Pediatric Policy Council Update

The APS and SPR are members of the Pediatric Policy Council (PPC) which actively advocates for children and academic pediatrics at the federal level. SPR representatives to the PPC are Dr. Joyce Javier, Dr. Shetal Shah, and Dr. Ashwini Lakshmanan; Dr. Lisa Chamberlain and Dr. Scott Lorch represent APS.

The PPC also includes representatives from the Academic Pediatric Association (APA) and the Association of Medical School Pediatric Department Chairs (AMSPDC). The PPC is based in the Washington DC office of the American Academy of Pediatrics (AAP), who supplies staff and other support.

The latest advocacy developments are summarized by the PPC below:

PPC CAPITOL CONNECTION

January 2, 2025

What Matters Now in Washington:

  • The 2024 election will return Donald Trump to the White House and usher in a Republican trifecta to Washington. More…
  • The Trump transition team has been rolling out top-level picks for health policy roles, with Robert F. Kennedy, Jr. slated to lead HHS. More…
  • With the balance of power set to shift in Washington, Congress wrapped up the lame duck session of the 118th Congress by passing legislation to keep the government open temporarily. More…
  • As congressional Republicans outline their agenda for the 119th Congress, dramatic cuts to Medicaid and the social safety net appear to be on the table. More…
  • PPC members authored policy commentaries in Pediatric Research exploring the intersections of child health policy, advocacy, and pediatric research. More…
  • Find new funding opportunities, research findings, and more below. More…
  • See what other developments we’re tracking with implications for child health advocacy. More…

PRESIDENT-ELECT DONALD TRUMP AND VICE PRESIDENT-ELECT JD VANCE WIN WHITE HOUSE, BRINGING UNIFIED REPUBLICAN CONTROL TO WASHINGTON. After a hotly contested election, former President Donald Trump will return to the White House alongside Ohio Senator JD Vance, his Vice Presidential running mate. Now President-elect Trump becomes the first president elected to non-consecutive terms since President Grover Cleveland. In Congress, Republicans have won control of the U.S. Senate, after successfully flipping three seats held by Democrats in states won by President-elect Trump. Republicans will hold a 53-47 advantage in the upper chamber. On the other side of the Capitol, Republicans have retained control of the U.S. House of Representatives, but with a slim majority of 220-215, narrower than the majority they held in the 118th Congress after Democrats gained a seat in an unexpectedly positive performance.

Although falling just short of the unprecedented levels of voter turnout observed in the 2020 election, turnout in the 2024 elections was extremely high, an indication of the fervor that Americans on both sides of the aisle felt for the issues at stake in the election. With more than 77 million votes, President-elect Trump won the popular vote for the first time in his three presidential campaigns, though he did not clear 50% of ballots cast in the presidential race. He outscored Vice President Kamala Harris by about 2.5 million votes, or 1.5 percentage points. The close margin of the election paints a picture of an American electorate closely divided.

As has become customary in presidential elections, the outcome of the race came down to contests in a handful of swing states: Michigan, Pennsylvania, Wisconsin, Arizona, Georgia, Nevada, and North Carolina. All these states were called in favor of President-elect Trump. Six of those states – with the exception of North Carolina which voted for President-elect Trump in 2020 – were flipped from the Democratic to Republican column in this election. Although Vice President Harris managed to match or exceed President Biden’s totals in states such as Georgia, North Carolina, Nevada, and Wisconsin, President-Elect Trump improved his vote totals in all major swing states and will ultimately take back the White House with 310 Electoral College votes.  Notably, Democratic Senate candidates in four of the five swing states to elect U.S. senators in the 2024 election outperformed Vice President Harris, retaining seats in Michigan, Wisconsin, Arizona, and Nevada while very narrowly losing a seat in Pennsylvania.

— Voters Largely Turn Out Against The Status Quo. The election revealed key features of voter sentiment this cycle. According to exit polling following the election, 32 percent of voters cited the economy as their number one issue, and 81 percent of those voters cast their ballots for President-elect Trump. Heading into the election, more than two-thirds of registered voters believed the country is on the wrong track. Although Harris was trusted more on health-related issues such as preserving access to abortion and health care costs, concerns over the economy, inflation, and border security trumped all other major issues this election, and a majority of voters viewed Trump as a better leader than Harris. Americans’ broader dissatisfaction with the state of the nation and negative evaluations of the economy with a Democratic administration in power proved too much for Harris to overcome.

Harris struggled to offer a clear contrast between her platform and the policies of the Biden administration. Polling before the election consistently showed that voters had several concerns over President Biden’s handling of the economy, immigration, and the war in Gaza. The Democratic Party faces its own reckoning in the aftermath of the election despite down-ballot candidates in congressional and state-level elections faring better than Harris. Trump’s closing message, in which he attacked Democrats’ handling of the economy and immigration, ultimately resonated with disenchanted voters in crucial swing states, and his victory suggests voters were willing to overlook Trump’s sometimes crude rhetoric for someone they felt would fix their problems. Republicans’ victories in this election are the latest in a worldwide trend of losses for incumbent parties in 2024, largely driven by post-pandemic era inflation and broad feelings of economic distress.

WITH TRANSITION PROCESS IN MOTION, TRUMP BEGINS TO ASSEMBLE HIS HEALTH TEAM. President-elect Trump has begun the process of assembling his cabinet and naming nominees for appointments across all major federal agencies.

Trump announced Robert F. Kennedy, Jr. as his choice to lead the U.S. Department of Health and Human Services (HHS) marking the beginning of what may be a long confirmation fight in the Senate. If confirmed by the Senate, Kennedy would have control over major health agencies like the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA), which fall under the purview of HHS. Mr. Kennedy, an environmental lawyer with no formal health experience, has stated he will use his appointment to realign U.S. health policy and reorganize the constellation of federal health agencies. Kennedy has long questioned the value of federal health research and the processes through which it is implemented. Kennedy’s stated priorities for U.S. health have ranged from issues with broad support, like addressing chronic disease, to advancing widely debunked anti-scientific claims, including the disproven claim that vaccines cause autism in children. Following Kennedy’s appointment, the AAP released a statement emphasizing the vital role of vaccinations in supporting the lifelong health and well-being of children and expressing the importance of having these conversations with national leaders, just as pediatricians do with families each day.

Dr. Marty Makary has been nominated for the role of FDA commissioner. Dr. Makary, a surgical oncologist at Johns Hopkins University, is a public health advocate and a regular contributor to major media outlets. Dr. Makary emerged during the Covid-19 pandemic as a critic of FDA’s response and of other pandemic-related public health measures, including school masking policies and vaccine mandates. However, he has supported COVID-19 vaccination for high-risk groups while advocating for clear communication about benefits and risks, particularly for younger individuals, and his nomination may quell fears about anti-vaccine sentiment at the agency charged with evaluating those products for the American market. In the nomination announcement, President-elect Trump pledged that Makary would work with Mr. Kennedy to evaluate harmful chemicals in the nation’s food and drugs supply to address the childhood chronic disease epidemic.

The Trump transition team has also selected Dr. Jay Bhattacharya to serve as director of the National Institutes of Health (NIH). Bhattacharya, a health economist who received his medical degree from Stanford University, is known most prominently for his criticism of lockdowns during the COVID-19 pandemic, as well as school closures and mandates, drawing attention for his co-authorship of the Great Barrington Declaration in October 2020; the document argued against lockdown measures and called for the rollback of pandemic-related shutdowns for low-risk individuals to build herd immunity while keeping in place “focused” protections for vulnerable populations. The letter garnered praise from Republican lawmakers but was rebuked by public health experts, including then-NIH Director Francis Collins, as premature and dangerous. Bhattacharya has also urged for a significant overhaul of NIH, specifically calling for the creation of more centers of power inside the agency to decrease the influence of career civil servants. In early December, Bhattacharya indicated he would like to use the NIH funding process to take on what he sees as “cancel culture” at universities.

Trump’s health nominations serve as a reminder of the ongoing influence that the pandemic has had on public health policy.

CONGRESS PUNTS ON FULL-YEAR SPENDING BILLS IN CLOSING HOURS OF 118TH CONGRESS. In the final hours of the 118th Congress, lawmakers narrowly averted a government shutdown by approving a last-minute, short-term government funding bill shortly before the December 20 deadline. Lawmakers will now have until March 14 to complete the annual government funding process for Fiscal Year (FY) 2025, which runs through September 30. However, the path to the short-term continuing resolution (CR) saw a number of twists and turns that nearly plunged the federal government into shutdown just before the holidays.

The initial bipartisan proposal that the House unveiled in the days leading up to December 20–brokered by Speaker of the House Mike Johnson (R-La.) and Senate Majority Leader Chuck Schumer (D-N.Y.)—would have funded the government until March and included a one-year extension of the Farm Bill, $110 billion in natural disaster relief, as well as a number of reauthorizations for crucial child health programs, including those related to child welfare programs, pediatric cancer research, decreasing preterm birth, supporting lifespan respite care, and updating pediatric drug laws. The deal fell apart after unexpected vocal opposition from President-elect Trump, prompted by close ally Elon Musk, in which Trump pilloried the bill for its inclusion of extraneous provisions and insisted that Congress raise the debt limit, which federal officials do not expect to be reached until mid-2025. After a failed attempt to pass a much narrower bill which would have extended government funding and raised the debt limit, Speaker Johnson was yet again forced to reach across the aisle and find bipartisan agreement. The third and final CR package included funding for disaster relief and the one-year Farm Bill extension, but it did not include Trump’s demand for a debt ceiling increase amid Democratic opposition, much to the President-elect’s chagrin. Unfortunately, multiple child health priorities initially agreed to in the first government funding agreement were not included in the final version of the bill.

This process highlighted yet again the difficulties House Republicans have had finding unity amidst narrow majorities and internal disagreements over policy priorities. Although Republicans’ ability to pass legislation will ease somewhat with control of the presidency and both chambers of Congress, narrow margins in the House and Senate will undoubtedly limit what they can accomplish when they turn their attention to full-year spending bills next spring. With a decreased majority in the House, Republicans will need close to unanimous approval within their caucus or Democratic votes to pass major legislation.

REPUBLICANS PREVIEW THEIR LEGISLATIVE AGENDA, INCLUDING CUTS TO MEDICAID AND SOCIAL PROGRAMS. Republicans in Congress and the incoming Trump administration are beginning preliminary discussions about making significant changes to Medicaid, nutrition supports, and other federal safety net programs, as they look to pay for extensions of the tax cuts included in the 2017 Tax Cuts and Jobs Act that are set to expire in 2025. An extension of these tax cuts is expected to cost $4 trillion over the next decade and would require significant spending cuts if lawmakers also want to avoid large increases in the federal deficit. Republicans are expected to make use of the budget reconciliation process to do so, a legislative maneuver that allows the Senate to sidestep the 60-vote threshold typically required to pass legislation and will make it easier for them to succeed in their legislative goals.

Some of the policies being considered for offsetting the cost of the tax package include substantial cuts to Medicaid. House Budget Committee Chairman Jodey Arrington (R-Texas) has stated that he supports enacting work requirements for Medicaid and urged Republicans to consider cuts to mandatory spending for health care programs. Sen. John Cornyn (R-Texas) has teased the idea of block grants, in which states get a lump sum of federal Medicaid spending, regardless of states’ actual cost to administer the program. Rep. Brett Guthrie (R-Ky), the current chair of the House Energy and Commerce Health Subcommittee and incoming chair of the full committee, has stated that he would like to pursue Medicaid per capita caps, reviving a provision from the failed 2017 bill to repeal the Affordable Care Act. Under per capita caps, states would receive only a fixed amount of federal Medicaid funding per beneficiary. All three of these proposals would result in reduced spending on Medicaid and ultimately cuts to the program. Recent GOP proposals have also proposed a reduction of the 90 percent federal matching rate for the Medicaid expansion population to each state’s regular Medicaid matching rate, which is on average 57 percent.

Republicans are also discussing alterations to the Supplemental Nutrition Assistance Program (SNAP). These alterations may take the form of limiting which food items SNAP beneficiaries can purchase with benefits or broadening work requirements for SNAP eligibility. Republicans are also considering stripping presidential authority to recalculate benefits for the program, an authority granted to the executive branch under the 2018 Farm Bill.

The political ramifications of such steep cuts, which would impact programs that support tens of millions of low-income Americans, are a major source of worry for some Republicans. The last time damaging cuts to Medicaid were on the table, academic pediatricians and other child health advocates overwhelmingly mobilized to oppose efforts that would leave children uninsured. It should be noted that all ongoing discussions at this stage are preliminary only, but it will be important to heed the spending cuts that are included to offset the cost of any possible tax packages and their impact on child health.

PPC POLICY COMMENTARIES. Members of the PPC have authored commentaries detailing the policy implications of research published in Pediatric Research. You can read these PPC-authored commentaries online:

KEY RESEARCH UPDATES FROM NIH

WHAT WE’RE READING