Inside the Beltway - February 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.

Impact of Immigration Enforcement on Youth

Contributed by Health Policy Committee Member Jessica Francois, DNP, CPNP-PC

New immigration policy and increased enforcement tactics threaten to have widespread implications among the children, adolescents and communities pediatric health care providers serve. Immigrant families are most directly affected; however, all children may experience stress and anxiety as they watch enforcement activities in their neighborhoods or in the media. In addition to actions and statements on protecting health care access for immigrant children and families, NAPNAP recently published a position statement focused on child health equity that noted, “NAPNAP respects the human dignity of all people, regardless of race, background, ethnicity, religion, sexual orientation, sex, gender, gender expression, age, ability, language, economic circumstances, immigration status, or country of origin” (Carson et al., 2024).

There are 2.5 million immigrant children (documented and undocumented) in the United States, and another 5 million U.S. citizen children live with at least one undocumented family member (American Immigration Council, 2022). While these families may be most affected, the implications may extend to others in the community. The Kaiser Family Foundation completed focus groups regarding the impact of immigration policy under the last Trump administration. In addition to a decrease in families accessing public health care programs like CHIP and Medicaid, they found that families and health care providers reported negative impact from toxic stress including poor sleep, anxiety and depression (Pillai et al., 2025).

In its Providing Care for Children in Immigrant Families policy statement, the American Academy of Pediatrics (AAP) clearly outlines pediatric providers’ role in protecting the health and well-being of immigrant children including protecting sensitive areas like health institutions from immigration enforcement (Linton & Green, 2019). Since the sensitive locations policy was rescinded, families may be fearful of accessing health care facilities (National Immigration Law Center, 2025).

All pediatric providers are highly encouraged to take steps to protect their patients by ensuring there is a plan in case immigration enforcement officials enter your place of work.

Designate specific people to review warrants, engage with officials and/or answer questions, including:
- Asking for immigration officers’ credentials and contact information and making copies.
- Copying additional paperwork, including warrants.
- Understanding the difference between warrants.
  - Administrative warrant – signed by an official from ICE or federal agency, but not a judge. This warrant is NOT sufficient to grant access to private areas.
  - Judicial warrant – signed by a judge. Personnel must comply with these warrants; however, people still have the right to remain silent.
- All other staff should decline answering questions, not give out patient information (protected by HIPAA) and not grant access to private areas.

The National Immigration Law Center has updated its Health Care Providers and Immigration Enforcement: Know Your Rights, Know Your Patients’ Rights. If you work with immigrant families, you should review this resource and have a copy available in your practice.

Immigrants from around the world are essential parts of our communities, and the Administration’s new policies and enforcement actions can lead to fear and uncertainty and directly impact the physical and mental health of pediatric patients and their families. Pediatric nurse practitioners, family nurse practitioners and their fellow pediatric providers are uniquely positioned to provide their elected officials with real-life experiences and examples of how increased immigration enforcement impacts the health and well-being of children and adolescents. As a constituent, your message can raise awareness in Congress and your state capital.

References

American Immigration Council. (2022). Immigrants in the United States. https://map.americanimmigrationcouncil.org/locations/national/#
Carson, R., Tate, N., Jordan, J., & Bowen, F. (2024). NAPNAP position statement on child health equity. Journal of Pediatric Health Care, 38(6), 943-946. https://doi.org/10.1016/j.pedhc.2024.07.017
Linton, J. M. & Green, A. (2019). Providing care for children in immigrant families. Pediatrics, 144, (3), e20192077.
National Immigration Law Center. (2025, January 25). Factsheet: Trump’s rescission of 0rotected areas policies undermines safety for all. https://www.nilc.org/wp-content/uploads/2025/01/Protected-Areas-Policies-Undermines-Safety-for-All-.pdf
Pillai, A., Pillai, D., & Artiga, S. (2025, February 2). Potential impacts of mass detention and deportation efforts on the health and well-being of immigrant families. Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/potential-impacts-of-mass-detention-and-deportation-efforts-on-the-health-and-well-being-of-immigrant-families/b

Key NAPNAP Advocacy Activities

See NAPNAP President Dr. Dan Crawford’s Feb. 17 email and post to members.
Issued calls to action for NAPNAP members to contact U.S. Representatives to pass the “Kids Online Safety and Privacy Act” to strengthen online protections for children before the end of the 118th Congress’s lame-duck session and to share their opinions with U.S. Senators in the 119th Congress about individuals nominated by President Donald Trump to lead federal agencies.
Coordinated with staff for Rep. Jen Kiggans (R-VA) on reaffirming NAPNAP’s endorsement of the reintroduction of the “Providing Real-World Education and Clinical Experience by Precepting Tomorrow’s Nurses (PRECEPT Nurses) Act” (H.R. 392/S. 131) in the 119th Congress, establishing a temporary $2,000 tax credit for nurses and health care providers who serve as nurse preceptors in health professional shortage areas, and providing a quote from NAPNAP President Dr. Dan Crawford for the Congresswoman’s press release on the introduction of the bill.
Coordinated with staff for Sen. Brian Schatz (R-HI) on reaffirming NAPNAP’s endorsement of the reintroduction of the “Kids Off Social Media Act” (S. 278) in the 119th Congress, prohibiting social media platforms from knowingly allowing children under the age of 13 to create or maintain accounts and requiring them to delete existing accounts held by children and any personal data collected from child users.
Coordinated with staff for Sen. Richard Blumenthal (D-DE) and Rep. Adriano Espaillat (D-NY) on NAPNAP’s endorsement of the “Protecting Sensitive Locations Act,” codifying the Protected Areas Policy prohibiting immigration enforcement action in locations including hospitals, community health centers, and health care practitioners’ offices.
Coordinated with the American Thoracic Society on participating in amicus briefs in Kentucky v. EPA, a lawsuit challenging the Environmental Protection Agency’s authority to set tailpipe emissions standards for cars, SUVs, and light-duty trucks, and in Nebraska v. EPA, a lawsuit challenging the EPA’s authority to set tailpipe emissions standards for heavy-duty trucks and buses, focusing on the adverse health effects of exposure to air pollution for children and adolescents.

Flood of Executive Orders Follows Trump Inauguration

Within hours of taking the oath of office as the 47th President of the United States, Donald J. Trump signed more than two dozen executive orders shifting federal agency functions, overturning previous policies, and testing the limits of his constitutional authority. Four weeks into the new administration, Trump has issued more than 65 orders attempting to end diversity, equity, inclusion, and accessibility programs and policies and terminate DEI program employees, withdraw the U.S. from the World Health Organization and the Paris Agreement on climate change, and halt federal support for gender-affirming care. Federal courts have blocked several of the controversial orders.

The administration generated confusion and concern among recipients of federal grants on Jan. 27 when the Office of Management and Budget issued a memorandum imposing a temporary pause of federal grant, loan, and other financial assistance programs that might be affected by executive orders on foreign aid, nongovernmental organizations, DEI, gender ideology, or environmental policies. While the memo was withdrawn after two federal courts weighed in to block it, Medicaid programs, community health centers, and other grantees reported problems in accessing funding. The administration also imposed a temporary freeze on agencies’ communications with the public, cancelled advisory committee meetings and public appearances by officials, and scrubbed websites to remove some data sources and references to DEI and gender identity.

NAPNAP joined other leading associations in a variety of advocacy actions/events regarding the Executive Orders. For more information, read NAPNAP President Dr. Dan Crawford’s Feb. 17 post and email to members.

Senate Confirms Robert F. Kennedy, Jr. as HHS Secretary

Despite his long history of opposing widely accepted vaccines, Robert F. Kennedy, Jr. was confirmed by the Senate as Secretary of Health and Human Services on Feb. 13 on a mostly party-line 52 to 48 vote, with only former Republican leader Sen. Mitch McConnell of Kentucky joining all Senate Democrats in opposing the nomination. Kennedy’s confirmation appeared to be assured after Sen. Bill Cassidy (R-LA), a gastroenterologist who chairs the Health, Education, Labor, and Pensions Committee, endorsed the appointment after expressing concerns about Kennedy’s responses to questions on vaccine safety and his refusal to acknowledge there is no connection between immunizations and autism. In hearings before two Senate committees, Kennedy appeared to confuse aspects of Medicare and Medicaid coverage and skirt questions on abortion and reproductive rights.

With Kennedy’s confirmation, appointees to fill other key health policy posts are preparing for hearings on their nominations. Mehmet Oz, the doctor and TV personality known as Dr. Oz, has started meeting with senators to garner support for his nomination to lead the Centers for Medicare and Medicaid Services. The Finance Committee will also decide whether to favorably report his appointment to the full Senate, as well as Jay Bhattacharya to head the National Institutes of Health, Marty Makary to run the Food and Drug Administration, and former Rep. Dave Weldon to direct the Centers for Disease Control and Prevention.

In advance of and throughout the Senate hearings and confirmation process, NAPNAP has been encouraging members to contact their U.S. Senators to voice any and all concerns about nominees. The campaign is active on NAPNAP’s Advocacy Center if you would like to comment on any upcoming nominee hearings. Constituent voices have power.

Republican-led Congress Faces Deadline on Government Funding

After narrowly reelecting Rep. Mike Johnson of Louisiana as Speaker, House Republicans are a month away from another potential government shutdown and have yet to agree with their Senate counterparts on a plan to fund federal agencies for the rest of fiscal year 2025. Party leaders also have to deal with raising the federal debt limit and providing billions in disaster relief for California wildfires, all with a historically narrow majority in the House that will force party leaders to deal with Democrats. If she is confirmed as U.N. ambassador, the departure of Rep. Elise Stefanik (R-NY) will leave House Republicans with only a 217 to 215 majority for several weeks.

With the current bill funding government programs set to run out on March 14, congressional leaders have yet to agree on the overall funding allocation for defense and domestic programs – an essential first step to negotiating amounts for individual agencies and programs such as the nursing workforce development programs under Title VIII of the Public Health Service Act. Lawmakers also have to deal with authorizations for community health centers and telehealth flexibilities that will expire at the end of March unless they are extended. Members of both parties are anxious to revive a package of health policies that included Medicare payments, pharmacy benefit reforms, and extensions of substance use disorder programs that were dropped from the funding extension enacted before the Christmas holidays.

Bill to Improve Access to APRN Care Reintroduced

Legislation to remove outdated federal barriers to patients’ access to advanced practice registered nurses (APRNs) was reintroduced in the House and Senate on Feb. 13. Sens. Jeff Merkley (D-OR) and Cynthia Lummis (R-WY) filed the “Improving Care and Access to Nurses (ICAN) Act” (S. 575/H.R. 1317) in the Senate, while Reps. David Joyce (R-OH), Suzanne Bonamici (D-OR), Jen Kiggans (R-VA), Lauren Underwood (D-IL), and Mike Rogers (R-AL-3) joined in introducing the legislation in the House.

NAPNAP has strongly supported the ICAN Act to improve access to health care for Medicare and Medicaid patients and to modernize the programs by removing barriers to practice for nurse practitioners (NPs) and other APRNs. The bill includes provisions to authorize NPs to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, fully include NPs’ patients in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, and certify and recertify a patient’s terminal illness for hospice eligibility.

Member advocates can use our Advocacy Center pre-formatted campaign to share their support for ICAN to their Congressional leaders. It only takes a few minutes.

Medicaid Faces Massive Cuts, Changes in Looming Tax and Budget Debate

Republican congressional leaders are trying to reach agreement on a budget blueprint that will set the spending and savings targets for massive legislation to implement President Trump’s tax, border security, and energy agenda, with Medicaid, nutrition, and other benefit programs likely to face fundamental policy changes that could reduce federal support by hundreds of billions of dollars. The House Budget Committee approved a fiscal 2025 budget resolution on Feb. 13 that envisions a single all-encompassing reconciliation bill, a day after Senate budget writers endorsed a resolution that outlined spending and savings targets for an initial bill on defense, energy, and immigration policies, with a separate bill to extend expiring tax cuts coming later.

Leaders are looking to dramatically cut current spending to help pay for extending tax cuts and funding defense and border security priorities and – despite the President’s statement that Republicans would “love and cherish” Social Security, Medicare, and Medicaid – House budget writers targeted more than $880 billion in Medicaid cuts over ten years. The list of policy options included converting the current Medicaid entitlement to a capped amount of funding based on a state’s enrollment, eliminating enhanced funding for expanded Medicaid coverage, and limiting the ability of states to fund their share of Medicaid costs through taxes on providers. Those ideas and others will be debated by House and Senate committees after a final budget resolution is passed by both chambers.

Preceptor Tax Credit Bill Has Bipartisan Support

Legislation that would establish a federal tax credit for nurse preceptors has been reintroduced in Congress, with the hope that it will be included in the expected budget reconciliation bill. Reps. Jen Kiggans (R-VA), Jim Costa (D-CA), Claudia Tenney (R-NY), and David Joyce (R-PA) joined Sens. Mark Kelly (D-AZ) and Marsha Blackburn (R-TN) in introducing the “Providing Real-World Education and Clinical Experience by Precepting Tomorrow’s Nurses Act,” or the “PRECEPT Nurses Act” (H.R. 392/S. 131), creating a temporary $2,000-a-year federal tax credit for nurses and health care providers who serve as nurse preceptors in health professional shortage areas for at least 200 hours during a tax year from 2026 through 2032. The sponsors of the bill hope to include it as part of the legislation that will extend a host of tax cuts currently set to expire at the end of the year.

In Other News

Preventive Services Case Poised for Supreme Court Hearing
The fate of the Affordable Care Act’s requirement that insurers provide cost-free coverage of screenings and other services deemed appropriate by the U.S. Preventive Services Task Force now rests with the Supreme Court, which agreed last month to the Justice Department’s request that it review a circuit court decision that put the mandate in question. The Biden administration petitioned the high court to review the Fifth Circuit Court of Appeal’s ruling in Becerra v. Braidwood Management that found the structure of the task force violates the constitution’s Appointments Clause as well as the court’s refusal to fix the problem by severing language from the statute.

The court did not take up the Braidwood plaintiffs’ petition to review a lower court ruling that rejected their claim that the ACA requirements to cover vaccines recommended by the CDC Advisory Committee on Immunization Practices or women’s health services endorsed by the Health Resources and Services Administration also violate the Constitution’s Delegations Clause. The case is likely to be set for oral arguments this spring, with a decision by July. However, it is unclear if the Trump administration’s Justice Department will pursue the appeal or whether the case could still be remanded back to a district court for further review.

Trump Challenges Birthright Citizenship in Immigration Crackdown
A second federal judge this month blocked President Trump’s effort to end birthright citizenship for the children of parents who are in the U.S. illegally, decrying what he described as the administration’s attempt to ignore the Constitution for political gain. A Seattle district judge put Trump’s order on hold for the duration of lawsuits brought by four states and an immigrant rights group challenging it. That ruling followed one by a Maryland federal judge in a separate but similar case involving immigrants’ rights groups and pregnant women whose soon-to-be-born children could be affected.

Health care providers and other professionals are concerned about the impact of Trump’s executive order revoking a Biden-era policy that prohibited U.S. immigration agents from making arrests at or near health care facilities, schools, places of worship, and other places deemed to be “sensitive locations.” In a statement defending the termination of the policy, the Department of Homeland Security said the Trump administration “will not tie the hands of our brave law enforcement and instead trusts them to use common sense.” Immigrant advocates are worried that revocation of the rules will allow authorities to implement mass deportation plans in clinics and hospitals, as well as schools and churches.