- Washington Report
Late last year, members of Congress worked across the aisle to address a critical issue impacting U.S. mothers and newborns: neonatal abstinence syndrome (NAS).
Lawmakers passed the Protecting Our Infants Act of 2015, which aims to reduce the number of newborns who are exposed to opioids or other drugs in utero and experience medical complications associated with drug withdrawal. Not only is the legislation a victory for children’s health, but it also represents a straightforward path of lawmaking: identify a problem, work with champions in both political parties to introduce and pass legislation to influence change, and sign a bill into law.
In this case, the bill became law about nine months after its inception, with the Academy and its partner organizations advocating every step of the way.
Given today’s challenging and often partisan climate, the bill’s passage is an example of advocacy success that deserves celebration. It also is worth looking at how the legislation became a reality.
Identifying the problem
According to recent data, from 2000 to 2012, there was a five-fold increase in the proportion of U.S. infants born with NAS. In 2012, one infant was born every 25 minutes experiencing drug withdrawal. Infants with NAS can have seizures, low birthweight and respiratory complications, and can be difficult to console.
These medical complications often lead to prolonged and costly hospital stays. In fact, the average hospital costs for newborns suffering with the syndrome are shown to be five times greater than other hospital births; for more than 75% of these babies, Medicaid is the primary insurance provider.
“There could not be a more critical time to help families affected by substance use and abuse give their babies the healthiest possible start in life,” AAP Immediate Past President Sandra G. Hassink, M.D., M.S., FAAP, said in a press release.
Although similar legislation previously was introduced in the U.S. House of Representatives and the U.S. Senate during the 113th Congress, neither bill advanced.
To help bring the issue back to the top of the federal agenda in 2015, the Academy, the March of Dimes and the American Congress of Obstetricians and Gynecologists hosted a briefing early in the 114th Congress addressing the prevalence, symptoms and treatment options for babies born with NAS.
On March 20, 2015, Congress re-introduced the bipartisan, bicameral Protecting Our Infants Act of 2015, with lead sponsors Rep. Steve Stivers (R-Ohio), Rep. Katherine Clark (D-Mass.), Senate Majority Leader Mitch McConnell (R-Ky.) and Sen. Bob Casey (D-Pa.).
The legislation directs the U.S. Department of Health and Human Services (HHS) to identify recommendations for the prevention and treatment of prenatal opioid use disorders and for the diagnosis and treatment of NAS; coordinate federal research efforts; and assist state health agencies with data collection. Previously, there were no standardized guidelines for these efforts.
Due to the work of pediatrician advocates, the Academy and its partners as well as the dedication of federal leaders and congressional staff, the House passed its version of the bill with 99 bipartisan co-sponsors on Sept. 8, 2015. Over a month later, the Senate passed its nearly identical bill with 22 bipartisan co-sponsors. Final passage of the bill came on Nov. 16, 2015, and President Barack Obama signed it into law before Thanksgiving.
“The Protecting Our Infants Act will help address neonatal abstinence syndrome in a coordinated way by beginning to address the research and service gaps and helping to improve efforts taking place at the state level,” said Stephen W. Patrick, M.D., M.P.H., M.S., FAAP, a member of the AAP Section on Neonatal-Perinatal Medicine. “This legislation sets us on a path toward finding solutions for babies born with NAS.”
While the legislation makes strides in addressing this issue, there still is work to be done. From establishing the most effective ways to care for babies born with NAS to understanding how to best support their families after they leave the neonatal intensive care unit, Dr. Patrick emphasized that additional research and funding for these efforts are imperative.
It now is up to HHS to implement the legislation’s provisions within one year. The Academy will work with the agency to ensure the voices of pediatric experts are well-represented in the process to improve the federal government’s response to this problem.
Congress passes spending bill with key gains for children’s health
With just days to spare before leaving Washington for the holiday recess, Congress passed a bipartisan $1.1 trillion spending bill, called an omnibus, to fund the federal government until Sept. 30, 2016. Shortly after the bill’s passage, President Obama signed the bill into law, offering his own words of support for the legislation.
In the past, lawmakers passed short-term spending deals as piecemeal funding solutions, and the effects from sequestration limited funding for critical child health programs. This recent compromise is a historic and important advocacy achievement.
By lifting across-the-board budget caps set in 2011, the bill increases funding for several key programs and federal agencies important to children’s health. Two AAP priorities that saw funding increases are research at the National Institutes of Health and the Head Start program.
The legislation also preserves funding for programs such as the Emergency Medical Services for Children program and the Special Supplemental Nutrition Program for Women, Infants and Children, and excludes an exemption of e-cigarettes from federal regulation.
Despite these gains, there are a few areas where the Academy will continue its federal advocacy, including its work to eliminate restrictions on funding for federal gun violence prevention research, which were included in the spending deal.
In conjunction with the omnibus, both chambers approved a $680 billion package of tax cuts, which include permanent extensions of the Earned Income Tax Credit for low-income workers and the Child Tax Credit of $1,000 per child, which lifted 5 million children out of poverty in 2013.
For a summary of the final spending agreement, visit http://federaladvocacy.aap.org/appropriations.