At the 2016 Annual Leadership Forum (ALF), chapter, committee, council and section leaders adopted 120 resolutions and selected the top 10 that they felt the Academy should address urgently.
Following is an update on the status of those priority resolutions.1. Medicaid Parity for the Children of Puerto Rico and all United States Territories
The Academy has taken significant steps to support the children and pediatricians of Puerto Rico.
In an April letter to the chairs of the U.S. Senate Committee on Finance and House Committee on Energy and Finance, the Academy called for parity in federal Medicaid financing for Puerto Rico. In late June, Congress passed and President Obama signed into law the Puerto Rico Oversight, Management and Economic Stability Act, which provides federal relief for Puerto Rico but does not restructure federal Medicaid financing. The Academy will continue its advocacy to ensure that Puerto Rico receives the same federal Medicaid match as do states and will advocate for policies that lessen the burden on Puerto Rico’s pediatricians due to the current economic crisis.
To further support Puerto Rico’s pediatricians, the AAP Friends of Children Fund provided a $37,600 grant to the AAP Puerto Rico Chapter to help the territory respond to the Zika outbreak. In addition, the Academy has approved a 50% reduction in national dues for Puerto Rico’s pediatricians for one year while they endure the fiscal and public health crises.2. AAP Policy Statement on Personal Belief (Non-Medical) Exemptions for Immunizations
The policy statement Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance has been published, http://dx.doi.org/10.1542/peds.2016-2145. It was co-authored by the AAP Committee on Practice and Ambulatory Medicine, Committee on Infectious Diseases, Committee on State Government Affairs, Council on School Health, and Section on Administration and Practice Management. See related article http://www.aappublications.org/news/2016/08/29/VaccineExemptions082916.3. Supporting Pediatricians Who Discharge Families Who Refuse to Immunize
The AAP Committee on Infectious Diseases and the Committee on Practice and Ambulatory Medicine and the Committee on Infectious Diseases co-authored a new AAP clinical report Countering Vaccine Hesitancy, http://dx.doi.org/10.1542/peds.2016-2146. In it, the Academy states that dismissal may be considered in certain circumstances for patient families who categorically refuse vaccines. Pediatricians are encouraged to continue to work with vaccine-hesitant families. See related article http://www.aappublications.org/news/2016/08/29/VaccineHesitancy082916.
4. AAP Support of Planned Parenthood’s and Other Providers’ Missions to Provide Critical Sexual Health Care Services to Adolescents
The Academy continues to advocate for robust federal funding for family planning programs without political interference. Proposals to cut funding for the Title X Family Planning Program and bar Planned Parenthood as a Title X grantee have not been successful.
On June 27, the U.S. Supreme Court struck down a Texas law that would have severely limited women’s access to abortion services at Planned Parenthood and other facilities in Texas. In its 5-3 decision in the case Whole Women’s Health v. Hellerstedt, the majority concluded that the law violated the Constitution by imposing “undue burdens” for women seeking safe and legal abortions. If the law had been upheld, it would have resulted in the closure of a vast majority of facilities providing abortion services across the state. Prior to oral arguments in the case, the Academy joined an amicus curiae brief with other public health and medical organizations refuting the claim that the requirements of the law were medically necessary.
The Academy has also weighed in with Congress in support of continued federal funding for fetal tissue research while a congressional panel has been examining fetal tissue donation practices.5. Protecting the Rights of Children Born to Unauthorized Immigrants in the United States
The Academy and the Texas Chapter continue to advocate that all children born on U.S. soil receive the birth certificates to which they are entitled. In May 2015, civil rights groups sued the state of Texas, alleging that Texas was illegally denying birth certificates to children of undocumented immigrants in violation of the U.S. Constitution. Since that time and thanks to efforts to address the issue programmatically, the Texas Chapter indicated that babies of undocumented immigrants born in Texas hospitals were receiving birth certificates, Social Security cards and Medicaid cards (as eligible), regardless of parental citizenship.
In July, the state settled the lawsuit, agreeing to accept a wider array of identification from undocumented immigrants to document the citizenship of their U.S.-born children. The settlement reiterates that Mexican voter ID cards are accepted and expands the list of other forms of acceptable documentation. This will allow the state to provide birth certificates to U.S. born children as appropriate.
The Academy and Texas Chapter will continue to monitor the situation and work to ensure all citizen children receive the birth certificates to which they are entitled.6. Protecting the Well-being of All Undocumented Immigrant Children Detained by United States Officials
The AAP Council on Community Pediatrics is developing a policy statement on protecting the health and safety of immigrant children who are detained at the U.S. border. The statement will review the unique health and safety needs of children who are detained and the issues they face while navigating the immigration system and resettling into communities. AAP leaders and council members visited the border to observe the conditions of processing as well as the Office of Refugee and Resettlement facilities.
Policy recommendations will address children’s access to health care while they are in custody as well as their post-release care in the community. Special attention is paid to children’s mental health needs, and recommendations will address the need to limit children’s exposure to traumatic conditions and experiences. The statement also will address the importance of expanding access to legal and educational support services for immigrant children.
The Academy has a representative on the Federal Advisory Committee on Family Residential Centers, established to advise the Department of Health and Human Services and Immigration and Customs Enforcement on helping to improve the services and conditions of the centers where immigrant families are housed temporarily. In 2015, the Academy wrote to Department of Homeland Security Secretary Jeh Johnson expressing strong concerns about the continued detainment of children in the existing family detention centers.7. Mandatory Child Resistant Packaging for all Marijuana (Including Edibles) Sold in States Which Have Legalized Recreational or Medicinal Marijuana
The Academy is working with chapters that are advocating for child-resistant packaging on marijuana products and other public policy to reduce child and adolescent access to marijuana. Lessons learned from regulating tobacco and alcohol at the state level, as well as regulating liquid nicotine at the federal level, inform the policy guidance. The AAP Division of State Government Affairs is developing an Advocacy Action Guide for chapters on this issue.
Currently, 25 states and the District of Columbia allow the sale of recreational and/or “medical” marijuana. Sixteen states (Alaska, Arizona, Colorado, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Ohio, Oregon, Vermont and Washington) require that marijuana be sold in child-resistant packaging (which is defined in different ways). Child-resistant packaging is not required in California, Delaware, Maine, Michigan, Montana, New Hampshire, New Jersey, Rhode Island, Pennsylvania and the District of Columbia.
At its fall meeting, the AAP Council on Injury, Violence and Poison Prevention will discuss whether further limitations are needed.8. AAP Participation and Advocacy for Firearm Safety Research
Through the Periodic Survey of Fellows, the Academy conducts ongoing assessment of members’ experiences with treating gun injuries, current counseling practices and views on gun injury prevention strategies and policies. See article http://www.aappublications.org/news/2016/08/10/GunViolence081016.
The AAP Pediatric Research in Office Settings (PROS) network has demonstrated through a randomized, controlled trial increased safe firearm storage as a result of a brief office-based violence-prevention approach (http://pediatrics.aappublications.org/content/122/1/e15).
Through the Department of Federal Affairs, the Academy is continuing to advocate for funding for the Centers for Disease Control and Prevention to research the causes and prevention of gun violence. This research can include work like the PROS study, to bring an evidence-based approach to addressing the national epidemic of gun violence.9. Creation of a Center for Physician and Other Health Care Provider Resiliency
In a survey of AAP members, 22% agreed they were experiencing burnout, and 45% agreed they had experienced burnout in the past. Studies also have demonstrated a link between perceived levels of stress and reported job satisfaction and productivity, as well as patient safety.
Following are some of the Academy’s wellness initiatives:
- The clinical report Physician Health and Wellness, http://pediatrics.aappublications.org/content/134/4/830, provides an update on work in the field of preventive physician health and wellness and a discussion of emerging initiatives that may promote health at all levels of pediatric training.
- The Section on Integrative Medicine website holds a repository of information on physician health and wellness, http://bit.ly/1Ut4sSd.
- The AAP News article “Focus on physician health, wellness should start during training,” was published in January, http://www.aappublications.org/news/2016/01/22/Wellness.
- Physician health and wellness was selected as the topic for the Pediatrics for the 21st Century session prior to the 2017 AAP National Conference & Exhibition.
- The Section on Hospice and Palliative Care launched the curriculum on Resilience in the Face of Grief and Loss, which includes a section on personal wellness, http://www2.aap.org/sections/palliative/ResilienceCurriculum.html.
- Accreditation Council for Graduate Medical Education Initiatives have included the revision of Pediatric Core Competencies to reflect findings of the Pediatric Milestone Project and paradigm shift to incorporating evidence-based approaches to resident wellness into training.
- Pediatric Resident Burnout-Resilience Study Consortium involving more than 30 pediatric residency programs and 1,400 pediatric residents started in 2015.
- The Academy participated in a meeting sponsored by the National Academy of Medicine titled Clinical Resilience and Well-Being, which convened over 25 medical organizations, payers and funders to address the issues as well as each organization’s resources and initiatives.
The Academy was represented at the U.S. Department of Health and Human Services Pharmaceutical Forum on drug prices in November 2015. In addition, AAP Committee on Drugs Chair Kathleen Neville, M.D., FAAP, is representing the Academy on the American Medical Association Task Force on Pharmaceutical Costs, which is considering various transparency proposals as well as Medicare price negotiation authority.
Provider organizations and coalitions, including the American College of Physicians and the Campaign for Sustainable Rx Pricing, have released policy proposals for addressing drug pricing.
Congress has held several hearings on drug pricing. Legislative action in Congress on drug pricing this year seems unlikely, although the issue has received quite a bit of national attention. The AAP Department of Federal Affairs will continue to monitor and weigh in on proposals under consideration to ensure the continued availability of affordable, safe medications for children. See related article http://www.aappublications.org/news/2016/08/26/EpiPen082616.