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.
The Need for Clean Water Advocacy Continues
Contributed by Health Policy Committee Members Jennifer F. Flippo, DNP, CPNP-PC, PMHS, CNEcl and Sacheen Harris, CPNP-PC
Access to clean drinking water remains a critical health issue for many children across the United States, particularly within Native American, border, migrant and economically disadvantaged communities. Native American communities, for example, face significant water access challenges, with nearly half of households on reservations lacking adequate water services1. Border communities along the U.S.-Mexico border have been impacted by industrial pollution and agricultural runoff, which contribute to water contamination2.
Fifty years ago, Congress passed the Clean Water Act (CWA) to regulate pollutants and monitor quality and integrity of drinking water. Shortly after the CWA was signed, the Safe Drinking Water Act of 1974 was passed to protect drinking water and its sources from contamination. Amendments in the 1980s and 1990s established standards for drinking water from sources such as lakes, springs and groundwater wells.
The Environmental Protection Agency (EPA) is charged with ensuring safe drinking water for all residents, yet some families have no access to water at all, regardless of quality. Rural and tribal communities are often geographically distant from sources of water, and their small populations do not always gain much needed attention from legislators. The Tribal Access to Clean Water bill introduced to the Senate in 2023 has not seen further activity after its referral to the Bureau of Indian Affairs.
Migrant communities, particularly those in agricultural areas, face additional barriers to safe drinking water due to exposure to pesticide runoff and limited access to sanitary facilities3. These communities suffer disproportionately from inadequate infrastructure and environmental hazards, which put children at risk of waterborne illnesses and chronic health issues. The Clean Water Act has not provided the protection rural and marginalized areas require to ensure potable water for their residents.
Low-income areas have experienced severe water crises affecting thousands of children and causing long-term developmental and behavioral health issues4. In 2014, the city of Flint, Mich. changed its municipal water source as a cost-saving measure, causing distribution pipes to leach lead, bacteria and other contaminants into the community water supply. From 2013 to 2015, the incidence of elevated blood lead levels in children nearly doubled5. Residents complained about the taste, smell and appearance of the water, but it wasn’t until 2016 that the Flint water crisis was declared a state of emergency. This crisis exposed how financially-driven decisions can negatively impact vulnerable populations and thrust the topic of children’s access to clean water into the national spotlight.
Ensuring safe water access for all children requires a concerted effort to improve infrastructure, enforce water safety regulations, and prioritize resources for vulnerable communities.
References:
1 U.S. Water Alliance. (2019). Closing the Water Access Gap in the United States: A National Action Plan.
2 Environmental Protection Agency & Border Environment Cooperation Commission. (2020). Health and Environmental Risks on the Border.
3 National Center for Farmworker Health. (2020). Water and Sanitation Challenges for Migrant Communities.
ICYMI – Watch CHPLC Archives
Our Dec. 4 CHPLC session featuring Dr. Mona Hanna discussing Rx Kids, the nation’s first citywide maternal and infant cash prescription program aiming to strengthen family economic security and improve health outcomes, is now available on our CHPLC archive webpage along with other great advocacy webinars hosted by NAPNAP and featuring guest speakers from leading organizations.
NAPNAP’s Key Advocacy Activities
- Coordinated with staff for Rep. Jerry Nadler (D-NY) Oct. 2 on NAPNAP’s endorsement of the “Children’s Health Protection Act of 2024” (H.R. 9982), permanently authorizing the Office of Children’s Health Protection and the Children’s Health Protection Advisory Committee within the Environmental Protection Agency, providing a quote from NAPNAP President Dr. Daniel Crawford for the Congressman’s press release on the introduction of the bill.
- Coordinated the sign-on of 13 NAPNAP chapters to an Oct. 18 Children’s Health Group letter to bipartisan Senate leaders and the chair and ranking member of the Senate Finance Committee urging them to pass the “Protecting America’s Children by Strengthening Families Act” (H.R. 9076), reauthorizing and reforming federal child welfare programs under Title IV-B of the Social Security Act and expanding its emphasis on primary prevention.
- Met virtually Nov. 12 with the Director of Strategic Partnerships in the Department of Health and Human Services Office of Intergovernmental and External Affairs to discuss opportunities for NAPNAP to collaborate with the department on maternal mortality, infant health, and pediatric nursing education and practice issues.
- Met with Senate Finance Committee Democratic professional staff Nov. 14 to discuss opportunities for NAPNAP to support efforts to address children’s health issues in the lame duck session of Congress and ideas for legislation within the committee’s jurisdiction to strengthen and expand the pediatric nursing workforce.
- Issued updated calls to action Nov. 19 encouraging NAPNAP members to urge members of Congress to pass a full-year fiscal 2025 appropriations agreement funding nursing education and workforce development, the Vaccines for Children Program, and other priorities, and to pass the “Kids Online Safety and Privacy Act” to strengthen online protections for children in the year-end lame duck session.
- NAPNAP Executive Director James Wendorf, President Dr. Daniel Crawford, and President-elect Dr. Felicia Bowen met virtually with NAPNAP staff Nov. 25 to discuss how the association should prepare to respond to policy issues and concerns that could arise under the incoming Trump administration and the 119th Congress.
Republicans Sweep Election, Altering Health Policy Agenda
Republicans’ sweeping victories in the Nov. 5 election returned Donald J. Trump to the White House, flipped majority control of the Senate and shifted the policy environment in Washington, DC. The president-elect swiftly nominated a slate of nominations. Decisions on confirming the nominees will fall to the Republican-majority Senate in the 119th Congress, led by South Dakota Sen. John Thune, who was chosen by his colleagues to succeed long-time Senate Republican leader Mitch McConnell of Kentucky. House Republicans retained a historically narrow majority and nominated current Speaker Mike Johnson of Louisiana to retain the gavel, while high-level Democratic leadership in both chambers will be largely the same as in the 118th Congress. Leadership of Senate committees will flip to Republican control in January, while retirements and election losses will result in new chairs for key committees overseeing nursing priorities – notably, Kentucky Rep. Brett Guthrie succeeding the retiring Cathy McMorris Rodgers of Washington as chair of the House Energy and Commerce Committee, which has jurisdiction over Medicaid, the Children’s Health Insurance Program, nursing workforce programs under Title VIII of the Public Health Service Act, and a host of children’s health programs.
Lame Duck Congress Balks on Government Funding Deal
The November election results dissipated any energy for congressional budget-writers to negotiate a full-year appropriations agreement for fiscal 2025 during the short post-election lame duck session, leaving congressional leaders to pursue another short-term extension of current funding and putting final decisions in the hands of the incoming Republican Congress and White House. The stopgap funding will limit the ability of nursing students and schools to know how programs, grants, and scholarships will be funded, and it is virtually certain to push the Trump administration to delay the release of its proposed budget for fiscal 2026, scheduled to be delivered to Congress in February. Talks on final fiscal 2025 spending could also interfere with Republicans’ plans to pass a massive reconciliation bill on tax cuts, border security, defense policies, and energy production in the first 100 days of the new Trump administration.
The 118th Congress will leave behind fiscal 2025 proposals from the House that would have cut Title VIII nursing programs by $18 million and eliminated the Nursing Workforce Diversity Program and the Senate’s proposal to increase Title VIII funds by $5 million. It is unclear how much weight those proposals will have in the new Congress or how the differences will be resolved.
Lawmakers Struggle to Agree on Year-End Health Priorities
After weeks of relative inaction, congressional leaders launched post-election negotiations on a year-end package of health policies that could be attached to a stopgap spending deal. Despite some areas of bipartisan agreement, the competing proposals included significant differences to resolve with very little negotiating time, increasing the odds of a narrow, three-month extension of a few high-priority policies being linked to the bill extending government funding.
Republicans began December by proposing a three-year extension of expiring Medicare telehealth rules, offsetting proposed cuts in 2025 Medicare Part B fee schedule payments with a 2.5 percent increase, flat funding for federally qualified health centers, and full reauthorizations of the opioid and substance use disorder programs and flat funding for federally qualified health centers. The offer would require greater transparency in the practices of pharmacy benefit managers, including “delinking” the PBM payments from the list price of drugs, and it would be partially paid for by repealing the Biden-era rule to increase nursing home staffing.
Days later, Democrats responded by offering a two-year Medicare telehealth extension, extending funding for safety-net hospitals, increasing community health center funding over two years, and extending the Affordable Care Act’s enhanced premium tax credits due to expire at the end of 2025. The offer included $5 billion to boost Medicare Part B provider payments and PBM reforms similar to but more extensive than the Republicans’ plan.
Supreme Court Hears Arguments on Transgender Ban, E-Cigarette Regulation
Supreme Court justices heard oral arguments in December on two of the most significant health care cases on its current docket in challenges to the federal government’s regulation of e-cigarettes and state restrictions on gender-affirming care.
Transgender rights advocates seeking to overturn a Tennessee law banning some gender-affirming care for minors got a mostly chilly reception on Dec. 4 when most of the court’s conservative majority seemed inclined to leave in place a lower court ruling in U.S. v. Skrmetti that upheld the state’s ban on hormone treatments and puberty blockers. Chief Justice John Roberts and Justices Clarence Thomas, Samuel Alito, and Brett Kavanaugh all appeared to favor upholding an appeals court decision that concluded the Tennessee law does not discriminate based on sex because it bans both those born male and those born female from receiving drug therapies intended to support a transition to a different gender. Opponents of the Tennessee law contended that denying certain medicines to adolescents based on their sex amounted to discrimination. The outcome of the case could affect 23 other states that have passed laws restricting gender-affirming care.
Two days earlier, justices appeared unsympathetic to a challenge from the maker of flavored e-cigarette products to a Food and Drug Administration decision denying authorization to bring them to market. Texas-based Triton Distribution argued in FDA v. Wages and White Lion Investments that the court should affirm a lower court’s ruling that the agency should reconsider its applications to sell flavored liquids containing nicotine that e-cigarettes heat for a user to inhale. The FDA denied Triton’s applications to sell the flavored e-liquids out of concern that they appeal to children. Conservatives on the court questioned whether there would be any point in asking the agency to reconsider its decision and implied that the manufacturer would do better to reapply for approval from the Trump administration’s FDA.
Separately, the justices last month rejected a tobacco industry appeal and refused to block a new federal rule that will require cigarette packages to carry graphic new warnings about the health dangers of smoking. The federal 5th Circuit Court of Appeals decision in R.J. Reynolds v. FDA that said the warnings, which include prominent images of people with cancer and lung disease, do not violate the free-speech rights of cigarette makers. The FDA said it plans to begin enforcement starting in December 2025.
Hopes Dim for Passage of Kids Online Safety Bill
Appeals for the House to pass the bipartisan “Kids Online Safety Act” (KOSA) in the waning days of the 118th Congress appear to be falling on deaf ears with Republican leaders. House Speaker Mike Johnson confirmed last week that KOSA is unlikely to come to the floor or end up in an end-of-year spending bill, telling reporters, “I think we can do it early next year and get that achievement done,” and adding the law needs more tweaking to avoid opening the door for free speech violations. Rep. Kathy Castor (D-FL), who co-sponsored the bill, conceded that changes made to garner Trump adviser Elon Musk’s endorsement had not changed House leaders’ position.
KOSA, which requires social media companies to ensure their platform’s features are safe for children, passed the Senate on an overwhelming 91 to 3 but stalled in the House when Johnson and Majority Leader Steve Scalise refused to schedule a floor vote. Two of the bill’s lead sponsors, Sen. Marsha Blackburn (R-TN) and Rep. Gus Bilirakis (R-FL), hoped that support from Musk and Donald Trump Jr. for a new “X negotiated” version of KOSA would boost the chance for a House vote.
In Other News
Regulators Agree to Extend Teleprescribing Policies
Bowing to backlash from health care providers, the Drug Enforcement Administration released regulations last month extending telemedicine prescribing of controlled substances flexibilities through 2025. However, it will be difficult for the DEA to finalize a permanent special registration solution for telemedicine prescribing of controlled substances under the one-year extension. It will take time for the incoming Trump administration to properly staff the DEA, HHS, and other agencies that would work on a permanent telemedicine prescribing solution and to go through the process of crafting and finalizing a permanent solution.
Despite the uncertain future, telehealth stakeholders welcomed the agency’s decision to extend pandemic-era flexibilities for another year. Telemedicine prescribing flexibilities have been the subject of intense lobbying in recent months amid reports that the DEA was planning to propose a strict registration system that would essentially eliminate telehealth access to certain controlled substances. More than 300 telemedicine stakeholders sent congressional leadership and the White House letters calling for a two-year extension of DEA telemedicine flexibilities while a permanent solution could be worked out, although Congress appears likely to approve a much shorter extension.
Republicans Plot Using Budget Procedures to Pass Sweeping Policy Changes
Republicans’ sweep of the White House and Congress in the November election created a “trifecta” majority that will enable the new administration and lawmakers to use the parliamentary procedure known as “reconciliation” to advance one or more massive budget bills without the threat of a Democratic filibuster in the Senate. However, disagreements between House and Senate leaders on the best strategy, accompanied by relative silences from the incoming administration, has hampered plans for the next Congress to move quickly on a bill in January.
Incoming Senate Majority Leader John Thune proposed a two-part reconciliation strategy, with a first bill moving quickly in January focused on immigration, defense, and energy policies, followed by a second tax reconciliation bill centered on extending the 2017 tax cuts adopted in the first Trump administration and expiring at the end of next year, as well as other tax reforms. House leaders were quick to reject the two-bill strategy, pointing to the extremely narrow House majority and the difficulty of passing even one reconciliation bill. The two chambers’ leaders are under pressure to work with the Trump White House and agree on a plan by the time the 119th Congress convenes in January.
To activate the reconciliation process, Republicans will first have to pass a budget resolution for fiscal 2025 that includes instructions to House and Senate committees on how much they need to cut spending or increase revenue in order to comply with the budget. While the budget resolution is non-binding, the committees will draft specific policy proposals to meet the instructions, potentially including massive changes in Medicaid funding and eligibility along with other policy reforms.
FDA Makes Last-Ditch Move to Cut Nicotine in Cigarettes
The Food and Drug Administration is seeking White House approval in the final days of the Biden administration to require a drastic reduction in the amount of nicotine in cigarettes, a longstanding goal of public health experts that has faced stiff opposition from the powerful tobacco lobby. The FDA submitted the proposed regulations to the Office of Management and Budget last week, a sign that the move was perhaps more symbolic than realistic for a White House juggling late-term agenda items. It will likely be up to the incoming Trump administration to decide whether to finalize the rule, given sustained opposition from the tobacco industry.
While details of the proposal were not released, the agency said in a statement, “A proposed product standard to establish a maximum nicotine level to reduce the addictiveness of cigarettes and certain combusted tobacco products, when finalized, would be among the most impactful population-level actions in the history of U.S. tobacco product regulation.”
The FDA will also begin enforcing a new rule in a year from now that requires graphic warnings to cover the top half of the front and back of cigarette packs and at least 20 percent of cigarette advertisements. The Supreme Court declined to hear a tobacco industry challenge to the rule, clearing the way for the implementation of image-based warnings to show the health impacts of smoking.
