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MNAAP Newsletter

MNAAP Policy Committee Begins Agenda-Setting Work

Eric Dick headshotBy Eric Dick, MNAAP Lobbyist

While fall has only recently arrived, planning for the 2018 legislative session has begun in earnest with the first meeting of the MNAAP’s Policy Committee in late September. The 2018 session is slated to begin on February 20.

Despite the difficulty in predicting the issues that will dominate the action at the Capitol in 2018, some predictions can safely be made. As the second year of the biennium, the 2018 session will be dominated by debate on policy issues, rather than the budget-focused nature of the previous session.
Many Capitol veterans are predicting a session with very little substance. Though it’s a policy year, it’s also possible that legislators will have to address budget issues should tax revenue not meet projections. All too often, deficits have been “fixed” by cutting health care programming.

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Threats to Children’s Health Care Abound


Eric Dick headshot

By Eric Dick, MNAAP Lobbyist 

The program that provides care to millions of America’s infants, children, and adolescents is under siege, and the threats come from multiple directions.  From Washington, D.C. to St. Paul to the boardrooms of major insurers, coverage for pediatric patients is under constant risk.

As of this writing in mid-July, legislation under consideration in the U.S. Congress remains a moving target. Solid intelligence about what is being included or left out of proposals is rare, and reports suggest that many different versions of these bills remain in play.

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Advocating for Prenatal to Three Investments and Interventions

By Mark Nupen, MD

As a retired pediatrician but lifelong child advocate, I had the privilege of recently attending the bipartisan “Prenatal to Three Policy Forum” hosted by Elders for Infants and Representatives Deb Kiel and Dave Pinto.

These quarterly forums, which have been gaining traction among policy makers and pediatric advocates, are designed to help attendees “learn about what key organizations and coalitions are working on to improve state policy for early childhood, from prenatal through age 3.”
I highly recommend pediatricians attend, if possible, because prevention works best when it’s done early.

Literacy, for example, is an extremely important social determinant of health. Although language development is critical in the first three years, half of all new mothers receiving Medicaid do not have books in their house. Research suggests as many as 70 percent of prison inmates are mostly illiterate. Low literacy is also a key factor in high school dropouts and teen pregnancies.

If I were still in practice, parental literacy would be one of my new “vital signs.”

In my opinion, prenatal to age 3 is the perfect span of time for focused interventions. It is the prime age for child abuse and family dysfunction, which is why it is the prime age for building parenting skills and literacy.

During the forum, legislators spoke about the importance of keeping in contact with your own representatives and senators because it is likely they have little knowledge about these issues and need your help.

Following the forum, I connected with Clara Sharp, a doula from North Minneapolis who works with at-risk moms. I also connected with Laura Lacroix-Dalluhn who works with the Minnesota Coalition for Targeted Home Visiting, which includes pregnant moms in prison.

We cannot do this work alone, nor can we rely on a few legislators. We all need to contribute to our legislators’ skills and knowledge.

Reflections on Caring for Refugees in Lesbos, Greece

boys at fireBy Chuck Oberg, MD

As President Trump’s proposed U.S. refugee travel ban continues to work its way through the courts, I make a plea for benevolence and tolerance rather than that of fear.

I recently returned home from working in the refugee camps in Lesbos, Greece. I was volunteering with the Boat Refugee Foundation, a Netherlands based NGO.

I spent the majority of my time in the notorious Moria Refugee Camp. The camp is beyond description and is a surreal mix of an interment camp and shanty, squatter community encampment. Based in an old army compound, it is defined by the steel gates, high fencing and barb wire from the outside and an amorphous sea of tarps and tents on the inside. The weather had turned brutally cold. Over a foot of snow was followed by freezing rain. The cold and dampness penetrated to the bone. Food queues, inadequate unsanitary toilet facilities and ubiquitous garbage were the norm.

There are over 4,500 refugees. They had traveled from Syria, Iraq, Iran, Afghanistan and Pakistan from the Middle East. They came from across the African Continent with families from the Democratic Republic of the Congo (DRC), Ghana, Uganda, Somalia, Eretria and Sudan. In addition, I treated families from as far east as Bangladesh and west from Haiti and the Dominican Republic.

Almost all had experienced trauma. Some beaten, shot, tortured, and raped and all had experienced the stress of living in unlivable conditions. The complaints were a blur of physical, mental, and spiritual aliments.

Yet there was a palpable hope that one day things would be better with aspirations of a better future. Daily they expressed their gratitude that someone would listen as they shared the story of their journey, affirmed their worth, acknowledged their struggle and celebrated their humanity. You could see it in their eyes and their smiles that each was seeking a better life for themselves and their children.

I saw no terrorist. I just saw families, children, men and women–all vulnerable and suffering. So let us remember that our kindness will make us safer than any ban.

Legislative Update: 6,000 Bills and Counting

“When they come back, the real work begins,” said Gov. Mark Dayton as legislators began the Easter/Passover break on April 10.
Despite being almost three quarters complete (as of this writing in mid-April), the most difficult and consequential pieces of the 2017 legislative session yet remain. While almost 6,000 bills have been introduced in both houses of the legislature this session, the year’s most important task – crafting a two year biennial budget – remains on legislators’ “to do” list.
Both the House and Senate have passed budgets that fund state government, including the Health and Human Service (HHS) programs. As is always the case with budget bills that span more than 700 pages, there are pieces that the MNAAP can strongly support, and there are elements that we forcefully oppose.

Most directly, the Senate HHS funding proposals cuts physician reimbursement for services provided under MinnesotaCare and Medical Assistance by 2.3% in 2017 and by 3% in 2019. The House takes a slightly different approach, counting on new client eligibility verification tools and efforts to reduce hospital readmissions to save state resources. Should these mechanisms not create the savings the authors intend, reimbursement to physicians and other providers would be cut by up to $204 million. These cuts, on top of Minnesota’s already anemic payment rates, represent a real threat to continued access to care for Minnesota’s most needy children and families.

There are bright spots in the budget bills. Both the House and Senate include funding for several MNAAP priorities.

Eric Dick headshotChildren’s mental health receives significant attention, with funding for school-linked mental health grants, text-based suicide prevention programming, and support for first episode psychosis training.

Minnesota’s yawning racial and economic health disparities also receive some attention with funding included for nurse home visiting programs for prenatal and postpartum follow-up for at-risk parents, another MNAAP priority.

The House and Senate both fund the Safe Harbor program, an effort to prevent child sex trafficking while supporting victims.
Foster families also receive support via several programs that aim to assist foster children who are not adopted.

When session began, there were real concerns that the MNAAP would be forced to play defense to preserve hard-fought wins on a number of issues, as well as preventing dangerous proposals from becoming law. There are legislators at the Capitol who seek to roll back the newborn screening program, repeal a minor’s ability to receive health care in certain limited instances without parental consent, and make Minnesota’s already-weak immunization law even weaker. And while harmful bills regarding some of these issues were introduced, I’m happy to report that none of these proposals gained traction this session.

The end of session is now in sight, as the Minnesota Constitution mandates that the session end no later than midnight on May 22. If you haven’t already contacted your elected officials to share your perspective on these important issues, now is the time to do so.

Legislators do want to hear from you, and your voice as a pediatrician is amongst the most credible and powerful.

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