Trump Administration’s Moves Continue to Fracture the U.S. Healthcare System


The Trump Administration continues to create uncertainty in the U.S. healthcare system – uncertainty that has led states to take measures which could ultimately result in drastically disparate health outcomes, both across states and populations. In addition to repealing the individual mandate in December 2017’s tax legislation, the administration in the last several months has proposed several rules which could further exacerbate these divides (ANA will submit comment letters on all three of these proposed rules).

  • The first of these rules was issued by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and would act to expand the ability of employers to offer health insurance coverage through Association Health Plans; ANA submitted a comment letter on this proposed rule on Friday March 2nd. This rule would facilitate the proliferation of insurance coverage that does not cover Essential Health Benefits, and would make it more difficult for older individuals and those with pre-existing conditions to purchase individual health insurance coverage while driving up prices in the federal and state health insurance exchanges.
  • The second proposed rule comes from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights and focuses on enforcing statutory conscience rights of healthcare workers – including nurses. ANA strongly supports the fundamental right of nurses and all healthcare workers to listen to their moral and ethical consciences; however, we also believe that this proposed rule as written opens the door for discrimination against marginalized groups, including LGBT individuals, which already experience lower quality health outcomes and would lead to further population health disparities.
  • The third proposed rule comes from the U.S Department of Treasury’s Internal Revenue Service, EBSA, and HHS and focuses on expanding the use of short-term, limited-duration insurance. This rule would have an impact similar to that of the Associated Health Plan proposed rule described above.

These rules – in addition to the repeal of the individual mandate – threaten to fracture the national healthcare system framework established under the Affordable Care Act (ACA). This is not the first time this has happened since President Obama signed the ACA into law in 2010 – the King v. Burwell  Supreme Court decision in 2012 ensured that not all states would provide the same level of Medicaid coverage, and as a result 17 states still have yet to expand Medicaid. The Trump Administration, however, has accelerated this fracturing, and states are increasingly taking measures to react to these federal policy decisions.

Some states – including California, New York, and Maryland – have seen proposals to pass their own state-level individual mandate, while others such as Oregon have created reinsurance programs to insulate insurance companies from the extremely high costs of covering patients with chronic and complex health conditions – thus helping to keep premium costs down for the overall population.

Other states – bolstered by the Trump Administration’s moves – have pushed the limits of what is allowable under the ACA. While the ACA allows states to experiment with their health systems under Section 1332 waivers, some states are arguably moving beyond what is allowed even under such waivers. Idaho, for instance, recently attempted to allow insurers to sell individual health insurance policies which do not comply with some of the ACA’s requirements, including the elimination of lifetime caps and the coverage of Essential Health Benefits. The Trump Administration, however, informed Idaho that this plan is non-compliant with federal statute and that the sale of such plans would not be allowed.

ANA strongly supports innovation and creative approaches to ensuring comprehensive, affordable healthcare coverage for all Americans. These proposals, however, would likely have the opposite effect by driving up premium prices, pushing individuals in at-risk populations out of the insurance market, and widening population health disparities. ANA reiterates its previously stated support for legislative proposals which shore up the individual health insurance marketplace and reinstate critical cost-sharing reduction payments to help low-income families pay for much-needed primary care and other healthcare services.

Photo: Evan Vucci/Associated Press



For decades, the American Nurses Association has called on lawmakers to come together and pass common sense policies that prevent gun violence and protect Americans. Nurses have pushed for action to enhance our background check system, enact mandatory waiting periods, prevent potentially dangerous individuals from getting guns, and allow the Centers for Disease Control and Prevention (CDC) to research gun violence and firearm injury prevention.

These calls were strengthened and renewed at our 2016 Membership Assembly and took on new urgency in the wake of the mass shooting at Marjory Stoneman Douglas High School last month. And while it is frustrating that we made appeals after Sandy Hook, Aurora, Orlando, Las Vegas, and so many other horrific mass shootings, with nothing done to stop this violence, nurses will not stop calling for action.

ANA, along with 95 other organizations, recently called on Congress to establish a bipartisan National Commission on Mass Shootings. We are also actively supporting Congresswoman Stephanie Murphy’s Gun Violence Research Act (H.R. 1478). This bill repeals the current provision that prohibits the CDC and other federal agencies at the Department of Health and Human Services from researching gun violence and firearm injury prevention. This bipartisan bill is a first step in working toward preventing gun violence.

Nurses have a unique perspective on this issue and their input is needed now more than ever. We call on you to help lend your voice to this important issue. Please send a message to your legislators letting them know you support Congresswoman Murphy’s legislation, and be sure to include your own perspective on this critical issue. ANA is committed to working with our partners on and off Capitol Hill to bring nurses’ dedication and ideas forward to help solve this issue. We stand together in calling for meaningful gun violence prevention and increased dialogue with our communities to take action against hate and death.

Our thoughts remain with the victims, students, parents, teachers, first responders and the medical professionals in Parkland, Florida, as they work to heal. ANA is also cognizant of the impact these mass causality shootings have on survivors of gun violence and the continued challenges of recovery that they face. The Parkland community has mobilized around their grief and anger to spark a national conversation, which we have not seen in quite some time. This is a conversation that is long overdue.

Gun violence like this is far too familiar in the United States, and, like so many others, nurses are dealing with the consequences. On average, there are more than 35,000 gun deaths per year in the United States, including almost 13,000 homicides. Even more outrageous is that nearly seven children under the age of 19 are killed with guns every day in the United States. Nurses are being called to care for victims of not only mass shootings but homicides, suicides and accidental shootings in clinics and emergency departments throughout the country. It is because of this that so many nurses and their families are joining the students, parents and teachers at Stoneman Douglas by standing up and saying #NeverAgain.

“We (nurses) are on the front lines of every mass shooting, which over time has become deadlier and more frequent. We have a duty to advocate for the safety of all through stricter gun laws and research the growing trend of gun violence” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of ANA.


Introducing the Safe Staffing for Nurse and Patient Safety Act


Advocating for and passing legislation that helps nurses and patients is a fundamental part of our Year of Advocacy. Nurses advocate every day for their patients, their communities and the profession, but it is also important that nurses lend their expertise to elected officials as they draft and pass legislation relevant to the nursing profession.

Earlier this month our bipartisan champions in the House of Representatives and Senate introduced a bill that will improve care and help keep nurses and patients safe. Champions including Reps. David Joyce (R-OH-14), Suzan DelBene (D-WA-10), Suzanne Bonamici (D-OR-1), and Tulsi Gabbard (D-HI-2) as well as Senator Jeff Merkley (D-OR), came together to introduce the Safe Staffing for Nurse and Patient Safety Act of 2018 (S. 2446, H.R. 5052).

The bill requires hospitals to establish a committee, composed of at least 55 percent direct care nurses, to create nurse staffing plans that are specific to each unit. As nurses across the country know, patients risk longer hospital stays, increased infections, and avoidable injuries when units are understaffed. Understaffing also leads to lower nurse retention, higher rates of injury and burnout.

“RN staffing makes a critical difference for patients and the quality of their care,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association. “Appropriate nurse staffing keeps patients safe and protects them from preventable complications, even lowering the risk of death. Nursing care is like medication—we would never withhold a medication when we know its lifesaving effects. The Safe Staffing for Nurse and Patient Safety Act empowers direct care nurses to determine the unique and variable needs of their patients to ensure the safety and quality outcomes of care.”

Our Congressional champions also understand why this legislation is so important.

“As a husband of a nurse, I have experienced first-hand the many challenges and responsibilities nurses face on a day to day basis,” said Joyce. “Ensuring patient safety and care has always been a priority but has faced many challenges when nurses are over worked and hospitals are under staffed. As Co-Chair of the House Nursing Caucus, I am proud to introduce legislation that addresses the issue and protects our patients and nurses.”

“As the husband of a nurse, I know firsthand the many challenges nurses face and how critical their care is to patients,” said Merkley. “Safe staffing enhances the quality of patient care, reduces medical errors, and increases nurse retention.”

But introducing this bill is just the first step. We need your help getting more cosponsors for this legislation – let your Senators and Representatives know why safe staffing is so critical. Click here to send them an email asking them to support this bill and be sure to include a personal note on why nurse-driven ratios are so important.