Skip to Main Content
Skip Nav Destination
Capitol building

What federal appropriations process means for child health

September 1, 2023

Lawmakers are returning to Washington this month with a busy agenda. At the top of the list is reaching an agreement by Sept. 30 to fund the federal government. If they cannot agree on spending levels by then, they will need to pass a short-term agreement to keep the federal government operating with its current funding levels — called a “continuing resolution” — or face a government shutdown.

When lawmakers left the nation’s capital for August recess, there were significant discrepancies between the appropriations bills in the House and Senate, which will require ongoing negotiation.

The Academy will be tracking these developments and urging lawmakers to prioritize children’s health in any spending decisions and reject any harmful cuts.

Why it matters

The federal appropriations process often is lengthy and complex. Although it is an annual undertaking by Congress, each appropriations season can be shaped by a number of factors such as political party control of the chambers and where spending priorities align or differ.

This process is vital to keeping the government operating. For children and families, it means ensuring they can continue to rely on government programs that are critical to their health and well-being. For that reason, the Academy advocates for robust funding for federal agencies and programs that play a key role in supporting child health.

Appropriations 101

The appropriations process takes place over a months-long cycle. While the details can vary from year to year, following is a nuts-and-bolts breakdown of the process.

The president’s budget request for the next fiscal year typically is presented to Congress in the winter as an outline of an administration’s spending priorities.

Following the budget request, appropriations advocacy kicks into full gear.

After the House and Senate decide the spending amounts available for each bill, legislators determine their own funding line requests and often meet with constituents and other stakeholders about their funding priorities.

During this time, the Academy urges strong federal investments in children’s health, outlining its funding asks to legislators and key committees and subcommittees. It also joins other child health groups to advocate for funding for specific programs.

Playing the leading role in this process are the House and Senate Appropriations Committees, including 12 subcommittees that have jurisdiction over federal agencies and programs. The appropriations bills originate in their respective subcommittees and eventually are considered by the full committee, which can change the legislation.

Of the 12 bills, the Labor, Health and Human Services, Education, and Related Agencies appropriations bill contains most of the funding for the child health programs the Academy advocates for and the federal agencies that oversee them. The AAP also follows bills that include funding for issues like global child health, nutrition, tobacco cessation, child welfare, environmental health and the Indian Health Service.

After the committees approve the bills, they head to the House and Senate floor to be reviewed and potentially amended by the full chamber before passage. Often, the bills passed in each chamber differ, so lawmakers must agree on a final bill that can pass both the House and Senate. Often, the House and Senate will combine them all into one package, known as an “omnibus,” or package several bills in “minibuses.”

Finally, the president signs the bill into law. Every year, lawmakers have until midnight Sept. 30 to complete this process — or they need to pass a continuing resolution to avoid a government shutdown and buy themselves more time.

Critical moment for child health

Every appropriations season is a critical moment to advocate for child health.

This year, lawmakers are coming off the heels of negotiating the Fiscal Responsibility Act to raise the country’s debt ceiling, avoiding a default and setting spending caps for fiscal years 2024 and 2025. As is evident by the appropriations debate, however, lawmakers’ interpretation of those spending caps vary across the aisle.

The House majority is using the debt limit agreements as a “ceiling” and produced bills with spending amounts much lower than outlined. The Senate majority and minority, on the other hand, stayed in line with the numbers agreed to in the Fiscal Responsibility Act. The two chambers will have 12 legislative days in September to resolve their differences.

A lot is at stake for children and families and the federal programs and agencies on which they rely. As negotiations continue, the Academy will remain steadfast in its advocacy to keep child health at the forefront.

National Conference advocacy opportunities

With this year’s AAP National Conference & Exhibition taking place in the nation’s capital, there will be numerous opportunities to learn about pediatricians’ important role in child health advocacy and ensure children’s needs are heard in Washington.

If you are attending the conference and are interested in learning more about AAP advocacy priorities and developing your skills as an advocate, check out the following sessions:

  • The Toll of Gun Violence: How AAP Members Can Advocate for Reform at the State and Federal Levels
  • A National Emergency: Advocating for Child and Adolescent Mental Health
  • Advocacy 201: Advocating Through Adversity, Building Your Resilience and Catalyzing Change

For session dates, times and locations, see the conference schedule at

On the final conference day (Tuesday, Oct. 24), the Academy is organizing a rally for pediatricians at the U.S. Capitol complex from 11 a.m. to 1 p.m. Participants will gather with pediatrician advocates to hear about child health policy issues and collectively demonstrate pediatricians’ passion for policies that put children first.

Be sure to stop by the AAP Advocacy Action Center booth to learn how to get involved in the Academy’s advocacy efforts and design a poster for the rally with your own child health message.

Pediatricians gathered for a rally on the U.S. Capitol grounds during the 2015 AAP National Conference & Exhibition in Washington, D.C.

AAP president visits White House for event on mental health parity

AAP President Sandy L. Chung, M.D., FAAP, recently attended an event at the White House, marking the announcement of proposed rules from the Biden administration to increase access to mental health services. The regulations would require insurers to examine whether they are providing equal access to medical and mental health benefits and address any gaps. The Academy will submit comments on the proposals.

Close Modal

or Create an Account

Close Modal
Close Modal