Adult Autism Health Resources

In The Politics of Autism, I write:

Many analyses of autism speak as if it were only a childhood ailment and assume that parents are the main stakeholders. But most children with autism grow up to be adults with autism, and they suffer uniquely high levels of social isolation. Almost 40 percent of youth with an autism spectrum disorder never get together with friends, and 50 percent of never receive phone calls from friends. These figures are higher than for peers with intellectual disability, emotional disturbance, or learning disability. When school ends, many adults with autism have grim prospects. Though evidence is sparse, it seems that most do not find full-time jobs. Compared with other people their age, they have higher rates of depression, anxiety, bipolar disorder, and suicide attempts.

Studies show that autism services can be complicated, creating difficulties for autistic people and their families. 

Tonya Phillips at Harvard Medical School:

Thanks to the generous financial support of the Nancy Lurie Marks Family Foundation (NLMFF), Harvard Medical School has launched the Adult Autism Health Resources initiative. Focused on improving autism care and the lives of autistic adults and their families, the project aims to educate clinicians, caregivers, and self-advocates in leading meaningful change across health care systems.

While most people are aware of the increasing number of autistic children, they may not understand how many autistic people there are in the current adult population. Christopher McDougle, MD, the Nancy Lurie Marks Professor in the Field of Autism at Harvard Medical School, faculty director of the Adult Autism Health Resources initiative, and director of the Lurie Center for Autism at Massachusetts General Hospital explains that “autistic individuals may live as long as the rest of us but once they graduate high school they no longer qualify for many services or receive guidance about ongoing medical care. This initiative is a way to acknowledge the existing population of autistic adults and to inform the world that they need access to quality medical care in the same way that neurotypical individuals do. It’s a wakeup call.”

...
Sarah T. Campbell, a patient/family advocate for the initiative and the parent of an autistic adult, was brought on board to be the voice of lived experience. She created the Patient Experience Board, a virtual classroom site where group members could engage in discussions, pose questions, and share their thoughts on topics designed to inform the clinician course and website content. Campbell also identified clinicians and experts who might contribute to the Adult Autism Health Resources project.

...

The Adult Autism Health Resources initiative keeps clinicians and autistic adults and their families up to date through two platforms:

 
Clinical Care for Autistic Adults

Clinical Care for Autistic Adults is a self-paced, online course that offers a fundamental understanding of autism spectrum disorder and best practices involved in diagnosing, treating, and coordinating adult health care. Anyone who seeks to provide quality care to this population will develop more confidence in their ability to deliver patient-centered, equitable care.

In addition, physicians, nurses, social workers, and physician assistants who complete the course will have the opportunity to earn HMS continuing education credits.

Beth Malow, MD, MS, professor of neurology and pediatrics and the director of the Sleep Disorders Division at Vanderbilt University Medical Center, is a key member of the Adult Autism Health Resources initiative.

"I’m a sleep specialist who sees children and adults on the autism spectrum,” she says. “Clinicians who want to get a better understanding of sleep problems in autistic people are an ideal audience for the Clinical Care for Autistic Adults course, and will find the materials and resources to be informative.”

Adult Autism Health Resources

The Adult Autism Health Resources patient and family website provides information and links to resources that will help autistic adults, their families, and caregivers navigate the health care system, prepare for later life transitions, communicate with providers, and meet the unique challenges of aging with autism.

"Families can use these resources to learn about areas they can advocate for and assist with, and to provide support for their autistic family member,” says Janice Jutras, special projects development editor, for the Adult Autism Health Resources website. “These supports range from collaborating with clinicians to taking ownership of crucial financial or insurance paperwork.”

"An effort was made from the start to involve autistic adults and their parents as consultants,” adds McDougle. “They reviewed the content and have input in the way it is presented.”

Prevalence in Australia

In The Politics of Autism, I discuss international perspectives. I also discuss evaluation, diagnosis, and the uncertainty of prevalence estimates.

Maathu Ranjan and Dr Anthony Lowe, "Providing Better Support for Children with Autism and Developmental Delay," Actuaries Institute, September 2023."

Over the past ten years, the National Disability Insurance Scheme (NDIS) has transformed the lives of hundreds of thousands of Australians living with disability — there is much to be proud of. However, the reality of the current Scheme is very different to the original vision. In large part, this is because the Scheme was envisioned and legislated based on the social model of disability but has been implemented using the medical model. One of the fastest-growing cohorts of participants is children, particularly children with autism and developmental delay. The system gives families little choice but to seek out formal medical diagnoses, resulting in considerable diagnostic waitlists and the prevention of timely access to early interventions, which evidence shows are most effective. We should use this current window of opportunity presented by the Independent Review of the NDIS to implement a social model of disability which would better support children and help make the NDIS financially sustainable by restoring specialist support in everyday settings and ensuring the support it provides is delivered in the most effective way. 

The Financial Review reproduces a graph from Ranjan's new paper.  See the LinkedIn post.

Voting and Disability 2022

 In The Politics of Autism, I write:  "Support from the general public will be an important political asset for autistic people. Another will be their sheer numbers, since a larger population of identified autistic adults will mean more autistic voters and activists."

Lisa Schur and colleagues, "Disability and Voting Accessibility in the 2022 Elections:

Final Report on Survey Results," Submitted to the Election Assistance Commission, May 11, 2023

Executive Summary:

Analysis of the 2022 Disability and Voting Accessibility Survey, based on representative samples of citizens with and without disabilities eligible to vote in the November 2022 elections, indicates similar voting accessibility as in the comparable 2020 survey and greater accessibility than in the 2012 survey. The disability sample includes people with a range of disabilities based on Census Bureau measures. Some key results include the following:

• People with disabilities voted at a 3.6% lower rate overall than people without disabilities in 2022.
• About one in seven voters with disabilities encountered difficulties voting in 2022, which was a slight increase from the one in nine voters with disabilities who encountered difficulties in 2020.
• The likelihood of difficulties voting in person in 2022 was 20% among people with disabilities compared to 6% among people without disabilities. The likelihood of difficulties voting with a mail ballot was 6% among people with disabilities compared to less than 1% among people without disabilities.
• One in five voters with a disability either needed assistance or had some difficulty in voting in 2022, which was three times the rate of voters without disabilities.
• Voting difficulties were most common among people with vision and cognitive impairments.
• Close to three-fifths of voters with disabilities voted with a mail ballot or early in person in 2022, compared to just over half of voters without disabilities. The shift in mail voting between 2020 and 2022 was similar between voters with and without disabilities.
• Voters with disabilities were similar to voters without disabilities in perceived treatment by election officials, confidence that their votes were accurately counted in 2022, and the extent to which they report following politics.

Following the substantial drop from 2012 to 2020 in voting difficulties among people with disabilities (documented in our previous report), there was a slight uptick in 2022. This is partly explained by a shift toward voting in polling places in 2022, following the low rate of polling place voting in 2020 due to the pandemic. Voting difficulties are generally more likely in polling places than in voting by mail. The shift partly reflects reversals of eased pandemic-related voting rules in 2020. Another explanation includes changes in the composition of the voting electorate between 2020 and 2022, particularly a small increase in disability severity that may reflect the effects of long Covid. This report reviews other key results contained in 35 tables, making comparisons to the 2020 survey where available. These tables cover a variety of aspects of the voting experience, including specific difficulties, need for assistance, confidence that one’s vote was accurately

Wait Times for Diagnosis

In The Politics of Autism, I discuss evaluation, diagnosis, and waitlists

 A release from Cognoa:

Cognoa, a leading child development and behavioral health company, today published a new report, The State of Pediatric Autism Diagnosis in the U.S.: Gridlocks, Inequities and Missed Opportunities Persist, that underscores the longstanding waitlist crisis for children and their families seeking a diagnosis of developmental delays and autism evaluation. The report assesses results from 111 specialty centers across the U.S.

On average, children and their families are forced to wait three years from the time of first concern of developmental delay to an autism assessment. Delays in diagnosis mean that children are missing the opportunity for early intervention during the critical early neurodevelopmental period when interventions have the greatest life changing impact.

Excessively long waitlists to see the small number of available specialists and the absence of a "standard of care" are major causes for concern throughout the healthcare community. The study, which was conducted by Scott Badesch, Former President of the Autism Society of America, and sponsored by Cognoa, uncovers widespread reimbursement issues that prevent families, especially the already disadvantaged, from receiving an evaluation and subsequent early interventions altogether.

Key findings reveal the inequities and inefficiencies in status quo processes that are leaving most children and families behind:

Unacceptably Long Wait Times for Evaluation

• Nearly two thirds of specialty care centers surveyed report wait times of over 4 months between an initial request for an autism evaluation to the time a diagnostic evaluation is conducted.
• Of that group, 21% report waitlists of more than a year or that are so impacted that they are no longer accepting new referrals.

Reimbursement Barriers Reinforce Healthcare Inequality

• 44% of centers surveyed do not accept Medicaid, pointing to access disparities which affect already underserved communities most.
• Only 65% of practices accept commercial insurance, forcing those who cannot pay initial costs up front to forego care.
• 77% of clinics identified the extreme length of assessment processes and heavy documentation burdens among the top barriers to timely evaluation.
• 69% of clinics identified staffing issues, including clinician and administrator shortages.
• 43% cited burdensome reimbursement processes and inadequate or lack of reimbursement as barriers to timely care.

No Standard of Care

• The data shows high variability in the assessment tools used in today's diagnostic processes, of which there are over 30 listed.
• There are vast state-to-state and healthcare payer-to-payer differences in requirements of both assessment and provider type for an autism diagnosis to be recognized for reimbursement.
• 83% of centers report that autism evaluations take over 3 hours. Of these, 25% report evaluation completion times of over 8 hours. Research shows that these lengthy assessments are not necessary for most children.

The full report can be found here.

Pennsylvania Governor Acts on Insurance

 The Politics of Autism includes an extensive discussion of insurance and Medicaid services.

 A release from Governor Josh Shapiro:

Today, Governor Josh Shapiro and Pennsylvania Insurance Department (PID) Commissioner Michael Humphreys announced that starting on January 1, 2024, the Shapiro Administration will require all commercial insurers to meet their obligations under Pennsylvania law to provide coverage for autism benefits.

The PID published a Notice in the Pennsylvania Bulletin on November 4, 2023 announcing that by no later than January 1, 2024, PID will require insurers offering commercial health insurance policies that include coverage for autism services to handle claims for those services in a manner that complies with the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and Pennsylvania’s mental health parity requirements.
...

The Shapiro Administration is working to make mental health parity a true reality in Pennsylvania – and part of making this a reality includes requiring that commercial insurers comply with all mental health parity laws to cover autism services fairly and consistently. With this action, the Shapiro Administration will require those insurers to fully comply with parity requirements in administering autism coverage, which means recognizing that autism services are mental health benefits.

Some commercial insurers have historically categorized autism services as a physical health benefit while other insurers categorize all services for autism as mental health benefits. Most of the major health insurers offering comprehensive health insurance in Pennsylvania already treat autism as a mental health condition, subject to parity requirements. PID’s Notice directs the remaining insurers to do the same.

In his first budget address, Governor Shapiro called for stronger mental health parity and directed Commissioner Humphreys and the PID to hold insurers accountable to ensure that mental health benefits are covered fairly. As a result, PID announced that it has strengthened its review of mental health and substance use disorder coverage in 2024 health plans and will enhance its compliance review of mental health and substance use disorder parity requirements to prevent potential violations before they have a chance to harm Pennsylvania consumers.

...

Categorizing autism as a mental health benefit will make a positive impact on the approximately 55,000 Pennsylvanians with autism by requiring health insurers to adjust their insurance policy form language and claims handling processes to provide Pennsylvanians with autism the protections afforded by the mental health parity provisions. As a result, health insurers may not: charge higher copays or deductibles for autism services than for physical health services, cover fewer autism service visits than they would for other health conditions, impose an annual limit for autism services, as well as other safeguards afforded by state and federal parity laws.

“Parity between coverage for autism-related care and other services has long been a goal of the disability community,” said Rep. Jessica Benham. “I am grateful to Governor Shapiro and his Administration for prioritizing this change, which is a step in the right direction toward ensuring greater access to care for individuals with developmental disabilities.”

Drexel University’s A.J. Drexel Autism Institute is a partner of the Commonwealth’s ASERT (Autism Services, Education, Resources & Training) Collaborative, which is funded by the Pennsylvania Department of Human Services’ Bureau of Supports for Autism and Special Populations. The mission of the ASERT Collaborative is to innovate, collaborate, and lead to improve access to quality services, data, and information; to provide support, training and education in best practices; and to facilitate the connection between individuals with autism, developmental disabilities, and special populations, families and key stakeholders at local, state, and national levels.

...

Eagles Autism Foundation Executive Director Ryan Hammond joined the Shapiro Administration and the A.J. Drexel Autism Institute for the announcement. The Eagles Autism Foundation helps to fund innovative research, drive scientific breakthroughs, and provide critical resources to create a major shift from awareness to action in the autism community.

...

PID believes that treating autism as a mental health condition is consistent with the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, which was in effect at the time of enactment of Act 62 of 2008, state and federal MHPAEA laws, as well as generally recognized independent standards of current medical practice, including both the current edition of the DSM and the current edition of the International Classification of Diseases, as recognized in the federal mental health parity regulatory definition of “mental health benefit.” The DSM is the authoritative source under Pennsylvania’s autism law, Act 62.

Pennsylvania law requires coverage of the diagnostic assessment and treatment of autism spectrum disorders by certain group insurance policies or contracts. Through the Affordable Care Act, that law also applies to individual and small group policies. The Department has monitored the coverage of autism services, including whether they have been covered as a mental health condition subject to the federal MHPAEA law that was adopted into state law in 2010.

For support with insurers, Pennsylvanians can contact PID’s Consumer Services Bureau online or at 1-877-881-6388. For more information on the Shapiro Administration’s commitment to supporting Pennsylvanians with autism, visit pa.gov/autism.

# # #

No, RFK Jr. Is Not Going to Win Double Digits

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. A leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.

He is now running for president as an independent.

A new poll seems to show substantial support for him in swing states.  There is a catch. Look carefully at the survey:  It identifies him as "Robert F. Kennedy Jr., the independent" with no further information.  Voters like "independence" and they surely have heard the Kennedy name.  But do they know anything about the man and his bizarre views?  Probably not.  Votes are unhappy with a choice between two old men, "The independent" is merely a proxy for "none of the above." 

Reid J. Epstein, Ruth Igielnik and Camille Baker at NYT:

A looming rematch next year between President Biden and former President Donald J. Trump has left voters deeply dissatisfied with their options, longing for alternatives and curious about independent candidates like Robert F. Kennedy Jr., according to new polls of six battleground states conducted by The New York Times and Siena College.

Both Mr. Biden and Mr. Trump are viewed unfavorably by a majority of voters in these states, one-fifth of voters don’t like either of them, and enthusiasm about the coming election is down sharply compared with a poll conducted before the 2020 contest.

That frustration and malaise have prompted voters to entertain the idea of other options. When asked about the likeliest 2024 matchup, Mr. Biden versus Mr. Trump, only 2 percent of those polled said they would support another candidate. But when Mr. Kennedy’s name was included as an option, nearly a quarter said they would choose him.

That number almost surely inflates the support of Mr. Kennedy, the political scion and vaccine skeptic, because two-thirds of those who said they would back him had said earlier that they would definitely or probably vote for one of the two front-runners.

A Case for Subminimum Wages

In The Politics of Autism, I discuss the employment of people on the autism spectrum

Amy S.F. Lutz at WP:

These are the facts: Rather than going to for-profit businesses, 93 percent of 14(c) certificates are held by nonprofit community rehabilitation programs. And no participants are expected to live off the wages they earn. Typically, 14(c) placement is part of a suite of federal and state benefits — including Supplemental Security Income, transportation and residential services — whose costs frequently run into the six figures per year per person.

Most important, 14(c) programs are extraordinarily popular with participants and their families. In 2020, the U.S. Commission on Civil Rights (UCCR) considered the future of the subminimum wage. In doing so, it solicited comments from the public and received nearly 10,000 — more than it had for any other issue.

Almost all the comments (98 percent) favored preserving 14(c) and cited many factors, including the supportive environment and participants’ preference for a community of similarly disabled peers — the chance to work alongside others while engaged in a variety of tasks, such as shredding documents, recycling plastic, slipping greeting cards into envelopes, or sorting and shelving items in a thrift shop. But the biggest reason, typically articulated by parents on behalf of adult children whose impairments make self-advocacy impossible, was that their kids are simply not capable of competitive, minimum-wage labor.

Venture Capital and Autism

The Politics of Autism includes an extensive discussion of autism services  

Michael Bernick at Forbes:

Can venture capital drive innovation in the autism field, as it has in other fields? Can the dynamism of capital markets be applied to autism’s stubborn challenges of diagnosis, therapies, services and employment?

In the past few years, several autism-focused venture capital funds have been launched, including Moai Capital, Autism Impact Fund, and Neuvation Ventures. Their founders and chief leaders have family members on the autism spectrum, and come to their funds with a strong sense of mission and urgency. The funds are structured as traditional venture capital funds, aiming to maximize investor returns, but with focus on products for improving the lives of individuals with autism.

Anyone in the autism community today—persons with autism, family members, advocates—will be encouraged to see the innovation already underway in the field. Companies in the venture capital portfolios are rapidly advancing the sciences in diagnostic techniques, early intervention, and therapies/therapeutics to address autism co-morbidities.

Currently the autism diagnosis is a behavioral one—behaviors are observed and evaluated and fit into categories. The process is given to wide variation in interpretations and to misuse. Companies in the venture capital portfolios are developing blood tests and brain imaging tests that can far more effectively give meaning to any autism diagnosis.

The main behavioral intervention today is Applied Behavioral Analysis (ABA). ABA is difficult to access, very uneven in quality of services, and effective with only a limited number of children with autism. Portfolio companies, drawing on speech and language technologies as well as big data insights, are developing alternatives to ABA.

Autism-Friendly Dublin

In The Politics of Autism, I discuss the need for more study of the issue in other countries.

 Emma Nevin at Dublin Live:

New plans to make Dublin the world's first autism friendly city with announced by Lord Mayor Daithi de Roiste today.

The Council is participating in the AsIAm Autism-Friendly Communities Awards Programme and will launch a three-year plan to make the capital an autism-friendly city in January. A steering group consisting of the Lord Mayor, elected officials, stakeholders, advocacy groups, those with lived experience, parents and academics and the group will carry out four public events between now and Christmas to establish this plan

The three-year plan will not only address physical infrastructure but also take into account education, healthcare, recreation and community support, all guided by input from Autistic people and their families and supported by key metrics. The city will also recruit Champion organisations, in the business, public and voluntary sectors, who will undertake training and commit to making small changes, such as implementing quiet times.

Growing Belief in the Vaccine-Autism Lie

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.  

Many posts have discussed attitudes toward this dangerous myth.

From the Annenberg Public Policy Center:

• Vaccinations affecting childhood autism: There’s been a decline in the number of people who know it is false to say that “increased vaccinations are why so many kids have autism these days,” dropping to 65% from 71% in April 2021. The number of people who believe that this is true has grown to 16% from 10% over that period. The Centers for Disease Control and Prevention (CDC) says that vaccines do not cause autism.
• Growing belief in false MMR-autism link: Asked if it is true or false that vaccines given to children for diseases like measles, mumps, and rubella (MMR) cause autism, 12% incorrectly say this is true, up from 9% in June 2021, a statistically significant rise. Most people (70%) correctly say that this allegation is false. According to the CDC, vaccine experts say “the MMR vaccine is not responsible for increases in the number of children with autism.” ...
• MMR vaccine*: 81% say the MMR vaccine is safe (down significantly from 88% in August 2022), while 9% say it is unsafe and 10% are not sure.

RFK Jr. Pledges to Freeze Research on Infectious Disease

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread.   And among those diseases could be COVID-19.

Antivaxxers are sometimes violent, often abusive, and always wrong. A leading anti-vaxxer is presidential candidate Robert F. Kennedy, Jr.  He has repeatedly compared vaccine mandates to the Holocaust.  Rolling Stone and Salon retracted an RFK article linking vaccines to autism.

He is now running for president as an independent.

Brandy Zadrozny at NBC:

At an anti-vaccine conference in Georgia on Friday, presidential candidate Robert F. Kennedy Jr. confirmed his commitment to the cause and spoke to his base about how he, as president, would serve the movement he built.

“I feel like I’ve come home today,” he said to a standing ovation, crediting the assembled audience with his candidacy.

He then laid out his vision for a Kennedy presidency, which would include telling the National Institutes of Health to take “a break” from studying infectious diseases, like Covid and measles, and pivoting the agency to the study of chronic diseases, like diabetes and obesity. Kennedy has suggested without evidence that researchers and pharmaceutical companies are driven by profit to neglect such chronic conditions and invest in ineffective and even harmful treatments; he includes vaccines among them.

“I’m gonna say to NIH scientists, God bless you all,” Kennedy said. “Thank you for public service. We’re going to give infectious disease a break for about eight years.”

Kennedy’s remarks came at the end of the first day of a conference for the country’s largest anti-vaccine organization, Children’s Health Defense. Kennedy signed on with Children’s Health Defense in 2015 and served as its chairman and chief litigation counsel until April, when he announced he would go on leave to run for president.

...

In addition to his proposed moves at NIH, Kennedy said that as president, he’d appoint a like-minded attorney general, “maybe Aaron Siri,” he said. Siri is a lawyer who has done millions of dollars of work for leading anti-vaccination groups, including a recent case that opened up religious exemptions for childhood vaccines in Mississippi. The crowd erupted in applause.

He said he would use the power of that attorney general to threaten editors of medical journals and force them to publish studies that had been retracted (he often cites the retracted studies saying ivermectin, a parasite drug, is an effective treatment for Covid). “We’re gonna say we’re fixing to file some racketeering lawsuits if you don’t start telling the truth in your journals.”

Firefighter Training

In The Politics of Autism, I discuss interactions between first responders and autistic people. 

Bella Caracta at WOWT-TV in Omaha:

 Papillion firefighters started their training Wednesday morning learning what not to do.

In 2017, a Buckeye, Arizona police officer confronted a teenage boy with autism. He ended up tackling him, and the boy sustained cuts, bruises, and an ankle injury that needed surgery. The officer claims he thought the boy was using drugs.

After showing the video Autism Action Partnership (AAP) based in Omaha encouraged metro responders to add one question to their routine: “Could it be autism?”

“You have the training to come on scene and you ask all sorts of questions to evaluate what kind of situation you’re dealing with. Where’s the danger? What do I need to do first? If we just add, ‘Could it be autism?’ to that list of questions, it’s really going to reframe the way you might approach a situation,” said Michaela Ahrens with AAP.


Throughout the month, AAP is working to help first responders improve their understanding of autism in hopes of helping those on the spectrum in an emergency safely and smoothly.

During the training, the group did interactive exercises to get a better understanding of autism. Aherns had them complete complex tasks while blaring a siren to simulate an emergency situation.

“It can be chaotic,” she said.

The exercises pushed the first responders to consider how emergency situations may further stress those with autism.

“

Coalition for Autism Research and Education

 In The Politics of Autism, I discuss the congressional role in the issue. As with disability policy more generally, it has tended to be bipartisan.

From the Autism Society:

The Coalition for Autism Research and Education (“CARE” or “Autism Caucus”), the first-ever Congressional Membership Organization dedicated to autism advocacy on Capitol Hill, was founded in 2006 and is co-chaired by Representative Henry Cuellar (D-TX)  and Representative Chris Smith (R-NJ). The Caucus was created to help advocate for autism research, education, and support. 

Refer to the chart below for current members of the Autism Caucus. If your Member of Congress is not yet a member, please contact them and ask them to consider joining using this Action Alert. They can contact Alicia Seagraves, staff of Rep. Cuellar (alicia.seagraves@mail.house.gov), or John McDonough, staff of Rep. Smith (john.mcdonough@mail.house.gov) to learn more and join. 

Co-chairs: Rep. Henry Cuellar (D-TX) and Rep. Chris Smith (R-NJ)

Memember

• Rep. Alma Adams (D-NC)
• Rep. Robert Aderholt (R-AL)
• Rep. Rick Allen (R-GA)
• Rep. Jake Auchincloss (D-MA)
• Rep. Don Bacon (R-NE)
• Rep. Troy Balderson (R-OH)
• Sen. Tammy Baldwin (D-WI)
• Rep. Don Beyer (D-VA)
• Rep. Stephanie Bice (R-OK)
• Rep. Andy Biggs (R-AZ)
• Rep. Gus Bilirakis (R-FL)
• Rep. Earl Blumenauer (D-OR)
• Rep. Lisa Blunt Rochester (D-DE)
• Rep. Suzanne Bonamici (D-OR)
• Sen. John Boozman (R-AR)
• Rep. Mike Bost (R-IL)
• Rep. Brendan Boyle (D-PA)
• Sen. Mike Braun (R-IN)
• Sen. Sherrod Brown (D-OH)
• Rep. Julia Brownley (D-CA)
• Rep. Michael Burgess (R-TX)
• Rep. Ken Calvert (R-CA)
• Sen. Maria Cantwell (D-WA)
• Sen. Shelley Moore Capito (R-WV)
• Rep. Salud Carbajal (D-CA)
• Rep. André Carson (D-IN)
• Rep. Buddy Carter (R-GA)
• Rep. John Carter (R-TX)
• Rep. Matt Cartwright (D-PA)
• Sen. Bob Casey (D-PA)
• Rep. Judy Chu (D-CA)
• Rep. Katherine Clark (D-MA)
• Rep. Emanuel Cleaver (D-MO)
• Rep. Ben Cline (R-VA)
• Rep. Steve Cohen (D-TN)
• Rep. Gerry Connolly (D-VA)
• Rep. Lou Correa (D-CA)
• Rep. Joe Courtney (D-CT)
• Rep. Angie Craig (D-MN)
• Rep. Danny Davis (D-IL)
• Rep. Debbie Dingell (D-MI)
• Rep. Lloyd Doggett (D-TX)
• Rep. Jeff Duncan (R-SC)
• Sen. Dick Durbin (D-IL)
• Rep. Tom Emmer (R-MN)
• Rep. Anna Eshoo (D-CA)
• Rep. Brian Fitzpatrick (R-PA)
• Rep. Mike Gallagher (R-WI)
• Rep. Ruben Gallego (D-AZ)
• Rep. Andrew Garbarino (R-NY)
• Rep. Josh Gottheimer (D-NJ)
• Rep. Kay Granger (R-TX)
• Rep. Garret Graves (R-LA)
• Rep. Raúl Grijalva (D-AZ)
• Rep. Brett Guthrie (R-KY)
• Rep. Andy Harris (R-MD)
• Rep. Jahana Hayes (D-CT)
• Rep. French Hill (R-AR)
• Rep. Jim Himes (D-CT)
• Rep. Chrissy Houlahan (D-PA)
• Rep. Jared Huffman (D-CA)
• Rep. Hank Johnson (D-GA)
• Rep. Dave Joyce (R-OH)
• Rep. John Joyce (R-PA)
• Rep. Marcy Kaptur (D-OH)
• Rep. Bill Keating (D-MA)
• Rep. Mike Kelly (R-PA)
• Rep. Andy Kim (D-NJ)
• Rep. Raja Krishnamoorthi (D-IL)
• Rep. Ann Kuster (D-NH)
• Rep. Rick Larsen (D-WA)
• Rep. John Larson (D-CT)
• Rep. Ted Lieu (D-CA)
• Rep. Zoe Lofgren (D-CA)
• Rep. Blaine Luetkemeyer (R-MO)
• Rep. Stephen Lynch (D-MA)
• Sen. Ed Markey (D-MA)
• Rep. Doris Matsui (D-CA)
• Rep. Jim McGovern (D-MA)
• Rep. Cathy McMorris Rodgers (R-WA)
• Rep. Gregory Meeks (D-NY)
• Sen. Bob Menendez (D-NJ)
• Rep. Dan Meuser (R-PA)
• Rep. Carol Miller (R-WV)
• Rep. Seth Moulton (D-MA)
• Rep. Jerry Nadler (D-NY)
• Rep. Grace Napolitano (D-CA)
• Rep. Richard Neal (D-MA)
• Rep. Donald Norcross (D-NJ)
• Delegate Eleanor Holmes Norton (D-DC)
• Rep. Frank Pallone (D-NJ)
• Rep. Bill Pascrell (D-NJ)
• Rep. Donald Payne (D-NJ)
• Rep. Mark Pocan (D-WI)
• Rep. Bill Posey (R-FL)
• Rep. Mike Quigley (D-IL)
• Rep. Jamie Raskin (D-MD)
• Rep. Mike Rogers (R-AL)
• Rep. David Rouzer (R-NC)
• Delegate Kilili Sablan (D-MP)
• Rep. Linda Sánchez (D-CA)
• Sen. Bernie Sanders (I-VT)
• Rep. Adam Schiff (D-CA)
• Sen. Chuck Schumer (D-NY)
• Rep. David Scott (D-GA)
• Rep. Austin Scott (R-GA)
• Rep. Brad Sherman (D-CA)
• Rep. Mikie Sherrill (D-NJ)
• Sen. Kyrsten Sinema (I-AZ)
• Rep. Elissa Slotkin (D-MI)
• Sen. Tina Smith (D-MN)
• Rep. Adam Smith (D-WA)
• Rep. Jason Smith (R-MO)
• Rep. Darren Soto (D-FL)
• Rep. Abigail Spanberger (D-VA)
• Rep. Eric Swalwell (D-CA)
• Rep. Claudia Tenney (R-NY)
• Rep. Bennie Thompson (D-MS)
• Sen. John Thune (R-SD)
• Sen. Thom Tillis (R-NC)
• Rep. Lori Trahan (D-MA)
• Rep. David Trone (D-MD)
• Rep. Mike Turner (R-OH)
• Sen. Chris Van Hollen (D-MD)
• Rep. Ann Wagner (R-MO)
• Rep. Debbie Wasserman Schultz (D-FL)
• Rep. Maxine Waters (D-CA)
• Rep. Bonnie Watson Coleman (D-NJ)
• Rep. Jennifer Wexton (D-VA)
• Sen. Roger Wicker (R-MS)
• Rep. Susan Wild (D-PA)
• Rep. Joe Wilson (R-SC)
• Rep. Frederica Wilson (D-FL)
• Rep. Rob Wittman (R-VA)