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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.​​​​​​​​​​​
February 21, 2019: State Adoption and Implementation of Newborn Screening for CCHD

A new CDC study, coauthored by AAP Utah Chapter and AAP Section on Cardiology and Cardiac Surgery member Nelangi Pinto, MD, FAAP and the AAP state advocacy team’s Jeff Hudson, found that, as of 2018, all 50 states and Washington, DC have newborn screening programs that test for critical congenital heart defects (CCHD). According to the CDC, newborn screening for critical congenital heart defects could save the lives of at least 120 babies each year nationwide. All US newborns now have the opportunity to be screened for critical congenital heart defects, which can prevent early death. Key findings are available from the CDC.

For more information from the AAP on newborn screening for CCHD, please visit the Program to Enhance the Health & Development of Infants and Children (PEHDIC).

February 19, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

The AAP Arizona Chapter recently held its annual Pediatricians Day at the Capitol. As part of the day, the chapter unveiled its Arizona Blueprint for Children. Pediatric residents in attendance met with their legislators, utilizing the blueprint to advocate for the chapter’s priorities.

Pediatric trainees from the AAP Georgia Chapter visited the state capitol to hone their advocacy skills and meet with their legislators. The residents discussed several issues with legislators, including pediatric workforce, prohibiting smoking in cars when a child is present, and protecting LGBTQ youth from conversion therapy. 

The AAP Kansas Chapter held its recent meeting in the state capitol. As part of its 2019 advocacy day, the Chapter, in partnership with national AAP and Casey Family Programs, held briefings for legislators and staff about the Family First Prevention Services Act (FFPSA), a key priority of the Kansas Blueprint for Children. Kansas Governor Laura Kelly (center, red jacket), a champion of improving the state's child welfare system, joined the event to support FFPSA efforts. 

Members of the New Hampshire Pediatric Society/AAP New Hampshire Chapter visited the state capitol for the chapter's first ever advocacy day to speak with lawmakers about paid family leave, home visiting, gun violence protection, regulation of marijuana, and behavioral health. Prior to meeting with legislators, participants learned about key issues and honing their advocacy skills from advocacy partners at New Futures, the AAP advocacy team, and the New Hampshire Medical Society (NHMS). Pediatrician Tessa Lafortune-Greenberg, MD, FAAP, is the current president of NHMS.

February 14, 2019: Pediatrician Sworn in as First Surgeon General of California
Nadine Burke Harris, MD, MPH, FAAP, California’s first surgeon general, was officially sworn in on February 11th. Dr Burke Harris, pictured below with California Governor Gavin Newsom, enters office ready to take on the numerous challenges facing the health of California’s children, and has highlighted toxic stress as one of her top priorities.

February 12, 2019: Measles Outbreak Continues, Prompting Action by State Legislators
Outbreaks of measles in the Pacific Northwest and other regions of the country have prompted public calls for state policy reforms on school entry immunization requirements—and state lawmakers are listening. In Oregon, legislation may soon be filed to eliminate nonmedical exemptions to school entry immunization requirements. In neighboring Washington, a house bill aimed at eliminating the philosophical (but not religious) exemption for measles, mumps, and rubella specifically, will be heard in committee this week. A more expansive measure introduced in the Washington Senate would eliminate the philosophical (but again, not religious) exemption for all school entry immunization requirements. New York, with more than 130 measles cases reported since October of 2018, is also considering legislation to eliminate nonmedical exemptions. The AAP policy statement “Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance calls on states to end nonmedical exemptions outright, as California successfully did in 2015, under the leadership of state legislator Richard Pan, MD, MPH, FAAP.

For more from the AAP, see our Childhood Immunizations State AdvocacyFOCUS resource and our Child Vaccination Across America interactive infographic. Contact the AAP State Advocacy Team for additional support and technical assistance. 

February 11, 2019: State Gun Violence Prevention Advocacy in 2019
Building off success 2018, with 26 states enacting 67 new guns safety laws, 2019 promises to be another big year for new gun violence prevention laws across states.  Extreme Risk Protection Orders (ERPO)—also known as “red flag laws”, which allow for the removal of firearms from the environment of a person at risk of harming themselves or someone else, are expected to be the legislation with the most bipartisan support, along with the removal of weapons from the homes of domestic violence perpetrators.

Some state lawmakers have made this issue a top priority. Just 4 days into his tenure, Illinois Governor JB Pritzker signed legislation to require state licensure of gun dealers doing business in the state, in order to reduce illegal sales of firearms commonly used in acts of gun violence. In addition, the New York legislature has already passed a bill that includes an ERPO provision as well as a ban on bump stocks, an extended waiting periods for gun purchases, and a prohibition on teachers carrying guns in schools. Governor Andrew Cuomo is expected to sign the bill.

For more from the AAP on state gun violence prevention efforts, see our State AdvocacyFOCUS resources on Safe Storage of Firearms, Extreme Risk Protection Orders (ERPO) or “Red Flag” Laws, Waiting PeriodsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans.

February 7, 2018: Short-Term Plans Lacking ACA Protections Being Marketed to Consumers
Many consumers search for affordable health care coverage online. A recent study, The Marketing of Short-Term Health Plans, shows that these consumers (during the recent Affordable Care Act (ACA) open enrollment period that ended on December 15, 2018) were most often directed to websites that promoted individual health insurance plans that do not include the protections provided for in the ACA, such preexisting condition coverage.

State insurance commissioners indicated that tracking the marketing and sales of short-term plans can be challenging and some expressed concerns that the marketing tactics could result in consumers choosing plans that ultimately do not meet their needs. The study also includes early evidence that after recent federal regulatory changes that some insurers are aggressively marketing short-term plans as a replacement for traditional health plans, while not informing consumers of the limited coverage.

As efforts to weaken ACA insurance standards continue, states play a critical role in regulating health insurance. For more from the AAP on these efforts, please see our Advocacy Action Guide for AAP Chapters, New Rules Advance Insurance Plans Without ACA Protections

February 5, 2019: The State of Tobacco Control

Following the US Surgeon General’s advisory declaring teen vaping a youth epidemic and the release of the AAP policy statement E-Cigarettes and Similar Devices, the American Lung Association has released its annual State of Tobacco Control Report. The new resource evaluates current state and federal policies addressing tobacco and e-cigarette use and prevention and outlines the policy strategies that should be taken to reduce the deadly impact of tobacco and e-cigarette use.


Among the needed state strategies are increased tobacco and e-cigarette taxes, raising the purchase age of all tobacco and e-cigarette products to 21, improving access to tobacco cessation treatment, prohibiting the use of all tobacco and e-cigarette products in public places, and banning the sale of all flavored tobacco and e-cigarette products—including menthol.

 

For more from the AAP, see our Raising the Tobacco Purchase Age to 21 and Electronic Nicotine Device Systems (ENDS) State AdvocacyFOCUS resources and visit the AAP Julius B Richmond Center of Excellence


February 4, 2019: Pediatricians and State Health Departments Sound Alarm on Measles

Measles outbreaks in the Pacific Northwest, New York, and 6 other states are putting individual children and entire populations in peril of a preventable and dangerous disease, and the outbreak is placing unvaccinated children at particular risk. In response, pediatricians and other advocates for children are calling for states to tighten state level policies that ensure that children are vaccinated prior to school entry, and make it more difficult for parents to opt out of immunization requirements. Fearing a loss of community immunity amid rising opt-out rates, Maine has also filed legislation to reform its immunization policies, and other states where vaccine refusal outpaces national rates may soon follow suit. 

AAP state chapters advocating for stronger state level immunization policies have found that parents of young children are some of the most effective volunteer advocates on these issues, and Voices For Vaccines and Vaccinate Your Family are ideal partners in these efforts. 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. The AAP State Advocacy Team is here to help you with this important work.

January 31, 2019: Pediatrician Named California Surgeon General

California Governor Gavin Newsom recently appointed Nadine Burke Harris, MD, MPH, FAAP as the state’s first surgeon general. Dr Burke Harris is a national leader on adverse childhood experiences and founding CEO of the Center for Youth Wellness. With her appointment, California becomes the 5th state to create a surgeon general position. Arkansas and Florida currently have a surgeon general, while Pennsylvania has a similar position, physician general. Michigan previously had a surgeon general, but the position was eliminated in 2010.

Dr Burke Harris is now the second pediatrician, joining Pennsylvania’s Physician General Rachel Levine, MD, FAAP, serving as a chief state health officer. From 2005-2015 Joe Thompson, MD, FAAP, served as Arkansas Surgeon General for the administrations of Governor Mike Huckabee and Governor Mike Beebe.

January 29, 2019: Virginia Pediatric General Assembly Day
Earlier this month, 70 members of the AAP Virginia Chapter visited the state capitol to meet with legislators and advocate for the chapter’s top 2019 child health priorities. Chapter members spoke up on the importance of improving access to mental healthcare, ensuring coverage of essential health benefits in new insurance plans, gun violence prevention and reducing food insecurity and poor nutrition.

We’re here to help you with your chapter advocacy days and related events! Contact the AAP State Advocacy team at stgov@aap.org or 800.433.9016, extension 6240.


January 28, 2019: AAP Chapter Advocacy Action Guides | CHIP Funding & Insufficient Insurance Plan Coverage

The AAP is releasing new resources to help chapters and advocates work to advance the needs of children among state policymakers. CHIP Funding: Opportunities for State Advocacy advocates for states to fully fund their share of CHIP and provides guidance on other aspects of recently enacted CHIP funding legislation. An updated Association Health Plans (AHPs), Short Term, Limited Duration (STLD) Plans, and Section 1332 Waivers Advocacy Action Guide provides new information on opportunities for states to regulate AHPs and STLD plans, which, by their nature, offer limited coverage. The resource also provides updated information on Centers for Medicare and Medicaid Services (CMS) Section 1332 waiver guidance, which will allow states to direct premium subsidies toward such plans. Both action guides can be helpful as chapters and pediatrician advocates work to ensure children have access to affordable, robust health insurance coverage.

Working on these or other access issues in your state? Please contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 24, 2019: Rural Hospitals in Greater Jeopardy Where States Do Not Expand Medicaid
Since 2010, nearly 100 rural hospitals across the US have closed and another 600 or more are currently at risk of closing. Most of these hospitals are in states that have not expanded the Medicaid program to adults earning up to 138% of the federal poverty level (FPL) as permitted by the Affordable Care Act (ACA). By not expanding Medicaid, hospitals in the 14 states (AL, FL, GA, KS, MO, MS, NC, OK, SC, SD, TN, TX, WI, and WY) that have not done so continue to experience high levels of uncompensated care costs, as the uninsured continue to go to hospitals where care will not be denied due to inability to pay.

While expanding Medicaid alone may not resolve all rural hospital funding issues, it can serve to ease the burden. A 2018 Health Affairs study demonstrated that expansion of Medicaid resulted in improved financial performance and substantially decreased the likelihood of closure.

If your chapter is advocating to expand Medicaid, please contact the AAP at stgov@aap.org for consultation and technical assistance. 

January 22, 2019: Illinois Enacts Licensing Law for Gun Dealers

Just 4 days into his tenure, Illinois Governor JB Pritzker signed legislation to require state licensure of gun dealers doing business in the state, in order to reduce illegal sales of firearms commonly used in acts of gun violence. The new law will require gun shop owners to demonstrate that they have already received a federal license from the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF), and require them to install surveillance equipment and electronic record keeping systems that can be used to detect straw purchases of guns intended to divert firearms to the illegal market. A similar bill was passed by both chambers of the legislature last year, but was vetoed by then-Governor Bruce Rauner. 

For more from the AAP, see our Safe Storage of FirearmsUniversal Background Checks for Gun Purchases, and Assault Weapon Bans State AdvocacyFOCUS resources. For information on state-level gun violence research and data collection options, also see our State Advocacy Engagement on Firearm Data Collection resource.

January 21, 2019: States Join to Further Limit Carbon Emissions

Ten years into a multistate partnership focused on reducing power plant carbon emissions, 9 of those states have now joined forces to address the second largest source of greenhouse gas—the tailpipes of our cars, trucks, and mass transportation. Connecticut, Delaware, Maryland, Massachusetts, New Jersey, Pennsylvania, Rhode Island, Vermont, and Virginia, along with Washington, DC, have committed to adding transportation emissions to their ongoing efforts to limit greenhouse gas as part of the Regional Greenhouse Gas Initiative.

States and municipalities face region-specific threats from climate change, ranging from longer wildfire seasons to rising sea levels, and can also play a significant leadership role in the national and international effort to reduce carbon emissions. AAP chapters can be essential partners in the effort to 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.

January 17, 2019: States Strained by Federal Shutdown

State governments are being pressed to fill the void and provide support to recipients of federal benefits and federal employees during the ongoing federal shutdown. While the current state budgetary environment is largely stable across the country, states may begin looking at using rainy day funds in absence of payments from Washington. The National Governors Association has called on the federal government to end the shutdown, citing the impacts on both state economies and working families.

January 15, 2019: Few States Test for Lead in School Water
The Flint Water Crisis helped to draw much-needed public attention to the hazards posed by lead contamination of drinking water, but in the years following the crisis, many regulatory gaps in water monitoring remain, particularly in our nation’s schools. Only 7 states and the District of Columbia currently require testing of school drinking water sources for lead, as outlined in a new report published by the Harvard TH Chan School of Public Health.

Pediatric advocacy on this issue can have a dramatic impact in making children’s drinking water safe from lead hazards; last year, the Florida chapter outlined this issue in the winter edition of their monthly journal, the Florida Pediatrician, and since that time, legislation has been prefiled in the Florida Senate to mandate lead testing of school drinking water.

For more from the AAP, see our policy statement, Prevention of Childhood Lead Toxicityand visit the AAP Council on Environmental Health Web page. Guidance on lead exposure in children is also available from HealthyChildren.org.

January 14, 2019: HRSA Extends Pediatric Mental Health Access Program Funding Opportunity
In September 2018, the Health Resources and Services Administration (HRSA) awarded 18 states (AL, AK, CO, DE, IA, MI, MS, MO, MT, NE, NV, NH, NJ, NC, ND, RI, VA, and WI) a total of $7.9 million through the Pediatric Mental Health Care Access Program with the goal of integrating behavioral health into pediatric primary care using telehealth care. HRSA has now opened this grant opportunity to 3 additional states. A total of $1.3 million per year for 4 years is available.

Although not eligible as grantees, we encourage AAP chapters to reach out to relevant state agencies to encourage them to apply. As experts in pediatric health, these grants can provide opportunities for you to work to improve access to mental health services for children and families while maintaining the medical home.

Learn more about this opportunity.

January 10, 2019: Standing Orders for Newborn Care in NY
Advocacy by New York District II and New York members of the Section on Administration and Practice Management (SOAPM) has led to important reforms of nursery care of newborns. New York’s new law, which will take effect in April, will permit births of healthy newborns to be subject to hospital-approved standing orders, eliminating the need to contact the attending physician for approval of routine care. The statute enables the prompt institution of routine newborn care orders, thereby improving the timeliness of care and positively impacts physician wellness.

Working on this issue in your state? Contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 8, 2019: State Legislative Sessions Underway | Chapter Blueprints for Children
Happy New Year! All 50 states will hold regular sessions this year and are expected to introduce and consider more than 175,000 bills. A majority of state legislatures will convene their 2019 sessions this month and AAP chapters are preparing to be the voice for children in every state capital across the country.

To support your state advocacy efforts, our 2019 Chapter Blueprint for Children template and accompanying toolkit, released during the November Chapter Chat, is a fully customizable resource that includes your state name, chapter logo, and chapter contact information and is designed to include your 2019 advocacy agenda. Development of a blueprint or agenda is a proactive way to share your pediatric advocacy priorities with your members, lawmakers, and other stakeholders. Posting it to your chapter website and sharing on your social media platforms, sharing it with members, policymakers, and other stakeholders is a great way to promote your advocacy agenda and to strengthen the alignment of the agenda for children across the country.

When your 2019 chapter blueprint or advocacy agenda is complete, please share it with us so we can post them on the Chapter and District Collaboration Site.

Remember, we’re here to help you with your state advocacy work throughout the year! Please contact the AAP State Advocacy team at stgov@aap.org or 800.433.9016, extension 6240.

January 7, 2019: New Medicaid Expansions Proceeding
Despite the uncertainty created by the December 14 US District Court ruling overturning the Affordable Care Act (ACA), states are continuing to move forward with plans to implement the laws Medicaid expansion provision. Idaho, Nebraska, and Utah all expanded Medicaid to the ACA uninsured adult population via ballot initiative in the November 2018 election, bringing the total number of states with an expansion policy to 36 plus the District of Columbia. While Montana voters failed to extend its Medicaid expansion, the legislature is beginning debate now on the program’s future. Meanwhile, on January 1, Medicaid coverage for the ACA expansion population also went into effect in Virginia, and the newly elected governor of Maine used her first executive order to implement Medicaid expansion in that state, over a year after voters had approved the expansion there. Advocacy has also begun anew in other states where lawmakers more favorable to expansion are assuming their offices this year.

Working on Medicaid expansion or other Medicaid issues in your state? Please contact the AAP state advocacy team at stgov@aap.org for consultation and technical assistance.

January 3, 2019: State Lawmakers Race to Keep Up With Electric Scooters
Since the end of 2017, 39 of the 100 largest US cities have been introduced to electric scooters, also known as e-scooters, which look like regular scooters, but travel up to 15 MPH. E-scooter rental services allow users to download an app, find an electric scooter nearby, unlock it, and ride. Because e-scooters are relatively new, regulation is catching up. Often users can operate them on sidewalks and bike paths without helmets, leading to injuries for both users and pedestrians. State lawmakers in at least 15 states plan to consider legislation to regulate the e-scooter industry in 2019.

Currently, 10 states (California, Delaware, Massachusetts, Minnesota, New Jersey, Oregon, Texas, Virginia, Utah, and Washington) have laws addressing electronic scooters. Of these states, Massachusetts, New Jersey, and Oregon require helmets for all electronic scooter riders and California, Delaware, and Minnesota require helmets only for those younger than 18. Virginia’s law authorizes localities to establish helmet laws for electronic scooters but does require such provisions.

For safety information on related products see Bicycle Helmets: What Every Parent Should Know and Skateboarding and In-Line Skating.

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E-mail your comments and suggestions to the AAP State Advocacy team. Please contact us at 630/626-6240 if you require additional assistance or information.​​​
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