Reprinted with permission of AAP News, March 2005

Academy's efforts pay big dividends for children

AAP Department of Federal Affairs

As the Academy celebrates its 75th anniversary, it is fitting to recognize the organization's accomplishments in federal advocacy.

Indeed, the Academy's birth started with pediatricians who broke away from the American Medical Association because of its refusal to support legislative efforts to improve children's health.

Since 1970, the Academy has had an office in Washington, D.C., to help AAP members in the legislative/regulatory process. Following are some highlights of the Academy's federal efforts over the past 35 years to provide access to quality health care for children.

Early years (1970s)

Despite tight federal budgets, the Academy enjoyed many victories, and child health programs began to grow.

In 1973, President Richard Nixon called national health insurance his top domestic priority. Donald W. Schiff, M.D., FAAP (AAP president, 1988-'89), testified before Congress in June 1974, emphasizing the Academy's national health care principles and asking Congress to "mark the'70s as the decade for children."

The biggest challenge was modifying the national health planning law (PL93-641) to include children's needs and then delivering 50 state plans. To hold down the mounting national medical bill of $100 billion, this law was intended to make sure costly health services and facilities were developed as needed.

Through the leadership of John MacQueen, M.D., FAAP (AAP president, 1974-'75), materials were provided to AAP chapters on the plan. Lessons learned by AAP members at the local level proved invaluable in building strong AAP chapters.

Dawn of devolution (1980s)

This was a time when the gap between the rich and the poor widened. One million children were removed from the Medicaid rolls, and funding for children's programs grew at only one-quarter the rate of the overall federal budget.

Block grants, or lump sums of money to be used for program funding, were targeted at public health programs, including Medicaid.

Through the leadership of R. Don Blim, M.D., FAAP (AAP president, 1980-'81), and Don Cornely, M.D., FAAP, the Academy led an effort to fashion a block grant to plan for and deliver health services to mothers and children. Pediatrics scored a major victory with the establishment of this Maternal and Child Health block grant, which continues to serve as a safety net.

Despite this major victory, budget cuts continued to threaten pediatric programs. President Ronald Reagan proposed to take federal control of Medicaid if states would run the 43 other federal health, welfare and nutrition programs, with a significant reduction in dollars. This plan, however, did not come to fruition.

Another victory occurred when, after years of intensive AAP efforts to revise Early and Periodic Screening, Diagnosis and Treatment from its emphasis on screening to a more comprehensive health program, regulations were passed that effectively promoted the concept of a "medical home" for children. Birt Harvey, M.D., FAAP (AAP president, 1989-'90), led the Academy through these lengthy and often rocky negotiations.

Medicaid gradually became a model health insurance bill with comprehensive benefits. In the early days, though, pediatrician participation in Medicaid was somewhat uneven because of administrative hassles and poor reimbursement.

Between 1984 and 1990, Congress used the federal budget as the vehicle to implement a series of reforms that fundamentally restructured children's coverage. Medicaid eligibility was de-linked from cash welfare benefits, and by 2002 coverage was mandated for children up to 19 years of age.

Recognizing the need to build on successes in an increasingly complex world of public policy, the Academy held its first legislative conference in 1988 to train AAP Fellows in effective legislative interaction. The 16th annual Legislative Conference will be held in April, and Medicaid reform will be the top issue of discussion.

Some Medicaid problems continue. The Academy filed a legal complaint in 2000 against the Health Care Financing Administration (HCFA) for failing to provide access for patient care and appropriate reimbursement for pediatricians. Letters were sent from HCFA to the states to encourage their compliance. The AAP Department of Federal Affairs has continued to be a voice on Capitol Hill regarding inadequate payment to pediatricians.

`Children First' (1990s)

In 1989, universal access to quality health care for all infants, children, adolescents and pregnant women was designated a top AAP priority. The Academy developed a detailed proposal, "Children First." To ensure congressional commitment, the Academy drafted a joint resolution titled, "Health of America's Children," which was introduced in the Senate and was co-sponsored with bipartisan support from 75 members. During 1989 and 1990, congressional committees called on 51 AAP members to testify.

In October 1991, Rep. Robert Matsui introduced a bill with some of the AAP principles called "The Children and Pregnant Women's Health Insurance Act of 1991" (HR 3393), making the Academy the first medical association to have its access objectives included in legislation. A "Children First!" coalition was organized, co-chaired with the National Parent-Teacher Association and other organizations. Despite hopes, the bill did not pass.

During President Bill Clinton's administration, the Academy helped to create the State Children's Health Insurance Program (SCHIP), a response to the growing problem of uninsured children. Pediatricians across the country worked with members of Congress on both sides of the aisle to help pass this legislation. SCHIP is a block grant that allows states discretion in eligibility, design and implementation and encourages participation by offering a larger federal match rate. As an adjunct to Medicaid, SCHIP provided health insurance to more lower-income children with funding from the 1997 tobacco settlement.

Children next (2000 and beyond)

In 2000, with the election of President George W. Bush, AAP leadership began work to find a better legislative vehicle to pursue access to care for every child. The Academy's latest solution was the endorsement of legislation called "MediKids," which embodies key AAP principles.

AAP Past President Joel Alpert, M.D., FAAP (1998-'99), announced the evolution of yet another AAP proposal proclaiming, "It is simply unconscionable that the U.S. remains the only industrialized nation that does not insure all its people."

During the last 10 years, the Academy has fought and won several key legislative battles. The Academy helped to pass into law both the bipartisan supported Best Pharmaceuticals for Children Act and the Pediatric Research Equity Act, which together ensure drugs prescribed to children will be tested for their use.

Today, after 35 years of advocacy work, the Academy has earned a reputation as one of the most respected bipartisan organizations in Washington. AAP members also continue to be leaders on Capitol Hill, testifying before Congress and meeting with congressional leaders to assure the health and well-being of our nation's children and adolescents.

October excerpt

November excerpt

December excerpt

January excerpt

February excerpt

April excerpt