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December 2, 2020

Eric Dick, MNAAP Lobbyist

With the November elections having recently passed, it’s once again safe to turn on one’s television without being assaulted by negative and ugly political advertisements.  As of this writing, the results of the presidential election indicate that President-elect Biden is set to take office in January 2021, though President Trump has yet to concede and the results may yet end up in litigation. Here in Minnesota, the picture is much clearer. Senate Republicans surprised many by retaining their majority, albeit with a narrow one-vote margin. The House will remain in DFL hands, though with a smaller margin of just three votes (and at least one contest headed to a likely recount). 

The 2021 session promises to be a challenging one on many fronts. Perhaps most notably, the state will be facing an enormous deficit of $2.4 billion in this biennium, and an even greater $4.7 billion deficit in the next biennium. This is a stark change from earlier this year when budget analysts projected a surplus approaching $1.5 billion. The dramatic change came about in large part because of the COVID-19 pandemic and its enormous impact on the economy and, with it, reduced revenue coming into the state’s coffers. While Minnesota is fortunate to have a robust reserve account to mitigate some of the deficit, the budget hole will be difficult to fill. In many past legislative sessions, legislators often turn first to health and human service spending for budget cuts, and securing spending on new programs will be extraordinarily difficult. And unlike the federal government, the state is obligated under law to balance its biennial budget. Without question, the budget deficit will dominate the legislative session.

Minnesota will once again be the only state in the nation to have a legislature with split partisan control.  Divided control will mean that neither party will be able to achieve its priorities, and compromise will be necessary to complete the session. Past MNAAP priorities such as strengthening the state’s vaccine requirement and enacting common-sense firearm safety measures will face exceedingly long odds in the Minnesota State Senate. 

MNAAP held a series of robust conversations with members in recent weeks to help set our 2021 legislative and advocacy priorities. With the input of many pediatricians, chapter working groups, and the MNAAP Board of Directors, the chapter has identified several priorities to focus upon in 2021. The pandemic has made the use of telehealth all the more critical, and MNAAP will advocate for increased flexibility for telehealth services and reimbursement parity. To make telehealth available for all Minnesotans, the chapter will work to expand broadband access across the state.  The budget deficit will also be a focus of MNAAP, as we will work to mitigate against cuts to programs that serve children and families. Repeal of the state’s weak vaccine requirements faces difficult odds, but the chapter will work to educate legislators about the very real risks to Minnesota’s children and adolescents from vaccine-preventable diseases. MNAAP also stands ready to assist with efforts to expand mental health access for children and adolescents, as well as addressing the harms of e-cigarettes and nicotine. 

MNAAP faces multiple threats and opportunities during the 2021 legislative session.  Stay tuned to the MNAAP website, chapter emails, and this newsletter for additional news and action items in the coming weeks and months.

The fall and early winter of 2020 continue to remind us that we are living very differently than we did just a year ago. I missed Halloween this year since I have now retired from my clinical practice and thus did not dress up in a costume for my patients, and because of the pandemic and not wanting hundreds of kids (that’s how many we normally get) to come to my door for candy in a non-socially distanced, and probably unmasked way – I didn’t give out candy. Both brought sadness to me. I did, however, recently have the chance to be with our youngest granddaughter (almost 5 years old) and her parents for the first time in 9 months and it was great.

As this article goes to press, the outcome of the 2020 presidential contest faces great scrutiny, and a number of other election results may be subject to recounts. It appears that both the United States Congress and the Minnesota State Legislature will feature divided partisan control. Unfortunately, this will make passing some key MNAAP priorities, such as a repeal of the personal belief vaccine exemption, unlikely to succeed. However, MNAAP will continue to work with all interested parties, both in and outside of the legislature, to do what is best for children and adolescents.

There are three issues and their impact on pediatrics that are standing out to me (separate from the election): low rates of routine vaccinations, potential for a COVID-19 vaccination and when it would be available for our pediatric patients, and the declining birth rate. The ongoing low rates of routine vaccinations being given is very concerning for the health of all our patients and even if we don’t have another measles outbreak in the near future, we have already been seeing higher incidence of pertussis for years and lower vaccination rates can only make this worse.

The second issue is when will there be a COVID-19 vaccine and when it will be available for administration to our pediatric patients.

There is an excellent interview with William H. Foege, MD, MPH, in the October issue of JAMA Pediatrics, entitled “Who Gets Coronavirus Vaccine First” (You can watch it at https://edhub.ama-assn.org/jn-learning/video-player/18547812). Dr. Foege co-chaired the National Academy of Medicine consensus study report and talks about how the workgroup came up with their recommendations for vaccine distribution when it is available. It is very well thought out, but I will share that children are not at the top of list for getting the vaccine.

Finally, the U.S. birthrate is declining, which often happens with a recession, but its long term impact on pediatric practices and children’s hospitals, on top of the impact of the pandemic, may have a significant financial impact for the foreseeable future. I have also been hearing that the rates of kids with increasing BMIs and mental health issues are also becoming a major problem during the pandemic.

I don’t want to be all negative, and I want to let you know that our anti-racism task force has started meeting with 20 members and gave an interim report to our board in November. I want to thank the members of this task force for their willingness to help our chapter and our communities move forward to becoming anti-racist.

Finally, our entire pediatric community suffered a huge loss this fall when Dr. Michael Bendel Stenzel was killed in a car crash in which his wife (Dr. Ellen Bendel-Stenzel) and son were injured, but are thankfully, recovering. I worked with Michael for the better part of the last 2 decades, initially in his role as a pediatric nephrologist at the U of M and then more recently as a hospitalist at Children’s Minnesota. Michael was a kind, considerate, very thoughtful physician. We will miss him dearly. May his memory always be a blessing.

Sheldon Berkowitz, MD, FAAP

MNAAP President

sheldon.berkowitz@childrensmn.org

November 19, 2020

The Minnesota, North Dakota, and South Dakota Chapters of the American Academy of Pediatrics came together on behalf of the more than 2 million children in their states in a joint letter to Governors Walz, Burgum, and Noem.

Pediatricians are deeply concerned about an increased spread of COVID-19 throughout the holidays, which could result in a substantial number of children who may become sick, hospitalized or asymptomatic carriers. Additionally, an increased spread will have a ripple effect on health care, childcare and education communities. Indeed, all families and every community, will be deeply impacted.

North Dakota and South Dakota currently have the two highest rates of COVID-19 cases per 100,000 children in the country and Minnesota is 10th in the country.

In the hopes of keeping all children in Minnesota, North Dakota, and South Dakota safe and ultimately be able to attend school in person, which we know is the best way for them to learn and thrive, the chapters are asking their governors to share this simple set of powerful instructions to citizens as we head into the holidays:

  • Stick with the basics. Go out only for the essentials, wear a mask, keep your distance from others while you are out, and wash your hands. We know these practices work to prevent COVID-19 from spreading.
  • Limit contact outside your immediate household. Socialize with only the members of your household. It’s tempting to want to include our extended family members in our plans because they feel safe and comforting during uncertain times, but doing so actually increases the risk that someone (little or grown) will get COVID-19 from that gathering.
  • Be creative. Find ways to make the holidays special while observing disease prevention measures. Engage your children in the brainstorming, whether it is a virtual holiday play for loved ones, a surprise snowman left in the front yard, or cookie decorating online. Kids and teens are creative and adaptable.

Pediatricians are still here for families and strongly recommend that children continue to come in for their regular check-ups and vaccinations to stay healthy. If families suspect their child is ill, they should call their pediatrician for guidance on the appropriate next steps.

As medical experts and child advocates, pediatricians stand ready to support each governor’s direction with these methods, and other ways that mitigate the spread of this devastating disease in our states.

Read  Tristate COVID Letter.

November 13, 2020

A multi-state virtual learning collaborative is available to connect pediatricians interested in improving performance, documentation, and follow-up (including referrals and genetic testing) on screening for developmental disabilities and dysmorphic features in pediatric primary care clinics. The project can be completed in 4 months. There is no charge for participation in this HRSA-funded project. To register for this MOC4 opportunity, click here. This project will begin in January 2021.

The Adolescent Depression Screening MOC4 is wrapping up in December 2020. Participating pediatricians who would like to claim MOC4 credit in 2020 for their work should email or fax (651-699-7798) their completed audits before Dec. 8, 2020.

The MNAAP Mental Health work group will be meeting on Tuesday, Dec. 8, from 12:15-12:45 p.m. to review summary data on the results and improvement noted in adolescent/young adult depression screening, referral and documentation.

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