ARTHRITIS AMBASSADOR PROGRAM

1. ARTHRITIS AMBASSADOR PROGRAM AMBASSADOR BRIEFING JUNE 5, 2013 3PM EASTERN

2. AGENDA • I. Welcome & Update on April Assignment • Laurie Markle, Grassroots Advocacy Manager • II. Ambassador Spotlight • Karen Anderson, California Arthritis Ambassador • III. Issue Expert Training: Pediatric Subspecialty Loan Repayment • James Baumberger, MPP, American Academy of Pediatrics • IV. June Ambassador Assignment: Ask your Rep. to cosponsor HR 1827 • Laurie Markle, Grassroots Advocacy Manager • V. Launch of Ambassador Reporting Center • Laurie Markle, Grassroots Advocacy Manager • VI. July Ambassador Call Notification • Laurie Markle, Grassroots Advocacy Manager

3. WELCOME AND UPDATE LAURIE MARKLE Manager, Grassroots Advocacy Public Health Policy & Advocacy Arthritis Foundation

4. MAY 9TH BRIEFING: ATTENDANCE Rep. Spencer Bachus (R-AL) Rep. Ami Bera (D-CA) Rep. Anna Eshoo (D-CA) Rep. Alan Lowenthal (D-CA) Rep. Jackie Speier (D-CA) Rep. Dianna DeGette (D-CO) Sen. Marco Rubio (R-FL) Rep. Debbie Wasserman Schultz (D-FL) Rep. Bill Young (R-FL) Sen. Mark Kirk (R-IL) Rep. Daniel Lipinski (D-IL) Rep. Andy Barr (R-KY) Sen. Angus King (I-ME) Sen. Jon Tester (D-Montana) Rep. Mark Amodei (R-NV) Rep. Tim Bishop (D-NY) Rep. Suzanne Bonamici (D-OR) Sen. Jeff Merkley (D-OR) Rep. Pat Meehan (R-PA) Rep. Eddie Bernice Johnson (D-TX) Rep. Kevin Brady (R-TX) Rep. Steve Stockman (R-TX) Rep. Robert Hurt (R-VA) Rep. Peter Welch (D-VT) Rep. David McKinley (R-WV)

5. AMBASSADOR SPOTLIGHT Karen Anderson Goleta, CA Arthritis Ambassador National Public Policy Committee Member

6. ISSUE EXPERT TRAINING Pediatric Subspecialty Loan Repayment Program JAMES BAUMBERGER, MPP American Academy of Pediatrics

7. Ensuring Access to Pediatric Subspecialists Arthritis Foundation Ambassador Briefing James D. Baumberger, MPPSenior Policy Associate Department of Federal Affairs American Academy of Pediatrics June 5, 2013

8. Pediatric Subspecialty Shortagesand Access • Shortages in many pediatric subspecialties impact access to medical care for children with serious medical conditions • Pediatric rheumatology is emblematic of this problem • Financial incentives drive pediatric providers to primary care

9. Wait Times Reproduced from NACHRI, Pediatric Subspecialty Shortages Affect Access to Care

10. Difficulty Referring % of Primary Care Pediatricians ReportingToo Few Subspecialists to Meet the Needs of Patients Reproduced from Pletcher et al. Primary care pediatricians' satisfaction with subspecialty care, perceived supply, and barriers to care. The Journal of Pediatrics. 2010;156:1011-1015.

11. Mean Distance to Care Pediatric Subspecialty: Distance to Care (miles): • Adolescent medicine • Critical care medicine • Developmental pediatrics • Neonatal medicine • Neurodevelopment • Pediatric cardiology • Pediatric endocrinology • Pediatric rheumatology • Pediatric sports medicine • Pediatric nephrology • Pediatric gastroenterology • 42 • 26 • 44 • 15 • 73 • 22 • 26 • 60 • 78 • 36 • 32 Myer ML. Are We There Yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118:2313-2321.

12. Percentage of children who must travel > 80 miles to care Subspecialty: Percentage of U.S. Children: Myer ML. Are We There Yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics. 2006;118:2313-2321. 12 Adolescent medicine Critical care medicine Developmental pediatrics Neonatal medicine Neurodevelopment Pediatric cardiology Pediatric heme/onc Pediatric endocrinology Pediatric rheumatology Pediatric sports medicine Pediatric gastroenterology Pediatric nephrology 19 7 20 4 26 7 8 11 24 30 12 16

13. Pediatric Subspecialty Loan Repayment Program • Loan repayment of up to $35,000/year for up to 3 years • For pediatric subspecialists and child mental health providers who agree to practice in underserved areas • Eligible providers: • (1) those in or entering fellowship training; or • (2) those who completed training after 2010. • Other details to be determined by Health Resources and Services Administration (HRSA)

14. Funding Levels

16. Reauthorization Bill

17. Authorization Levels

18. Obstacles • Difficult budget environment • Difficult to reauthorize a program that has yet to be funded • Original authorization in the Affordable Care Act Opportunities • Data-driven program based on a real need for sick children • Not a partisan issue

19. Advocacy • Need to raise profile of bill by gaining co-sponsors • Republican co-sponsors especially important • Reauthorization helps appropriations • Appropriations helps reauthorization

20. Messages • Too few subspecialists for children in need of specialty care, particularly in underserved areas • Access impacted by wait times, distance traveled, etc. • Student debt deters providers from subspecialty training • “Straight” reauthorization: no policy changes or authorizing level increases

21. James D. Baumberger, MPP • jbaumberger@aap.org • 202.347.8600

22. JUNE AMBASSADOR ASSIGNMENT Ask your Representative to Cosponsor HR 1827 • TWO STEPS TO REQUESTING YOUR REP’S SUPPORT: • Call • Email • CALL • Hi XXXX, this is [first name, last name]. I’m calling today about the pediatric subspecialty loan repayment program at HRSA (pronounced “her-sa”) • There are over 300,000 children in America living with Juvenile Arthritis and less than 250 board-certified, practicing pediatric rheumatologists to care for them. • This means delayed diagnoses, increased disability, and greater healthcare costs. • While I am hopeful that the program will be funded in FY 2014, I’m cautiously optimistic and would like to see Rep. XXXX cosponsor HR 1827 to reauthorize the program should it go unfunded. • Thank you for your consideration. I look forward to hearing the Representative’s decision. • I can be reached via email at XXX@XXX.com or via phone at (XXX) XXX-XXXX

23. JUNE AMBASSADOR ASSIGNMENT Ask your Representative to Cosponsor HR 1827 • TWO STEPS TO REQUESTING YOUR REP’S SUPPORT: • Call • Email • EMAIL • Hi XXXX, • I hope you’re well! I’m writing today to follow up on a voicemail I left regarding the reauthorization of the Pediatric Subspecialty Loan Repayment Program. • There are over 300,000 children in America living with Juvenile Arthritis and less than 250 board-certified, practicing pediatric rheumatologists to care for them. This means delayed diagnoses, increased disability, and greater healthcare costs. • I would like to see Rep. XXXX cosponsor HR 1827 to reauthorize the program should it go unfunded in FY 2014. • Thank you for your consideration. I look forward to hearing the Representative’s decision. • Name • Address • Email • Phone

24. AMBASSADOR REPORTING CENTER Center Launch www.arthritis.org/report

25. Your email Last name

27. Your comments here. Select: Closed Select: Current date **SAVE & CLOSE**

28. AMBASSADOR REPORTING CENTER Center Launch www.arthritis.org/report

29. ARTHRITIS AMBASSADOR AWARDS You’ve out-performed our wildest expectations! 2013 PLATINUM AMBASSADOR STATUS: 100% assignment compliance and reporting October 2012-October 2013. Travel awards may change. Ambassador awards will change in 2014.

30. JULY AMBASSADOR CALL JULY 10TH @ 3PM Eastern Preparing for August Recess: Visiting with your Representative in your Congressional District during the month of August

31. AMBASSADOR BRIEFING RECAP / ACTION PLAN NOW: Call your HLA using draft language available at www.arthritis.org/ambassador_assignment. IN TWO DAYS: If you haven’t heard back, email your HLA with a follow-up. REPORT: Visit www.arthritis.org/report and enter your email and last name. Submit a report for your activity. Instructions available at www.arthritis.org/ambassador_assignment SAVE THE DATE: July 10th at 3PM Eastern. We’re prepping for district visits August recess! IF YOU’RE NEW: Join us at 4PM for the New Ambassador Orientation!