning for its August recess, the Senate approved its version of the fiscal 2027 continuing resolution (H.R. 6500) that would keep federal agencies operating through Dec. 11. The agreement includes targeted funding adjustments and extensions of expiring programs, as well as temporarily blocking the implementation of a controversial proposed Office of Management and Budget grant-review policy. That plan differs from the version passed by the House in July that would extend funding through Dec. 4 and doesn’t include some of the Senate’s policy provisions.
Senate Republicans Disagree on Third Partisan Budget Bill
Lawmakers adjourned for August with the prospects for a third partisan budget reconciliation package unsettled after the Senate adjourned without taking action on a House-passed fiscal 2027 budget resolution (H. Con. Res. 113). The House proposal instructs four committees to draft a $95 billion bill that could avoid a filibuster by Senate Democrats by following strict budget reconciliation rules. House Republicans called for $73 billion in defense and intelligence spending, $12 billion for agricultural assistance, and $10 billion for election-related initiatives, but did not include any provisions for the committees with jurisdiction over health care programs. House leaders also chose not to pay for any of the increased spending with additional revenue or spending cuts.
Senate Budget Committee Chair Ron Johnson (R-WI) offered a different plan as senators raced to complete work before the August recess, but disagreements among Republicans over the package’s size, defense funding, and election provisions left them short of the votes required to proceed. Johnson’s proposal would significantly expand on the House’s package, envisioning roughly $105 billion in spending, including $20 billion for election-related measures, and issuing instructions to 11 Senate committees. However, his outline didn’t include directions for the Finance or Health, Education, Labor, and Pensions Committees, the panels with jurisdiction over health programs. Although the resolution’s instructions could accommodate as much as $150 billion in spending without offsetting savings to pay for it, Johnson said the added amount was intended to provide committees with some procedural flexibility. The proposal would require committees to draft their provisions of a reconciliation bill by Sept. 11, the same date as the House-passed version.
Head Start Reform Plan Raises Concerns
The Trump administration on Aug. 7 proposed the most sweeping change to Head Start since the program began, seeking to rescind current performance standards, expand enrollment, and shift authority to state regulators. The “Reducing Federal Burden for Head Start Programs” proposed rule would replace roughly 130 pages of regulations with about ten and redirect an estimated $2.2 billion into direct services, potentially supporting as many as 236,000 additional enrollment slots. The proposal calls for federal standards governing class size, staff-child ratios, transportation, curriculum implementation, home visits, and some staff qualifications to yield to state or local rules. It would also remove detailed requirements for health, dental, and mental-health services; require instruction primarily in English; and reduce the cap on administrative costs from 15 percent to 5 percent. New provisions would emphasize whole foods, nutrition education, and daily physical activity.
Head Start advocates and providers are concerned that the proposal could expand access by sacrificing quality. They fear that replacing national standards with uneven state licensing rules could produce larger classes, fewer comprehensive services, and weaker safeguards for vulnerable children.
Nutrition Dispute Blocks Senate Farm Bill
The Senate Agriculture, Nutrition, and Forestry Committee rejected the long-awaited farm bill on Aug. 6, stalling the effort to advance the legislation until after the August congressional recess. After haggling over Democrats’ demands for changes in the Supplemental Nutrition Assistance Program, the panel voted 10-11 against advancing it, with two key Republican members absent.
Democrats were united in demanding a two-year delay of the provisions in the One Big Beautiful Bill Act that imposed cost-sharing requirements on states based on Supplemental Nutrition Assistance Program (SNAP) benefits payment error rates. Starting in fiscal 2028, states have to cover an increasing portion of the benefits if their error rates are 6 percent or more, with states having some of the highest error rates given until 2029 or 2030 before the rule kicks in. Committee Chair John Boozman (R-AR) proposed a one-year delay to 2029 for most affected states and 2030 for states with the highest rates, as well as allowing states to use more recent years’ data. But the committee’s top-ranking Democrat, Sen. Amy Klobuchar (D-MN), said Boozman’s proposal “still advantages high error rates states over states with mid-level error rates.”
