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StateView

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​​StateView compiles up-to-date information on state policy trends and resources for chapter advocacy efforts and focuses on important state-level child health advocacy issues, and summarizes valuable resources from the AAP and other public and private sector sources.

December 5, 2017: Coming Soon—2018 State Legislative Sessions
With all but 4 states (Montana, Nevada, North Dakota, and Texas) set to convene regular legislative sessions shortly after the start of the new year,
State Net Capitol Journal takes a look at the road ahead and examines some of the priority issues that are likely to rise to the forefront at the state level next year. Leading the list are health care concerns, opioids, marijuana legalization and state preemption of local laws—all issues of concern for AAP chapters.

As we head into the end of 2017, StateView will be taking a short break. The AAP state advocacy team is here to provide you with one-on-one consultation, technical assistance, and strategy guidance as you prepare for 2018—contact us at stgov@aap.org.

We wish you a happy holiday season and a new year filled with peace and happiness, and thank you for all you do to advocate for children in your states. We’ll see you in 2018!

December 4, 2017: Maine’s Vote to Expand Medicaid Revives Debate in Other States
Last month, voters in Maine overwhelmingly voted to expand their Medicaid program. Almost 60% of voters approved a ballot measure that will allow more low-income adults to become eligible for Medicaid under the Affordable Care Act (ACA). While Governor LePage has said he would only implement the measure under specific circumstances, the win has reenergized advocates hoping to do the same in their states.

A 2012 Supreme Court ruling made Medicaid expansion an option for states, and 32 states and the District of Columbia have now chosen to expand their programs. Advocates in states that have not yet expanded coverage such as Idaho, Nebraska, and Utah continue to push for expansion, and are working to put their own ballot initiatives to voters. In Virginia, the election of Governor-Elect Ralph Northam, MD and the flipping of more than a dozen seats in the state’s House of Delegates improve the chances of Medicaid expansion there as well.

For more from the AAP, please see our Expanding Medicaid Matters infographics.

November 30, 2017: Ending the Opioid Epidemic: A Practical Guide for State Policymakers
A guide from the National Center on Addiction and Substance Abuse outlines strategies that state policymakers can enact to prevent opioid misuse and reduce the number of deaths and injuries caused by opioids every year. The guide supports a public health approach to address the opioid epidemic and invest in the implementation of evidence-based substance misuse prevention and treatment initiatives.

Included within the strategies are expanding access to public and private insurance coverage for treatment programs, improving access to medication-assisted treatment programs, and improving prescription drug monitoring programs (PDMPs).

For more from the AAP, see our clinical reports Neonatal Drug Withdrawal and Medication-Assisted of Adolescents with Opioid Use Disorders. The AAP is also a member of the AMA Opioid Task Force.​

November 28, 2017: States Make CHIP Contingency Plans
Nearly 2 months have passed since the federal funding deadline to extend the Children’s Health Insurance Program (CHIP), with
October projections indicating that as many as 11 states could run out of CHIP funds by the end of 2017. As states await Congressional action, some are beginning to take steps to address the program’s funding uncertainty. Most recently, West Virginia announced it would be shutting down its CHIP program on February 28, and Colorado and Virginia are beginning to inform families that their programs will end. Oregon, meanwhile, announced it would spend $35 million of state funds to keep the program operational, and Minnesota has tapped its own funds to keep its program running after exhausting leftover funds.

To advocate for an immediate extension of CHIP funding, the AAP is joining other child health advocacy organizations for a CHIP Day of Action Thursday, November 30, 2017. AAP chapters and members are encouraged to participate using the newly updated CHIP Advocacy Toolkit, which contains the latest state of play, talking points, social media messages, graphics, and other helpful resources to help you advocate. ​

November 27, 2017: Vigils Commemorate Sandy Hook Anniversary
As the 5th anniversary of the Newtown, Connecticut elementary school shooting approaches, Moms Demand Action will host over 200 vigils in 40 states from December 2 until December 17, 2017. To find a vigil in your state, consult this list or check the Nationwide Vigils and Events to #EndGunViolence Facebook page.

As you prepare for your 2018 state legislative sessions, our State AdvocacyFOCUS resources on Assault Weapon Bans, Safe Storage of Firearms, and Universal Background Checks for Gun Purchases are available to support your advocacy efforts.

​November 23, 2017: Happy Thanksgiving!
With special gratitude at Thanksgiving, we thank you for all you do to advocate for children and families in your states.

We wish you and your families all the very best on this Thanksgiving Day.​

November 21, 2017: Medicaid Retroactive Coverage Waivers
Iowa recently had its Medicaid 1115 waiver amendment eliminating 3-month retroactive coverage for all new Medicaid applicants approved by the Centers for Medicare and Medicaid Services (CMS). This change will affect children older than 1 year of age, parents with low incomes, people with disabilities, newly eligible adults, and seniors. Medicaid retroactive coverage allows state programs to pay for medical bills incurred by Medicaid beneficiaries for up to 3 months prior to a final eligibility determination, if that person would have been eligible for coverage during that time.

A new Kaiser Family Foundation issue brief discusses Iowa’s waiver amendment as well as the potential policy implications of states eliminating Medicaid retroactive coverage. Other states, such as Kentucky and Maine, have pending waiver proposals that also include eliminating retroactive coverage for most Medicaid populations.

The AAP advocacy team continues to work with chapters on important waiver issues. For more from the AAP on 1115 waivers, please watch our recent webinar, State Waivers: How They Could Alter Coverage and Care for Children, and contact us at stgov@aap.org for consultation and technical assistance.​

November 20, 2017: 2017 AAP Child Health Advocate Award
Washington State Representative Tom Dent and Washington State Representative Tana Senn received the 2017 AAP Child Health Advocate Award in recognition of their collaborative work to improve behavioral and mental health services for children in Washington. The award was presented to Representatives Dent and Senn by members of the AAP Washington Chapter’s Legislative Committee and members of the Washington Society of Child and Adolescent Psychiatry at the chapter​’s Children’s Mental Health Forum in Olympia last week.

Early next year, the AAP Committee on State Government Affairs will be soliciting nominations from chapters for the 2018 award. For more information, please contact Jeff Hudson at jhudson@aap.org.


November 16, 2017: Massachusetts Bans Bump Stocks
Massachusetts recently became the first state to ban bump stocks, which are trigger accelerating devices that can be attached to semiautomatic weapons to increase firing speed. The assailant in the October Las Vegas concert shooting used the device to kill and injure countless concert-goers.

Generally considered as novelty devices by gun owners, both sides of the gun violence debate have called for bans on bump stocks following the Law Vegas shooting. In addition to Massachusetts, 9 states (Illinois, Michigan, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, and Wisconsin) have introduced legislation (to be considered this year or prefiled for 2018) to ban bump stocks and other trigger devices that increase the speed of semiautomatic weapons.

Are you working on gun violence prevention in you state? See our State AdvocacyFOCUS resource on Assault Weapon Bans, Safe Storage of Firearms, and Universal Background Checks.  ​

November 14, 2017: 2017 State Elections Recap
Last Tuesday, voters went to the polls in a number of states. Here are some highlights:​

  • Virginians elected pediatric neurologist, Dr Ralph Northam to be the next Governor of Virginia. Dr Northam currently serves as Virginia’s Lieutenant Governor, and previously served 2 terms in the Virginia Senate.
  • In Maine, voters approved a ballot measure directing the state to expand Medicaid, and is the first state to do so via a voter initiative. Maine’s governor has vowed to block implementation of this voter-approved initiative, but advocates are prepared to ensure that expansion happens. Other ballot measures considered by voters addressed environmental policy, prescription drug costs, gubernatorial appointments, and other issues. A brief summary of these initiatives and referenda is available from the Council of State Governments.
  • State legislative elections in Virginia and Washington will influence the balance of political power in their states in 2018. In Washington, control of the senate will shift to Democrats; control of the Virginia House of Delegates will be decided following recounts of a handful of very close races.

The period of time after the elections and before state legislatures reconvene is a perfect opportunity to meet new lawmakers and educate them about your chapter's priority issues. For more ideas for postelection engagement, see the AAP Advocacy Guide.

November 13, 2017: Prefiling Procedures for 2018 State Legislative Sessions
In 2018, 46 state legislatures will be in session. Montana, Nevada, North Dakota and Texas lawmakers don’t meet in regular session during even-numbered years. Of the 46 states with regular sessions, 38 will convene in January, 6 in February, Louisiana in March and North Carolina in April. By the time the North Carolina session begins, 19 state legislatures will have already adjourned from scheduled sessions.

November and December are a good time to get a jump start on your advocacy work for next year by monitoring the bills that are being prefiled for 2018. Prefiling procedures, processes, and calendars vary considerably within and across states, but this resource can help you determine if and when prefiling is happening.

Please contact us at stgov@aap.org for consultation, technical assistance, and resources to support your chapter’s state advocacy work.​

November 9, 2017: States Preempt Local Laws Addressing Child Health Issues
As cities and counties strive to address current gaps in state health policy by instituting policies such as electronic nicotine delivery systems (ENDS) regulations, sugar sweetened beverage taxes, and paid sick day requirements, some states have moved to
prohibit local governments from enacting stronger regulations than the state. State preemption laws are not new and, in fact, preemption laws addressing firearms are found in 45 states, while just over half of states​ have some form of tobacco preemption law.

Preemption Watch, a resource from Grassroots Change monitors state preemption laws on discrimination, paid sick days, firearms, ENDS, nutrition policy smokefree laws, and residential fire sprinklers. This resource can help you navigate your advocacy strategy on key child health issues.

Working on legislation addressing firearms, tobacco prevention, or electronic nicotine delivery systems (ENDS) in your state? See our related State AdvocacyFOCUS resources on our State Advocacy page.

November 7, 2017: Election Day 2017
Despite being an “off-cycle” year, today is Election Day in several states—please remember to vote with kids in mind! Voters will cast ballots for governor in 2 states—New Jersey and Virginia. In addition, Virginia voters will also select candidates for the House of Delegates, the lower chamber of the Virginia General Assembly, and in New Jersey, all state legislative seats in both chambers will be contested.

Candidates for mayor in several large metropolitan areas will also be on the ballot in today’s election, and some states and localities will also consider important ballot measures impacting child health and pediatric practice.

Following today’s elections, it is important to connect with newly elected or reelected decisionmakers and educate them about your chapter advocacy priorities. Visit the AAP State Advocacy pages to get State AdvocacyFOCUS resources for use in meetings with officeholders, and get ideas for other postelection activities in the AAP Advocacy Guide

November 6, 2017: Consequences of CHIP Extension Delay
Last week, the US House of Representatives passed the Championing Health Kids Act of 2017, which would extend funding for the Children’s Health Insurance Program (CHIP). While the AAP supports the bill’s extension of CHIP for 5 years and preservation of current federal funding levels through 2019, the way the bill is paid for could be detrimental for kids. The bill would cut funding for the Prevention and Public Health Fund, makes changes to Medicaid financing and includes barriers for families in accessing health care coverage in the marketplaces. Learn more from the AAP Statement on House CHIP Legislation.​

The slow pace of progress on the bill has created real world consequences for children and states. What are Consequences of Congressional Delay on CHIP?, a recent report from the Georgetown Center for Children and Families (CCF), examines how the delay has created confusion and is forcing states to develop contingency plans. For example, Arizona Governor Doug Ducey recently announced the need to reallocate current state budget dollars to ensure 23,000 children do not lose coverage in his state.

​For more from the AAP, please see our CHIP Advocacy Toolkit and the new CHIP State Infographics for social media. Thank you for your continued advocacy on this important issue.

November 2, 2017: State Bounce House Regulations
According to a report from the Consumer Product Safety Commission (CPSC), injuries from inflatable bounce houses increased from 5,311 to 17,377 injuries from 2003 to 2013. An analyst from the Pew Charitable Trusts found that the trend continues, with an estimated 20,700 injuries last year. Recognizing the risks, half of states regulate the inflatable attractions, but enforcement of the regulations is found to lack considerably. Advocating to improve safety requirements and enforcement provisions, as well as offering safety information to parents and children can help make these popular attractions safer.

For more from the AAP on this issue see Bounce Houses: Safety Information for Parents from healthychildren.org.​

October 31, 2017: State Concussion Laws Are Effective

A recent study published in the American Journal of Public Health found that state laws addressing concussion management have been effective in reducing rates of repeated concussions in high school athletes. According to the study, student athletes were also more likely to report suspected concussions after the laws went into effect.

As of this year, all 50 states and the District of Columbia have enacted laws that require student athletes suspected of suffering a concussion to be cleared by a pediatrician or another member of the child’s medical team.  Laws vary across states and many can still be improved through your advocacy work.

Are you working on this issue in your state? For more from the AAP, see our State AdvocacyFOCUS resource Concussion Management: Return to Play.

October 30, 2017: State ACEs and Trauma-Informed Policy Efforts

Recognizing the growing body of research, state policymakers are increasingly focused on the role that adverse childhood experiences (ACEs) play in the health and well-being of children, and are promoting trauma-informed public policy across the country. This year, almost 40 related bills were introduced in 18 states. According to the ACEs Connection Network, in recent years 15 states have enacted 20 statutes aimed at mitigating ACEs.

Adverse Childhood Experiences and Trauma-Informed Policy Approaches, an update from the Network for Public Health Law, reports that issues addressed in these bills include educating school personnel about ACEs; encouraging health care providers to use an ACEs questionnaire or screening tool; creating task forces or study committees for ACEs-related issues; appropriating funds for ACEs prevention; and funding pilot projects or initiatives for ACEs prevention.

For more from the AAP, see our policy statement Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health.

October 26, 2017: How States Are Keeping CHIP Afloat

Congress has not yet renewed funding for the Children’s Health Insurance Program (CHIP), but some states continue to run their programs with federal funds that remained at the end of federal fiscal year (FFY) 2017. States can use their left-over federal CHIP money to continue running their programs, but under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, states are required to reduce that carryover by one-third and return that amount to the federal government.

States that did not have excess funds to spend on CHIP have now received additional funding from the Centers for Medicare and Medicaid Services (CMS) to continue the program. A total of $230 million has been disbursed to 5 states (AZ, CA, MN, OR, and WA) and 4 territories (American Samoa, Guam, the Northern Mariana Islands, and the Virgin Islands).

The AAP continues to advocate for CHIP funding without delay. To support ongoing chapter advocacy efforts on this important issue the AAP has an updated CHIP advocacy toolkit.

October 24, 2017: AAP State Waiver Webinar Recording Now Available

The October 18 AAP webinar recording, State Waivers: How they Could Alter Coverage and Care for Children, is now available. On the webinar, Jane Perkins, Legal Director of the National Health Law Program (NHeLP), discusses new state Medicaid Section 1115 and Affordable Care Act (ACA) Section 1332 waivers that could restrict or limit access to health care for children and families. Tune in to learn more about the waiver provisions states are proposing, the legal framework for these waivers, and hear from AAP leadership about the comprehensive advocacy strategy underway to address this threat. 

Working on waiver-related issues in your state? Please contact us for advocacy consultation and technical assistance.

October 23, 2017: The Lingering Toll of Disasters

State level resource allocation for mental health services is strained even under nondisaster conditions. With the growing frequency and severity of extreme weather events, state policymakers face an enormous challenge to keep pace with the increased needs of their citizens, and pediatricians and other physicians will continue to play a frontline role in response efforts.  

The damage from this year’s hurricane season continues to affect the daily lives of children and families in the mainland US and on the island of Puerto Rico. There is a growing body of evidence that these events may have a long-lasting impact on the psychosocial well-being of children and their caregivers.

Learn more from the Centers for Disease Control and Prevention (CDC) on a Webinar titled, “Primary Care Providers’ Role in Supporting Children, Families, and Professional Self-Care Following Hurricanes and Other Disasters”, October 26, 2017, from 1:00-2:00 PM Central/2:00-3:00 Eastern.

For more from the AAP, see our Children & Disasters page.

October 19, 2017: National Teen Driving Safety Week
It’s National Teen Driving Safety Week. Although motor vehicle crashes remain the leading cause of death for teenagers in the US, graduated driver licensing (GDL) laws have proven very effective in reducing teen crash fatalities and injuries. Strengthening these state laws can further improve safety. 

At the Intersection of Teen Driving and Tire Safety, from the Network for Public Health Law explores the intersection of teen driving safety and technology. A National Highway Traffic Safety Administration (NHTSA) study found 12% of crashes among inexperienced drivers were tire-related, compared to 5% for experienced drivers, signaling the need to include tire safety instruction in driver education curricula.

To aid AAP chapter advocacy efforts to strengthen GDL laws, we offer the Teen Driving infographic and State AdvocacyFOCUS resource on Teen Driving. For more from the AAP on teen driving safety see the Parent-Teen Driving Agreement and other teen driving safety resources on healthychildren.org.​

October 17, 2017: AAP State Advocacy Infographic | Tobacco 21
Raising the legal purchase age for tobacco products would reduce youth smoking initiation, particularly among children ages 15 to 17, lead to substantial reductions in tobacco use, and improve the health and lives of Americans, according to a report from the Institute of Medicine. Since this report was issued last year, 5 states (California, Hawaii, Maine, New Jersey, and Oregon) and more than 250 localities have enacted laws raising the minimum purchase age of tobacco products to 21 years.

To help AAP chapters in other states with advocacy efforts to enact Tobacco 21 laws, we share our new state advocacy infographic. Infographics are great awareness-raisers and can be used as leave-behinds when meeting with policy makers.

For more from the AAP, see our Raising the Tobacco Purchase Age State AdvocacyFOCUS resource and visit the AAP Julius B. Richmond Center of Excellence.

October 16, 2017: States Act to Control Prescription Drug Prices
States are currently working to address high prescription drug costs. Most recently, California passed a comprehensive prescription drug price transparency law which will require pharmaceutical companies to notify insurers at least 60 days before the price of a drug is expected to increase 16% of more. Currently, there is no notification requirement when there is a price increase.

Other states have also taken action. Maryland passed a law this year requiring healthcare officials to notify the state’s attorney general if the price of a generic drug increases by 50% or more (that law is currently being challenged in court). New York passed a law that will also put pharmaceutical companies under scrutiny when they increase drug prices. And this year, voters in Ohio will consider a ballot measure that would allow state health agencies to pay the same prices for prescription drugs as the US Department of Veterans Affairs, which gets a 24% discount from drug manufacturers prices.

In 2016, as the price of epinephrine autoinjectors increased dramatically, the AAP released a statement urging swift action to alleviate this access burden to families. For more from the AAP, see our State Advocacy Engagement on Epinephrine Autoinjector Costs resource.

​October 12, 2017: October 18 Webinar on State Waivers | Register Today!
States are contemplating new waivers that would have the effect of restricting or limiting access to health care. Please join the AAP for a webinar, State Waivers: How they Could Alter Coverage and Care for Children on Wednesday, October 18, at 1:00 pm ET/12:00 pm CT, where we will discuss the issue of Medicaid Section 1115 and Affordable Care Act (ACA) 1332 waivers.

We will be joined by Jane Perkins, Legal Director from the National Health Law Program (NHeLP), who will provide an overview of this issue and information on what has transpired recently with waivers. The AAP will also provide AAP chapters with guidance on how chapters can advocate to ensure all children maintain access to the care they need.

Register today for this webinar! And please contact us for consultation and technical assistance on waiver advocacy in your state.​

October 10, 2017: States Sound Alarm on CHIP
As the uninsured rate for children recently dropped to another historic low of only 4.5%, states are continuing to sound the alarm that the expiration of federal Children’s Health Insurance Program (CHIP) dollars will thwart this national progress. Utah became the first state to request permission to close its CHIP program, and Colorado issued a statement announcing no immediate changes but warning that CHIP might end when federal funds run out. Minnesota, facing an emergent CHIP funding crisis, reportedly received a $3.6 million infusion of unused CHIP funds to keep its program running, and Arizona, which is required by state law to end its CHIP program if funding is cut, announced it had received word of a similar influx of emergency funds to keep the program temporarily afloat.

Eleven (11) states (AZ, CA, CT, HI, ID, MS, NV, OH, OR, PA, and UT) are now projected to run out of federal CHIP funds by the close of 2017, and only 2 states, NH and OK, made state budget adjustments this year to address the possibility of federal CHIP funds expiring.

To help chapters advocate on this critical issue, the AAP has updated its CHIP advocacy toolkit and is encouraging chapters and members to participate in our #ExtendCHIP Day of Action tomorrow, October 11.

​October 9, 2017: State Policies on Energy Drink Consumption
A
study published in the October edition of the Journal of Nutrition Education and Behavior found that public policy interventions addressing sales, price, packaging and visibility of energy drinks could reduce the rate of consumption by children and young adults. The AAP encourages pediatricians to counsel adolescents and their parents about the health risks associated with consuming energy drinks.

In 2017, 2 states (Illinois and Massachusetts) considered legislation that would prohibit the sale of energy drinks to children younger than 18; 2 states (Montana and Texas) considered bills that would prohibit the purchase of energy drinks using Supplemental Nutrition Assistance Program (SNAP) funds; and 1 state (New Jersey) considered a bill that would require labels warning of the dangers of energy drink consumption by those younger than 18. None of these bills have been enacted, though similar measures may be seen when state legislatures reconvene in 2018.

For more from the AAP on energy drinks, see the HealthyChildren.org.​

October 5, 2017: A Look at State Gun Laws​​

The AAP responded to Monday’s deadly mass shooting in Las Vegas with a plea to lawmakers to advance stronger state and federal laws. In 2017, states have seen progress on efforts to prevent domestic violence perpetrators from obtaining weapons, but efforts to weaken existing state gun laws gained more traction in 2017.

In recent years, states have had success strengthening guns laws through state ballot measures. Though Nevada voted to require background checks for all gun purchases via a November 2016 ballot initiative, Nevada Attorney General Adam Laxalt has declared the law unenforceable. Threatening a potential lawsuit, attorneys for Nevadans for Background Checks have asked Nevada Governor Brian Sandoval to start enforcing the law by October 9th.

For more from the AAP, see our State AdvocacyFOCUS resources on Assault Weapon BansSafe Storage of Firearms, and Universal Background Checks.​

October 3, 2017: States Risk CHIP Fund Depletion
Funding for the Children’s Health Insurance Program (CHIP) officially ended on September 30, 2017, when Congress failed to act. The missed deadline has real implications for children and families across the country. According to the
Kaiser Family Foundation, there are now 10 states (AZ, CA, CT, HI, ID, MS, NV, OR, PA, UT) that say they will run out of CHIP funds before the end of the year. Due to the lack of federal funding, some states have already begun to make alternative plans for the program. For example, Utah has announced it will end CHIP altogether if funding is not extended, putting nearly 20,000 children at risk of losing coverage.

The AAP is calling on Congress to immediately pass the Keep Kids’ Insurance Dependable and Secure (KIDS) Act of 2017, which would extend CHIP funding for 5 years. To support chapter advocacy efforts on this important issue the AAP has updated its CHIP advocacy toolkit​. We ask that AAP chapters participate in our #ExtendCHIP Days of Action on Wednesday, October 4 and Wednesday, October 11.​​

October 2, 2017: Colorado Bans Edible Marijuana Products to Protect Kids
Colorado has seen a 34% rise in poison control reports due to marijuana exposure, and the prevalence of edible products that are appealing and palatable to young children are believed to be a significant contributor to the incidents. To address this, a new state law prohibiting the sale of edible marijuana products in the shape of fruit, animals, or people went into effect on October 1. The law is aimed at preventing other children from unintentionally ingesting cannabis-infused gummy candy or other seemingly kid-friendly products. The Colorado bill also requires potency labeling on edible marijuana products to be more prominent.

The AAP opposes the legalization of both recreational and medical marijuana, but recommends that states that have legalized marijuana regulate the drug as closely as possible to alcohol and tobacco and that all forms of marijuana be sold in child-resistant packaging to prevent unintentional ingestion by children.

For more from the AAP, see our policy statement, The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update and our Medical Marijuana and Marijuana Legalization State AdvocacyFOCUS resources.​

September 28, 2017: Return on State Investment in Prevention
As part of the health system transformation efforts across the country, governors, state legislators, and other state officials are focused on finding interventions that improve population health and health care quality while reducing health care spending.
Health Investments That Pay Off, a series of resources from the National Governors Association (NGA) Center for Best Practices examines how states can finance and deliver selected population health strategies that improve health outcomes and can demonstrate programmatic savings, or return on investment, within a short timeframe, potentially in less than 5 years. The series highlights tobacco control, asthma in children, and oral health and explore the need to extend health services provided in physician offices into homes and communities to improve health generating savings for states.

Learn more from the AAP about State Health Care System Transformation and Practice Transformation.

September 26, 2017: Updated CHIP State Fact Sheets Available as Congress Debates Critical Issues
The Graham-Cassidy proposal to repeal the Affordable Care Act (ACA) and significantly cut and cap Medicaid would harm children and families as it greatly limits access to care. The AAP strongly opposes this proposal and urges Congress to instead turn to bipartisan solutions that are crafted in the best interest of children and families, like the Children's Health Insurance Program and Maternal, Infant and Early Childhood Home Visiting program, which are both nearing expiration. Federal CHIP funding to states ends on September 30, 2017. Without continued federal dollars, states may have to end coverage for CHIP eligible children.

To support AAP chapter advocacy efforts, the AAP and Georgetown Center for Children and Families (CCF) have issued updated State CHIP Snapshot resources. They can be found on the AAP’s Children’s Health Care Coverage Fact Sheets Web page. These provide state specific data on the CHIP program as well as children’s coverage.

September 25, 2017: Mapping Child Care Availability
The term “food deserts” has been used to describe areas where the availability of nutritious food is lacking. A new term “child care deserts”, has emerged to describe areas with little or no access to quality child care. A new study from the Center for American Progress (CAP), Mapping America’s Child Care Deserts, examines the availability of child care in 22 states, in which two-thirds of the US population reside. The report finds that more than half of the US population live in child care deserts. More than half of the rural areas studied qualified as child care deserts, and 44% of suburban areas were found to be lacking. Hispanic and Native Americans were the most likely to face a lack of child care services, with about 60% of the combined population living in child care deserts.

CAP has also developed an interactive version of the report—click on your state to assess child care availability.

For more from the AAP, visit Healthy Child Care America | Early Education and Child Care Initiatives.​

September 21, 2017: States Declare Opioid Disasters
The opioid crisis is responsible for 91 deaths daily across the country, a 400% increase since 1999. Many states have
acted to limit opioid prescriptions or otherwise use state law to reduce opioid supply over the course of this year, and this week, 37 state attorneys general cosigned a letter to the insurance industry urging their assistance in curbing overprescribing of opioids. In a dramatic step, the governors of 6 states have used their authority to declare disasters in response to the growing numbers of deaths attributed to opioid overdose, and several tribal governments across numerous states have taken similar actions as well.

Declared States of Emergency—Opioid Crisis, a new resource from the Network for Public Health Law, includes a fact sheet and primer on the issue, offering a comparative look at these actions and how state level policy and authority can be leveraged to combat the current opioid crisis and mitigate its effects on children, families, parents, and caregivers.

For more from the AAP, see our Neonatal Drug Withdrawal clinical report and the AAP Disaster Preparedness Advisory Council Web site. The AAP is also a member of the AMA Opioid Task Force.

September 19, 2017: New AAP Resource | Telehealth Care Advocacy Opportunities
Removing barriers to telehealth care can help extend the reach of pediatric physicians and increase access to care, especially to pediatric specialists and subspecialists. There are many issues related to telehealth care that continue to be debated in state legislatures across the country. Matters such as payment parity, coverage of services delivered via telehealth care, establishment of the physician patient relationship, and licensure all have been part of state telehealth care legislation.

To help AAP chapters work to remove barriers and increase access to care through telehealth care and sort through these issues, the AAP has a new resource, Telehealth Care | Advocacy Action Guide for AAP Chapters. Included are an overview of the issue, and policy and advocacy guidance that chapters can use in related state advocacy efforts.

September 18, 2017: Wisconsin Leads in Trauma Informed Policy
In recent years, a growing number of state policymakers have come to realize that the cost of not responding to violence and trauma in the lives of children is too high to ignore. A number of states have been working to advance trauma-informed organizational change, and have supported greater collaboration across child welfare, education, and health sectors.

In its goal to become the first trauma-informed state, Wisconsin state agencies have completed their first year of trauma-informed learning. In 2016, Wisconsin Governor Scott Walker directed 7 state agencies to learn about adverse childhood experiences (ACEs) science and to incorporate the science throughout their scopes of work. Wisconsin First Lady Tonette Walker heads up the state’s Fostering Futures efforts.

The AAP Wisconsin Chapter has been a leader in related efforts to support members in their efforts to become trauma-informed through education and public health advocacy, including the establishment of the Child Psychiatry Consultation Program (CPCP) pilot. WIAAP closely collaborates with state officials and agencies to ensure that all Wisconsin children and families are thriving in nurturing communities; individuals, communities and government integrate trauma-informed, strength-based principles into their relationships, culture, policies, and practices.

For more from the AAP, see our policy statement Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science Into Lifelong Health.

September 14, 2017: Spotlight on State Home Visiting Programs
State home visiting programs have a long track record of providing targeted interventions to promote the long-term health and well-being of children and families, resulting in measurable benefits. The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program has funded much of this work, however states have also used state dollars, Medicaid funding, and private resources to finance home visiting programs.
Medicaid Financing of Home Visiting Services for Women, Children, and Their Families, a new resource from the National Academy for State Health Policy (NASHP), examines Medicaid program authorities—including state coverage options, targeted case management, EPSDT, and waivers—that can be used by states to fund home visiting services. This resource can be utilized by AAP chapters seeking innovative Medicaid pathways to fund home visiting programs.

The AAP policy statement, Early Childhood Home Visiting provides recommendations on expanded federal and state support for home visiting services and integration of home visiting into the medical home. To learn more about evidence-based home visiting services in your state, visit the new National Home Visiting Resource Center state-by-state map.

​​​September 12, 2017: ​2017 AAP National Conference and Exhibition | Advocacy Sessions and Activities​​

The 2017 AAP National Conference and Exhibition begins this weekend in Chicago IL, where meeting participants will have numerous opportunities to learn more about the important policy issues impacting child health and pediatric practice. The meeting will also provide great opportunities to connect with your colleagues engaged in chapter advocacy around the country.​

​Take part in our NCE advocacy sessions and learn how you can make a difference for children in your state and across the country. Be sure to stop by the AAP Advocacy Action Center in the McCormick Place West Concourse, and please visit the State Government Affairs staff in the AAP Resource Center in the Convention Center exhibit hall. We hope to see you there!​

September 11, 2017: States Extend ACA Sign-Up Beyond Federal Limit

The open enrollment period for Affordable Care Act (ACA) marketplace plans for the 2018 plan year runs from November 1-December 15, 2017, giving consumers 45 days to buy health insurance. This shortened time frame was announced via the  Centers for Medicare and Medicaid (CMS) final rule released in April. The rule, however, also gives state-based marketplaces the ability to extend the amount of time consumers will have more time to purchase plans. 

California, Colorado, Massachusetts, Minnesota, and Washington and the District of Columbia, will be exempting themselves from the administrative rule and expanding the time allowed to purchase coverage for 2018. These states will allow consumers to shop for coverage until the middle or end of January 2018, which is similar to previously ACA timelines. In California, legislators are additionally considering legislation which would sidestep this rule in future years.

As the next open enrollment period approaches, pediatricians can inform families of opportunities to seek marketplace coverage November 1-December 15, 2017. Enrollment options can be investigated in any state starting at www.healthcare.gov. Children who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll in these programs at any time.​

September 7, 2017: CS Mott Children’s Hospital Annual Poll on Health Concerns for Children

In this year’s Annual National Poll on Children’s Health conducted by the CS Mott Children’s Hospital, adults rate health concerns that children are facing.

The top 10 health concerns are: bullying/cyberbullying (61%); not enough exercise (60%); unhealthy eating (57%); drug abuse (56); Internet safety (55%); child abuse and neglect (53%); suicide (45%); depression (45%); teen pregnancy (43%); and stress (43%). There are some key differences based on children’s age and race. Parents of teenagers are more concerned about depression than parents of young children, who are more worried about cancer. Parents of black children report more concern over school violence and motor vehicle accidents than white and Hispanic parents, who focused more on bullying/cyberbullying and Internet safety.

New to the poll this year, parents were asked specifically about health concerns they believe their own children may face. Parents believe the top 3 health concerns to their own children are: bullying/cyberbullying (34%); Internet safety (30%); and stress (28%) and motor vehicle accidents (28%).​


August 1, 2017: Chapter Advocacy in 2017—Thank You!
As we enter August, most state legislatures have also adjourned their 2017 regular sessions. We want thank every AAP Chapter and the thousands of dedicated pediatric advocates for the work you do on behalf of children and families in your states. We invite you to have a look at a special presentation (slides will automatically advance) highlighting AAP Chapter and District advocacy days from this year. 

As many of you enjoy vacations and make back-to-school preparations, StateView will be taking a brief August recess. We’ll be back in September after Labor Day to guide you through your fall state advocacy activities and help you to prepare for the 2018 state legislative sessions. Have a safe and relaxing August!

July 31, 2017: ACA Enrollment Funds for Cities Ends

The Trump administration has ended contracts with 2 companies that help people sign up for health insurance on the Affordable Care Act (ACA) marketplaces in 18 cities. The companies hired “navigators” in these cities who helped to both inform the community and help individuals as they signed up for coverage. While these 2 companies were responsible for signing up just some of the 9.2 million people who enrolled overall, they did target younger and healthier individuals who are the key to bringing premiums down and stabilizing the insurance market. Following failed efforts to repeal the ACA, the law remains in place and it is important to maintain enrollment in the marketplaces and ensure that individuals who need coverage are able to obtain it.

The 18 cities that will no longer receive federal dollars for enrollment assistance are Atlanta; Austin; Charlotte, NC; Chicago, Cleveland; Dallas; Houston; El Paso; Indianapolis, Miami, McAllen, TX; New Orleans; Orlando; Philadelphia; Phoenix; Tampa; and San Antonio. The federal government still funds navigator grants in 34 states, but those contracts are expected to end in 2018.

Pediatricians can inform uninsured families seeking marketplace coverage that the next open enrollment period is November 1-December 15, 2017. Enrollment options can be investigated in any state starting at www.healthcare.gov.  Children who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP) can enroll at any time.

July 27, 2017: State Tobacco 21 Trends
New Jersey Governor Chris Christie recently signed a bill prohibiting sales of tobacco, including electronic nicotine delivery systems (ENDS), to anyone younger than 21. New Jersey becomes third state, joining California and Hawaii, to raise the tobacco purchase age to 21.

In related actions, a Maine bill to prohibit tobacco sales to purchasers younger than 21 was vetoed by Governor Paul LePage last Tuesday but that bill passed the legislature by a veto proof margin, so observers await a possible veto override. In Oregon, a Tobacco 21 bill has passed the legislature and awaits action by Governor Kate Brown; she has previously expressed her support for the policy. 

For more from the AAP, see our Raising the Tobacco Purchase Age State AdvocacyFOCUS resource and visit the AAP Julius B. Richmond Center of Excellence.

July 25, 2017: The State of Home Visiting
Early childhood home visiting programs are designed to help new parents and their children through the help of a trained professional. In 2015, more than 250,000 families nationwide received evidence based home visiting services. Home visiting is based on the idea that working with children while they are young helps to improve outcomes throughout a child’s life.

Early Childhood Home Visiting: Lift Up Families to Lift Up Communities, from the Urban Institute, discusses the importance of home visiting programs and the challenges the programs can face, such as funding to reach more families and meeting the need in rural areas. The resource also highlights innovative community and state programs and how they’re helping families in need.

For more from the AAP, please see our policy statement, The Role of Preschool Home Visiting Programs in Improving Children’s Developmental and Health Outcomes.​

July 24, 2017:Will That Bill be Back Next Year?

State legislatures and their rules are as varied as the states themselves. A majority of states (27) permit bill carry over—that is, if a bill is not passed in the current legislative year, it can remain viable until the legislature reconvenes the following year (and as such, this excludes the 4 states that meet every other year—namely, Montana, Nevada, North Dakota, and Texas).

Carry over bills can remain in their current stage of the legislative process, can be sent back to their original committee, or can be returned to the rules committee in the chamber where they were introduced. Some states set calendar limitations by which a carried over bill must be reconsidered, otherwise it dies. The National Conference of Legislatures examines this process across the states in To Carry Over or Not?

Building support for a bill prior to its introduction is an important for its ultimate success, but by understanding the legislative process, your advocacy priorities can get a second chance if at first you don’t succeed. For more, see our State Advocacy Planning Resources for AAP Chapters.​

July 20, 2017: Innovative State Funding for Health-Related Social Needs
States have been creative in their efforts to address the needs of low-income and vulnerable populations as they take on social determinants of health and seek to improve health outcomes. Innovative funding models have helped some states respond to the health-related social needs of their citizens.

In Times of Constrained Resources, How Can States Innovatively Fund Health-Related Social Needs?, an analysis from the National Academy for State Health Policy, examines funding models from Virginia and Louisiana. Virginia’s Children’s Services Act combines state and local community funding to help at-risk children and their families, and Louisiana’s Permanent Supportive Housing Program provides housing and other services for individuals with low-incomes and disabilities, and the homeless. Both programs have demonstrated how blending previously separated funding can help them to better address the needs of these populations, while also making it easier for populations to access services.

For more from the AAP see our policy statement, Community Pediatrics: Navigating the Intersection of Medicine, Public Health, and Social Determinant of Children’s Health.​

July 18, 2017: Governors Voice Concerns in Advance of Senate Health Bill Stall
Yesterday, 2 additional US Senators announced they would not support the Better Care Reconciliation Act (BCRA) in its current form, bringing the current total to 4 and effectively halting the bill from proceeding. Prior to this, at a meeting of the National Governors Association (NGA), governors from both parties voiced unease with significant BCRA provisions, including its drastic cuts to federal Medicaid spending and the end of the Medicaid expansion. Today, a bipartisan group of 11 governors released a statement opposing plans to repeal the Affordable Care Act without a replacement. Governors, as executives in charge of Medicaid programs across the country, will continue to have a critical voice as the Senate debates its next steps on health care.

The stall of the Senate bill means your advocacy is working! An enormous thank you to all AAP chapters and members for your tireless efforts to draw attention to the harmful effects the BCRA would have on children’s coverage and care. The AAP is carefully monitoring and analyzing this quickly-changing situation and will update AAP chapters and members in the days and we​eks ahead on next steps and our continued advocacy on behalf of children. Stay tuned!

July 17, 2017: Children, States, and the Rising Costs of Prescription Drugs

Medicaid and the Children’s Health Insurance Program (CHIP) provide children with a comprehensive benefit package, including prescription drugs. Federal protections such as Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and limits on out-of-pocket costs in both Medicaid and CHIP, help safeguard children from increasing drug costs.


How Medicaid and CHIP Shield Children from the Rising Costs of Prescription Drugs, a report from the Georgetown Center for Children and Families, examines limits on prescription drug coverage in the private market and the ways Medicaid and CHIP protect children from harmful effects of such barriers to coverage. The report includes recommendations to ensure existing Medicaid and CHIP protections for children remain in place.


In addition, the National Academy for State Health Policy (NASHP) has established the Center for Rx Drug Pricing to help states with related issues. The Center provides states with technical and strategic assistance, leverages legal and actuarial expertise, distributes funding to a subset of states, and convenes state leaders on this issue.


Last year, as the price of epinephrine autoinjectors had increased dramatically, limiting access to this important prescription drug for children, the AAP released a statement urging swift action to alleviate this burden to families. For more from the AAP, see our State Advocacy Engagement on Epinephrine Autoinjector Costs resource.

July 13, 2017: State Strategies to Promote School Entry Immunizations
State governments play a pivotal role in making immunization policy, and state and local level decision makers need accurate information and experiences from other states to help them in that task. The Vaccination-Exemption Challenge by the Governing Institute examines the issue, citing California’s experiences with reform. Worthy of note, overall exemptions in California saw a decline following the implementation of the law, and a rise in immunization rates in children entering kindergarten.

Vermont, which acted in recent years to curb nonmedical exemptions, has found that following repeal of their philosophical exemption to school entry immunization requirements—while still allowing religious exemptions—that the state experienced a decrease in total exemptions for kindergarteners, and a 5-year high in immunization rates for older children.

For more from the AAP, see our policy statement Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, our State AdvocacyFOCUS resource on Childhood Immunizations, and our Child Vaccination Across America interactive infographic. ​

July 11, 2017: States and Cities Address Rising Homeless Youth Population
​Homeless youth present a unique set of needs for state and local social service agencies to address, and now, the number of youth, teens, and young adults living on the street appears to be growing. Reaching, serving, and sheltering this population is more difficult, compounded by the greater risks to young people who are without permanent and safe housing. Homelessness is often a product of those same vulnerabilities, with many youth escaping parental abuse or drug addiction; additionally, up to 40% of homeless youth are lesbian, gay, bisexual, or transgender—a contributing factor in why youth leave home or are displaced by their parents—and most homeless youth have faced sexual exploitation and violence.

A Hidden Population: Youth Homelessness Is on the Rise, a report from the Pew Charitable Trusts, examines this important issue and explores how state and local governments are responding.

For more from the AAP, see Providing Care for Children and Adolescents Facing Homelessness and Housing Insecurity.

July 10, 2017: Washington State Enacts Paid Leave
Washington is now the 5th state (joining California, New Jersey, Rhode Island and New York) to require paid family and medical leave, offering eligible employees time and pay for the birth or adoption of a child, serious medical condition of the worker or the worker’s family member. The District of Columbia also approved a paid family leave law earlier this year. Both the Washington State and DC laws become effective in 2020.

The new Washington law is the culmination of efforts that began a decade ago with the enactment of a paid family and medical leave law that was never implemented due to lack of funding.

The Washington Chapter of the AAP (WCAAP) has been a leading advocate in this effort. Paid leave is one of the chapter’s 2017 Legislative Priorities and WCAAP Legislative Affairs Committee Cochairperson, Lelach Rave, MD, FAAP, testified in support of the bill.

For more from the AAP, see our 2017 State Actions | Paid Leave resource.​

July 6, 2017: Meet Rachel Levine, MD, FAAP—Pennsylvania’s Physician General
In 2015, national AAP and AAP Pennsylvania Chapter member Rachel Levine, MD, FAAP was confirmed unanimously by the Pennsylvania Senate as the state’s physician general. As the state’s top doctor, Dr Levine also became one of the few transgender public officials in the US.

Recently, she spoke with Governing Magazine as part of its "The 23%: Conversations With Women in Government,” podcast series. In the interview, Dr Levine discusses her role in state government, the opioid crisis, and serving as a transgender public official.

Hundreds of pediatricians serve in state and local elected, appointed, and career public service positions across the country and make a real difference for children and families every day. The AAP applauds and thanks them for their important work.​

​July 4, 2017: State Coverage and Spending Losses Under the BCRA
As the AAP continues its advocacy against the Better Care Reconciliation Act (BCRA) and its harmful effects on children, the Urban Institute’s State-by-State Coverage and Government Spending Implications of the Better Care Reconciliation Act highlights the potential coverage and spending repercussions for states. Researchers found that 24.7 million nonelderly Americans would be uninsured in 2022 (largely in line with the Congressional Budget Office (CBO) estimate of 20 million by 2022 and 22 million by 2026). Every state would face a coverage decline, with the uninsured rate more than doubling in 25 states, and tripling in 4 states.

Federal Medicaid spending would be $102.2 billion lower in 2022 under the BCRA (a 26.4% decline), and federal funding for premium tax credits/cost-sharing reductions would fall by $38.2 billion that year (an 84% decline). For specific state-by-state data, please see the complete Urban report as well as its map of coverage losses and map of federal spending losses.

Thank you for your continued advocacy! Please keep the phone calls, emails, Op/Eds, and social media messages coming—use our Rapid Response Toolkit (PDF and Word) for assistance and please provide us with feedback at kids1st@aap.org as you take action.​

July 3, 2017: State Laws Addressing Fireworks
With the Independence Day upon us, the AAP encourages families to enjoy public firework displays—leaving the pyrotechnics to the professionals—and cautions families about the
dangers of consumer fireworks. Some or all consumer fireworks are still legal in 44 states. Only 2 states (Delaware and Massachusetts) ban all consumer fireworks, and 4 others (Illinois, New Jersey, Ohio, and Vermont) allow only sparklers and other novelty items. New Jersey previously banned all consumer fireworks, but lifted their restriction on novelty items last week. In addition, legislation enacted this year in Iowa now permits the sale of a full range of consumer fireworks, and similar legislation is pending in Ohio. The AAP recommends a ban on the public sale of all consumer fireworks.

For over 10 years, the AAP has joined forces with the National Fire Protection Association (NFPA), other medical specialty societies, and numerous health and safety organizations to form the Alliance to Stop Consumer Fireworks in an effort to warn the public about the dangers of consumer fireworks. In 2015, hospital emergency rooms in the US treated an estimated 11,900 people for fireworks related injuries. Children younger than 15 years of age accounted for 26% of the estimated 2015 injuries.

For more from the AAP, see our Firework-Related Injuries to Children policy statement. See the NFPA infographic and tip sheet for more on the dangers of consumer fireworks.​

June 29, 2017: Pre-K Gets Boost in Indiana Thanks to Pediatricians
Members of the Indiana Chapter of the AAP joined Governor Eric Holcomb and fellow early childhood advocates for the signing of a bill that will increase funding for the state’s pre-K program by $22 million over the next 2 years. Expansion of the program was one of the chapter’s 2017 advocacy goals, and with this increase in funding the state’s program will expand from 5 to 20 counties.

Below, advocates joined (at desk, left to right) Representative Robert Behning (R-91), Speaker of the House Brian Bosma (R-88), Governor Eric Holcomb (R), and Lieutenant Governor Suzanne Crouch (R) for the bill signing. IN AAP Chapter Executive Director Christopher Weintraut, JD, and IN AAP Chapter Vice President Tony GiaQuinta, MD, FAAP are in the back row, fifth and sixth from the left.​

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June 27, 2017: How Would AHCA Affect State Economies?
As the US Senate considers the major changes proposed by the Better Care Reconciliation Act (BCRA), analysts continue to examine the effects of the House-passed American Health Care Act (AHCA).
The American Health Care Act: Economic and Employment Consequences for States, a report from George Washington University and The Commonwealth Fund, examines the policy’s effects on state economies, concluding that it would cause an economic downturn in almost every state and would result in nearly 1 million job losses by 2026. In addition, gross state products could fall by $93 billion, and state business output could fall by as much as $148 billion by 2026. While the AHCA may have an initial stimulating effect due to its tax cut provisions, researchers predict that the AHCA would spark “sharp job losses and broad disruption of state economies” in subsequent years. States that expanded Medicaid would be hardest hit under the AHCA.

State fact sheets from the report provide details on the AHCA’s harmful economic consequences. AAP chapters can use this information in ongoing advocacy work.

The AAP appreciates all of your efforts on the BCRA and AHCA. Your advocacy is helping so please keep calling, writing, tweeting, and talking to your senators and representatives. For more from the AAP, see our Rapid Response Resource (PDF and Word).

June 26, 2017: Nevada Enacts School Bus Seat Belt Mandate
The effort in state legislatures to strengthen passenger safety requirements on school buses continues to advance. Following a school bus crash in Tennessee in late 2016, over a dozen states introduced legislation to require seat belts on school buses. Nevada’s legislation to mandate seat belts on all new school buses was signed into law earlier this month, and joins Arkansas as the other state to successfully enact legislation on this issue in 2017. California, Florida, Louisiana, New Jersey, New York, and Texas have enacted similar mandates in prior legislative sessions, though some of these states have not fully implemented or funded their seat belt programs.

For more from the AAP, see our School Bus Safety state advocacy infographic and the School Transportation Safety policy statement.​

June 22, 2017: EPSDT at Risk Under AHCA | Take Action!
For the 37 million children enrolled in Medicaid—Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) is a vital benefit that helps ensure that the vulnerable child population, especially children with special health care needs and children in foster care, gets the care they need.

At Risk: Medicaid’s Child-Focused Benefit Structure Known as EPSDT, a report from The Georgetown Center for Children and Families (CCF) examines how the American Health Care Act (AHCA), currently under consideration in the US Senate, would put EPSDT benefits in jeopardy. Not only would the AHCA drastically change how Medicaid is financed by moving to a per capita cap or block grant, but it would also make providing EPSDT optional for children except for those with disabilities. This would end the current guarantee of comprehensive services that ensure the healthy development of the country’s most at-risk population. In addition, the ability of pediatricians to make health care decisions that are in the best interests of children would be eliminated, putting benefit decisions for children, instead, in the hands of lawmakers.

For more from the AAP on threats posed by the AHCA to children’s coverage and what you can do to take action, please see our Days of Action Rapid Response Resource—Contact your Senators TODAY!​

June 20, 2017: 2017 KIDS COUNT Data Now Available

The 2017 KIDS COUNT Data Book, an annual report from The Annie E. Casey Foundation, examines state level child health, education, and well-being data. Overall, the 2017 report finds that while the poverty rate for children has declined, there is still a substantial number of children living in concentrated areas of poverty. Additionally, fewer families are living with high housing costs and the teen birth rate has continued its recent decline, resulting in the lowest rate ever.

State and topic specific data are easily searchable through the KIDS COUNT Data Center. This customizable resource is an excellent tool to lend support to a wide variety of AAP chapter advocacy initiatives.

June 19, 2017: State of the Cities 2017
State of the Cities 2017, a new report from the National League of Cities (NLC), examines 120 speeches by mayors across the country. The attention of mayors is focused on a wide array of issues ranging from economic development and public safety to education, the environment, and health. Specifically addressed are matters such as the availability of public recreation space, the prevention and treatment of opioid addiction, the availability of health care facilities, and access to nutrition support programs.

Municipal and county government agencies and officials are playing an increasingly active role in the development of public policy related to children’s health and well being. Engagement with local governments by AAP chapters and members is a vital part of an overall advocacy strategy and is one that can bring you significant success.

June 15, 2017: Pediatric Neurologist Wins Virginia Gubernatorial Primary
Dr Ralph Northam, a pediatric neurologist at Children’s Hospital of the King’s Daughters in Norfolk, recently won Virginia’s Democratic gubernatorial primary election. Dr Northam is currently the state’s Lieutenant Governor and previously served two terms in the Virginia Senate.

If elected this November, he will be the first pediatric subspecialist to serve as a US governor. Dr Pedro Rosselló, a pediatric surgeon, served as governor of the Commonwealth of Puerto Rico from 1993-2001.

Other AAP members are currently or have in the past served state government in elected, appointed, or career public service positions and bring a unique perspective to advocacy, lawmaking, and governing. Do you know a pediatrician serving in this capacity? Let us know at stgov@aap.org.​

June 13, 2017: States at Risk With AHCA Medicaid Changes

Factors Affecting States’ Ability to Respond to Federal Medicaid Cuts and Caps: Which States Are Most At Risk?, a new report from the Kaiser Family Foundation, examines states’ capabilities to respond to the drastic federal Medicaid changes in the American Health Care Act (AHCA). The AHCA, as passed by the House, would halt the open-ended nature of Medicaid funding and replace it with either a block grant or per capita cap, at state choice. The AHCA would further eliminate the Medicaid adult population expansion—taken together, the Congressional Budget Office (CBO) found these House bill changes would result in cuts of $834 billion in federal Medicaid funding and over 14 million Medicaid enrollees losing coverage.

The Kaiser report examines 30 high risk factors that could affect states’ abilities to respond to Medicaid cuts and caps. All states would face challenges in responding to the AHCA Medicaid changes, but 6 in 10 states rank in the top 5 for multiple risk factors, and 11 states rank in the top 5 for 5 or more risk factors. States with multiple risk factors will have greater difficulties responding to the AHCA’s federal cuts to Medicaid.

This report documents how difficult it will be for states to respond to Medicaid changes via the AHCA, and can support advocacy efforts to oppose them. Thanks to all AAP chapters, committees, councils, sections and members for your ongoing advocacy to prevent the AHCA from harming children’s health care. ​

June 12, 2017​​: Massachusetts Pediatric Trainees Visit the State House

More than 60 residents and fellows from the AAP Massachusetts Chapter recently visited state lawmakers in Boston during the chapter’s annual Residents and Fellows Day at the State House (RFDASH). Participants advocated for legislation to improve mental health services for children, to protect the civil rights of all state residents, and to improve public health by streamlining the state’s application process for public benefit programs.

RFDASH was founded in 2005 by the Massachusetts General Hospital for Children Pediatrics residency program, and is now a collaborative effort of all the pediatric residency programs in the state. Over the years, RFDASH participants have advocated for nearly 30 child health and well-being bills, many of which have become law.

Here a group of RFDASH participants pause for a break between their meetings with state legislators.​

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​June 8, 2017: Medicaid for Children in Small Towns and Rural Communities
Medicaid in Small Towns and Rural America: A Lifeline for Children, Families, and Communities, a new report from the Georgetown Center for Children and Families (CCF) Rural Health Project, highlights the significant impact Medicaid has on children and families in small towns and rural areas of the US.

Researchers found that Medicaid plays a significantly larger role in providing health coverage to children in small towns/rural communities than it does in metropolitan areas—nationally about 45% of children in small towns/rural communities are covered by Medicaid, compared to 38% in metro areas. The data also show a link between increases in Medicaid coverage generally and decreases in children’s uninsured rates in such nonmetro areas, with significant decreases in specific communities. This report and its state-by-state county level data provide important information to support AAP chapter advocacy against threats to Medicaid.

Chapters are encouraged to utilize the recently updated AAP Protecting Children’s Coverage Advocacy Toolkit for talking points, sample Op/Eds, and other advocacy materials, and to contact the AAP at kids1st@aap.org or stgov@aap.org for additional consultation and technical assistance.

June 6, 2017: Support for Medicaid | Webinar Explores Proposed Changes
Recent
polling by the Kaiser Family Foundation (KFF) found that there’s a great deal of public support for the Medicaid program as it is currently structured, including continued funding for states that have expanded the program under the Affordable Care Act (ACA). In fact, 71% of Americans prefer to keep the program as it is today and 58% say Medicaid is either “very” or “somewhat” important to their families.

For a closer look at how changes to Medicaid included in the American Health Care Act (AHCA) may affect those insured by the program and state which administer it, join a Network for Public Health Law (NPHL) ​​​ Webinar on Thursday, June 15. Register today.

For more from the AAP, please see our AAP Statement Opposing House Passage of American Health Care Act, our Protecting Children’s Coverage Advocacy Toolkit and our state Children’s Health Care Coverage Fact Sheets.​

June 5, 2017: Children and Youth With Special Health Care Needs and Medicaid
Medicaid plays a significant role for children and youth with special health care needs (CYSHCN). They often have conditions or require treatments that are not adequately covered under private insurance, such as nursing care or therapies to address developmental delays. Currently, Medicaid provides federal matching funds with no preset limit to help states cover CYSHCNs. The proposed restructuring of the Medicaid program in the American Health Care Act (AHCA) would put this funding at risk.

The Kaiser Family Foundation (KFF) has developed resources that can help AAP chapters in their advocacy to support CYSHCNs. An infographic demonstrates how Medicaid helps CYSHCNs and how funding the program via a per capita cap or block grant would limit coverage for those with the most need. A state-specific data table examines state indicators of Medicaid’s role for CYSHCN.

For more from the AAP, please see our AAP Statement Opposing House Passage of American Health Care Act, our Protecting Children’s Coverage Advocacy Toolkit and our state Children’s Health Care Coverage Fact Sheets.

June 1, 2017: Michigan Chapter Hosts Resident Advocacy Day

The AAP Michigan Chapter recently hosted its annual Resident Advocacy Day. More than 70 residents and fellows from across Michigan converged on the state capitol building in Lansing to meet with legislators and discuss chapter advocacy concerns including e-cigarettes, immunizations, safe sleep, safe storage of firearms, and the state's earned income tax credit.

May 30, 2017: State Legislatures Promote Sunscreen Use

To help protect children from the consequences of prolonged sun exposure, state legislatures are acting to permit them to have and use sunscreen at school without a doctor’s prescription or permission note. Related legislation, enacted this year in Alabama, Arizona, Washington, and Utah, and pending in several others, can help children to protect themselves from harmful UV rays, but also models sun-safe behavior for their peers. State dermatology societies have been leading many of these policy change efforts, and are ideal advocacy partners for AAP chapters.

​For more from the AAP, please see our policy statement, Ultraviolet Radiation: A Hazard to Children and Adolescents and our Sun and Water Safety Tips.​

May 29, 2017: Happy Memorial Day

We remember those Americans who give Memorial Day its special meaning and wish you and your families a safe and relaxing day.

May 25, 2017: Impact of Federal Spending in States
Federal spending in states varies considerably, with
some states relying on federal dollars for nearly 40% of their total annual revenues. With a budget proposal in Washington that would significantly decrease federal spending on dozens of domestic programs, state legislators face the daunting task of accurately forecasting their budgets for the next fiscal year, while also meeting the needs of their constituents.

The 3 largest categories of federal funding to states—health and social welfare, education, and transportation—all have considerable effect on children, but most notable is the Medicaid program; 43% of Medicaid enrollees are children, though they account for just 19% of program spending.

Learn how federal dollars help to insure children in your state with our Children’s Coverage Fact Sheets. For more, see the AAP Statement Opposing President Trump's Fiscal Year 2018 Budget.

May 23, 2017: State Actions Sustain Efforts on Climate Change
Suspension of the Environmental Protection Agency (EPA)’s
Clean Power Plan has led state governments to reassess how they can take the lead in reducing carbon emissions. Last week, Virginia's Governor Terry McAuliffe issued an executive order to limit carbon emissions in the state and to promote use of renewable energy.

States and municipalities face region-specific threats from climate change, ranging from longer wildfire seasons to rising sea levels, spurring some local leaders to act. Oppositional efforts are also underway, however, which seek to preempt local and municipal actions on climate and energy.

The threat of climate change impacts us all, but children are uniquely vulnerable. AAP chapters can be essential partners in the effort to combat climate change by giving voice to its threat to child health. For more from the AAP, see our Climate Change resources from the Council on Environmental Health.

May 22, 2017: CHIP Offers Families Financial Protection
Families of children with chronic conditions are likely to see
large increases in out-of-pocket costs when they switch from the Children’s Health Insurance Program (CHIP) to an Affordable Care Act (ACA) marketplace plan. A new study demonstrates the financial impact of moving chronically ill children between the 2 types of plans and shows the transition can leave families financially vulnerable. For example, a child with asthma whose family earns between 251-400% of the federal poverty level (FPL), would pay $1,227 in out-of-pocket costs each year in a marketplace plan, compared with $84 in CHIP.

Federal funding for CHIP ends in October 2017 unless Congress acts. The AAP continues to advocate for long term funding of CHIP. The National Governors Association (NGA) has also called for a 5-year federal extension of CHIP funding at the current match levels, citing the need for such certainty for children, families, and states.

For more from the AAP, please see our state Children’s Health Care Coverage Fact Sheets.

​May 18, 2017: AAP Delaware Chapter and Kids Caucus Meet With Governor
Earlier this week, the
AAP Delaware Chapter and the Delaware Kids Caucus met with Governor John Carney to discuss access to care, medical marijuana, nonmedical immunization exemptions, and substance exposed newborns and other important issues.  Pictured are (left to right) Chapter President Katherine King, MD, MPH, FAAP; Sam Stubblefield, MD, FAAP; Shirley Klein, MD, FAAP; Katelyn Fritzges, MD; George Meldrum; Chapter Vice President Laura Lawler, MD, FAAP; Kevin Sheehan, MD, FAAP; Governor John Carney, and Chapter Immediate Past President Cathy Zorc, MD, FAAP.

 

May 16, 2017: State Medicaid Strategies on Adolescent Depression
Depression is the second most common behavioral health disorder among children insured by Medicaid, and state Medicaid programs are increasingly looking for new approaches to identify children suffering from depression and link them with treatment. The recently released
AAP Bright Futures Guidelines, 4th Edition and the accompanying Bright Futures/AAP Recommendations for Preventive Pediatric Health Care (Periodicity Schedule) recommend universal depression screening for adolescents, annually beginning at the 12-year visit. Early identification, diagnosis, and treatment of children with depression can have a significant impact on their overall and future health and wellbeing.

State Strategies to Measure and Incentivize Adolescent Depression Screening and Treatment in Medicaid from the National Academy for State Health Policy (NASHP) highlights the efforts of the Minnesota and Oregon Medicaid programs to implement innovative quality measures and incentives for adolescent depression screening and follow-up treatment. These examples can serve as models for other state Medicaid programs.

For more from the AAP, visit our Mental Health Initiatives, where you’ll find Strategies for System Change in Children’s Mental Health: A Chapter Action Kit.​

​May 15, 2017: Ohio Pediatric Residents Advocate in Columbus
Recently, the
AAP Ohio Chapter joined the Ohio Children’s Hospital Association for their annual resident advocacy day in Columbus. Chapter members and staff presented advocacy skills building workshops and coordinated legislative visits pediatric residents. Here, (left to right) Meredith Merkley, DO; Sarah Denny, MD, FAAP; Sarah Kincaid; Representative David Leland (R-22); Stephanie Bogart; Jenn Norman-Pitzer, MD; and Ben Cole, MD gather to discuss child health priorities in Ohio.

May 11, 2017: State Immigration Policy
Although the federal government regulates immigration, states have wide latitude to develop policies to complement or counter federal laws. This has led to a patchwork of policies that shape the lives of immigrants and their children across the country.
State Immigration Policy Resource, a new resource from the Urban Institute, examines state-level immigrant and immigration policies in the areas of enforcement, public benefit access, and integration from 2000-2016.

During the 2017 state legislative sessions, states have been debating the issue of sanctuary cities. Mississippi became the first state to ban sanctuary cities earlier this year and this week, Texas did the same.

For more from the AAP see our Immigrant Child Health Toolkit.

May 9, 2017: AHCA’s Impact on Medicaid Funding for States
The US House of Representatives passed the American Health Care Act (AHCA) on May 4. The AAP opposes this legislation and is urging the Senate to start over and find a new way forward.

The House version of the AHCA includes provisions that would cap federal Medicaid funding to states in the form of a per capita cap or block grant and eliminate the Medicaid expansion. To better help states understand the financial impact of these significant potential changes, State Medicaid Financing Fact Sheets have been developed by Manatt Health for the Robert Wood Johnson State Health Reform Assistance Network. These state-specific resources include data on the current amount states spend per capita and what level of funding they could be locked into if caps become a reality. AAP chapters can use this information as they continue to advocate for children who are insured by Medicaid.

For more from the AAP, please see our Protecting Children’s Coverage Advocacy Toolkit for child focused messaging on the bill as well as our state-by-state Children’s Health Care Coverage Fact Sheets. ​

May 8, 2017: State Budget Actions on Early Education

State funding for early childhood programs and services can come from a variety of funding streams. Early Care and Education State Budget Actions FY 2017, a report from The National Conference of State Legislatures examines how 36 states are using general and dedicated state funds, federal funds, and other funding mechanisms to pay for child care, prekindergarten, and home visiting programs and services. A 2015-2017 year-by-year comparison is included to help chart state increases or decreases.

For more from the AAP about early childhood, see resources from our Council on Early Childhood site—a forum for pediatricians and others interested in promoting the optimal development, health, and safety of young children at home, in early education, child care, or other early childhood settings.

May 4, 2017:Wisconsin Law on Substance Use During Pregnancy Struck Down

A federal judge has blocked a Wisconsin law that allows pregnant women to be civilly committed if suspected of substance use during pregnancy. The law, passed in 1997, permits pregnant women who refuse substance abuse treatment to be sent to jail. Wisconsin was 1 of 3 states including Minnesota and South Dakota to allow for civil commitment of pregnant women. 

Last year, the Tennessee legislature voted to sunset a law that allowed pregnant women who used opioids during pregnancy to be sent to jail if they refused treatment. Though Alabama and South Carolina do not have laws criminalizing substance abuse during pregnancy, the Alabama Supreme Court held that drug use while pregnant is considered chemical endangerment of a child and the South Carolina Supreme Court held that a viable fetus is a "person" under the state's criminal child-endangerment statute and that "maternal acts endangering or likely to endanger the life, comfort, or health of a viable fetus" constitute criminal child abuse.       

For more from the AAP, see our policy statement, A Public Health Approach to Opioid Use in Pregnancy.

May 2, 2017: Interstate Medical Licensure Compact
Physicians in some states can now apply for expedited licenses under the Interstate Medical Licensure Compact (Compact).The Compact streamlines the process of applying for licenses for physicians seeking to practice in multiple states. The Compact allows physicians, including qualified pediatricians, pediatric medical subspecialists, and pediatric surgical specialists, to practice medicine across state lines in a safe and accountable manner while protecting patients and expanding access to care.

Of the 18 states that have passed enabling legislation to implement the Compact, 7 (AL, IA, ID, KS, WV, WI, WY) are currently able to issue licenses. The remaining 11 states (AZ, CO, IL, MN, MS, MT, NH, NV, PA, SD, UT) are expected to begin the process in the near future. Legislation to join the Compact has been introduced in 7 other states (MI, ME, NE, RI, TN, TX, WA) and the District of Columbia this year.

The AAP supports the Compact and encourages AAP chapters to advocate for adoption by state legislatures. For more on this issue, please see our Advocacy Action Guide | Interstate Medical Licensure Compact.​

May 1, 2017: AAP District II–New York Visits Albany

Recently, more than 140 New York pediatricians gathered in their state capital, Albany for AAP District II’s annual advocacy day. Members from all 3 AAP New York chapters advocated for the District’s 2017 Legislative Priorities, which include raising the age of criminal responsibility from 16 to 18 years, requiring insurance coverage for donor breast milk, and requiring flu immunizations for child care attendance. Additionally, district members spoke with their state legislators about the importance of supporting New York's Child Health Plus and Children's Medicaid Programs.

Below, AAP District II Chairperson Warren Seigel, MD, MBA, FAAP and AAP District II Director of Policy & Advocacy Elie Ward, MSW, meet with with NY State Senator Kemp Hannon (R-6), Chair of the NY State Senate Health Committee.
 

April 27, 2017: State Spending on Children
State per child spending on key programs varies considerably across the country. These differences can be attributed to a wide range of factors—from demographics and population growth within individual states, to political will and ability of states to match program costs with existing revenues.
Unequal Playing Field? State Differences in Spending on Children in 2013, a new research report from the Urban Institute takes a closer look.

 

States that currently are low-spending and that also face a growing child population will have challenging political and fiscal hurdles to meet the needs of children in the future. The report notes that block granting of federal programs in states experiencing child population growth should be avoided in order to maintain stable revenue streams. Read the full report for a 50-state comparison of state per child spending.​​​​​​​​​​​​​​

​​​April 25, 2017:State and Local Support for Undocumented Immigrants

In recent years, state and local governments have issued special drivers’ licenses and identification cards to help undocumented immigrants legally drive, enroll their children in school, open bank accounts, and obtain state benefits. Recent federal activity related to undocumented immigrants has prompted state and local governments to work to protect the data they collect from these individuals and related programs. Such actions are aimed at prohibiting federal immigration authorities, who are seeking to use the data to help identify undocumented immigrants, from obtaining it.

Use the
AAP Immigrant Child Health Toolkit to better understand the challenges that immigrant children face and how you, as pediatricians, can support their health and well-being.​

April 24, 2017: AAP Missouri Chapter in Jefferson City

The AAP Missouri Chapter and the Missouri Collaborative for Advocacy and Resident Education (MOCARS), which includes pediatric residents from each of the state’s 4 medical school programs, recently headed to the state capitol to speak with lawmakers about key advocacy priorities.


 

The group encouraged support for a prescription drug monitoring program (Missouri is the only state without one), promoted the value of strong and stable Medicaid and CHIP programs, and emphasized the safety and effectiveness of vaccines. Participants carried pinwheels to raise awareness that April is Child Abuse and Neglect Awareness month and to initiate conversations about child protection.


April 20, 2017: National Infant Immunization Week Begins April 22nd
Vaccines are safe. Vaccines are effective. Vaccines save lives.

As part of our ongoing commitment to this important priority, each year the AAP participates in National Infant Immunization Week (NIIW) to highlight the importance of protecting infants from vaccine-preventable diseases. This year, during the week of April 22-29, 2017, sharing positive messages about the value of immunizations is vitally important.

Our campaign hub at www.aap.org/whyivax includes social media messages, images, HealthyChildren.org links, blogging tips (AAP members are being asked to participate in a Blog-A-Thon in cooperation with the CDC), and other tools you and your chapters can use to educate others about this child health priority.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our interactive infographic Child Vaccination Across America.​

April 18, 2017: Safe Storage and Disposal of Opioids
The AAP, together with the AMA and 20 other medical specialty and state medical societies, as part of the work of the
American Medical Association Task Force to Reduce Opioid Abuse, has developed and released a Promote Safe Storage and Disposal resource encouraging physicians who prescribe opioids to counsel their patients about safely storing and disposing these medications.​

State and local governments are also considering efforts to encourage safe storage and disposal of opioids. Massachusetts, along with 9 additional cities and counties have laws requiring drug manufacturers that sell drugs within their jurisdictions to design and operate programs for the collection, transportation, and safe disposal of opioids. Lawmakers in Connecticut and Georgia have introduced legislation this year requiring physicians to educate patients and their families about proper storage and disposal of opioids. The Network for Public Health Law (NPHL) has issued an issue brief highlighting state and local efforts to increase safe storage and disposal of opioids.

For more on safe storage and disposal of opioids see Mandatory Drug Stewardship Programs from the Network for Public Health Law and visit healthychildren.org

April 17, 2017: 2017 AAP-CA Legislative Day
Recently pediatricians from all
4 AAP California Chapters convened for the 2017 AAP-CA (District IX) Legislative Day. Assemblymember Shirley Weber and Senator Richard Pan, MD, FAAP addressed participants prior to their meetings with state lawmakers. AAP-CA members discussed their legislative priorities, including: ensuring universal access to quality, comprehensive medical care for all California children, including vulnerable populations such as children with special health care needs, foster children, children of immigrant families, and LGBTQ youth; reducing childhood poverty, obesity and food insecurity, and toxic stress and its causes; preventing youth marijuana use; and ensuring the safety of children undergoing dental anesthesia.

April 13, 2017: New Mexico Bans School Lunch “Shaming”
New Mexico has become the first state in the nation to
pass legislation to ban the practice of “shaming” students whose families have outstanding school lunch debt. On April 7, Governor Susana Martinez signed the Hunger-Free Students’ Bill of Rights Act, which  requires New Mexico schools to directly assist families with applications for free- and reduced- school lunch programs. The law further prohibits schools from stigmatizing students with outstanding debts by discarding their lunches, making children do chores, or publicly identifying them with a sticker or other marker. The law applies to all public and private schools in the state that receive federal school lunch or breakfast aid.

For more from the AAP about the important role pediatricians can plan in addressing food insecurity, please see Addressing Food Insecurity: A Toolkit for Pediatricians.

April 11, 2017: Proposed EPA Budget Cuts and Potential State Impact
Proposed cuts to the Environmental Protection Agency (EPA) budget would have dramatic effects on the ability of states and localities to prevent childhood exposure to toxic substances—currently, 43% of the EPA budget is allocated to state and local monitoring and enforcement actions. Cuts to the EPA
Office of Children’s Health Protection would severely affect the agency’s ability to protect the country’s most at-risk populations, and specific cuts to important children’s environmental health programs, like lead poisoning prevention programs, have been highlighted in initial budget memos.

Recently, past EPA Administrator and former New Jersey Governor Christine Todd Whitman also raised concerns about the impact of these budget cuts on state and local efforts to prevent radon exposure, promote air quality, and protect Great Lakes drinking water supplies.

For more from the AAP, see the
Council on Environmental Health Web page. To connect and engage on this issue, please contact the AAP Department of Federal Affairs or Division of State Government Affairs and we’ll help you!​

April 10, 2017: State Earned Income Tax Credits (EITC)
State earned income tax credits (EITC) can play a pivotal role in helping working individuals and families with low incomes. Modeled after the federal EITC, 26 states and Washington, DC have adopted state EITCs. The amount of each state’s credit varies, but is generally a percentage of the federal EITC. Additionally, state EITCs can be either refundable, meaning a taxpayer receives a cash refund, or nonrefundable, meaning they reduce a taxpayer’s liability.

Tax Credits for Working Families: Earned Income Tax Credit (EITC)
, a resource from the National Conference of State Legislatures (NCSL) examines state EITCs and how they can benefit working individuals and families.

For more from the AAP, see
Poverty and Child Health State Advocacy Resources.

 

April 6, 2017: AAP Wisconsin Joins State Doctor Day
More than 30 members of the
AAP Wisconsin Chapter recently headed to Madison as part of the state’s annual Doctor Day. Joining 400 other physicians, chapter members advocated for expanding the state’s child psychiatry consultation program, increasing the number of resources to fight the opioid crisis, and ensuring Medicaid continues to deliver care for those who need it. Pictured are (left to right) Chapter Secretary/Treasurer Dipesh Navsaria, MD, MPH, MSLIS, FAAP; Chapter President Jeffrey Britton, MD, FAAP; Chapter Board Member Paula Cody, MD, FAAP; and Chapter Vice President Mala Mathur, MD, FAAP.

April 4, 2017: AHCA Failure Brings Medicaid Expansion to the Forefront
Since Congressional activity on the American Health Care Act (AHCA) stopped last month, states that had previously been opposed to expanding Medicaid are now considering the possibility. Georgia, Maine, and Kansas have all expressed openness to expanding Medicaid in order to serve more low income individuals and help lower their higher than average rates of uninsured.

Failed Health Bill Fuels New Momentum for Expanding Medicaid discusses the current activity in several states. Governor Deal of Georgia has indicated his administration is open to applying for federal waiver to expand the program.  Meanwhile, in Maine–where Governor LePage has vetoed Medicaid expansion 5 times–the public will decide the issue in November as it votes on a ballot initiative. Just this week, the Kansas legislature narrowly failed to override Governor Brownback’s veto of Medicaid expansion legislation.

For more on this issue from the AAP, please see our Medicaid Expansion State AdvocacyFOCUS resource and State Advocacy Infographics.

April 3, 2017: AAP North Carolina Chapter’s White Coat Wednesday
Last week, members of the
AAP North Carolina Chapter visited Raleigh as part of the state medical society’s White Coat Wednesday program. Chapter members met with legislators to stress the critical role that Medicaid plays in providing access to health insurance for the state’s children.
March 30, 2017: EPA Clean Power Plan and State Level Actions
The AAP
issued a statement opposing the recent Executive Order rolling back Environmental Protection Agency (EPA) protections under the Clean Power Plan, which sought to lower carbon emission levels from existing electric power generating plants. These emissions are responsible for one-third of all greenhouse gas emissions in the US, and have immediate implications for children’s respiratory health and changes in global climate. 

A
number of governors whose states have taken proactive steps to limit carbon emissions also responded, highlighting how states can to play a leadership role in preventing climate change.

For more from the AAP, see our
Climate Change and Children's Health resources and learn more about our partnership with the Medical Society Consortium on Climate and Health.​

March 28, 2017: Medicaid an Economic Lifeline for Families
In the wake of the
American Health Care Act (AHCA) and its rejection by Congress, a growing body of research finds that Medicaid coverage improves many indicators of economic security. These include limiting family exposure to high medical costs, reducing family difficulties paying non-medical bills, cutting bankruptcies, and even lifting an estimated 2.6-3.4 million individuals out of poverty in 2010. 

The Medicaid per capita caps or block grants contemplated by the AHCA would have had a drastic effect on the financing of state Medicaid programs. Such caps on federal Medicaid funding would have caused states to likely cut benefits, enrollment, and/or payment to providers. These cuts would not only have had a direct impact on the physical health of enrollees, but as
a new Georgetown Center for Children and Families (CCF) brief points out, on the economic health and wellbeing of families as well. 

Learn more about the critical work Medicaid, the Affordable Care Act (ACA), and Children’s Health Insurance Program (CHIP) are doing to provide much needed coverage to children in your state with our
Children’s Coverage Fact Sheets.

March 27, 2017: Pediatrics Day at the Minnesota Capitol
The
AAP Minnesota Chapter recently held its annual Pediatrics Day at the Capitol with more than 150 participants meeting with over 60 state legislators to discuss the chapter’s 2017 priority issue—Access to Care. Chapter member messages focused on related states bills in addition to sharing with state lawmakers’ the chapter’s opposition to the American Health Care Act (AHCA). AAP Minnesota Chapter President Dr Andrew Kiragu, Senator John Marty, and chapter lobbyist Eric Dick prepared participants for their visits during a training session.

March 23, 2017: Georgia Governor Receives Friend of Children Award

Leaders of the AAP Georgia Chapter recently presented Governor Nathan Deal with the chapter’s Friend of Children Award to acknowledge his work, dedication, and commitment to making Georgia better for children.

March 21, 2017: New Studies Highlight the Impact of the Opioid Epidemic on Children
Children continue to be impacted by the increase in opioid misuse, as detailed in 2 new studies in the April edition of Pediatrics.
Prescription Opioid Exposures Among Children and Adolescents in the United States: 2000–2015 highlights the need for stronger preventive measures, while Trends in Medical and Nonmedical Use of Prescription Opioids among US Adolescents: 1976-2015 found that teenagers with previous opioid prescriptions were more likely to report the nonmedical use of opioids.

Increasing access to opioid antagonists like naloxone is one way that states are addressing the increase in opioid overdose deaths. Since 2007, 47 states and the District of Columbia have enacted laws to increase layperson access to naloxone and/or have made it easier for medical professionals to prescribe and dispense naloxone. 36 states and the District of Columbia have enacted laws to provide immunity to people who administer naloxone in case of a suspected opioid overdose.

For more from the AAP, see The Opioid Epidemic: How to Protect Your Family from HealthyChildren.org.​

March 20, 2017: AHCA Medicaid Restructuring Would Directly Affect States
The
Congressional Budget Office (CBO) analysis of the American Health Care Act (AHCA) found that the legislation would reduce total federal Medicaid spending by $880 billion between 2017-2026. This significant reduction in federal Medicaid funding—stemming from the bill’s fundamental change in Medicaid financing to per capita caps—would result in substantial issues for states, as a new Kaiser Family Foundation brief details.

For example, the AHCA would lock states into their past Medicaid spending experiences and not adjust for differences between states and over time. This financing structure would also limit states capacities to respond to changing coverage needs and public health emergencies, place additional pressures on state budgets that would threaten enrollment, and weaken the viability of Medicaid expansion programs to parents and other adults after 2020.

The AAP opposes the AHCA as it fails to preserve the enormous coverage gains made in the United States, where 95% of children are now insured. The Academy has created a new advocacy toolkit to equip pediatricians to advocate to protect children's health care coverage—now available at federaladvocacy.aap.org (MyAAP login required).

March 16, 2017: AAP Tennessee Chapter Day on the Hill 

The AAP Tennessee Chapter held its annual Day on the Hill on March 14, 2017. Members met with state legislators to discuss key advocacy issues being considered during this year’s session, including the chapter’s support for legislation that would allow local governments to regulate smoking in public. Here, chapter members gather with State Representative Raumesh Akbari (D-91) and leave her with a prescription to advocate for children.

 

March 14, 2017: State Advocacy All Stars 
Leaders from the AAP Utah, Arizona, and Tennessee Chapters highlighted recent advocacy successes at this year's Annual Leadership Form (ALF). Topics at our "How to Succeed at State Advocacy-Advice from the All Stars" session included Utah's efforts to prevent drug overdoses through expanded access to naloxone, restoration of the Children's Health Insurance Program (CHIP) in Arizona, and repeal of Tennessee's religious exemption to felony crimes against children. Thanks to Chuck Pruitt, MD, FAAP, Utah Chapter President, John Pope, MD, MPH, FAAP, Arizona Chapter President and Ruth Allen, Tennessee Chapter Executive Director for their advocacy work and presentations, and to all who participated in the session.

Session presentations are available on the AAP Web site (MyAAP login required).

March 13, 2017: ACA and Medicaid Help States Address Opioid Crisis
America’s opioid crisis continues to grow. In 2015 alone, an average of 91 people died of accidental opioid overdoses every day. Treatments and early interventions to prevent substance use disorders (SUD) and opioid use disorder (OUD) can help save lives, however, there has been very limited access to these services for the individuals who need them.

How Medicaid and the ACA are Helping States Address Opioid Overdose, a report from the Network for Public Health Law, examines how Medicaid and the Affordable Care Act (ACA) have been vital in improving access to treatment for OUD. Medicaid is the largest source of insurance coverage for behavioral health services and SUD treatment. Since 2016, 1.2 million individuals with SUD have gained coverage in states that expanded Medicaid under the ACA. Repeal of the ACA could result in a 50% increase in the coverage gap for these vital services.

For more from the AAP, see our policy statements on Medication-Assisted Treatment for Adolescents With Opioid Use Disorders and A Public Health Response to Opioid Use in Pregnancy, our Medicaid Expansion State AdvocacyFOCUS resource, and our letter opposing proposed ACA and Medicaid changes.

March 9, 2017: What Medicaid Per Capita Caps Would Mean for Kids and States
The American Health Care Act (AHCA) being considered by Congress would restructure how the Medicaid program is financed, converting it to a per capita allotment of federal dollars. This means the legislation would create a federal spending cap for states per Medicaid enrollee, including children.

How Restructuring Medicaid Could Affect Children, a report from The Georgetown Center for Children and Families examines why a per capita cap is harmful to children and families, as well as the impact these caps could have on states. Such changes could jeopardize a child’s guarantee of coverage as well as put limits on benefits currently available to them.

The AAP opposes the American Health Care Act. The bill is being considered by the US House of Representatives, so now is the time to follow-up with your US Representative’s office to express your chapter’s opposition to the bill and urge them to preserve the gains in children’s health care coverage. Use our AAP Children’s Health Care Coverage Fact Sheets to reinforce how these programs have worked together for children.

March 7, 2017: 52 Ways AAP Chapters and Districts Improved Child Health in 2016
AAP chapters and districts had tremendous success in their advocacy work for children and pediatricians in 2016.
52 Ways AAP Chapters and Districts Improved Child Health in 2016 highlights these achievements.

Celebrate your victories and learn about great ideas from other chapters and districts. Thanks for all you do to improve the health and well-being of children!

​March 6, 2017: AAP Iowa Chapter Defeats 2 Bills Threatening Physician Counseling on Firearms
Though the US Court of Appeals for the 11th Circuit upheld a decision that allows physicians to counsel patients and their parents about gun safety, states are still considering similar legislation. Iowa and Texas have both introduced bills in 2017 that would restrict physician counseling firearm safety. In addition, an Iowa introduced a bill that would restrict physicians, dentists, nurses, audiologists, psychologists, physical therapist and many other professions within and outside of the health care industry from asking questions “unrelated to their treatment”.

The AAP Iowa Chapter was able thwart legislative efforts in their state through their advocacy efforts. Amy Shriver, MD, FAAP met with the senate sponsor to discuss the important reasons that pediatricians ask questions on gun safety. Both Iowa bills failed to pass committee before required deadlines. The Texas bill remains in committee.   

Is your state legislature considering a bill to restrict physician counseling on firearm safety? Contact us at stgov@aap.org.

March 2, 2017: Insurance Across State Lines—Does It Work?
Allowing health insurance plans to be sold across state lines has been raised as part of the debate on Affordable Care Act (ACA) replacement. With such a policy, insurance plans would only have to abide by the laws of the “home” state in which the plan is created. What may not be well known is that states already have some
experience with this concept.

Since 2008, 21 states have introduced bills—and 5 states have enacted laws—to allow for the sale of insurance products created out-of-state. Three (3) of these laws were passed after enactment of the ACA, which permits insurers to sell policies in any state participating in a health care choice compact (such a compact must largely follow the ACA’s consumer protections). No insurer has yet to offer out-of-state coverage in any of these 5 states. There are a number of reasons why this is the case and they offer lessons to lawmakers as the concept is further discussed. In addition, the National Association of Insurance Commissioners (NAIC) has raised concerns with the sale of out-of-state insurance, calling it a “race to the bottom” where insurance companies will be allowed to “choose their regulator.”

The AAP continues its steadfast advocacy to protect the health care of children as Congress debates changes to programs children rely on. Learn more at the AAP Federal Affairs Advocacy Action Center.

StateView SPECIAL | #KeepKidsCovered | New Resources for AAP Chapters
Ensuring children have access high-quality, affordable health care is a priority for the AAP and state chapters. To assist the collaborative state and federal advocacy efforts by chapters and the national AAP to support the Affordable Care Act (ACA), keep Medicaid strong, and renew the Children’s Health Insurance Program (CHIP), we’re pleased to share our just released AAP
Children’s Health Care Coverage Fact Sheets. These state-specific resources on the ACA, CHIP, and Medicaid highlight how each of these programs support and improve children’s health and were created in partnership with the Georgetown University Health Policy Institute Center for Children and Families.

To further promote your advocacy efforts, the AAP will be highlighting these state resources on social media using #KeepKidsCovered and will be highlighting specific state data over the coming weeks, mentioning AAP chapter Twitter handles when doing so.

February 27, 2017: AAP Maryland Chapter Hosts Advocacy Day
The
AAP Maryland Chapter hosted the chapter’s Annual Resident Advocacy Day in Annapolis on Wednesday, February 15, 2017. Chapter leaders and residents from Johns Hopkins University, Sinai Hospital, and the University of Maryland met with state legislators to advocate for improvements in maternal mental health, including maternal depression screening and expansion of the state’s Behavioral Health Integration in Pediatric Primary Care (BHIPP) program.

February 23, 2017: AAP Statement on Protecting Transgender Youth
The AAP issued a
statement voicing strong opposition to new guidance from the US Departments of Justice and Education that eliminates protections for transgender youth in public schools, no longer allowing them to use restrooms corresponding with their gender identity. In the statement, the AAP renews its support for those same legal protections offered through Title IX funding, noting, "Transgender children should be supported, nurtured and cared for, whether in their homes, in their schools, or through policies enacted at the state and federal levels."

Continuing a trend from 2016, bills have been introduced in 15 states (Alabama, Arkansas, Illinois, Kansas, Kentucky, Minnesota, Missouri, New York, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington, and Wyoming) this year that would restrict access to multiuser restrooms, locker rooms, and other sex-segregated facilities on the basis of a definition of sex or gender consistent with sex assigned at birth or biological sex. To date, the bills in South Dakota and Virginia have failed to pass.

For consultation and technical assistance on related state policy and advocacy issues, please contact us at stgov@aap.org.

February 21, 2017: Victory in Florida Firearm Physician Counseling Lawsuit
In a
10-1 decision, the US Court of Appeals for the 11th Circuit recently upheld a lower court ruling against Florida's Privacy of Firearm Owners Act, which would have restricted physicians from counseling families on how to keep children safe around firearms. This decision marks a major victory for Florida pediatricians after a more than 5-year legal challenge.

The decision protects the physician’s First Amendment right to counsel patients and families on firearm safety, however the court allowed a provision that prohibits discrimination against firearm owners by physicians, to stand. The decision notes examples of a physician "failing to return messages, charging more for the same services, declining reasonable appointment times, not providing test results on a timely basis, or delaying treatment because a patient (or a parent of a patient) owns firearms" as activities consistent with discrimination.

Since 2011, 14 states have introduced bills that would restrict physician counseling on firearm safety, including 2 states (Iowa and Texas) in 2017. While the 11th Circuit’s jurisdiction does not reach Iowa or Texas, the ruling will likely have an impact on the viability of both bills. The state of Florida expended a great deal of time and resources defending the 2011 law, which may be a strong deterrent to similar initiatives in other states. The state of Florida now has the option to appeal the ruling to the US Supreme Court, but the future course of action is unclear at this time. AAP chapters will be kept apprised of any further legal developments in this lawsuit. 

The pro bono legal team representing the AAP Florida Chapter, individual pediatrician plaintiffs, and other physicians were among the recipients of the 2015 AAP Child Health Advocate Award in recognition of their ongoing commitment to the case and to ensuring that pediatricians can provide important safety counseling to patients and families.

Is your state legislature considering a bill to restrict physician counseling of patients and families about firearm safety? Contact us at stgov@aap.org.

February 20, 2017: Opioid Use in Pregnancy—A Public Health Approach
Today, the AAP released the new policy statement,
A Public Health Approach to Opioid Use in Pregnancy, which emphasizes the need for primary prevention and appropriate identification and treatment of women who misuse opioids during pregnancy. The statement notes that pregnant women who fear prosecution or referral to the child welfare system are far less likely to obtain appropriate prenatal care, leading to worse outcomes for the baby.    

In response to an increase in the number of babies born with neonatal abstinence syndrome, some states have considered incarcerating pregnant women and other punitive measures. In 2014, Tennessee passed a law that allowed for the prosecution of pregnant women whose infants were born with narcotic dependency. The law was sunset in 2016. States have also addressed drug use during use during pregnancy as a child welfare issue. Twenty-three (23) states and the District of Columbia (DC) currently consider substance use during pregnancy to be child abuse under civil child welfare statutes and 3 states consider drug use during pregnancy as grounds for civil commitment. In addition, 23 states and DC require health care professionals to report suspected prenatal drug use, and 7 states require them to test for prenatal drug exposure if they suspect drug use.

For more from the AAP, see our Neonatal Drug Withdrawal clinical report.

February 16, 2017: State of Tobacco Control 2017
Tobacco control, cessation, and prevention efforts have made great strides at the state level—with smoking rates by adolescents falling to historic lows—but much more remains to be done.

State of Tobacco Control 2017, a report from the American Lung Association, grades state progress on several key tobacco control measures—including, for the first time, policies restricting the sale of tobacco products to minors younger than 21 years of age. The report highlights where states have made strides in curbing tobacco use, and where additional efforts are required. See if your state made the grade and learn what you can do to make a difference.

For more from the AAP on tobacco prevention efforts, see our policy statement Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke and visit the AAP Julius B. Richmond Center of Excellence. Also see our Tobacco 21 and Electronic Nicotine Delivery Systems (ENDS) State AdvocacyFOCUS resources.

February 14, 2017: Ready, Set, ADVOCATE | Is your governor speaking UP for children?
New governors have been sworn in and given their inaugural addresses, while others have started to lay out their priorities in their state of the state addresses. These speeches offer a quick look at governors’ top line issues and are a great way for your chapter to identify shared interests, make a connection, and offer your expertise.

The AAP Division of State Government Affairs has been listening in to what governors are saying, and we’re keeping track of some things you’ll want to know in our Is your governor speaking UP for children? resource. So take a look, contact your governor’s office, and make sure they #PutKids1st.

If your governor hasn’t given his or her address yet, be sure to check back as the resource will be updated as more governors present their plans for the year.

February 13, 2017: AAP Mississippi and Washington Chapters Talk Kid’s Health

On January 31, 2017, the AAP Mississippi Chapter visited the state capitol in Jackson to meet with legislators to advocate for continued access to health insurance coverage for children and to keep the state’s immunization laws strong. Chapter members also had the opportunity to meet with Governor Phil Bryant (center) and share their child advocacy messages with him.

 

The AAP Washington Chapter headed to the state capitol in Olympia on February 3, 2017 to discuss the chapter’s 2017 legislative priorities with state lawmakers. Key issues included Medicaid payments, improving access to behavioral health care, investing in early childhood programs, providing paid family and medical leave, raising the purchase age of tobacco products to 21, preventing children’s access to firearms, and updating the state’s distracted driving laws.

 

February 9, 2017: State Funding of Pre-K Programs
An understanding of the importance of early brain and child development is increasing among state lawmakers and, in turn, they’re investing in early learning. A
new analysis from the Education Commission of the States of fiscal year (FY) 2016-2017 state appropriations for pre-K programs shows widespread funding increases and demonstrates bipartisan support from governors, legislators, and state boards of education. For FY 2016-2017, 30 states increased funding levels for pre-K programs; in aggregate, state funding for pre-K has increased by $480 million, or 6.8%, since 2015-2016.

While states have increased funding, it’s important to note that the rate of growth appears to be slowing. Although pre-K funding has gained traction with lawmakers, its place within state budgets remains far from secure, as budget uncertainties loom. AAP chapters and other advocates should be vigilant and remind state policymakers of the return that comes from investing in early brain and child development.

For more from the AAP, see our Early Brain and Child Development resources.

February 7, 2017: New AAP School Bus Safety Advocacy Infographic
Following a
school bus crash in Tennessee in late 2016, states are turning their attention to improving school bus safety. So far in 2017, 17 states (Arkansas, Connecticut, Hawaii, Illinois, Indiana, Kansas, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Hampshire, New York, Rhode Island, South Carolina, Virginia, and Washington) have introduced bills to require seat belts on school buses. In addition, 10 states (Arizona, Connecticut, Illinois, Massachusetts, Minnesota, Missouri, Montana, New York, South Dakota, and Tennessee) have introduced bills to strengthen licensing requirements for school bus drivers.

To aid in AAP chapter efforts to strengthen school bus laws, we’ve developed a new School Bus Safety state advocacy infographic. Chapters are encouraged to use it in related advocacy efforts and share it via social media.

For more from the AAP on school bus safety, see the School Transportation Safety policy statement.

February 6, 2017: AAP Indiana and Virginia Chapters Take On State Capitols
On January 25, 2017, the AAP Indiana Chapter joined fellow advocates to meet with state lawmakers and promote the expansion of high quality Pre-K programs in the state, which is one of the
goals of the chapter’s Early Brain & Childhood Development committee. Pictured are (left to right) Judy Ganser, MD, FAAP; Chapter Vice President Tony QiaQuinta, MD, FAAP; Daniel Carter, MD; Emily Sherer, MD, FAAP; Chapter Secretary/Treasurer Jim Bien, MD, FAAP; Chapter Early Brain & Childhood Development Committee Chair Katie Swec, MD, FAAP; Chapter Executive Director Chris Weintraut, Esq; Heidi Harmon, MD, FAAP; Chapter President Sarah Bosslet, MD, FAAP; Evan Kreutzer, MD, FAAP; and Christina Ricks, MD, FAAP.
Diane Pappas, MD, FAAP (center),
the AAP Virginia Chapter Advocacy Chair, briefs members on the chapter’s 2017 legislative priorities during the chapter’s annual Pediatric White Coat Day on January 30, 2017. Chapter members spoke with state legislators about support for mothers who are breastfeeding, food safety, neonatal abstinence syndrome, school nurses, improving care coordination, and practice issues.

February 2, 2017: State Efforts to Reduce Injuries
Despite technological and safety advances injuries continue to be the leading cause of death in children ages 1 to 21 years.
Safe States, an Alliance to Strengthen the Practice of Injury and Violence Prevention, just released their State of the States 2015 Report, which examines what states are doing to reduce injuries. States most commonly reported using programs to address fall injuries for both children and the elderly, unintentional poisoning/prescription drug overdose (PDO), sexual violence, child passenger safety, and suicide. Policy strategies were most commonly used for a to address child passenger safety, teen driver safety, unintentional poisoning/PDO, and seat belts.

The report features examples of states that have made significant strides on child health issues. The North Carolina Child Fatality Task Force worked to champion legislation requiring child-resistant packaging on liquid nicotine products. In California, the state department of health collaborated with partners to collect adverse childhood experiences (ACEs) data and develop county-specific dashboards to help spur discussions between parents, communities, and policymakers on promoting resilience in children.      

For more from the AAP and healthychildren.org on protecting children from unintentional ingestion of prescription drugs, see How to Safely Dispose of Old Medicines. Our State AdvocacyFOCUS resources on Child Passenger Safety, Distracted Driving, and Teen Driving offer guidance on policy and program responses to these challenges.

January 31, 2017: State Budgets Not Ready for ACA Repeal
Forty-seven (47) states will be creating new budgets in the coming months for the fiscal year (FY) 2018, which begins July 1 in most states. However, as Congress debates repeal and replacement of the Affordable Care Act (ACA), very few states are
expected to take ACA repeal into account when devising their budgetary plans.

Together with the possibility of Medicaid being converted to a block grant program, state officials cite difficulty with creating fiscal notes on ACA repeal and, as a result, are struggling to develop realistic fiscal contingency plans. Should either of these proposals be enacted, it is likely that many states would have to go back and revise existing budgets to address related state budget shortfalls.

To monitor what’s happening in your state, follow States' Proposed & Enacted Budgets from the National Association of State Budget Officers. The AAP continues to work to maintain ACA provisions that protect children and to prevent Medicaid from becoming a block grant program and appreciates related chapter advocacy work in the states.

January 30, 2017: State Regulatory Efforts on Marijuana Ballot Initiatives
As More Voters Legalize Marijuana, States are Left with Regulatory Hurdles, from The Pew Charitable Trusts’ Stateline, discusses the challenges state lawmakers face after recreational and medical marijuana ballot measures are enacted by voters. Because marijuana is illegal under federal law, states must create marijuana regulatory systems from the ground up, including efforts to protect children. Colorado, for example, following legalization, responded to an increase in emergency department visits and poison control center calls for children who accidentally consumed marijuana by enacting legislation that requires explicit labels and markings and sets limits on serving sizes on all edible products. Pediatric emergency physician George Sam Wang, MD, FAAP, led the advocacy efforts to enact the Colorado law.

The AAP opposes the legalization of both recreational and medical marijuana, but recommends that states that have legalized marijuana regulate the drug as closely as possible to alcohol and tobacco and that all forms of marijuana be sold in child-resistant packaging to prevent unintentional ingestion by children. For additional details on related AAP policy, please see our statement The Impact of Marijuana Policies on Youth: Clinical, Research, and Legal Update.

For more from the AAP, see our Medical Marijuana and Marijuana Legalization State AdvocacyFOCUS resources.

January 26, 2017: State and Municipal Policymaking in 2017
There are growing power struggles between state capitols and city halls across the country. This has led to an uptick in state efforts to preempt local laws in recent years and this trend is likely to continue in 2017. Preemption has widely been used to stymie local tobacco control efforts, but is now finding its way into
immigration, environmental, and social policy, all of which have deep implications for child health and pediatric practice.

AAP chapters have an opportunity to shape these issues and many others at both a state and local level. Engagement of municipal and county decision makers is another way to advance child-friendly policies.

For more from the AAP on advocacy at all levels, see the AAP Advocacy Guide.

January 24, 2017: State Roles in Improving Health Information Flow
Pediatricians know firsthand how difficult it can be to exchange meaningful clinical health information among providers and systems—numerous legal and market barriers often block this flow of information. However, states can play a unique role in tackling barriers and acting as a convener to work toward interoperable health information exchange.

Getting the Right Information to the Right Health Care Providers at the Right Time, a new resource from the National Governors Association (NGA), provides a roadmap for states to identify existing barriers, choose strategies to overcome them, and evaluate progress in moving toward meaningful health information exchange. The roadmap includes background on the current status of health information sharing and examples of state efforts to improve clinical information flow. States can use it to work toward improving health information exchange for providers, patients, and the health care system as a whole.

For more from the AAP on health information technology, please visit the AAP Council on Clinical Information Technology and the Child Health Informatics Center.

January 23, 2017: California Withdraws ACA Waiver to Cover Immigrants
In 2016, California became the first state to enact legislation enabling undocumented immigrants to have access to health insurance through the state’s marketplace,
Covered California. Since the Affordable Care Act (ACA) prohibits undocumented immigrants from purchasing insurance through marketplaces, California was required to submit a waiver to the US Department of Health and Human Services (HHS) to obtain approval.

In recent days, California lawmakers have decided not to pursue this plan. State Senator Ricardo Lara, sponsor of the enabling legislation, cited concerns that shifts in federal policy could result in information gathered from the state plan being used to identify and deport undocumented immigrants. State officials also indicated that approval of the waiver by new administration officials seems unlikely.

For more from the AAP, see our policy statement Providing Care for Immigrant, Migrant, and Border Children, our Immigrant Child Health Principles, and the Immigrant Child Health Toolkit. Please visit the Council on Community Pediatrics Immigrant Health Special Interest Group (SIG) page for news, recent activities, and additional resources.

January 19, 2017: What Would Medicaid Caps Mean for States?
Imposing caps on federal funding for state Medicaid programs is one of the proposals that has surfaced in recent policy debates. Capped funding would fundamentally shift the federal-state feature of Medicaid’s financing structure. Currently the federal government must share all allowable state Medicaid costs. Although spending caps may take may forms, they all reduce federal Medicaid spending and greater budget certainty.

Capping Federal Medicaid Funding: Key Financing Issues for States from the State Health Reform Assistance Network examines state policy concerns that may arise from caps on Medicaid funding. The brief also looks at the potential impact on Medicaid eligibility, coverage, and benefits.

The AAP believes Medicaid must remain a guaranteed source of coverage and opposes efforts to block grant Medicaid, implement a per capita cap, or otherwise shift significant costs to states. These changes would represent a step backward in federal funding to states and states would invariably cut payments, limit services, or bureaucratize enrollment to decrease the burden on state budgets.

January 17, 2017: State Advocacy for Childhood Immunizations
In their role as guardians of public health, states play a significant role in determining immunization policies. As with other public health programs, immunization programs are invisible when they are working well. A measles outbreak or bioterrorism threat, however, reminds us of the important role immunizations play in the public health system.

State legislators are asked to ensure community immunity by requiring and funding recommended vaccines, while addressing the concerns of small but vocal groups who may object to routine childhood immunizations.

As state legislators begin their 2017 sessions they will again consider a variety of immunization bills. AAP chapters can focus their advocacy outreach on 3 main messages:

  • Vaccines are safe, effective, and have dramatically boosted community immunity and reduced infectious diseases in children.
  • The overwhelming majority of parents immunize their children on time and according to current recommendations, and support policies requiring children to be fully immunized as a condition of school entry.
  • Childhood immunization programs are a public policy triumph—one of the most effective public health interventions available to society—and immunization rates remain high.  

For more from the AAP, see our policy statement Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance, our State AdvocacyFOCUS resource on Childhood Immunizations, and Child Vaccination Across America, our new interactive infographic. An overview of State School Immunization Requirements and Vaccine Exemption Laws is available from the Centers for Disease Control and Prevention (CDC).

January 16, 2017: State Level Disaster Preparedness
States have a considerable level of authority and responsibility in the area of disaster preparedness and response.
Ready or Not? Protecting the Public from Diseases, Disasters and Bioterrorism, examines states’ ability to respond to public health emergencies and finds that 26 states and Washington, DC scored a 6 or lower on 10 key indicators of public health preparedness. An annual publication by the Trust for America's Health (TFAH), the report finds a wide variability in preparedness across states on preparedness milestones, including public health laboratory biosafety, vaccination rates for influenza, food safety, public health funding commitment, and other metrics.

For more from the AAP on disaster preparedness and response, visit the Disaster Preparedness Advisory Council site.

January 12, 2017: The State of State Gun Laws
The
2016 State Gun Scorecard, a resource from the Law Center to Prevent Gun Violence (LCPGV) evaluates the strength of state gun laws. Seven (7) states (California, Connecticut, Hawaii, Maryland, Massachusetts, New Jersey, and New York) received “A” or “A-” ratings while 25 others received “F” ratings. LCPGV also released its 2016 Year-End Review Gun Law Trendwatch which provides an overview of state legislative on gun violence prevention for the year.

This week, New Jersey Governor Chris Christie signed a bill limiting access to guns for domestic violence offenders. The law prohibits individuals convicted of a domestic violence crime or subject to a domestic violence restraining order from possessing a firearm. It also requires anyone convicted of a domestic violence crime to sell or surrender their firearms.

For more from the AAP on state gun violence prevention efforts, see our Safe Storage of Firearms, Universal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources.

January 10, 2017: New State Advocacy Report
Happy New Year! As you prepare for the
2017 state legislative sessions, take time to celebrate your past success by reviewing the AAP 2016 State Advocacy Report, which details 24 significant child health and pediatric practice state policies. Thanks to the dedicated advocacy work of AAP chapters, significant achievements have been made across the country to shape the health policy landscape in every state. Your efforts in 2017 to preserve and build on these gains are vital to children’s health and well-being. Also featured in the report is the AAP 2017 State Advocacy Outlook, examining key state policy trends you’ll likely see this year along with resources to help you engage.

We’re here to help you with your state advocacy work! Please contact the Division of State Government Affairs at stgov@aap.org or 800.433.9016, extension 7799.

January 9, 2017: ACA Repeal Would Significantly Affect State Economies
New research demonstrates that states would be significantly hurt by repeal of the Affordable Care Act (ACA). According to a report from the Commonwealth Fund, repeal would result in
$140 billion loss in federal funding to states in 2019, leading to a loss of over 2.6 million jobs—mostly in the private sector—that year. Without replacement plans, ACA repeal would result in $1.5 trillion loss in gross state products and a $2.6 trillion reduction in business output from 2019 to 2023. One-third of jobs lost would be from the health care industry, with the remainder coming from other sectors.

The AAP continues to advocate on behalf of children and the practice of pediatrics in the debate over the future of the ACA. Last week, the AAP issued a letter urging Congressional leaders to protect the needs of children while considering any changes to the law and to safety net health care programs. The AAP also joined the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), and the American Congress of Obstetricians and Gynecologists (ACOG) in a letter urging Congress to protect patients' access to health care by outlining principles for any reforms and revisions to the current law. The AAP will continue to fight to ensure the needs of children and pediatricians are met as future of health reform is debated.

January 5, 2017: States Underfund Tobacco Prevention Programs 

In 1998, the attorneys general of 46 states and the District of Columbia reached an agreement with major tobacco companies, settling all claims that the states had initiated against the tobacco companies. The Master Settlement Agreement (MSA) will have provided states with over $246 billion by 2025.

Broken Promises to Our Children | A State-by-State Look at the Tobacco Settlement 18 Years Later, a report from the Campaign for Tobacco Free Kids and its partners, examines tobacco prevention funding by state. North Dakota is the only state to fund tobacco prevention programs at 100% of the Center for Disease Control and Prevention (CDC) recommendations, while 22 states fund tobacco prevention programs at less than 10% of the CDC-recommended levels.

For more from the AAP on tobacco prevention efforts, see our policy statement Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke and visit the AAP Julius B. Richmond Center of Excellence.

December 13, 2016: 2017 State Legislative Sessions Are Coming—Are You Ready?
With most state legislatures ready to begin their
2017 sessions shortly after the start of the new year, charting a course for chapter advocacy success is vital. AAP chapters have a powerful role in shaping state policy in the coming year. Striking the right balance between proactive initiatives and reacting to what else is “out there” requires planning, skill, and resources.

Resources from our Webinar, AAP Chapters | Crafting A State Advocacy Agenda, are available to support your planning efforts. The Webinar examines how our Washington, Iowa, and New Jersey chapters developed state advocacy agendas that fit their needs, engage members and stakeholders, and support AAP priorities. The AAP 2017 State Advocacy Outlook resource shares key AAP priorities, reflects opportunities and challenges for chapters, and identifies state trends to help you craft your state advocacy agenda.

As we head into the holidays, StateView will be taking a short break, but we’ll be here to provide you with one-on-one consultation, technical assistance, and strategy guidance as you prepare for 2017—contact us at stgov@aap.org.

We send you all the best wishes of the season and thank you for all you do to advocate for children in your states. We’ll see you in the new year!

December 12, 2016: US Surgeon General Cautions on E-Cigarette Use by Adolescents
Citing a 900% rise in use of electronic nicotine delivery systems (ENDS) by high school students in the years between 2011 and 2015, US Surgeon General Vivek Murthy, MD, released
a new report and accompanying Web page on use of the devices by youth. The report explores the impact of nicotine on the developing adolescent brain and the effect that ENDS use can have on priming the adolescent brain for future addiction and misuse of other substances of abuse. The AAP, in conjunction with the AMA and other medical professional groups, issued a statement of support for the report and its findings.

State governments are uniquely positioned to have an impact on preventing ENDS use by youth. Our Raising the Tobacco Purchase Age and Electronic Nicotine Delivery Systems (ENDS) State AdvocacyFOCUS resources can be used to support related chapter advocacy efforts.

For more on protecting children from tobacco and secondhand smoke, visit the AAP Julius B. Richmond Center of Excellence.

December 8, 2016: Network Directory Concerns Reported
Open enrollment for marketplace coverage runs until December 15 and consumers are signing up for health insurance plans in large numbers. As they do so, applicants will be reviewing network directories to ensure their current physicians are in a particular plan and that other needed physicians are accepting new patients. However, a recent review of network directories found that many are inaccurate or out-of-date.

Insurers’ Flawed Directories Leave Patients Scrambling For In-Network Doctors, a report from Kaiser Health News, outlines the issues consumers face as a result of inaccurate network directories, such as seeing out-of-network physicians and being held responsible for unexpected bills; or not having access to a primary care physician at all. States can play an important role in enforcing existing federal rules related to network directories, but reviews found that states rarely test directories for accuracy and rely on consumer complaints to identify issues.

For more from the AAP on network adequacy and directories, see our Network Adequacy | Advocacy Action Guide for AAP Chapters.

December 6, 2016: Child Vaccination Across America
To support your 2017 state advocacy efforts, the AAP has developed a new
interactive digital map that highlights state immunization rates for vaccine-preventable diseases and state laws regarding nonmedical exemptions to school entry immunization requirements. The map includes data on how each state measures up against immunization thresholds that are important to ensure protection for everyone.

It's much harder for a disease to spread when vaccination rates are high and the risk of disease is lessened for the entire community, including for those who can’t be vaccinated. This map illustrates the community immunity thresholds for each vaccine. Recent disease outbreaks that have occurred in communities where pockets of low-immunization rates left the population vulnerable are also highlighted. The AAP supports increasing immunization rates by raising awareness of the protections they offer to individuals and across populations.

For more from the AAP, see the Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance policy statement and the Countering Vaccine Hesitancy clinical report.

December 5, 2016: 22 States Allow Corporal Punishment in Schools
In a
letter to the nation’s governors, US Secretary of Education John B. King, Jr calls on the 22 states that allow corporal punishment in schools to abolish the practice. Of these states, 15 expressly allow corporal punishment and 7 do not prohibit the practice. A Persistent Practice—Corporal Punishment in US Schools found that more than 109,000 students in were paddled, swatted, or otherwise physically punished during the 2013-2014 school year.

In November, the AAP joined the National Women’s Law Center and more than 75 other child advocacy organizations to call on local and state education policymakers to end corporal punishment in schools.

For more from the AAP, see our policy statement Corporal Punishment in Schools.

December 1, 2016: Juvenile Justice Reform | State Policy Options
State lawmakers are increasingly considering bills
that raise the age when adolescents can be tried as adults, or that limit the use of solitary confinement for juvenile offenders, and the momentum for reform is likely to continue into the 2017 state legislative sessions. The AAP has recently joined the list of supporters of the Stop Solitary for Kids Campaign.

The Future of Youth Justice: A Community-Based Alternative to the Youth Prison Model, a report from the Annie E Casey Foundation, examines state juvenile correctional facilities and related public policy and explores alternative models for community corrections. State policymakers can make juvenile justice systems more effective, reduce mistreatment and recidivism, and prevent long-lasting harm to young offenders by changing the physical settings in which they are placed. Advocates can look to the report for ideas that can be implemented in their states and communities.

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E-mail your comments and suggestions to the Division of State Government Affairs. Please contact us at 800/433-9016, extension 7799, if you require additional assistance or information.​​​
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