With All Our Might...Elevating Child Health Policy

What the President Didn't Say in the State of the Union

If you watched the president’s State of the Union speech, you may have noticed that he spent barely any time discussing health care. In a speech that lasted more than an hour, the president said only: “I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage or charge women differently from men.” He also used the health care law as an example of how he strives to work with Republicans.

With the exception of those brief mentions, the president stuck mainly to manufacturing, innovation, and defense for the bulk of his speech. In fact, Obama spent so little time on the subject of health care reform that he chose not to acknowledge a cancer patient in the audience that was invited to the speech as an example of someone with a pre-existing condition who was helped by the law.

Something else the president chose not to mention was the decision by the Office of Management and Budget to delay the release of the proposed FY 2013 budget by a week. The president’s budget, which is traditionally released on the first Monday in February, will now be released on February 13. (The president also released the budget one week late in 2011.)

From an advocacy perspective, this presents an opportunity for us. In last year’s budget proposal, the president recommended eliminating funding for the Children’s Hospitals Graduate Medical Education (CHGME) program. Congress, however, did not take the President’s suggestion and maintained funding for the program, which trains 40 percent of the pediatric workforce.

This was not an easy battle – while there is broad bipartisan support for the program, some Democrats sided with the president and said the program was unnecessary, and some Republicans were suddenly all too eager to side with the president on a budget issue. Should the president once again decide to attempt to eliminate the program, we will face this same battle in 2012.

Let’s let the president know he should not be repeating mistakes of the past. Let’s let him know that a program that trains 5,600 pediatricians per year and is less than 1/1000th of the federal budget is a sound investment. Write to President Obama today and tell him to support CHGME.

Anxiously Awaiting the President's Budget

A quick review of something you probably learned in Civics 101:

On the first Monday in February, the president releases a detailed budget request for the upcoming fiscal year, which begins on October 1. This budget request tells Congress what the President recommends for overall federal fiscal policy.

Stripping what is normally a document of several thousand pages down to the barest of essentials, the budget tells Congress how much money the federal government should spend and what they should spend it on, and how much it should take in as tax revenues. The President’s budget is only a recommendation -- federal spending is ultimately decided by Congress (though the President must sign off on it).

As you heard frequently last year, federal spending usually exceeds revenues and the resulting deficit is financed through borrowing. Since this has been going on for years, the U.S. has dug themselves a fairly sizable hole from which Congress has spent a great deal of time trying to get out.

The easiest way to decrease the deficit is obvious –- spend less money. Sounds easy enough -- simply cut various duplicative and unnecessary programs and you’ll have a manageable budget. But like everything else about the federal government, it’s more complicated. For example, roughly half of the federal budget is set aside for Medicare, Medicaid, and Social Security. Defense programs make up another 20 percent of the budget, and six percent is set aside to pay down national debt. Add in another 14 percent for “mandatory” programs such as military retirement benefits, veterans' disability benefits, and unemployment insurance and you’re left with 10-15 percent of the budget that can actually be decreased in a given year. It is this small portion of the budget that keeps Congress arguing all year, every year.

If you’re the president and you’re trying to show fiscal responsibility, you attempt to trim as much of that portion of the budget as you can. A noble goal, but it can lead to some disastrous decisions, such as when the president chose to eliminate funding for the Children’s Hospitals Graduate Medical Education (CHGME) program last year. Eliminating a program that trains 40 percent of the pediatric workforce – 5,600 pediatric specialists per year – to save .0085 percent of the $3.72 trillion federal budget did not sit well with the nation’s children’s hospitals. Last year, children’s hospitals worked hard to let Congress know that the President’s decision was short-sighted and based on faulty logic, which luckily resulted in Congress restoring the majority of CHGME funding at the eleventh hour.

Now we’re less than three weeks away from the release of the 2013 budget. It’s time to let the president know not to make the same mistake twice. Take just a few minutes to send a message to the White House and urge President Obama to maintain funding for CHGME. The health of our children is worth far more than .0085 percent of the budget, yet that’s all we’re asking.

One More Thing Congress Didn't Do This Year...

On the eve of the holiday season, Congress ended one of the most contentious congressional sessions in recent memory on a particularly non-jolly note.

We’ll leave the editorializing and punditry regarding the payroll tax holiday to the TV talking heads and tell you what all this means for our key issues, the Children's Hospital Graduate Medical Education (CHGME) program and Medicaid.

Medicaid is not in any immediate danger on the federal level. As we mentioned in the previous post, Medicaid can – and likely will – be cut on the state level when legislatures reconvene early next year. Some states, such as Florida, are already proposing massive cuts to their Medicaid programs. As more governors put out their proposed budgets, we’ll learn where the main battles lie, and will update you on ways you can help in your state.

Congress will also adjourn without reauthorizing the CHGME program. Sen. Sheldon Whitehouse (D-RI) is holding the bill back from passage as he hopes to make certain children's psychiatric hospitals eligible for the funding. While this is a snag that will have to be addressed in 2012, the news is not all bad. The President has signed an "omnibus" bill, which will cover spending on all government programs. (The word omnibus is derived from Latin meaning “for everything;” if Congress can’t reach agreement on individual spending items, they pass an omnibus to keep spending levels for all programs at the previous year’s levels.) Thus, even though CHGME hasn’t been reauthorized, it will still be funded at this year’s level of $268.4 million (minus a tiny 1/5 of 1% budget cut being applied to health programs in the omnibus.) That might not be the case in 2012 if the program is not reauthorized.

While the U.S. House may be playing politics with the payroll tax, no one is using CHGME as a political football; it’s simply a matter of crafting legislation that is acceptable to all members of Congress. The House passed their version of the bill by a unanimous vote. In 2012, we will once again urge the Senate to pass the measure and ensure that CHGME – which trains 40 percent of all pediatricians and 43 percent of all specialists – is reauthorized for five more years. Until then, we wish everyone a happy and healthy holiday season.

What's Next for Children's Health Programs?

You’ve been hearing a lot lately about what’s been going on in Congress, whether it’s the dissolution of the “supercommittee,” or reduced funding for important federal programs. Below is a quick update on how two important children’s health programs are faring.

Children’s Hospitals Graduate Medical Education (CHGME) program
In mid-October we posted a blog entry on the status of the Children’s Hospital Graduate Medical Education (CHGME) program, the only federal program that supports the training of pediatricians and pediatric specialists in children’s teaching hospitals. This vital program trains 5,600 pediatricians and pediatric specialists each year.

Unfortunately, the roadblocks that held up the program more than a month ago are still in place. The reauthorization of the program – legislation that needs to be passed to continue the program for another five years – remains held up in the Senate. The current authorization has actually expired, but the program is being kept alive by a continuing resolution through at least mid-December.

The good news is the Senate remains our only holdup. The House of Representatives has already passed their bill, and N.A.C.H. staff have heard positive feedback from Senators on the future of the program. Ideally, the Senate will pass a bill that’s identical to the House version. That would eliminate the need for the two sides to come together to work out differences in the bill which would hold it up even longer. The issue seems to be one or two Senators who, in an effort to curb what they believe to be wasteful spending by Congress, are holding up a number of bills from reaching the floor.

Senate Majority Leader, Harry Reid (D-NV), and Senate Minority Leader, Mitch McConnell (R-KY), have acknowledged the importance of CHGME, and both have urged passage of the legislation. We need to let them know just how important this program is to ensuring that our children have access to quality medical care. Without CHGME reauthorization, the shortage of pediatric doctors for kids will only become worse. Using our new Speak Now for Kids website, you can send letters to your Senators urging passage of this important legislation. But CHGME isn’t the only program that’s in danger.

Medicaid
In an effort to reduce federal spending, the so-called supercommittee was tasked with finding billions of dollars in cuts to the Federal budget. The bipartisan group of 12 legislators was unable to come to an agreement; that set in motion a “trigger” that automatically cuts $1.2 billion in cuts from defense, Medicare and dozens of other federal programs. However, safety net programs such as welfare, social security and Medicaid are exempted from ANY of these cuts.

Good news, right? On the surface, yes, but Medicaid is not out of the woods yet. Congress could still find other ways of cutting Medicaid funding before the end of the year and beyond. In addition, Medicaid can still be cut at the state level. Several states are seeing economic recovery but with the Medicaid population growing, most new funds will be diverted to cover the costs of Medicaid — unless the states attempt to scale back on the program. We need to be vigilant on both the federal and state level to ensure this important program — on which one in three children rely for their health coverage — is not cut.

Our Speak Now for Kids page is a great way to keep up with these issues AND to write your legislators and tell them to put kids first as they think about spending cuts. Remember, children don’t have lobbyists or political consultants — they’re relaying on YOU to be their voice. We can’t let them down.

Life of the Party

Last week, we proudly relaunched our Speak Now For Kids website, which features a myriad of ways to get involved with our advocacy efforts to protect Medicaid and the Children's Hospitals Graduate Medical Education program (CHGME). On our site you'll find a wealth of information about the two programs and their benefits, a quick and easy link to contact Congress and voice your concerns over the potential cuts, and our new video, which illustrates the potential danger of cutting these programs.

To kick off the relaunch of of our website we were lucky enough to be joined by 200 others concerned about proposed cuts to Medicaid and CHGME for a "Twitter party." For those unfamiliar with the term, a Twitter party is a virtual conversation using the Twitter platform. Users "tweet" with a specified hashtag (#) for the party, in this case, #dontcutkids. This allows us to connect with scores of potential new allies and advocates through social media. Amy Lupold Bair, a well-known blogger and social media expert, moderated our party and kept the conversation moving with great questions and comments. We recorded more than 3,300 tweets during our one-hour long conversation, and were the #2 trending topic on the Washington, DC area.

We were able to chat with a wonderful group of potential new advocates, all concerned about the future of kids' health care. Throughout our fast-moving conversation we relayed facts and information to the group about the importance of Medicaid and CHGME to kids. Many were surprised to learn that one out of every three kids is on Medicaid, and that half of all kids treated at children's hospitals are on Medicaid. Many were also unaware that CHGME trains 5,600 pediatric specialists a year.

More importantly, the folks that joined us told us THEIR stories, about how their kids have benefitted from children's hospitals and Medicaid. @MamaSarahJane told us "We depended on medicaid for my kids up until about a month ago, I don't know what we would have done w/out it." @zebastyandylan noted "I haven't had to use medicaid...yet. I would like to know that it is there in case I ever do." In the end, we were very happy that so many users reported they had learned some new information and would help spread our message. As @momsCAF put it, "Definitely learned some things I didn't know. Great to see mom activism at work."

We will be regularly updating Speak Now For Kids, especially as Congress works through the final months of 2011. We anticipate a great deal of legislative activity on these issues, and our website will be the best way to find out how these changes can affect your health care, your hospital and your kids.