With All Our Might...Elevating Child Health Policy

CHGME and Pediatric Research Bills Pass Committee

The 113th Congress is off to a busy start, taking swift action on a couple of kid-friendly bills.

Just nine days ago we posted about the introduction of bills in the House of Representatives to reauthorize the Children’s Hospital Graduate Medical Education (CHGME) program and authorize the National Institutes of Health to facilitate the creation of pediatric research consortia. The bills were both passed unanimously this week by the House Energy and Commerce Committee. While they still need to be passed by the FULL House of Representatives (not to mention be introduced and passed in the Senate), this quick start bodes well for children’s health care.

CHGME bill (H.R. 297) sponsors Frank Pallone (D-NJ) and Joe Pitts (R-PA) as along with Reps. Henry Waxman (D-CA) and Bob Latta (R-OH) spoke in support of the program, citing how important it is to the health care needs of children. The bill now has 24 cosponsors.

Reps. Pallone (D-NJ), Diana DeGette (D-CO) and Lois Capps (D-CA) spoke in strong support of the National Pediatric Research Network Act (NPRNA), which now has 11 cosponsors.

Committee Chairman Fred Upton (R-MI) signaled he intends to get both bills to the House floor for a vote as soon as possible. We’ll keep you posted.

In the meantime, the CHGME program still needs to be funded. President Obama’s budget will be released next month, and you still have time to send him an email urging him to fully fund the program in 2014. 

Bill to Reauthrorize CHGME and Promote Pediatric Research Introduced in House

The 113th Congress got off to a promising start as Representatives Frank Pallone (D-NJ) and Joe Pitts (R-PA) introduced legislation to reauthorize the Children’s Hospital Graduate Medical Education program (CHGME). This early start is great news for children’s hospitals and the future pediatric specialists who train there.

The bill, H.R. 297, is nearly identical to the legislation passed the House in the previous Congress. That bill ultimately died in the Senate when they could not come to agreement on certain provisions. H.R. 297 would reauthorize the program for five years (through FY 2017) and maintain the current authorization level of up to $330 million a year (though the program has received less funding in recent years).

In a statement, Congressman Pitts reaffirmed his support of the program and challenged his Senate colleagues to see it through this year:

Children in our communities are counting on this program to train a future generation of pediatricians. This is a program with proven results and it is past time that we reauthorize CHGME and provide certainty to hospitals and doctors. The bill had overwhelming support in the last Congress, and we hope that this year the Senate will take it up and send it to the President.

Representative Pallone added, “I am proud to co-introduce this important bill in the 113th Congress with Congressman Pitts to make sure we continue to prioritize and expand pediatric care and thus protect the health of our children.”

Representatives Michael Burgess (D-TX) and Lois Capps (D-CA) joined Pitts and Pallone as co-sponsors of the legislation, which will be taken up by the House Energy and Commerce Committee for a “mark-up.” This select group will discuss the bill and make any necessary changes before sending it to the House floor for a vote by all 435 members. We will keep you posted on this process, as well as any action in the Senate. In the meantime, as we mentioned last week, you’re encouraged to send a message to President Obama urging him to fund CHGME in his proposed 2014 budget.

Representative Capps scored a one-two punch as on the same day she co-sponsored CHGME legislation she also reintroduced the National Pediatric Research Network Act (NPRNA) with Rep. Cathy McMorris Rodgers (R-WA). The NPRNA (H.R. 225) unanimously passed the House last year, but like the CHGME reauthorization legislation was not completed before Congress adjourned. The legislation would authorize the National Institutes of Health to facilitate the creation of pediatric research consortia focused on pediatric diseases, with the goal of increasing research and accelerating the development of clinical trials to treat rare pediatric diseases. “This bill would go a long way to increasing, coordinating, and improving research on children’s illnesses–especially rare and complex diseases–and developing new treatments to fight them,” said Rep. Capps. “Every parent’s worst fear is that their child becomes sick, and we owe it to every parent in America to do what we can to fight childhood illnesses.”

Rep. McMorris Rodgers, whose own son has Down’s Syndrome, added “Too often, research into pediatric disorders has lagged behind research into other medical conditions. The time has come to take pediatric research to the next level, and this bill will do just that.”

We thank these legislators for their efforts on behalf of our children's health.

Budget Season Begins Again In Washington

On January 3, a new Congress (the 113th) was sworn in, and any unfinished work by the previous Congress was left on the table. Unfortunately, one of the many things left undone was reauthorization of the Children’s Hospital Graduate Medical Education (CHGME) program. This means that CHGME continues to be an “unauthorized” program, but at the same time continues to be funded. Wait, you’re thinking – how can Congress provide money to an unauthorized program?

A brief explanation - the term “authorization” is used to describe two types of laws. One is an “organic,” or “enabling,” statute, which creates a federal agency, establishes a federal program, or allows a particular federal expenditure within a program. The second type of authorization is a specific provision that authorizes the appropriation of funds (generally allowing for “discretionary spending” – funding Congress chooses to provide, as opposed to “entitlement spending,” which Congress MUST provide) to carry out the program or function established in the enabling statute. Simply put, one creates a federal program; the other ensures Congress can fund it. But once the first authorization is completed – ie, the program is created – the second one needn’t necessarily exist to continue to fund the program. Congress can weigh the merits of a program whose authorization has expired and choose to fund it based on its quality.

Applying the above to CHGME, the “enabling” statute to create CHGME was passed in 1999. The program was reauthorized (the second type of authorization above) in 2000, then again in 2006. The authorization expired in 2011, but Congress continued appropriating money because of the proven quality of the program. (This happens every year with literally hundreds of federal programs – the Congressional Budget Office releases a report of these “unauthorized” programs every January.)

Despite the lack of authorization, Congress funded CHGME –which has enjoyed broad bipartisan support since its inception - at $265 million last year. The President, on the other hand, has not been so kind to the program, recommending last year that only $88 million be provided to the program (which was at least a step up from 2011, when he recommended no funding for the program at all). We have been fortunate that Congress has not taken the President’s advice. At least not yet.

The process starts anew now – the President will release his budget at some point in February (though some reports say it will be later than usual). The President’s budget recommends to 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. But his budget is only a recommendation – federal spending is ultimately decided by Congress (though the President must sign off on it).

The President knows that, despite temporarily avoiding the fiscal cliff, cuts must be made. And they can only be made in certain areas – those “entitlement programs” mentioned above must be funded, and they take up all but 10-15 percent of the overall budget. If you’re the President and you’re trying to show fiscal responsibility, you try to trim as much of that portion of the budget as you can, which is why he has attempted to cut or eliminate CHGME funding in the past. That’s why concerned advocates for children’s health like you need to let the President know not to make the same mistake three times in a row. Take just a few minutes to send a message to the White House and urge President Obama to maintain funding for CHGME and support the program in his budget blueprint. The health of our children is worth far more than .0085 percent of the budget, yet that’s all we’re asking.

And we will need to work once again this year to get CHGME reauthorized. Even though the program can be funded in its current state, it’s always better when a program has Congress’ official seal of approval.

Congress Averts the Cliff - What Does It Mean For Kids?

Unless you’re a hardcore policy wonk, you probably don’t care too much about the backroom dealings that led to Congress’ later-than-last-minute deal to avert the “fiscal cliff,” at least not as much as you care that a deal finally got done. (Either way, you can read a fascinating day-by-day breakdown of the negotiations - or lack thereof - here.) The deal happened late on New Year’s Day, when the House passed a measure to stave off the cliff by a vote of 257-157 (172 Democrats and 85 Republicans voted for the bill). The bill – largely a product of negotiations between Vice President Biden and Senate Minority Leader Mitch McConnell - passed  the Senate on New Year’s Eve by a vote of 89-8 (five Democrats and three Republicans voted against it). President Obama has signed it into law.

The law, known as the American Taxpayer Relief Act of 2012, freezes individual income tax rates for families making less than $450,000. This was the most important (and most contentious) part of the bill for lawmakers – neither party wanted to be seen as raising taxes on lower- or middle-class families.

But besides staving off steep tax increases, what does the 154-page law do? Among many other things, it delays what is commonly called the “sequester,” a series of budget cuts totaling $1.2 trillion that were scheduled to go into effect on January 1. These cuts were primarily split between defense and domestic spending. Medicare, though not Medicaid, was also to be subject to automatic cuts. By passing the fiscal cliff bill, Congress delays sequestration for two months, giving them more time – and a new Congress – to work on the problem. This means the Children’s Hospital Graduate Medical Education program (CHGME) and other programs, like Medicare, will not be subject to any of the across-the-board spending cuts that could have happened had Congress not struck a deal, at least temporarily.

Not coincidentally, the sequester is delayed until March 1, right around the time Congress will be discussing whether or not to raise the debt ceiling. Thus, Washington pundits will talk not of the “fiscal cliff” but of “budgetary Armageddon” as Congress and the President will need to deal with the triple threat of raising the debt ceiling, sequestration cuts, and the expiration of federal spending authority.

The fiscal cliff bill also addresses a host of other tax provisions and prevents a scheduled reduction in Medicare physician payments (good news for doctors), and does not include any cuts to the Medicaid primary care payment increase for 2013 and 2014 (great news for kids).

The bad news: the fiscal cliff bill does not include reauthorization of CHGME.  Despite passage in the House and strong support in the Senate, it appears Congress will not finalize a deal. Though it’s disappointing, it’s not a surprise – the 112th Congress enacted fewer laws than any Congress since 1947 (and probably longer since 1947 was the first year Congress tracked the number of laws it passed). The program is still funded, but we’ll need to work harder than ever to get it reauthorized, as well as let the President know that he needs to support CHMGE in his proposed budget.

And we won’t have to wait long – the 113th Congress starts January 3.