#319 - Medicaid at a Crossroads: What Neonatologists Need to Know

Hello friends 👋

In this special “advocacy roundup” episode, Dr. Shetal Shah and Stephanie Glier return to break down the latest developments in federal healthcare policy and their real-world consequences for neonatologists and the families they serve. With sweeping budget legislation threatening to cut Medicaid funding by nearly 10%, they explain how these changes could destabilize the financial foundations of neonatal care, reduce access to critical services, and deepen existing health disparities. From threats to NICU funding and children’s hospitals to the ripple effects of limiting postpartum and parental coverage, they connect the dots between Washington decisions and bedside realities. 

Listeners also get a pragmatic guide on how clinicians—without needing to be policy experts—can engage effectively with lawmakers to protect Medicaid’s role in children’s healthcare. If you work in neonatal care or advocate for health equity, this is an essential listen that explains what’s on the line and what you can do about it—now.

Link to episode on youtube: https://youtu.be/5RjrV7FpyCE

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Bios:

Dr. Shetal Shah: Dr. Shetal Shah is a practicing neonatologist and researcher, and a Professor of Pediatrics in the Division of Neonatology at New York Medical College, the academic affiliate of Maria Fareri Children's Hospital, a member of the Westchester Medical Center Health Network (WMCHealth). His research focuses on understanding the role of the neonatal intensive care unit in providing public health measures, particularly vaccinations to parents of admitted infants. He also aims to conduct research, which through sustained advocacy, can be translated to policy.

Dr. Shah’s work on providing parents influenza and Tdap immunization in the neonatal intensive care unit has resulted in two New York State public health laws. He was the principal advocate for the 2009 Neonatal Influenza Prevention Act and the 2012 Neonatal Pertussis Prevention Act. His work on the cost-effectiveness of donor milk for high risk neonatal infants resulted in co-authorship of a legislative measure mandating New York State Medicaid provide insurance payment for this vital resource. His current work focuses on the safety of administration of live rotavirus vaccine to preterm, NICU-hospitalized infants, bedside adult pneumococcal immunization and point-of-care smoking cessation referral.

From a basic science perspective, Dr. Shah’s current work examines the anti-inflammatory properties of stem cells on lung recovery from pulmonary hemorrhage and hyperoxic injury, focusing on cytokine biology and fibrosis. He is a recipient of many honors, including the American Medical Association’s Leadership Award, the National Physician Advocate Award, the New York State L. Stanley James Award for Perinatal Medicine and the March of Dimes Excellence in Advocacy Award.

Stephanie Glier: Stephanie Glier is a Director of Federal Advocacy for the American Academy of Pediatrics where she leads federal advocacy to promote children’s health care coverage and access to care, as well as effective financing, quality, and delivery of care for children. Prior to joining the Academy, Stephanie led the Consumer-Purchaser Alliance, a coalition of consumer, employer, and labor organizations collaborating to improve the value and outcomes of the health care system. Stephanie previously worked on health care policy in the Office of the Assistant Secretary for Planning and Evaluation at HHS, the Center for Medicare and Medicaid Innovation, and The Commonwealth Fund. She holds a Bachelor of Arts in Human Biology from Stanford University and a Master of Public Health from the George Washington University.

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The transcript of today's episode can be found below 👇

Daphna Yasova Barbeau:Good morning, everybody. I have a special early morning recording for a very special episode. We call this our Advocacy Roundup, because every few months we like to give listeners an update on what’s going on in neonatal advocacy. I actually have two return guests in the studio this morning—Dr. Shetal Shah and Stephanie Glier. Thank you both for joining me again.

Stephanie Glier:Thanks for having us back.

Shetal Shah:This is what we call "Incubator by Sunrise," because for those of you listening, it’s 6 a.m. It was the only time we could coordinate between pre-call, post-call, and travel.

Daphna Yasova Barbeau:That’s right. And you both felt it was so important that we had to make it happen. So, I want to make sure we talk about why this is such a critical time for people to be paying attention, and how to get engaged.

If people don’t know who you are—which would be surprising, but it happens—Dr. Shetal Shah, also known as “NICU Batman” on social media (and if you’re not following him, you should), is a practicing neonatologist and researcher, professor of pediatrics in the division of neonatology at New York Medical College, a member of the Westchester Medical Center Health Network, and co-chair of the AAP Section on Neonatal-Perinatal Medicine Advocacy Committee. He’s also a former chair of the Pediatric Policy Council. Dr. Shah is technically our advocacy correspondent and has been on the show many times.

And joining us is Stephanie Glier, Senior Director of Federal Advocacy for the American Academy of Pediatrics, where she leads efforts to promote children's healthcare coverage and access to care, as well as effective financing, quality, and delivery of pediatric care.

Thank you both again for being here. I want to let people know that we’ve had Shetal on many times to talk about advocacy, and we had you both on for episode 250 “Keeping Babies Covered: Medicaid Matters.” You can also find other advocacy episodes on our website—episodes 114, 121 to 124 (we did a whole series), and again, number 250. We also discussed Shetal’s op-ed on the PREEMIE Act on NeoNews episode 295. And actually, before we dive into the main topic this morning, can you catch people up on what’s going on with the PREEMIE Act?

Shetal Shah:Sure. So right now, unfortunately, the PREEMIE Act is kind of on the back burner. Stephanie has taught me (and the AAP’s DC office has really emphasized this) that Congress can’t walk and chew gum at the same time. I want to shout out the AAP’s DC office because they’ve been instrumental in educating all of us on these policies and have been a leading voice in Washington for children.

If it’s “infrastructure week,” that’s all they talk about. If it’s “defense week,” same thing. Right now, all the oxygen is being used to talk about the so-called “Big Beautiful Bill”—the terrible, no-good, very bad bill that passed the House and is now in play in the Senate. And because of that, things like the PREEMIE Act—funding for neonatal research, support for the CDC to provide education on issues like uncontrolled diabetes in pregnancy or folate supplementation—are all on the back burner. That funding is critical, but it’s been swept up into a larger debate about what the government should and shouldn’t pay for. We’re seeing moves to cut NIH funding, which would be devastating, and a shift at the CDC to focus more on infectious disease surveillance, reducing their role in maternal-child health education.

So while we’re still advocating, and I’ll never miss a chance to talk about it, the reality is that there are even bigger threats right now, like the destabilization of how children’s healthcare is funded in this country. That, in itself, is deeply concerning. Daphna and I were just talking about this before recording. If you can’t look at the House or Senate bills right now and draw a direct line to how they’ll affect our work, trust me—you’ll feel it in two or three years. We’ve spent a lot of time in neonatology thinking about how neonatologists get paid, how we generate RVUs, and how those funds are used by children’s hospitals. I know you’ve had Satya, Scott, and Duncan on the podcast to discuss all of this. If this bill passes, the entire financial structure of our field could be undermined.

Daphna Yasova Barbeau:Thanks for that overview. Stephanie, please weigh in. I imagine most of our listeners aren't as familiar with the specifics of these bills as you two are. Can you walk us through what’s in them and how they could affect our community?

Stephanie Glier:Absolutely, happy to. And I hope most of your listeners are not as familiar with this bill as I am! That would mean you’re spending your time caring for preemies and kids in the NICU, exactly where your focus should be.

To back up a bit, one important thing Shetal said is worth expanding on: many of us haven’t thought much about how Congress works since Schoolhouse Rock, right? We imagine a bill sitting on Capitol Hill, waiting patiently to be passed. But that’s not how things usually happen anymore. Today, Congress tends to pass massive omnibus bills or “mega-bills” where dozens of different pieces of legislation are bundled into a single package that’s tied to something that must pass, like funding the government.

This current bill is one of those. It’s driven by President Trump’s agenda: renewing the 2017 tax cuts, increasing border security, and other priorities that aren’t related to Medicaid. In fact, Medicaid wasn’t even part of his campaign agenda. But here’s the catch: because Republicans have narrow majorities in both chambers, it's hard for them to pass anything. In the Senate especially, the filibuster is a major hurdle. So thanks for bearing with me as we go back into our civics 101 here. The filibuster allows a senator to hold the floor and block any other discussion from happening and block votes from being able to go forward unless you can override a filibuster. You need a two-thirds majority to overcome it—and that’s rare, especially on partisan issues like this one.

So in order to get around that, Congress is using budget reconciliation. The budget qualifies for some special privileges in Senate procedures, and you cannot filibuster the budget in the Senate. We have decided that it's really important to be able to allow Congress to hold the purse strings of the US, and so that needs to be able to move forward every year. In order to qualify as a budget bill though, that means that legislation also has to be relevant to the actual federal budget, to the deficit, to federal spending. This allows them to pass the bill with a simple majority, but the trade-off is that the bill must be strictly tied to the federal budget—spending, revenue, or the deficit.

So right now we are using this mechanism which is called budget reconciliation, where they have put together the president's agenda for tax policy, for immigration policy, border policy, and they also need to be able to pay for all of those policy priorities in order for all of this to qualify as a budget bill. That has just changed the dynamics of how both the House and the Senate are talking about this.

Medicaid is really only on the table here because they are looking for ways to pay for those other priorities. Nobody was running on making major changes to Medicaid. President Trump promised not to touch Medicare or Social Security. After defense spending, Medicare and Social Security are the two biggest pieces of the federal budget. So if those are off-limits, the next biggest pot of money is Medicaid.

The only reason Medicaid is even being discussed right now is because they’re looking for ways to pay for everything else. So this is how they’re trying to push through all these unrelated priorities under the guise of a budget bill. And unfortunately, some lawmakers view Medicaid as a kind of piggy bank. They’re trying to pull money from Medicaid—cutting funding or changing eligibility—in order to fund these other priorities. That’s why it’s on the chopping block, even though it wasn’t a focus during the campaign.

Daphna Yasova Barbeau:That’s very helpful, thank you. So what exactly do they want to do with Medicaid? What would happen if this bill passes?

Stephanie Glier:Yeah, there are a whole bunch of things built into the Medicaid title right now that the House has passed. And I do want to answer this question, but I want to do one more level set of where we are. Over this year, we've had a lot of debates. Right now, the House has passed an entire budget reconciliation package. So the full House has voted on it and approved a specific set of policies. Currently, the Senate is considering that exact legislation and discussing whether they need to make tweaks, or major changes, to that legislation in order for the Senate to be able to pass it. After the Senate takes action, if they make any changes at all—which is very likely—then it will have to go back to the House. The House will reconsider the version the Senate passed. That means we're not done yet. The Senate is trying to finish by July 4th, so the next few weeks are going to be critical in making sure members of Congress—Senators in particular—understand how impactful and far-reaching these policies are.

Once both the House and Senate agree and pass the same bill, the President can sign it into law, and it will become real. But we’re not quite there yet. So, what’s in the bill? The House passed a bill that includes about $900 billion in savings out of the Medicaid program. Just for context, that's a little more than 10% of the total federal spending on Medicaid during the time period these policies would apply to. That’s not just a trim around the edges—that’s a huge amount of money being cut.

The biggest sources of those savings come from changes to how Medicaid expansion happens in the states. This affects non-elderly adults below 144% of the federal poverty level who don’t qualify for Medicaid through disability or other categories. Many are parents, and many don’t have dependents, but they are adults in the expansion population.

Another major change is the creation of a Medicaid work requirement. People in the expansion group would need to meet a work reporting requirement to stay eligible. This is tricky, and I’m happy to talk more about what it looks like—especially how it impacts children. The work reporting requirement doesn’t apply to kids. No children would be required to work, despite the broader public discussions about teenagers getting jobs. But parents would definitely be impacted.

The biggest sleeper issue here, which is harder to understand, is a change in how states can raise their share of the Medicaid budget. Medicaid is a federal-state partnership. The federal government sets a minimum floor, and states can build beyond that—by covering more people, offering more benefits, or including more providers. To encourage states to adopt Medicaid back in 1965, the federal government agreed to cover the majority of the cost. For every dollar a state spends on Medicaid, the federal government contributes at least 50 cents. That match can go up to 76 cents depending on the state’s per capita income.

Right now, there’s no cap on how much a state can spend or how much federal funding they can receive. So if a natural disaster happens and Medicaid needs spike, states spend more and federal dollars increase accordingly. We're not currently talking about capping federal funds, but we are discussing limiting how states raise their own budgets. If states are restricted in how they raise funding, outside of general taxation, they'll have a hard time sustaining current Medicaid spending levels.

Shetal Shah:I just want to pick up on a couple of things Stephanie said. First, while we’re getting into the specifics of the bill, I want to take a step back. If you’re like many of us—neonatologists working in a large health system or a children’s hospital—you probably don’t realize how important Medicaid is to children’s healthcare. Most of us are salaried employees, right? But I don't think people fully understand how foundational Medicaid is for children's healthcare in general, but especially for us as neonatologists. Nationally, about 50% of all children are covered by Medicaid or the CHIP program. When it comes to births—our primary population—about 41% are covered by Medicaid. But when you look at high-risk births, 55% are now covered by Medicaid. So I tell people, fellows, colleagues: whether you like it or not, directly or indirectly, we are all paid by Medicaid. It’s just a matter of how many steps exist between our work and federal policy.

It’s also important to understand how children are covered in the U.S. We have Medicaid, CHIP, and employer-sponsored insurance, which is how most of us get our own coverage. With the exception of perhaps during the pandemic, employer-sponsored coverage for children has stayed fairly constant. That means the number of uninsured children basically mirrors Medicaid enrollment. When Medicaid enrollment goes up, child uninsurance goes down. You can see it clearly on a graph—Medicaid enrollment goes up, uninsured rates go down.

Equity is another key issue. We’re increasingly aware that care in the NICU is not always the same across the board. But we’re probably a bit insulated from the disparities that occur more often in outpatient care. In outpatient settings, lower Medicaid reimbursements can limit access because providers can only accept so many Medicaid patients. If a provider sees 100 patients, they may cap their Medicaid patients at 5%, 10%, or 20%.

In the NICU, we tend to care for the patient in front of us without even knowing their insurance status until transfer or discharge. But within Medicaid, about 65% of births are to Black or African-American children, compared with about 20% to families identifying as Asian. That matters because it means that Medicaid is helping to level the playing field in NICUs – we give the same care to all of our babies. Hospitals aren’t saying they won’t take Medicaid for premature babies. That’s huge for equity. Medicaid isn't just a funding mechanism—it’s a tool for health equity in inpatient care.

Daphna Yasova Barbeau:That's really helpful. I wasn’t familiar with that, but it makes a lot of sense. That’s how we provide care for everyone. And you’re right—neonatologists don’t often think about how the payments come in. We just go to work and do our best for babies and families. Most of us don’t think about how we get paid in the NICU, or how Medicaid supports our patients after discharge. I mean, look at the services Medicaid provides—therapy, transportation, the five or six or ten follow-ups we schedule for babies, care for postpartum moms so they’re healthy enough to care for their child.

I think we’re starting to recognize as a community that what we do in the NICU is important, but what happens after discharge is just as critical. All the work we do setting up babies for success in the NICU can fall apart if we don’t support them afterward. So I really appreciate how you’ve laid that out.

Shetal Shah:Four out of every ten—well, I say babies, but I forget there are children too—four out of every ten children with special healthcare needs are covered by Medicaid. And that’s because those kids, on average, use about $20,000 in outpatient services per year. Compare that to a child without special healthcare needs, who uses about $1,000 to $2,000 annually. That includes some hospitalizations and ER visits. We’re not just using Medicaid to ensure care in the NICU; we’re using it to level the playing field after discharge, making sure our kids continue to thrive. Now, about parent coverage (because this is something we really need to go back to with Stephanie as we delve more into the bill): it's really easy for people (and I’ve seen politicians do this) when you raise your hand as the neonatologist in the room (or, more often, you just say pediatrician, because people don’t even know what a neonatologist is) and start talking about the impact on children’s coverage, the response you get is kind of what Stephanie is alluding to. They say, “Well, these are work requirements for adults. We’re not touching children’s coverage,” which is financially almost impossible, but that’s really what they’re saying.

But we know there’s a direct correlation between parent coverage and children’s coverage. There’s a great article by [Atheendar Venkataramani] and a few others that came out around the same time, showing that if parents are covered, there’s a 30% increased chance that children are also covered, and that benefit continues through early childhood. So if you start undermining the ability of parents to have insurance, you’re going to see lower insurance rates for children as well.

Daphna Yasova BarbeauYeah, it sounds like a lot is on the line here. Stephanie, you gave us such a nice overview of the program, especially the federal-state dynamic. I recognize that the way it’s set up makes advocating for the program really hard. Can you tell us a little about why that setup makes the program more vulnerable?

Stephanie GlierOne of the most challenging things about this structure is that federal policies set the floor, but every state and U.S. territory gets to decide their own policy levels and program designs after that. So we do a lot of “whack-a-mole,” trying to figure out where states are doing a great job, where they’re mediocre, and where they really need to hear loudly from pediatricians, neonatologists, and others about decisions that are going to disproportionately hurt children and families. It’s tricky to track all of it because it’s happening in many places at once.

A couple of things we’re really paying attention to—though they’re not directly required by the House bill that Congress is currently considering—are the choices states would make if this goes through. Because the cost shift to states is so large, we expect them to make cost-saving decisions that could significantly affect kids and families.

One major concern is postpartum coverage. Almost every state now offers 12 months of postpartum Medicaid coverage, which is fantastic and incredibly important. But that’s an optional benefit. If states need to trim costs quickly, that’s one of the first policies we expect them to rescind; we expect it would be cut back from 12 months to just 60 days. That’s a big loss for moms and newborns.

Another concern: about 14 states have trigger laws related to Medicaid expansion. They’ve expanded coverage to low-income parents, but if the federal government lowers its share of the cost, those states have said they’ll automatically pull back that expansion. That would reduce adult coverage—and as Shetal said, when adult coverage drops, children’s coverage tends to drop, too, even among kids who remain eligible.

There are also indirect impacts. If parents lose coverage, they may avoid seeking care for themselves, leading to untreated mental health issues and broader instability—affecting housing, food, and finances—which all impact children.

The other big concern is around optional benefits, particularly home and community-based services (HCBS). While HCBS for kids aren’t optional, services for adults are. But when states cut back those adult services, such as reducing provider payments or changing who they contract with, it affects the whole system’s infrastructure. That impacts access for children, especially NICU grads who rely on complex services. We’re already seeing kids on waitlists for services that help keep them safely at home. We expect those lists to grow if states face major Medicaid budget cuts. It makes me really nervous about how this might impact a lot of your former patients.

Shetal ShahDaphna, we’ve been talking a lot about the nuances of how the federal government might shift costs to the states. One thing I want to touch on, because I think it’s interesting, is provider taxes. States know this is coming. They’re not blind to what’s going on in Washington, so they’re already preparing, not just their regular state budgets but also what, at least in New York, people are quietly calling the “doomsday budget.” That’s the plan for what to do if Medicaid funding disappears. Remember, the federal money for Medicaid makes up a huge chunk of state budgets,  anywhere from 30% to 60% in some states. So they’re already closely evaluating where cuts will need to come from. If you’re a state government and you’re losing that federal funding, you have a few options: raise revenue (which no one likes during election years), reduce payments, limit who gets covered, reduce benefits, or tighten eligibility. I’ve been in a few state capitals, and they’re directly looking at NICU babies as one of the first places to make cuts.

Daphna Yasova BarbeauBecause it’s such a big part of the population budget.

Shetal ShahExactly. I had my head in my hands, thinking, “Are you kidding me—on the backs of babies?” But they explained it with the cold calculus of a state controller. They don’t see the babies like we do. Take ELBW or even VLBW babies: they’re about 1.5% of births but account for 60–80% of the cost. So if you curtail payments, you’re affecting a small number of people and saving a lot of money. And no hospital is going to say, “You cut payments so much we’re shutting the NICU,” because if the NICU shuts down, OB services go too—and OB brings in money that helps fund the hospital. So from a controller’s view, it looks like a great opportunity to save money.

Sure, we can talk about all the value we bring in neonatology—saving lives that wouldn’t have survived 20 years ago, kids going on to live full lives, the economic multipliers—but state leaders don’t have time to be that long-sighted. They’re trying to recover 30%–60% of their budgets, and they need to know where that money’s going to come from. That’s part of why I wanted to bring us together—this isn’t just a call to action for children, but it puts a spotlight on the care we provide.

Daphna Yasova BarbeauYeah, that really puts it into perspective. And I think it’s the perfect segue into helping people understand what we can do about it. I’m so glad we talked about the federal vs. state angle, because a lot of clinicians think, “How can I possibly influence something happening at the federal level?” But it sounds like we potentially have a lot of influence at the state level. So let’s spend the rest of our time on that—what can we do, how can we engage as individual clinicians, and what’s the timeframe?

Stephanie GlierThe timeframe is now. Now is the perfect time to reach out to your policymakers—especially your senators, regardless of party. They all need to hear how critical Medicaid is to your communities. Some Republican senators have already expressed concerns about the Medicaid cuts, and they need to feel supported in continuing to voice those concerns publicly. Others haven’t yet spoken out—and they need to hear that their constituents are worried. Even for Democratic senators who plan to vote “no” on the bill no matter what, it’s helpful for them to have real stories about Medicaid’s importance to their communities.

Don’t stop at the Senate. Reach out to your House members too—this bill will go back to the House once the Senate is done. You can call the Capitol switchboard or, if you're an AAP member, use the AAP’s Federal Advocacy Action Center to send tailored emails to your representatives. Share stories from your hospital, your patient population, your work.

As Shetal said, after Congress is done, this goes back to the states. That means you can shape how states respond to the changes. State legislators, governors, Medicaid directors, and budget officers are already reaching out to their members of Congress, warning them about what this bill would do to their states. That behind-the-scenes pressure is influencing how senators think about their votes. Some senators are weighing not just the national numbers, but the impact on their local hospitals, state budgets, and working families. The numbers coming out of state-level analysis are powerful. Right now is the time.

Daphna Yasova BarbeauI love that. We can call, email, or show up at their doorsteps. Shetal, my question for you—when we talk about mobilizing our community, you've often emphasized that our voices and stories really matter. But some people say, “Okay, I’ll send an email, but will anyone even read it?” Can you talk a little about how you’ve seen your own engagement actually make change?

Shetal ShahYeah, I think that the stories are important, and the lines of argument are important, because senators and other elected officials obviously don’t live our lives, right? So it’s really important for us to keep reminding people how this is going to impact babies. A lot of this is, frankly, just numbers in an Excel spreadsheet. What the stories do is humanize those numbers. And what the lines of argument do is give senators and House members—who may not support this bill no matter what—a discussion point for those who are on the fence.

I'll give you a perfect example. We mobilized a Section on Neonatal Perinatal Medicine letter-writing campaign the week before the House was considering this bill. We got about 75 letters out to 65 different members of Congress. And it was great because each one was somewhat personalized. They included stories of patients people had cared for or events that happened in their states. Many people talked about babies they cared for during their training, even if it wasn’t in that state. What was really important was that people also talked about the impact this would have on the children's hospitals where they work. That’s critical because senators—especially in states with only one children’s hospital—are very proud of those institutions. In New York, we have 18, but in other places, there might only be one. You've seen the photos—senators cutting the ribbon when a new lobby opens, getting frozen yogurt when the new machine is dedicated, whatever it is. They love those moments.

This matters for a couple of reasons. First, since so many kids are covered by Medicaid, children’s hospital budgets are really dependent on it, both physician and hospital payments. But if you talk to the Children’s Hospital Association, Medicaid pays only about 80% of costs, because it always pays less than Medicare. That means the entire children’s hospital is basically operating on the extra revenue it gets from private insurance. So children’s hospitals’ budgets are always a bit iffy compared to larger medical enterprises.

Talking about how this undermines children’s hospitals for everyone is important. Medicaid is seen as a social safety net, but if a children's hospital shuts down, it’s gone for everyone—even those with employer-sponsored insurance. And all the special services those hospitals provide—pediatric dialysis units, pediatric burn units, Level IV NICUs—go with it.

That’s what people need to understand. There's a belief that this only affects a socially vulnerable population, with no spillover effects. But that’s not true. That line of argument is crucial. If you’re in a state with just one children’s hospital and that hospital disappears, that shared resource is gone for the entire state. Senators don’t want that on their hands, and they certainly don’t want to be blamed for it. So when we speak for the babies and our neonatal units, we’re also speaking indirectly for the financial viability of children’s hospitals.

Stephanie GlierIt’s not even just children’s hospitals. Medicaid plays a disproportionate role in rural health too. Those small community hospitals in rural areas are very vulnerable, and a lot of them are threatening to close entirely. That would create more challenges. It exacerbates maternity care deserts and a lot of other issues. I’d imagine you’d end up seeing more babies requiring NICU care because of local hospital closures in those rural areas. It just undermines the wider healthcare net and creates bigger gaps that hurt hospital care for kids overall.

Daphna Yasova BarbeauThank you both for summarizing that. I worry there are still people thinking, “I can’t do it on my own.” Are there ways people can get engaged with the AAP or the Section to help make this a reality? Is there a benefit to going in as a group from a single hospital, or working with our hospital C-suites? How can we make a bigger impact?

Shetal ShahSure. First, congratulations to everyone just listening to this podcast—you’ve taken your first step by getting background information on why this is important. Now that you have that info and hopefully feel activated, the question becomes: how do you use your limited time most effectively? You have the Federal Advocacy Center at the AAP, which is super helpful. It lets you customize pre-templated messages and send them to your House members and senators. I’ve actually timed it—if you already know your AAP ID number (some of us casually drop it into conversation), it literally takes three and a half minutes. The hardest part is just looking up your AAP ID number.

Daphna Yasova BarbeauThat’s probably the easiest way for people to get involved, right?

Shetal ShahExactly. If you want to customize the letter, it takes a bit longer, but even the basic version is meaningful. Another thing you can do is connect with your AAP chapter—they're doing a lot of work on this, especially focused on spillover effects into outpatient practice.

If you want to speak on behalf of your children’s hospital, talk to your government affairs team and let them know you want a more vocal role. I’ve never seen a government affairs office that doesn’t want more physician input. They love it when we speak—we bring authority and lived experience. They may be seen as lobbyists, but we’re seen as advocates for our patients.

Also, develop a relationship with your Senate and Congressional offices. I go to mine about four times a year, but even if you don’t do that, you should at least know who the healthcare staffer is. Develop an email relationship. Send them notes saying, “Hey, I know this is coming. Here’s what I think and why it’s important. Let me know if you want to talk to others—I can help with that.” Do the same with your senators. Develop a relationship with them. It’s really no different than being at a referral center and maintaining relationships with hospitals that send you babies. You call them, give updates, follow up—just the collegial things we already do. Eventually, they’ll start calling you, because they’ll know: “Oh, this is a children's health thing. What does Daphna think? Oh, this affects the French? Let’s call Ben.” You become the local resource, which is exactly what you want—to be the go-to person for child health, so you can keep kids prioritized in their thinking.

Daphna Yasova BarbeauOkay, so when should we be reaching out to our senators? Is there a deadline?

Stephanie GlierThere’s no deadline. Today is a great day.

Daphna Yasova BarbeauPerfect. I really appreciate the work that you both are doing—not just now, but always—to protect our workforce and the babies and families we care for. And thank you for this lesson on how bills are made and how we can get engaged. I want you both to have the last word. Any closing thoughts?

Stephanie GlierJust to reiterate: you are the right person. If you’re still listening, thank you for staying with us. You are absolutely the right person to make this argument—to tell policymakers how critical these programs are. As Shetal said, you carry a ton of credibility. Even if it feels like you’re writing into a black box, someone is reading your message. I’ve seen the tallies they put together and tracking which issues constituents are raising and when. Your voice matters.

Shetal ShahYeah, and I’d just add that there’s a misconception that we have to be the experts on these programs. But that’s not true. We just need to know our own lives and how Medicaid changes impact the care we give. We're experts in our own experiences. We don’t have to know all the policy nuances or read every report from Kaiser Family Foundation. You just need to speak for your patients. I always say, “I’m here because my babies are on a ventilator, and they can’t speak for themselves.” And even though not all of them are on vents—some are on CPAP—that’s okay. It shows your motivation. One congressman pulled me aside once and said, “I love talking to you baby doctors,”—he confused neonatology with neurology, which happens all the time—but he said, “No one speaks with more moral authority.” We walk into these advocacy conversations with more moral authority than anyone else—because we’ve dedicated our lives and 10 years of training to babies. People assume that if you’ve done that, you must be a semi-decent person.

Daphna Yasova BarbeauI love that. So what I’m hearing is: we don’t have to be experts in policy or advocacy—we’re already experts in babies, and that’s valuable enough. I love that. Well, on our show notes page, we’ll have some links to help people get engaged quickly, maybe a sample letter or two. Stephanie, Shetal, thank you so much for being here and for your time.

Shetal ShahThank you for having us. You have to tell Ben we missed him!

Daphna Yasova BarbeauI will. And hey, I still want one of those “I’m Just a Bill” t-shirts.

Shetal ShahNo problem—we can definitely hook you up. It’s only fair—you guys hooked me up with an incubator t-shirt. I was excited.

Daphna Yasova BarbeauAll right, thank you all so much.