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Washington DC Update 12/14/21
This week in Washington, Congress will be tied up with the National Defense Authorization Act and voting to raise the debt ceiling - among many other things.

Build Back Better (BBB) is…still being built. Many steps in the building process still remain to be completed.

Bill Text
While the House passed their version of BBB, pieces of the Senate text are trickling out. Over the weekend, Finance and HELP committees released their text. Senators are still negotiating aspects of the text, especially around paid family medical leave, drug pricing, state and local tax deductions, and climate change provisions.

The parliamentarian must review each provision of BBB to ensure it satisfies the rules of reconciliation. Each tweak to text of the bill must be reviewed.

CBO Score
Last Friday the Congressional Budget Office (CBO) issued another score of the costs of the legislation. The first score (full record of scores on BBB can be found here) focused on the bill as proposed with some programs ending after a few years. The 12/10/21 CBO score looked at the cost of BBB IF the legislation was permanent; meaning programs included in the bill would continue for 10 years. The second score showed astronomical costs, however, it is important to note that as currently proposed, BBB only funds programs for a few years; not permanently. The second CBO score was released on the same day as data came out indicating that inflation is the highest it has been in 40 years.

  • Who is the CBO? The Congressional Budget Office is a nonpartisan agency that estimates how much proposed and existing legislation will cost American taxpayers. The office is strictly nonpartisan. It doesn’t recommend how to better spend money. It doesn’t take sides in a policy debate. It doesn’t even make policy recommendations. Its only job is to estimate the economic impact of legislation. It does this in a couple of ways, primarily:

  • Scoring proposed legislation to estimate how much it will cost over a period of time. Lawmakers request this a lot, apparently. The CBO estimates that it provides thousands of informal estimates a year to various lawmakers and congressional committees. Congress also requires a CBO score for nearly every bill approved by a committee before it comes to the floor for a vote.

  • The CBO also issues annual reports estimating the economic impact of all current laws over the next decade.

The effects of the second score on how democratic Senators might ultimately vote is unclear. There is now speculation that a vote on the reconciliation bill will not happen, if at all, until 2022. Congressional Democratic leadership remains focused on a Senate vote before the Holidays.
House Passes 15 Health-related Bills, 3 of Interest to CYSHCN:
H.R. 5551, the “Improving the Health of Children Act,” was introduced by Reps. Buddy Carter (R-GA), Henry Cuellar (D-TX), Lori Trahan (D-MA), G.K. Butterfield (D-NC), and Richard Hudson (R-NC). The bill would reauthorize the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the CDC, expand the scope of programmatic work, and increase the overall authorization level for NCBDDD. The bill passed on the House Floor by a vote of 405-20.

H.R. 3894, the “Collecting and Analyzing Resources Integral and Necessary for Guidance for Social Determinants Act of 2021" or the “CARING for Social Determinants Act of 2021,” was introduced by Reps. Lisa Blunt Rochester (D-DE) and Gus Bilirakis (R-FL). The bill would require the Secretary of Health and Human Services (HHS) to provide guidance and technical assistance to states on how to address social determinants of health through Medicaid and the Children’s Health Insurance Program (CHIP). It also requires that the guidance be updated every three years. The bill passed on the House Floor by a vote of 378-48.

H.R. 4026, the “Social Determinants of Health Data Analysis Act of 2021,” was introduced by Reps. Michael C. Burgess, M.D. (R-TX) and Lisa Blunt Rochester (D-DE). The bill would require, among other things, the GAO to submit to Congress within two years of enactment a report on the actions taken by the Secretary of HHS to address social determinants of health. The bill passed on the House Floor by a vote of 399-28.
From the White House: Customer Experience
Yesterday President Biden signed an Executive Order on transforming Federal Customer Experience. Viewed as an extension of the Administration’s equity work aimed at restoring trust in government, the order calls out High Impact Service Providers and sets standards. 

A fact sheet on the order can be found here.
ICYMI: Surgeon General Advisory on Mental Health
“Mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.” said Surgeon General Vivek Murthy. “The COVID-19 pandemic further altered their experiences at home, school, and in the community, and the effect on their mental health has been devastating. The future wellbeing of our country depends on how we support and invest in the next generation. Especially in this moment, as we work to protect the health of Americans in the face of a new variant, we also need to focus on how we can emerge stronger on the other side. This advisory shows us how we can all work together to step up for our children during this dual crisis.”

Read the full Surgeon General Advisory on Protecting Youth Mental Health here.

Consider this blog post from Georgetown CCF for analysis of the Surgeon General’s advisory.
Report: Federal Expenditures on Children
To inform policymakers, children’s advocates, and the general public about how public funds are spent on children, this 15th edition of the annual Kids’ Share report provides an updated analysis of federal expenditures on children from 1960 to 2020. This year’s Kids’ Share report also provides a view of public expenditures from the nation’s initial responses to the COVID-19 pandemic. In addition to the report, Urban Institute also published a new feature -- Six Charts about Federal Spending on Children during the Pandemic.
Report: Disability and Technology Policy
The American Association of People with Disabilities (AAPD) and the Center for Democracy & Technology (CDT) released Centering Disability in Technology Policy, a report highlighting the ways in which technology can discriminate against disabled people – and what advocacy groups, regulators, and funders can do to change this. A plain language version of the report, linked here, was also released. The report makes a number of recommendations for tech organizations, public interest groups, or anyone with an interest in using technology to meaningfully improve peoples’ lives. It covers a wide range of topics, including digital accessibility practices, equitable employment and education access, data privacy, online hate and harassment, law enforcement surveillance, algorithmic bias, and more.
Issue Brief: Policies and Investments Early Care and Education
Nemours Children’s Health has released an issue brief that offers policy recommendations for Congress and the Executive Branch to prioritize and invest in children's healthy development in the early care and education (child care) sector. Throughout the COVID-19 pandemic, families with young children have been faced with many challenges, including school and early care and education (ECE) program closures, unemployment, missed life events, and an overall sense of instability. African American and Latinx households with young children have reported higher levels of food insecurity and exhibit higher rates of obesity. The ECE sector is critical to children’s healthy development, providing them with daily nutrition supports and helping them to build social and emotional skills.
Key recommendations include:

  • Supporting evidenced-based professional development programs for ECE providers to ensure robust health and wellness training. 

  • Enhancing nutrition supports in ECE settings by strengthening the Child and Adult Care Food Program (CACFP) and promoting CACFP participation in ECE programs. 

  • Improving state systems to support obesity prevention and children’s healthy development. 
Bulletin: Child Quality Measures Core Set
Centers for Medicare & Medicaid Services (CMS) released an Informational Bulletin that describes the 2022 updates to the core set of children’s health care quality measures (the Child Core Set) for Medicaid and the Children’s Health Insurance Program (CHIP) and the core set of health care quality measures for adults enrolled in Medicaid (the Adult Core Set).

Request for Information: Whether and How Common Practices and Methods Used by Health Actuaries and Health Plans Affect Health Disparities
The Health Equity Work Group (HEWG) of the American Academy of Actuaries has issued a request for information (RFI) to solicit input to its work assessing whether and how common practices and methods used by health actuaries and health plans affect health disparities. Health actuaries often partner with other professionals in many different aspects of the health care and health insurance systems, including those related to administration, financing, and care management.

Through this RFI, the HEWG is seeking articles, links to resources, and other input, information, and existing or ongoing research in identified areas from anyone with relevant information or perspectives.

The four areas identified by HEWG in which health actuaries and health plans are involved that may affect health disparities, either by contributing to disparities or by mitigating disparities are:

  • Health insurance benefit design;
  • Provider contracting and network development;
  • Premium pricing; and
  • Managing population risk.

The work group is also exploring data collection issues.

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Family Voices is a national organization and grassroots network of families and friends of children and youth with special health care needs and disabilities that promotes partnership with families--including those of cultural, linguistic and geographic diversity--in order to improve healthcare services and policies for children.