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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. StateView is available as a weekly digest sent to AAP chapter leaders and State Government Affairs contacts.​ 
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 includes social media messages, images, 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

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
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. 

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
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

March 20, 2017: AHCA Medicaid Restructuring Would Directly Affect States
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 (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

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 28, 2017: Physician Counseling About Marijuana Use in the Era of Legalization
Counseling Parents and Teens About Marijuana Use in the Era of Legalization of Marijuana, a new clinical report from the AAP, highlights the dangers of a policy climate in which the drug increasingly is seen as acceptable, safe, and therapeutic. The report urges pediatricians to screen adolescents and preteens for substance use, offering interventions and treatment referrals, and motivational reinforcement techniques to abstain and resist peer pressure. AAP policy opposes the legalization of marijuana and “medical marijuana” outside the FDA approval process.

In November 2016, voters in 4 states (Arizona, California, Massachusetts, and Nevada) approved ballot measures legalizing marijuana for recreational use, joining Colorado, Oregon, Washington and the District of Columbia. In addition, 29 states have legalized medical marijuana and 16 states allow the use of low-THC cannabis oil to treat specific conditions.

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

February 27, 2017: AAP Maryland Chapter Hosts Advocacy Day
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

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

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 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
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 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

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.