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MNAAP Newsletter

Minnesota Pediatrician is published quarterly (February, May, August and November) and is written by pediatricians for pediatricians. The newsletter is mailed and emailed to over 1,000 members.

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February 27, 2019

The 2019 legislative session began with a crack of the Speaker’s gavel at noon on Tuesday, Jan. 8. Families of members joined them for the traditional pomp and circumstance that mark the beginning of a legislative session.

Legislators returned to a different Capitol, with several new faces and personalities. The DFL bucked history and successfully held the governor’s office thanks to former U.S. Rep. Tim Walz’s win. Even more surprising from many analysts’ perspectives, the House DFL flipped nearly 20 seats – many in the suburbs traditionally controlled by the GOP – to pick up control of the body.  While state senators were not on the ballot this year (all 67 seats will be on the ballot in 2020) a single special election for a Senate seat was retained by the GOP and with it their one-vote majority.

Given that 2019 is the first year of the biennium, the major task before legislators this session will be consideration of a two-year biennial budget. The legislature’s task has been made a bit easier thanks to an expected budget surplus of nearly $1.5 billion.  While an eye-popping figure and cause for cheer, legislators would be well served to note that the budget forecast does turn sour in subsequent years given anticipated spending increases and a cooling economy. The governor will be unveiling his budget proposal by mid-February, and the House and Senate will begin crafting their own versions shortly thereafter.

The scheduled repeal of the provider tax is likely to be the dominant health care debate at the Capitol in 2019. The provider tax, first levied in 1994, is a tax on the gross receipts of most health care providers and serves as the chief funding mechanism for Medical Assistance, MinnesotaCare, and a number of other health care access and public health programs. Its sunset was the result of a budget agreement from 2011.  Governor Walz and House Democrats are supportive of repealing the sunset, while Senate Republicans have generally indicated their opposition to any new revenue, including repeal of the sunset. Other health care advocates have proposed alternatives to the provider tax.

It’s also likely that Governor Walz and House DFLers will also press to allow more individuals to purchase MinnesotaCare, the state’s health insurance program for many low-income Minnesotans.

The Senate GOP has been quite skeptical of these proposals in recent years.

With input from MNAAP committees, survey results from polling of members, the political climate at the Capitol, and the chapter’s historical positions on various issues, the MNAAP board has selected four priorities for the 2019 session:

Reducing gun violence.  Far too many Minnesotans have been impacted by firearm violence, and yet even common sense measures have been difficult to enact. MNAAP will continue its vocal support for expanded background checks, “red flag” laws to allow law enforcement authority to seize guns if the gun owner has been acting suspiciously, and expanded public health research into gun-related violence.   

Extending the provider tax. Preserving and expanding access to care has been a central priority for MNAAP for decades.  To that end, MNAAP opposes the sunset of the provider tax unless a viable alternative can be found.

Strengthening Minnesota’s vaccine laws. Minnesota’s vaccine laws are among the weakest in the nation.  As such, MNAAP will work with partners to strengthen our immunization laws and ensure parents have access to medically accurate information.

Increasing behavioral health care access.  All too often, pediatricians and families alike are struggling to find resources to help children with mental illness. MNAAP will partner with allies across the Capitol to support efforts to expand access to these critical services.

While MNAAP has identified four legislative priorities, the chapter will be engaged on dozens of issues.  Efforts to raise the minimum age to purchase tobacco to 21 have been successful in cities and counties across the state, and advocates – including MNAAP – will be lobbying for a statewide law increasing the age. MNAAP will also work closely with others to invest in efforts to invest in early brain development, as well as supporting a growing coalition formed to prohibit the use of “conversion therapy” with LGBTQ youth and young people.

Pediatricians have exceptional credibility at the Capitol, and it’s imperative that you exercise your voice on behalf of the state’s most vulnerable young people. MNAAP’s goals for the 2019 session are bold, and our success will depend on an active and vocal chapter.  Make plans to join the Pediatricians’ Day at the Capitol on March 6, send your elected officials an email or letter, or simply pick up the phone to let them know you’ll be watching how they vote on these critical issues.

By Eileen Crespo, MD, FAAP, Pediatrician at Hennepin Healthcare and Vice President of Medical Services at Delta Dental of Minnesota

Eileen Crespo, MD, FAAP, recently returned from a trip to the United States – Mexico border to provide medical attention to migrants awaiting admission to the U.S. She offers this reflection of her experience to Minnesota Pediatrician.

I recently traveled to the Tijuana border shelters as part of the Minnesota Caravan Solidarity Group. The group was made up of three physicians (one pediatrician — yours truly — a med-peds physician and an adult neurologist), one nurse, two medical students, a diabetes clinic community health worker, and a retired child psychiatry nurse. It was a rag-tag team of volunteers who could get away on minimal notice for an intense, long weekend. Some in the group had done international medical volunteer work in the past but this was a unique situation. We’d seen reports that the Mexican people weren’t excited to “host” the group and there had been some backlash. So, we left feeling some anxiety about the conditions of the migrants and the general situation we might find ourselves.

We arrived in San Diego and were met by an amazing coordinator. Phil Canete is a math teacher during the week, but on weekends, he volunteers with San Diego Border Dreamers organizing medical volunteers, mostly from California. We were the first team from Minnesota. Phil communicates with the multiple shelters housing migrants and arranges the volunteer groups who are then deployed to provide care.

We saw common illnesses: coughs, colds, gastroenteritis, one likely case of influenza and a probable case of strep throat. The adult providers saw uncontrolled diabetes, hypertension, and headaches. The group saw a few unusual things, such as a severe eye infection in an adult, young siblings with a rare genetic metabolic abnormality (previously identified when the family had lived in California), and I saw one case of extensive varicella, something I haven’t seen since my University of Minnesota residency in the early 1990’s. And, we saw contagious conditions such as lice and scabies. The scabies issue was particularly vexing since it was already spreading at an encampment where environmental control was not possible.

We were most troubled, however, with the widespread mental health issues. This was reminiscent of what some in the group had experienced when we traveled to Puerto Rico in the aftermath of Hurricane Maria in 2017. In Tijuana, we saw stress and anxiety in both adults and children. One notable example was a little girl who refused to eat without her mother present for fear she might be separated and never see her mother again. It’s not difficult to imagine the pervasive stress and anxiety given the long, arduous journey from Honduras, mostly by foot, and the ongoing uncertainty that continues since they’ve arrived at the United States border. The entire trek is estimated to have been 2,700 miles and many had walked for three months or more to be met by a literal and figurative wall.

“…a little girl…refused to eat without her mother present for fear she might be separated and never see her mother again.”

We learned that claiming asylum is a human right through international law. Asylum seekers must have credible fear of persecution or torture in their home country that precludes their return.  Asylum seekers can remain in the country where they are applying while their asylum application is processed.  Migrants arriving at the border claiming asylum need to meet with an immigration judge. But we learned that immigration judges are overwhelmed by the sheer numbers, so migrants are waiting weeks to months. Many migrants shared harrowing stories about the conditions in their home country including gang violence, widespread corruption and a violent drug culture.

Our group was glad to get back safely. However, we are saddened by the ongoing negative characterization of the migrants and the injustice of delaying asylum claims. We are planning future missions and will tailor our teams to provide more psychologic resources based on our observations during this first trip. We will continue to monitor the situation as another migrant caravan is heading toward the U.S. border and is estimated at more than 10,000 people. They may need our help.

By Nathan Chomilo, MD, FAAP, Park Nicollet Health Services/HealthPartners; Krishnan Subrahamanian, MD, FAAP, Hennepin Healthcare

When it comes to education, health, and economic outcomes, Minnesota remains a national leader, ranking the 4th best state for children in America. Yet that success is not uniformly distributed and is too frequently unrealized by children living in low-income households, children of color and, American Indian children. These are the findings of the 2018 KIDS COUNT report published by the Children’s Defense Fund with support from the Annie E. Casey Foundation.

At the State Capitol, businesses can point to data on unemployment and GDP, energy companies can talk about energy utilization and pollution rates, and lawyers, prosecutors, and police can talk about crime rates, incarceration and recidivism. For lawmakers seeking out objective data on the state of children in the country, and their specific county, the Annie E. Casey Foundation’s KIDS COUNT project has become a welcome tool to track benchmarks for child well-being in the United States.

In Minnesota, the Children’s Defense Fund (CDF), annually helps to compile and distribute this information. The 2018 Minnesota KIDS Count data book focuses on critical areas of childhood needs including safe and supportive homes and communities, high-quality early childhood and K-12 education, economic well-being and health coverage and care. The report not only provides raw data, but in each general category also provides policy recommendations

Since implementation of the Affordable Care Act (ACA), there has been a 60 percent decline in the number of uninsured children in Minnesota. However, we continue to see a picture of two Minnesotas in the data: between 2009-2016 three times as many American Indian children were uninsured as were white children. Hispanic and Latino children were far less likely to have had insurance during this time with an uninsured rate of greater than 10 percent. Five times as many American Indian and African American children live in poverty, and more broadly American Indian and African American families in Minnesota are over 20 times more likely to live in an area of concentrated poverty.

To help address these inequities, the report recommends health policy solutions that are largely in line with the MNAAP’s 2019 legislative priorities including expanding access to coverage regardless of immigration and residency status. Also important are expanding home visiting for vulnerable families, expanding access for dental coverage, and extending the provider tax that provides funds for vulnerable children through the Health Care Access Fund. Further policy recommendations in the report were made around emphasizing targeted outreach and enrollment efforts for American Indian and Latino communities. The report also highlighted a program at Children’s Minnesota called Community Connect which proactively helps families address social determinants of health such as food insecurity, housing, and childcare.

Outside of health care, there were several recommendations to address economic and educational disparities. The report cites evidence that even a relatively small gain in annual family income of $1,000/year can improve a child’s chance at success. To address this, the report calls for support of paid family leave, creating a state child tax credit and greater funding of the child care assistance program, early learning scholarships, Head Start and voluntary pre-K. Furthermore, the report emphasizes greater cultural competency and funding for programs that aim to serve young students of color. Regarding K-12 education, recommendations included emphasizing programs that promote school attendance, hiring more teachers of color, and increasing resources to high-quality summer and after-school programs.

With discussion of repealing the ACA taking place once again, and many of these policies coming before the Minnesota legislature this session, this report provides a solid basis from which to make educated, effective and equitable policy. A great deal more data is available, and searchable at www.datacenter.kidscount.org and county level fact sheets are available at www.cdf-mn.org.

November 5, 2018
August 1, 2018
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