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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.​​​​​​​​​​​
April 23, 2019: State-based ACA Marketplace Enrollment Remains Stable

Starting in 2017, after a previous 3-year period of steady growth, enrollment on the Affordable Care Act’s (ACA) marketplaces began to decline—a trend that continues. Several factors contributed to this such as reduced federal funding for enrollment assistance, elimination of the federal individual mandate, and new federal rules that increased the availability of non-ACA compliant plans.

However, there were differences in enrollment trends between states that utilize the federally run marketplace and states that have their own state-based marketplaces. While there was a 4% decline in plan selections on the federally facilitated marketplace for 2019, plan selections in state-based marketplaces overall held steady. This may be due to state specific policies such as investing additional funds for advertising and enrollment assistance, expanded sign-up periods, and other policies, such as a state individual mandate. States that maintained or increased the number of plan selections due to state policy decisions demonstrate the continued need for comprehensive insurance coverage.

States continue to play a significant role in ensuring children and families get and stay covered. If your AAP chapter is working on access to care issues, please contact us at for consultation and technical assistance. 

April 22, 2019: Medicaid Expansion Helps Community Health Centers

As millions of people gained health insurance coverage via the Affordable Care Act (ACA), the demand for services provided by community health centers increased. A recent study from the Commonwealth Fund shows that community health centers in Medicaid-expansion states were more likely to report improvement in their financial security, are better able to address patients’ behavioral health needs and provide social services, and are more likely to participate in value-based payment arrangements. The study demonstrates that increased Medicaid revenue may help community health centers improve the way they deliver care. Community health centers in expansion states are also more likely to be recognized as patient-centered medical homes, which would result in improved outcomes and serve to reduce existing disparities in health care for low-income populations.

One remaining challenge reported by centers in the study is difficulty with filling mental and behavioral health staff positions, which could still result in limited access to such services.

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

April 18, 2019: Chapter Advocacy in Action | Making a Difference in NH, IL, and WA

Medical students Ashley Hamel and Emily Georges recently had their op/ed published in the Valley News (NH/VT) in support of New Hampshire Senate Bill 1. In it, Hamel and Georges, both set to begin residencies in pediatrics in the coming months, stress the importance of paid family and medical leave in health outcomes for children—with their own personal clinical encounters fresh in mind—and to promote economic and gender equality. Paid family leave was a focus of the AAP New Hampshire Chapter advocacy day earlier this year.

In the Midwest, AAP Committee on State Government Affairs liaison Dr Jennifer Kusma wrote to the Chicago Tribune emphasizing the importance of combatting vaccine misinformation on the Internet and calling on the state to enact policy changes to stop the spread of vaccine preventable diseases.

In the Pacific Northwest, AAP Washington Chapter President Dr Rupin Thakkar wrote in Seattle’s Crosscut about the need to connect children and adolescents with mental health services and the state legislature’s critical role in improving Medicaid payment rates for mental health services.  

All around the country, pediatricians are using their voices to raise awareness, spur action, and create policy change. For more from the AAP on ways to speak up for kids in your states see the tools and resources on our State Advocacy page and reach out to the state advocacy team.

April 16, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

Last week, more than 100 pediatricians, pediatric residents, and medical students from the AAP Missouri Chapter spent the day at the state capital advocating for the chapter’s Blueprint for Children. Members met with legislators to advocate for strengthening immunization policy, advancing trauma-informed care, and increasing child safety.

April 15, 2019: Medicaid Payment Reform for Children

As payment and delivery systems move away from volume toward value-based payment, ensuring that the needs of children are reflected in such reforms remains paramount. Medicaid payment reform efforts can have an outsized effect on children as they make up a large percentage of enrollees.

Two new United Hospital Fund reports provide insights from such payment reform activity. Drawing on the experiences of New York and other states, Achieving Payment Reform for Children Through Medicaid and Stakeholder Collaboration examines steps Medicaid programs might go through as they make the case for—and begin a conversation on—moving toward value-based payment with children foremost in mind. A companion document speaks to the importance of stakeholder collaboration as these efforts move forward. These resources are drawn from early state experiences and can be helpful to AAP chapters working on value-based payment or seeking to begin conversations around this important subject. AAP chapters working on payment or other Medicaid-related issues are encouraged to contact the AAP state advocacy team for consultation and technical assistance. 

April 11, 2019: Strong Gun Laws are Hampered by Local Enforcement Challenges in Some States

A recently enacted law in New Mexico aims to close the private sale loophole and require background checks for all firearm purchases. However, 29 out of 32 county sheriffs in New Mexico signed a letter stating their opposition to the new law. As a result, New Mexico Attorney General Hector Balderas has issued a statement warning local law enforcement that they must  enforce the new law or risk liability for damages incurred by illegal gun sales. 

The actions by New Mexico county sheriffs are part of a growing trend at the state level, with more than 200 counties in the United States declaring themselves “sanctuary” counties for gun owners. Counties in 9 states (Colorado, Illinois, Maryland, North Carolina, Nevada, New Mexico, New York, Oregon, and Washington) have passed ordinances or resolutions opposing enforcement of certain state gun laws.

Working closely with legal advocates, state attorneys general, and other legal community stakeholders will be important to ongoing advocacy on this issue and to address related challenges. 

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

April 9, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

The AAP Illinois Chapter recently held its annual Lobby Day in the state capital. Medical students, residents, and fellows met with legislators to discuss the importance of Medicaid, immunizations, school physical education, and ensuring that all children and their families are counted in the 2020 Census.

April 8, 2019: States Respond Differently to Rulings Medicaid Work Requirements

On March 27, 2019 a federal judge struck down Medicaid work requirement waivers in Kentucky and Arkansas. The court decisions effectively ended Arkansas’ program, which has resulted in more than 18,000 people losing coverage, and delays implementation of the program in Kentucky. However, states have responded differently to the rulings.

While the court decisions were narrow and only impact Kentucky and Arkansas, states are approaching this issue in different ways. In Iowa and Idaho legislatures have either stalled consideration of or altered their work requirement proposals. However, states with approved Medicaid work requirement waivers, such as Indiana and New Hampshire, are still planning to move forward. And state leaders in other states have indicated the court rulings will not derail their efforts to develop such a policy.   

For more from the AAP on this issue, please see our Principles on Waivers. AAP chapters working on waiver-related issues may contact us at for consultation and technical assistance. We’re here to help!

April 4, 2019: AAP Members Making a Difference in Their States

Pediatricians are natural advocates. AAP members in Minnesota and New Mexico have been speaking up for children in powerful ways.

AAP Minnesota Chapter Early Childhood Champion Dr Nathan Chomilo was invited by Governor Tim Walz to his state of the state address. Governor Walz honored Dr Chomilo, highlighting his efforts to prepare young children to thrive.

In New Mexico, chapter member Anjali Subbaswamy, MD, FAAP, a pediatric intensive care physician, wrote about the vital role pediatric advocacy plays in furthering the health and well-being of children. Dr Subbaswamy highlights ways that pediatricians can affect change on the individual, local, state, and federal levels. Dr Lance Chilton, also a AAP New Mexico chapter member, and chairperson of the AAP Council on Community Pediatrics, joined Dr Subbaswamy, noting “Children don’t get to vote, so we have to advocate on their behalf. I specifically go (to the capitol) to give a child-centered and physician-specific perspective to analysis and summary of some of the 1,300+ bills the legislators deal with during 60 action-packed days and nights of the legislative session.”

For more from the AAP on ways to speak up for kids in your states, visit our State Advocacy page and reach out to the state advocacy team for consultation and technical assistance.

April 2, 2019: Chapter Advocacy in Action What’s Happening in State Capitals

Recently, more than 140 pediatricians, residents, and medical students gathered in Albany, the state capitol, to advocate for the New York State AAP (District II) 2019 Legislative Priorities and 2019 Budget, Policy, and Practical Issues. Attendees educated lawmakers about raising the tobacco purchase age to 21 and protecting immunizations, among other priorities.

The AAP Tennessee Chapter recently hosted a day in the capital to advocate for their 2019 child health priorities, which include raising the tobacco purchase age to 21 and adoption of a Katie Beckett Waiver, which would allow Medicaid to cover at-home care for children with complex medical needs if they would otherwise be eligible for institutional care.

April 1, 2019: AAP Member Named Florida Surgeon General

This morning, Florida Governor Ron DeSantis announced the appointment of Scott A. Rivkees, MD, FAAP, as Florida Surgeon General and Secretary of the Florida Department of Health. Dr Rivkees, a pediatric endocrinologist, is the AAP Florida Chapter Treasurer, the Association of Medical School Pediatric Department Chairs (AMSPDC) liaison to the AAP Committee on Federal Government Affairs, chair of the Department of Pediatrics at the University of Florida College of Medicine, and physician-in-chief at the University of Florida Shands Children’s Hospital.

With the appointment of Dr Rivkees, pediatricians have been appointed as Surgeon General or Physician General in 3 of the 4 states (California–Nadine Burke Harris, MD, MPH, FAAP; Florida–Scott Rivkees, MD, FAAP; and Pennsylvania–Rachel Levine, MD, FAAP) that hold these cabinet level positions. The 4th state cabinet level position, which is in Arkansas, was previously held by a pediatrician, Joseph Thompson, MD, MPH, FAAP, who served as the state’s surgeon general from 2005-2015.

March 28, 2019: AAP Members Making a Difference for Children

Bird Gilmartin, MD, FAAP is 1 of just 51 pediatricians in Wyoming and 1 of 2 in the southwestern part of the state. She has worked tirelessly as a general child abuse pediatrician (Gen CAP) in her community across Wyoming. Dr Gilmartin effectively overhauled a system of care and response for child abuse at the hospital in Rock Springs, creating an improved medical response and multidisciplinary system in the community.  Now, in Evanston, she is working to accomplish the same goals. As a result of her work, Dr Gilmartin saw a gap in how children at risk for abuse, specifically siblings-at-risk, lacked protection and support because there was no process that allowed siblings-at-risk to undergo evaluation.  

Thanks to Dr Gilmartin’s skillful advocacy work, the Wyoming legislature passed—and Governor Mark Gordon recently signed—a new law that establishes a legal mechanism to evaluate siblings-at-risk. Dr Gilmartin, an early career pediatrician, AAP Wyoming Chapter member, and member of the AAP Council on Child Abuse and Neglect executive committee, reflects the power pediatricians have to create change in their communities, states, and across the country. Congratulations, Dr Gilmartin!

March 19, 2019: New AAP Drowning Prevention Statement and Advocacy Resources

Drowning is the leading cause of injury death among children ages 1-4 and the 4th most common cause of injury death to children ages 1-20. To address this important issue, the AAP has released the updated policy statement Prevention of Drowning with new data and recommendations to parents and policymakers to reduce drowning deaths and injuries.  

To aid related chapter/state advocacy efforts, the AAP has developed 3 new resources—Residential Pool Fencing and Life Jackets and a state advocacy infographic Drowning Prevention | Advocating for State and Local Action. This infographic can be customized with state specific data and your chapter logo—please contact us at for additional information. For more from the AAP on drowning prevention, please see the AAP Drowning Prevention Web page.

March 18, 2019: States Making Progress on Tobacco21 | Customizable State Advocacy Infographic Available

Last month, Virginia became the 7th state to raise the minimum purchase age of tobacco products and e-cigarettes to 21. The Illinois legislature has also passed a Tobacco 21 law and Governor JB Pritzker is expected to sign the bill later this month. In addition, 26 states have introduced bills to raise the minimum age of purchase for tobacco products and e-cigarettes.

The AAP has developed an infographic, Advocating for Tobacco21 in Your State, to support chapters working on these bills. If your chapter is interested in a customizing this infographic with state-specific information and your chapter logo, please contact us at  

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.

March 14, 2019: The State of Babies Yearbook 2019

The State of Babies Yearbook 2019, a report from Zero to Three, examines national and state data on the well-being of infants and toddlers, and provides advocates and policymakers with information to help advance policies that will improve the lives of babies and families. The report found that more than 8% of infants and toddlers have experienced 2 or more adverse childhood experiences (ACEs), 16.5% of babies don’t have access to healthy food, and only 30% of infants and toddlers received a developmental screening in the last year.

You can learn more about how your state’s infants and toddlers are faring by taking a closer look at these state profiles.

For more on early childhood from the AAP, visit the AAP Council on Early Childhood.

March 12, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

More than 140 members of the AAP Minnesota Chapter recently participated in a Day at the Capitol. Keynote speaker State Representative Matt Klein, MD, a hospitalist, rallied pediatricians' in their advocacy work on a range of issues including firearm safety, access to care, and immunization policy. More than 50 meetings were held with legislators to discuss the chapter’s 2019 legislative priorities.

The AAP South Carolina Chapter recently held its Legislative Advocacy Day where members worked to educate lawmakers about protecting children from gun injuries and violence as well as the health risks of e-cigarettes.

March 11, 2019: The Economic Cost of Vaccine Refusal

The Centers for Disease Control and Prevention recently reported on a 2017 case of tetanus in a 6 year old unvaccinated Oregon child. The boy, who was injured while playing outdoors on a farm, was the first case of tetanus reported in over 30 years in the state, and ultimately required 57 days of inpatient acute care. The economic costs related to his direct treatment (excluding medevac transportation, inpatient rehabilitation, and follow-up treatment) exceeded $800,000. While the child has now thankfully recovered, his parents refused a second dose of DTaP and any other recommended vaccines.

The costs of vaccine refusal and its role in vaccine preventable diseases are well known and significant. The total cost of containing just one case of measles in Iowa in 2004 is estimated at over $142,000 (almost $193,000 in CPI inflation adjusted dollars; see: Through reforms of state laws addressing vaccine refusal, states can help to prevent these diseases and their attendant economic costs.

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.

March 7, 2019: Children’s Medicaid and CHIP Enrollment Drops by 600K in 2018

Newly released data from the Centers for Medicare and Medicaid Services (CMS) show that enrollment in Medicaid and Children’s Health Insurance Program (CHIP) dropped by nearly 600,000 children in the first 11 months of 2018. While some point to a strong economy and low unemployment as reasons for this drop, such an enrollment decline is unusual and raises concerns, particularly as the uninsured rate for children has also recently reversed its decline.  

The Georgetown Center for Children and Families (CCF) provides state-by-state data from the CMS report, charting the change in children’s Medicaid and CHIP coverage from 2016-2017 and again from 2017-2018 across states. Enrollment declines in 2018 were experienced in 36 states, with declines of more than 4% in 5 states. While the strong economy might have played a role in this decline, other policies may have also been a factor, including the recent public charge proposed rule, the 2017-2018 delay in federal CHIP funding reauthorization, cuts to navigators, and the elimination of a federal penalty for not having insurance, among others. Whether this is an anomaly or a trend will become clearer as more data on children’s coverage is released in 2019. 

States play a role in ensuring children obtain coverage and remain covered. AAP chapters working on enrollment issues such as presumptive eligibility, 12-months continuous eligibility, streamlined renewal practices or other coverage concerns are encouraged to contact the AAP at for consultation and technical assistance. 

March 5, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals

AAP Kentucky Chapter President Pat Purcell, MD, FAAP (left) joins pediatric residents during the 15th Annual Children’s Advocacy Day at the Capitol. Chapter members advocated for the Blueprint for Kentucky’s Children, a statewide coalition of nonprofit, public, and private organizations that speaks with a common voice to create brighter futures for Kentucky kids.

Members of the AAP Mississippi Chapter are introduced on the floor of the Mississippi State Senate, which passed a resolution honoring the life and work of Blair Batson, MD, FAAPconsidered the “Father of Organized Pediatrics” in the state–during the chapter’s annual advocacy day. In addition, chapter members met with legislators to discuss the chapter’s 2019 Mississippi Advocacy Agenda, with a major focus of the day being on school bus safety.

Members of the AAP Oregon Chapter gather at the steps leading to the Oregon State Senate before heading to meet with legislators to discuss the chapter's endorsements of the statewide 2019 Children's Agenda. The chapter also had the opportunity to attend the first hearing of legislation to repeal the state's nonmedical vaccination exemptions, with chapter member Dawn Nolt, MD, MPH, FAAP testifying in support of removing the exemptions.

Attendees at the AAP Texas Chapter's 7th Annual Resident/Fellow & Medical Student Advocacy Day prepare to head off to the legislature to discuss the chapter's 2019 Legislative Priorities, with the focus being on access to Medicaid. Groups of pediatric trainees and chapter members made 40 legislative visits throughout the day.

Holding its 2nd Annual Pediatric Advocacy Day, members of the AAP Wisconsin Chapter join Dr Moo on the steps of the capitol. After a morning of preparation which included presentations by a state representative who is sponsoring an extreme risk protection order (ERPO) law in the state as well as the WI attorney general who supports the measure, chapter members visited legislators to discuss the importance of such a law and to roll out the chapter’s 2019 Wisconsin Blueprint for Children.

March 4, 2019: Who’s Speaking Up for Kids? | AAP State Advocacy Resource

State of the state and inaugural addresses offer a quick look at governors' top line priorities and are a great way for your chapter to identify shared interests, make a connection, and offer your expertise. 

The AAP State Advocacy team has been listening in to what governors are saying, and we’re keeping track of some things you’ll want to know in our Who’s speaking up for children? resource. The National Academy for State Health Policy (NASHP) has also issued a report that offers an in depth examination of key themes governors are discussing. Used together, these tools can help you identify policy priorities or issues of concern for your chapter. Utilize that information to reach out to your governor’s office, to discuss common interests, share your experience and expertise, and build or strengthen your advocacy relationship.

February 28, 2019:New York Enacts Extreme Risk Protection Order | New State Advocacy Infographics Available

New York became the 14th state to enact an Extreme Risk Protection Order (ERPO) law that would allow police officers, family or household members, or school personnel to petition a court to remove a gun from the environment of a person deemed at risk of hurting themselves or someone else.

More than 20 other states are considering similar legislation in 2019. The AAP has developed 2 new infographics Extreme Risk Protection Orders and Preventing Youth Suicide | Extreme Risk Protection Ordersto support chapters working on these bills. If your chapter is interested in a customizing these infographics with state-specific information, please contact us at

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

February 26, 2019: Chapter Advocacy in Action | What’s Happening in State Capitals
At its recent Day at the Statehouse, members of the AAP Indiana Chapter joined forces with other stakeholders to advocate for a $2.00 increase in the state’s tobacco tax as part of the Raise It For Health campaign to make the state tobacco free.

AAP Maryland Chapter’s Resident Advocacy Day in the state capital was an opportunity for pediatric trainees to advocate for legislation to provide adolescents with pre-exposure prophylaxis (PrEP) to help prevent HIV.

Members of the
AAP Washington Chapter braved snowy weather to visit Olympia for the chapter’s annual advocacy day. AAP President and chapter member Kyle Yasuda, MD, FAAP addressed the attendees and chapter members met with legislators to advocate for the chapter’s 2019 Legislative Priorities.

The AAP West Virginia Chapter held its second “Tiny Hearts Day” to advocate for the chapter’s
West Virginia Blueprint for Children. In recognition of the chapter’s dedicated advocacy to children and families, the West Virginia Senate adopted Senate Resolution 43, which honors the state’s pediatricians, the AAP WV Chapter, and their advocacy work.

February 25, 2019: AAP Members Making a Difference in Their States
AAP chapters know that advocacy for children is at their core. Two AAP members have recently spoken out to make a difference for kids in their states, demonstrating the power of the pediatrician's voice on key issues. 

In California, Dr Richard Pan, a pediatrician, member of the California Senate, and coauthor of the 2015 law to eliminate nonmedical exemptions to school entry immunization requirements in the state, called on the US Surgeon General to take action on vaccine refusal and to make the issue of vaccine hesitancy a top priority. In Michigan, Dr Mona Hanna-Attisha, the leading voice for children in the wake of the Flint Water Crisis, voiced her support for Governor Gretchen Whitmer’s plan to restructure the state’s Department of Environmental Quality in order to better protect public drinking water. Governor Whitmer has since issued an executive order to do so, despite an earlier attempt by the legislature to block the plan.  

For more from the AAP on ways to speak up for kids in your states, see the tools and resources on our State Advocacy page and reach out to the state advocacy team

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 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 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 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

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 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 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 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.​​​