FEDERAL LEGISLATIVE RESOURCES |
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U.S. Capitol, Washington, D.C. Medicaid Moratoria (April, 2008)Thirty million children depend on Medicaid, yet the Administration has issued several regulations over the past year, including the August 2007 Directive, that shift costs to the states at the time when they need help most. States estimate that these actions will result in a combined cut in Medicaid funding of nearly $50 billion over 5 years. The August 17 CMS guidance will effectively limit state SCHIP income eligibility to 250% FPL. See Georgetown University Center for Children and Families report for details on the full impact. This report finds that uninsured children have already lost out on coverage; that nearly half of states will be affected by August 2008; that the directive is already thwarting new initiatives to cover more uninsured children; and that a number of key questions about how the new directive will be implemented remain unanswered. On Wednesday, April 9 the House Energy and Commerce Health Subcommittee passed HR 5613 - the Protecting the Medicaid Safety Net Act of 2008. HR 5613 will delay implementation of these Medicaid regulations until Congress has had time to review their merit. Every Member at the mark-up voted in favor. During the mark-up, it was noted that the White House has indicated 'off the record' that President Bush will sign the bill. Now the bill must be approved by the full House and the Senate. Next week, it is expected that the full Energy & Commerce Committee will mark up the bill and that the bill will pass out of Committee in a bipartisan fashion. Additionally, on Friday, April 4 Senators Rockefeller (D-WV), Snowe (R-ME), and Kennedy (D-MA) introduced the Economic Recovery in Health Care Act of 2008 (S. 2819). Like the House companion bill, the S. 2819 would preserve access to Medicaid and SCHIP during the economic slowdown by extending the Medicaid moratoria already enacted and delaying the implementation of additional Medicaid regulations that are scheduled to go into effect in the near future. The Senate Act goes beyond the House moratoria bill and includes two additional provisions to guarantee access to care. The bill would preserve access to SCHIP for low-income children by implementing a one-year moratorium on the August 17 SCHIP guidance. Additionally, the bill would provide targeted state fiscal relief during these tenuous economic times. Now is the time to let your federal legislators know how important these issues are to children!
Economic Hardship Deferment for Residents (April, 2008)Here is the latest information on the economic hardship deferment for residents from Dr. Jennie Linebarger, Chair AAP Section on Residents: "In September 2007, the College Cost Access and Reduction Act was eliminated (effective in fall 2008). This act was important because it was responsible for the "20/220 pathway" used by 2/3 of all residents. The 20/220 pathway allowed residents to defer repayment of school loans if their debt burden was greater than 20% of their income and their income minus debt burden was not greater than 220% of the federal poverty level. Initially, the Department of Education agreed to work on a compromise to keep the 20/220 pathway intact, but they have since decided against that plan. The Senate and the House of Representatives have each passed bills which address lender transparency, consolidation, and ‘financial literacy', but have not re-instated the 20/220 pathway. The AAP and many other physician organizations sent a letter to Congress March 12, 2008, urging incorporation of the 20/220 pathway (or an equivalent) into the Higher Education Act Reauthorization due on March 31, 2008. The AAMC and the American Medical Association (AMA) (and the AAP) March 12 sent a joint letter to members of the House and Senate education committees, urging them to reinstate the debt-to-income ratio (20/220) of the economic hardship deferment in the ongoing conference of the Higher Education Act (HEA) reauthorization bills. The committees are expected to finish conferencing the bills in April following the Easter recess. The letter follows the Department of Education's announcement at the March 4-6 Negotiated Rulemaking sessions on student loans that the department intends to eliminate the 20/220 pathway in regulation after July 1, 2009 [see Washington Highlights, March 7]. The letter notes that "medical residents rely on the 20/220 pathway to help defray their high debt burden," and "Borrowers with high loan debt may be deterred from entering public health service, practicing medicine in underserved areas, starting a career in medical education or research, or practicing primary care medicine." Medical residents will be eligible for economic hardship until July 1, 2009, at which point they can enter the new income-based repayment (IBR) program. The 20/220 pathway allows medical residents to qualify for the economic hardship deferment and postpone repayment of their student loans (without penalty). Conversely, the IBR will require medical residents to make small monthly loan repayments. The economic hardship deferment has been operating under the Secretary of Education's authority after it was eliminated in statute last year by the "College Cost Reduction and Access Act of 2007" (P.L. 110-84)." Negotiators will meet again April 14 before the Department publishes draft regulations in the Federal Register for public comment. Please let your legislators know how important this issue is to those in residency programs! You can also make comment once the proposed regulations are posted for public comment prior to final approval.
Genetic Information Discrimination Act (April, 2008) Here is the latest from the AAP on the Genetic Discrimination Act. After more than a decade of congressional and advocacy efforts, the Genetic Information Discrimination Act (GINA) finally is on the verge of becoming law. The act, which would prevent insurers and employers from being able to discriminate against families and children if genetic testing shows they are at risk of getting certain diseases. The act, which would prevent insurers and employers from being able to discriminate against families and children if genetic testing shows they are at risk of getting certain diseases, has been stuck in the Senate for almost a year thanks to the blocking efforts of one senator. The legislation will prohibit insurers from dropping coverage, raising rates, or otherwise changing insurance policies on the basis of this genetic information. Employers would be prevented from firing or changing the terms or benefits of employment on the basis of this information. This legislation is vital to child health as it will allow families to take advantage of genetic tests and related technologies without risking the family's health coverage or the parent's or child's future employability. The U.S. House passed similar legislation in 2007 by a 420-3 vote. Now is the time to contact your Senators to let them know how this legislation is important to children. If you have any questions, please contact Cindy Pellegrini, AAP Department of Federal Affairs, (800) 336-5475, ext. 3307, or cpellegrini@aap.org. SCHIP Reauthorization Act of 2007 Academy members worked hard to reauthorize SCHIP in 2007. While an extension through March, 2009, with $1.6 billion in new funding resulted, a five-year reauthorization did not. The country cares about SCHIP. Continue to let Congress know the importance of this legislation to children. Legislation authorizing SCHIP, the State Children's Health Insurance Program, was enacted in 1997. SCHIP is funded jointly by the federal government and the state. Funds are allocated based on a formula and unused funds are reallocated to other states after a cetain period of time. SCHIP provides coverage to 6 million children, while Medicaid provides coverage to 28 million children. The addition of SCHIP reduced the rate of uninsured children from 23% to 15% once it was implemented. The benefits of SCHIP are many and include regular health care, improved access, and improved quality of care. There have also been positive spillover effects, such that as a result of outreach activities for SCHIP, more Medicaid eligible children were identified and enrolled in Medicaid. In addition, eligibility processes for Medicaid and SCHIP have been simplified and coordination between Medicaid and SCHIP has evolved. In Virginia, SCHIP is known as FAMIS and 90% of uninsured eligible children have been enrolled. Virginia has a "no wrong door" policy such that families can apply at the Department of Social Services (DSS), on-line, by phone, and jointly with Medicaid. FAMIS Moms is another program that covers low income pregnant women, while FAMIS Select allows families to receive $100/month/child to help pay family health insurance premiums to maintain private health insurance. Today, 9 million children remain uninsured (this is more than the number of children enrolled in 1st and 2nd grades in public education in the U.S.) and 6 million of these are presently eligible for SCHIP. For more information, see "SCHIP Achievements, Challenges and Policy Recommendations," AAP Policy Statement, March 2007 http://www.aap.org/advocacy/washing/ChildrensHealthCareCoverage.pdf Let Congress hear from you about the importance of both Medicaid and SCHIP to children's health. Call or email your representatives today and let them know what you think about these important issues. Be a Child Health Resource for Congress!The AAP will be addressing a wide variety of issues critical to children's health during the 110th Congress. The AAP will strive for the reintroduction of the Medikids Health Insurance Act, a bill which envisions a health care system that would achieve the Academy's goal of health insurance for all children regardless of family income. The State Children's Health Insurance Program (SCHIP) must be reauthorized and fully funded by Sept. 30, 2007. The Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA), both important pediatric drug research and labeling legislation, must also be renewed. See the AAP Members Only advocacy page for more information about children's health care coverage, immunizations, pediatric drugs and devices, disaster preparedness, and children's health statistics.
Campaign for Children's Health PetitionTell the administration and Congress that insuring every child in America should be a national priority. Sign the petition from the Campaign for Children's Health Care, which is supported by the American Academy of Pediatrics, and circulate to your family and friends! SIGN THE PETITION: Support the Campaign for Children's Health Care
AAP Always Has Up-to-date Information on Federal Legislative IssuesFor up-to-date information on federal legislative issues and how to communicate with your legislators, go to http://www.aap.org/advocacy/washing/chi97.htm
Election Time!Voting is one of the most important ways that you can effectively promote children's health care issues! See the websites below for more information on voting in Virginia. http://www.charlottesville.org/Index.aspx?page=100 http://www.albemarle.org/department.asp?section_id=1827&department=registrar
Federal Legislative ResourcesAAP Department of Federal Affairs The American Academy of Pediatrics maintains an excellent website which contains up to date information on federal legislative issues currently pending in Washington, D.C. Included on this website are a variety of resources for the pediatrician, including sample letters to your elected officials, how to contact your officials, and current issues and "talking points" to include in your communications. Using your zip code, you can readily identify your congressional representatives. You can also track the votes of your federal elected officials! The AAP also maintains at this site a FAAN (Federal Advocacy Action Network) network of interested pediatricians who wish to respond to federal legislative issues as they progress through the legislative process (you can join up right on this site!). This is a quick and easy way to communicate your concerns for children's health and welfare to Washington!
http://thomas.loc.gov/ This website (maintained by the Library of Congress) will allow you to find out who represents you in the Senate and the House of Representatives, and how to contact them via mail, phone, fax, or email. You may also track federal legislation from this site using a key word search or by bill number. There is also other information readily available here, such as an overview of the legislative process, as well as links to individual senator and representative websites.
Our two senators are Senator John Warner (225 Russell Building, Washington, D.C. 20510; (202) 224-2023 PHONE;(202) 224-6295 FAX; http://warner.senate.gov/) and Senator Jim Webb (204 Russell Building, Washington, D.C. 20510; (202) 224-4024 PHONE; (202) 224-5432 FAX;http://webb.senate.gov/ ).
Some other useful links:Too Close to Turn Back: Covering America's Children, Center for Children and Families, Georgetown University. This is a very readable summary of the current state of childen's health insurance coverage, the important role of Medicaid and SCHIP, and the need to continue to support these programs. The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2005. HRSA has released this new information on rural health. Data can be viewed at the state, regional, and national levels. CAHMI Data Resource Center. The Child and Adolescent Health Measurement Initiative (CAHMI) has just released national- and state-level findings from its 2005/06 National Survey of Children with Special Health Care Needs (NS-CSHCN). The provides "point and click" online access to new NS-CSHCN data on over 100 child health indicators. Users can also select and download findings for various population subgroups, including household income level, race/ethnicity, and insurance coverage. The NS-CSHCN is a national survey sponsored and designed by the federal Maternal and Child Health Bureau, and administered by the National Center for Health Statistics. The survey provides national and state-specific estimates for children with special health care needs, in combination with other information about their health, health care needs, and the quality of care CSHCN receive.
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