Legislative Update 3/22/2021: Graduate Medical Education Funding, Immigration, Nebraska & COVID-19

US capitol

This is the legislative update for March 23, 2021. View all updates here.


  • Children’s is working with the Children’s Hospital Association on securing additional funding for the Children’s Hospital Graduate Medical Education (CHGME) program.

  • The House passed an immigration bill that would provide a pathway to citizenship for the young, undocumented immigrants known as “Dreamers”.

  • The Nebraska Appropriations Committee is expected to report their FY21-22/FY22-23 budget package, which supports a 2% provider rate increase for each of the next two years

  • Nebraska is expected to receive $5 billion to $10 billion additional COVID-19 relief funds directed under the recently passed American Rescue Plan relief measure.

  • Nebraska is about to move into Phase 2A in the vaccine distribution timeline.


The March 23, 2021 legislative update includes highlights from both federal and state legislatures.

Federal Updates

Congress

Graduate Medical Education

One of the public policy priorities at Children’s is securing funding for the Children’s Hospital Graduate Medical Education (CHGME) program. CHGME supports training and teaching of future pediatric providers and specialists, building a much needed pipeline of experts for children’s hospitals across the country.

Last year, Congress provided $350 million for CHGME — less than half of the funding for adult-Medicare graduate medical education. As Congress puts together the Fiscal Year 2023 budget — which will need to pass by September 30 — we are working with the Children’s Hospital Association (CHA) to ask Congress to provide $485 million for CHGME. This would be a step toward achieving our goal of closing the gap between CHGME and adult-Medicare graduate medical education funding over the next three years.

Immigration

Last week, the House passed the immigration bill H.R. 6, the American Dream and Promise Act of 2021, which is aimed at giving recipients under the Deferred Action for Childhood Arrivals program (DACA) a path to citizenship.

The bill would provide a pathway to citizenship for the young, undocumented immigrants known as “Dreamers,” as well as for Temporary Protected Status recipients and Deferred Enforced Departure beneficiaries. According to the Migration Policy institute, nearly 4.4 million Dreams would be made eligible for permanent residence under this bill.

The final vote count was 228-197. Nine Republicans voted with Democrats in support, including Rep. Don Bacon of Nebraska.

However, this bill will face growing challenges in the Senate. The Senate is renewing a debate among Democrats about removing the filibuster. Senate Majority Whip Dick Durbin (D-Ill.) thinks that he is close to securing the 10 Republican votes needed to overcome the filibuster. He said they will reserve the right to remove the filibuster 60-vote requirement to advance a key immigration measure that would provide a pathway to citizenship for undocumented immigrants who were brought to the US as children.

Hearings this week on Capitol Hill include:

Monday, March 22 Tuesday, March 23 Wednesday, March 24 Thursday, March 25 Friday, March 26
House Education and Labor Committee Hearing: "Ending the Cycle: Examining Ways to Prevent Domestic Violence and Promote Healthy Communities" House E&C Committee Hearing: "Building on the ACA: Legislation to expand health coverage and lower cost. Senate Banking, Housing and Urban Affairs Committee Hearing: "The Quarterly CARES Act Report to Congress" Senate HELP Committee Hearing: "Examining Our COVID-19 Response: Improving Health Equity and Outcomes by Addressing Health Disparities."
Senate Homeland
Security Committee Hearing: "The 2020 Census and Current Activities of the U.S. Census Bureau"
Senate Rules Committee Hearing: "For the People Act." Senate Agriculture Committee Hearing: "Child Nutrition Reauthorization: Healthy Meals and Healthy Futures"
House Appropriations Committee Hearing: "Addressing the Maternal Health Crisis" House Education and Labor Committee Hearing: "Lessons Learned: Charting the Path to Educational Equity Post-COVID-19"
Senate HELP Committee Hearing: "Why Does the US Pay the Highest Prices in the World for Prescription Drugs?"

State Updates

Nebraska Legislature

We are past the halfway point in the 90-day legislative session and are cruising into the second week of all-day floor debate.

Last week, we reported a favorable list of individual senator and committee priority legislation that Children’s is monitoring this session. This has been updated to our master bill list.

This week, we have an even clearer picture of what legislation will be in focus, especially as time starts to run short. Speaker of the Legislature Mike Hilgers’ (R-Dist. 21, Lincoln) list of 25 Speaker Priority bills includes:

  • LB247 (Sen. Pansing Brooks): Create the Mental Health Crisis Hotline Task Force
  • LB411 (Sen. Lathrop): Require sharing of information with the designated health information exchange
  • LB452 (Sen. McKinney): Adopt the Financial Literacy Act
  • LB527 (Sen. Walz): Change provisions relating to transition services for students with a developmental disability
  • LB583 (Sen. Murman): Require electronic prescriptions for controlled substances
  • LB396 (Sen. Brandt): Adopt the Nebraska Farm-to-School Program Act

Appropriations Committee Budget Update

On Thursday, March 25, the budget-setting Appropriations Committee is expected to report their FY21-22/FY22-23 budget package to the floor. According to Speaker Hilgers’ memo, the legislature will then take up the package on the first round of debate (General File) next week.

The Appropriations Committee members, as well as several senators, continue to support a 2% provider rate increase for each of the next two years. This increase would cost the state about $90 million in this budget. Children’s is working closely with the Nebraska Hospital Association (NHA) and other hospitals to synchronize our talking points on the importance of having this Medicaid provider rate increase — especially in the midst of a pandemic — regardless of any one-time provider relief funding (PRF) support from the federal government.

The $90 million price tag is a big request. Fortunately, the Department of Revenue’s projections are more than favorable, and may ease that request.

Last week, the Department reported that February’s net general fund receipts were 96% over projections ($220M). A strong state economy, coupled with the federal stimulus funds will allow the Legislature and Governor Pete Ricketts (R-NE) to provide funding to a number of state initiatives, including broadband deployment, Medicaid provider rate increases, and increased funding for the Cash Reserve Fund.

COVID-19 Relief

Nebraska is expected to receive $5 billion to $10 billion additional COVID-19 relief funds directed under the recently passed American Rescue Plan relief measure. This includes:

  • $1.2 billion for state spending needs, which is more than 25% of the state’s annual general budget
  • $2.3 billion by way of the $1,400 stimulus payments going directly to Nebraskans
  • $685 million for Nebraska counties, cities, and municipalities
  • $566 million to K-12 Nebraskan schools
  • $211 million for public and private universities

The American Rescue Plan prohibits states from using their relief funds to offset new tax cuts or consider new credits. As Nebraska is experiencing strong economic growth, this could have an impact on the tax modernization efforts that are underway this session.

Questions around the utilization of the federal American Rescue Plan relief funds has prompted Nebraska Attorney General Doug Peterson to join twenty other GOP attorneys general in questioning the Biden Administration’s barring states from using its funds to offset tax cuts.

Executive Branch: Vaccines

Phase 2A of Nebraska’s vaccine distribution timeline is anticipated to begin in most local health jurisdictions by Monday, March 22. Governor Ricketts recently announced that as part of Phase 2A, about 10% of doses will be designated for Nebraskans who are at high risk of complications from COVID-19 due to their personal health status.

Children’s is currently working with other local health systems to ensure that the same criteria are being used to identify these highest risk patients across the community, specifically looking at availability of vaccine clinics in north Omaha. This collaboration helps ensure an equitable, effective framework for vaccine distribution.

Patients aged 16-49, with a visit of any type within the last two years, will be evaluated based both on medical diagnoses, as well as vulnerability index (as defined by CDC) using a tool that everyone in the collaboration agrees upon.

The new phase comes on the heels of President Biden announcing that every adult in the U.S. will be eligible for vaccination no later than May 1. Governor Ricketts has addressed his concerns for Nebraska (and other states) to be prepared by May 1 and continues to ask the Biden administration — just as he asked the Trump administration — for more transparency in their algorithm in determining how many vaccines go to each state and when.

In the meantime, another vaccine milestone will be achieved this week: The vast majority of public and private K-12 educators who wanted a vaccine will have gotten at least a first dose.

Child Health Champion Advocacy Team

Please join the Children’s Child Health Champion Advocacy Team every Thursday at 7:30 a.m. for a 30-minute call.

Advocating for children is extremely important at all stages. This internal group of stakeholders — comprised of providers and experts across the continuum of care at Children’s — meets weekly to ensure we are leading the discussion on child advocacy in the region.

Learn more about our advocacy and legislative work in our community.
Advocacy & Outreach

If you are interested in joining the movement, contact Liz Lyons at llyons@childrensomaha.org for more information.

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