In 1970, the American Academy of Pediatrics established its Washington, DC office to ensure that the federal government would address the needs of children and the practice of pediatrics. From modest beginnings, the Academy, with its dedication to advocacy, became a respected, credible and trusted voice in the federal government arena for infants, children, adolescents and young adults. Thirty-four years later, the Department of Federal Affairs covers a multitude of complex child health and related issues, including health care coverage, injury prevention, immunizations, medical liability and emergency medical services.

Success is achieved through the efforts of dedicated AAP chapters, members and staff working with federal legislators and regulators. Lawmakers are responsible for creating the guidelines and systems under which America's children receive health care, but lawmakers are not necessarily experts in children's health. They welcome, and often seek out, advice from the AAP and its pediatricians.

The federal legislative accomplishments of the Academy are impressive. The AAP played a major role in helping to create important programs, ranging in the earliest days from poison prevention packaging to the more recent State Children's Health Insurance Program (SCHIP).

Some Federal Legislative Accomplishments
In the 1980s, the AAP led an effort to fashion a separate Maternal and Child Health (MCH) Block Grant to plan for and deliver health services for mothers and children. Pediatrics scored a major victory with the establishment of a safety net for children through this MCH Block Grant. Soon after, the AAP spearheaded efforts to revise Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service beyond its emphasis on screening. As a result, new regulations made EPSDT a more comprehensive health program that effectively promotes the concept of a medical home for children.

In the mid-1980s, the US Congress began to focus on Medicaid reform as a vehicle for improving children's health. Between 1984 and 1990, Congress implemented a series of reforms that fundamentally restructured children's coverage. Notably, the Child Health Assurance Program was passed in 1984 and further revisions were enacted with the Omnibus Budget Reconciliation Acts of 1989 and 1990. AAP chapters worked vigorously to urge state governments to expand eligibility for low-income children.

In the mid 1980s, the AAP moved on to the Child Health Insurance Reform Plan, which required businesses to include children's preventive care services in their employee health plans for insurance premiums to be deductible as a business expense.

In 1989, universal access to quality health care for all infants, children, adolescents and pregnancy women was designated a top priority of the AAP as it prepared to address the national problem of 37 million uninsured people, of which 9 million were children. A congressional health policy retreat was held with key congressional staff, health agency representatives and AAP members. It was concluded that, despite the best of efforts, the current health care system was not working for all mothers and children.

In October 1991, U.S. Representative Robert Matsui introduced the Children and Pregnant Women's Health Insurance Act of 1991, making the AAP the first medical association to have its access objectives included in legislation. In l997, the State Children's Health Insurance Program (SCHIP) was established, and now in 2004, SCHIP provides health care coverage nearly 6 million children. But there are still millions of uninsured children in this country, and the AAP continues to support the MediKids Health Insurance Act that would guarantee health coverage to every child in America.

The AAP has established itself as a key voice in federal and state affairs relating to children's health issues, yet many challenges lie ahead in this tumultuous era of insurance reform. The leadership, passion, and active participation of the AAP and its members will play a key role in determining the future of health care reform for children.

American Academy of Pediatrics
Department of Federal Affairs
601 13th Street, N.W. Suite 400 North
Washington, D.C. 20005
Phone: 202-347-8600
E-mail: kids1st@aap.org
Web: www.aap.org