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.
Where We are with MAHA
Contributed by Health Policy Committee Member Allison Grady, DNP, MSN, APNP, PPCNP-BC
Since confirmation, Robert F. Kennedy, Jr. has worked quickly to influence the direction of health care in Americans. One of the first major releases from the Department of Health and Human Services (HHS) under Mr. Kennedy came in May of 2025 with the Make America Healthy Again (MAHA) Assessment. Known simply as the “MAHA Report,” the paper seeks to identify a root cause in the rise of chronic conditions in children but pointedly does not provide concrete actions or suggestions to achieve their goals. The report names ultra-processed foods, the cumulative load of chemical exposures, the decline of physical activity in children and the rise of mental health conditions, and the “overmedicalization” of children as possible culprits for changes in kids’ health.
The report recognizes that, compared to previous generations, children today experience more obesity, autoimmune diseases, food allergies and autism diagnoses. It suggests that changes to our food supply and easy availability and consumption of ultra-processed foods are causes for these complex health conditions. Further, the report also identifies flaws in the Dietary Guidelines for Americans which SNAP and the National School Lunch Program use for setting guidelines and standards.
The report’s section on chemical exposure details the increasing rates of conditions such as childhood cancer and behavioral disturbances and links them to chemicals found in toxic waste, pesticides, and other persistent organic pollutants (POPs) and its unique effects on fetuses and developing brains and endocrine and nervous systems. In addressing the recreational life of children, the report looks at the decline of physical activity, especially outdoor activity, the increase in screens for both learning and entertainment, and its effects on sleep and stress.
Perhaps the most concerning part of the report characterizes the “overmedicalization” of children. The authors point to increases in stimulant, antidepressant, antipsychotic, antibiotic and asthma prescriptions over a 30-year period. For each class of drug discussed, the authors provide citations about potential harm despite years of widely accepted published research that demonstrates safety and efficacy and provider practice improvements in curbing unnecessary treatments. The report also highlights vaccinations, alleging the U.S. has more vaccines than any other comparable country and that the number of vaccinations from in utero exposure to age one has increased exponentially, without noting the incredible decline in and/or eradication of infectious diseases due in large part to vaccine development and administration during the last 50+ years.
The fact that children’s health was at the heart of the first major policy report issued by HHS during this administration demonstrates an interest in improving and sustaining children’s health. To date, HHS has implemented numerous policy and infrastructure changes that challenge this commitment.
In September, HHS released the MAHA Strategy which reiterated the same claims and added several other areas for consideration and/or investigation. While the strategy document contains valuable points that align with pediatric health care experts’ priorities and concerns, the lack of widely accepted, evidence-based data to drive thoughtful decision-making and action plans is deeply concerning to pediatric health care leaders across the country. NAPNAP’s policy leadership team has evaluated the strategy and will be monitoring HHS’ actions to determine how to best advocate on behalf of children’s health and advance practice nursing. Please continue to read NAPNAP communications and follow our weekly video updates from Dr. Audra Rankin on NAPNAP’s social media accounts to learn more.
Key NAPNAP Advocacy Activities
- NAPNAP issued a call to action for members to contact their U.S. senators and representatives to urge them to support the highest possible fiscal 2026 funding for all of the Title VIII Nursing Workforce Development Programs and the National Institute of Nursing Research.
- NAPNAP and 13 chapters joined the Alliance of Nurses for Healthy Environments, the American Thoracic Society, and the Medical Society Consortium on Climate Change and Health to submit comments to the Environmental Protection Agency opposing the proposed rule, “Reconsideration of 2009 Endangerment Finding and Greenhouse Gas Vehicle Standards.”
- NAPNAP member Cynthia Chew, DNP, CPNP-PC, IBCLC, CHSE, participated in the Reagan-Udall Foundation for the Food and Drug Administration’s roundtable on information and data to support clinical decision-making, communication, and policies related to infant formula.
- NAPNAP submitted comments to the Centers for Medicare and Medicaid Services on the proposed rule, “CY 2026 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment and Coverage Policies.”
- NAPNAP joined representatives of other national nursing organizations in negotiating with professional staff of the House Energy and Commerce Committee on changes to Title VIII of the Public Health Service Act as part of the “Title VIII Nursing Workforce Reauthorization Act of 2025” (H.R. 3593/S. 1874).
Congratulations!
NAPNAP applauds the efforts of member Robyn Lao DNP, CPNP-AC who worked with state legislators to have the ADDE Bill (SB 68) introduced, passed and signed into law in California on Oct. 13. Named after nine-year-old Addie Lao, the ADDE Act aims to prevent allergic reactions by making it easier for diners to make safe food choices. Robyn rallied individuals and organizations to advocate in support of the bill, which had direct impact for her family. The opposition was well-funded by restaurants and businesses but Robyn and team prevailed.
Health Policy Dispute Shuts Down Federal Government
A partisan debate over extending tax credits to lower premiums for consumers purchasing health coverage on Affordable Care Act marketplaces has become the principal stumbling block in a standoff on funding federal agencies and programs. The first government shutdown in six years is set to extend into a third week, with tens of thousands of federal employees furloughed without pay, facing the threat of permanent layoff and potentially not receiving back pay once departments reopen. More than 32,000 Department of Health and Human Services employees were furloughed, with the Centers for Disease Control and Prevention laying off more than 60 percent of its workforce, postponing a scheduled meeting of the Advisory Committee on Immunization Practices, and curtailing many routine functions.
House Republicans narrowly passed their “Continuing Appropriations and Extensions Act, 2026” (H.R. 5371), which would extend current agency funding through Nov. 21, on a largely party-line vote last month. But hours later, the Senate rejected a Democrat-led alternative, the “Continuing Appropriations and Extensions and Other Matters Act, 2026” (S.2882), that would have kept the government open through Oct. 31 and permanently extending the ACA premium tax credits, as well as repealing Medicaid cuts adopted in the “One Big, Beautiful Bill Act” (H.R. 1). There has been no meaningful movement toward a bipartisan agreement to reopen the government since then, with senators repeatedly voting down the same two proposals.
Shutdown Slows Talks On Fiscal 2026 Appropriations
The government shutdown has complicated efforts by House and Senate appropriators to reach an agreement on full-year spending bills for fiscal 2026, including the Department of Health and Human Services’ nursing workforce and research programs. While progress has been made on some of the 12 annual appropriations bills, there has been little sign of movement on the Labor-HHS-Education measure.
House appropriators advanced a $108 billion HHS budget bill (H.R. 5304) in September, cutting the agency’s funding by 6 percent overall and completely eliminating the Nursing Workforce Diversity Program and the Nurse Faculty Loan Program under Title VIII of the Public Health Service Act. The House bill would reduce overall Title VIII funding by $46.84 million, to $258.63 million, providing a $5 million increase for the Nurse Education, Practice, Quality, and Retention Program and adding $1 million to the Nurse Practitioner Optional Fellowship Program.
Earlier this summer, Senate budget writers approved a Labor-HHS-Education funding bill (S. 2587) that retained all of the current Title VIII programs, reducing funding for the Nursing Workforce Diversity Program by $2 million. Both spending committees retained the National Institute of Nursing Research at its current funding level of $197.69 million.
States Rush for Rural Health Transformation Money
The Trump administration kicked off a scramble among the 50 states for a slice of a new $50 billion fund for rural health care. However, experts fear that its rushed timeline, lack of guardrails, and potential for politicization will leave some hospitals struggling to stay open. States have until Nov. 5 to submit detailed applications for the fund, which Congress created late in its negotiations over a bill this summer that made deep cuts to Medicaid and other health programs.
After the application window closes, half of the fund will be dispensed at the discretion of Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz, while the other half will be divided equally among states that apply – meaning Wyoming would get the same amount as California despite their massive population difference. States have no ability to appeal if their applications are rejected or they receive less money than they requested. Oz also said the federal government can “claw back” funding from states that “don’t perform” and redistribute it.
In Other News
CDC Director Fired Amid Vaccine Policy Changes
The Centers for Disease Control and Prevention accepted a recommendation of its vaccine advisory panel that children should receive chickenpox inoculations as a standalone vaccination, rather than in combination with MMR vaccines. Members of the Advisory Committee on Immunization Practices pointed to links between the MMRV vaccine and febrile seizures as the reason to remove the recommendation from the schedule. The CDC also accepted the panel’s recommendation that people 6 months and older receive COVID vaccinations after consultation with a physician, pharmacist, or nurse, but stopped short of requiring a prescription.
The advisory committee’s chaotic September meeting followed the firing of recently confirmed CDC Director Susan Monarez, who told a Senate committee that dismissal resulted from her refusal to follow directives from HHS Sec. Robert F. Kennedy, Jr., regarding vaccine policies and the firing of CDC personnel.
Diversity Dispute Threatens Nursing Workforce Programs
After winning bipartisan support in a House subcommittee, legislation to authorize funding for nursing workforce programs encountered problems last month due to concerns that the statutory language for a diversity program is inconsistent with the Trump administration’s priorities. The House Energy and Commerce Health Subcommittee approved the “Title VIII Nursing Workforce Reauthorization Act of 2025” (H.R. 3593/S. 1874) on a voice vote last month. However, Republicans at the full committee raised concerns about the current statutory authorization for the Nursing Workforce Diversity Program.
NAPNAP and other national nursing organizations are working with the committee’s majority and minority staff to resolve those concerns. The Senate Health, Education, Labor, and Pensions Committee has yet to consider its version of the bill. The funding authorization for the Title VIII programs lapsed on Oct. 1, potentially making the programs more vulnerable to consolidation or elimination.
Conversion Therapy Case Opens Supreme Court Term
The U.S. Supreme Court opened a new term this month that could be hugely consequential, addressing critical questions about the extent of power the Constitution grants to the president. Among the issues on the court’s docket are cases that could end what’s left of the landmark Voting Rights Act, do away with a law that limits campaign fundraising, challenge President Trump’s authority to levy tariffs, and test his authority to fire independent agency commissioners.
In one of the first significant cases of its new term, the court appeared to be deeply skeptical about a Colorado law banning conversion therapy for gay and transgender minors, suggesting the justices may overturn the statute and similar restrictions in nearly 30 states. A majority of the court appeared sympathetic during oral arguments to an evangelical therapist whose attorney argued that the state ban infringes on the therapist’s free-speech rights to counsel religious teens dealing with their sexual orientation and gender dysphoria in ways she says are consistent with biblical teachings on identity.
