Omnibus Spending Bill Is Two Steps Forward, One Step Back for Public Health Issues


President Trump today signed into law a major $1.3 trillion omnibus spending bill which funds the federal government through the end of the fiscal year on September 30, 2018. This bill significantly increases both defense and domestic discretionary spending, and includes several important healthcare provisions critical to nurses.

ANA is pleased to note that this spending measure fully funds Title VIII Nurse Workforce Development Programs and includes a $20 million funding increase for such programs. We applaud Congress for recognizing the importance of a nursing workforce that is ready to meet the challenges of our current healthcare environment. ANA also applauds Congress for providing an additional $3 billion to fight the opioid crisis. As providers on the frontlines of this epidemic, nurses witness firsthand the devastation of addiction and overdose. We hope that this combination of workforce and opioid funding will enable the health care system – and nurses in particular – to put an end to this devastating scourge.

Congress also started to show signs of progress on gun violence prevention, as thousands of engaged Americans across the country prepare for this weekend’s March for Our Lives. Congress clarified that the Centers for Disease Control and Prevention (CDC) is permitted to engage in some gun violence prevention research, and laid the groundwork for an improved background check system. That said, much work remains to keep our children and nation safe from these senseless tragedies.  Acknowledging the CDC’s authority to study the problem without actually allocating resources carries the same chilling effect on conducting research as an outright ban.

ANA is also very disappointed by Congress’s failure to ensure affordable and accessible healthcare coverage for all Americans. The omnibus spending measure notably did not include a measure or any funding intended to stabilize the individual health insurance markets. Without such market stabilization efforts, individual premiums will continue to skyrocket and many Americans will choose to forgo health insurance coverage altogether, exposing them to physical and financial risks. ANA continues to urge Congress to act toward implementing market stabilization measures.

ANA again applauds Congress for ending (for now) the familiar cycle of lurching from budget crisis to budget crisis with no long-term, bipartisan solutions to outstanding policy issues. While the provisions noted above – nursing workforce, opioids, gun violence prevention – are a start to solving some of these issues, they do not go far enough. We urge Congress to continue to work toward solving these critical policy issues, and to realize that continuing to play politics with the stability of the individual health insurance market hurts vulnerable Americans who rely on affordable and accessible health coverage.

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

Congress Passes Bipartisan Spending Measure with Funding for Critical Health Programs


Following a brief, overnight government shutdown, President Trump this morning signed a spending measure and continuing resolution which reopens the government and provides funding through March 23rd while setting broad spending levels through FY 2019. The measure provides roughly $500 billion in additional funding over the next two years, including roughly $140 billion in additional non-defense domestic spending, a similar increase in defense spending, and roughly $90 billion in federal relief funding for Puerto Rico, the U.S. Virgin Islands, Texas, and Florida, which were pummeled by devastating hurricanes last summer, and for those impacted by the California wildfires. The bill also waives the debt ceiling until March 1, 2019.

Crucially, the spending bill provides additional funding for some of the nation’s most important public health programs. It provides $7 billion in funding for the nation’s 2,600 community health centers, which provided care to 26.5 million Americans in 2016; this was a critical need and the $7 billion in this bill represents roughly 2 years of federal funding for the nation’s centers.

The spending measure also extends the Children’s Health Insurance Program (CHIP) for another 4 years, meaning that the program will now be fully funded at the federal level for 10 years. CHIP provides healthcare coverage for roughly nine million American children and is a critical provider of healthcare services. The measure also provides an additional $2 billion in funding to the Department of Veterans’ Affairs to better manage their health system and prevents automatic cuts to Medicare and Medicaid, while eliminating the Independent Payment Advisory Board (IPAB). The measure critically provides $6 billion in funding over the next two FYs to fight the opioid epidemic.

With a large portion of the nation’s fiscal policy taken care of, the House and Senate have now cleared their plates to work on a solution to the Deferred Action for Childhood Arrivals Program, better known as DACA. The Trump administration plans on ending the DACA Program on March 5th, giving Congress roughly four weeks to come up with a solution to shield hundreds of thousands of young immigrants from deportation. ANA supports the DACA program and urges the House and Senate to quickly come to an agreement to keep these young Americans in the country. The Senate has already taken up a measure this morning to begin debate on the fate of DACA; ANA will continue to monitor this important issue.

We applaud Congress for coming to a bipartisan, long-term spending deal which ensures that several of the nation’s most important healthcare programs receive long-term funding. CHIP, the nation’s community health centers, and the VA all provide critical healthcare access to some of the nation’s most vulnerable populations, and Congress should be commended for recognizing their importance.

ANA also applauds Congress for providing additional funding to areas hit hard by this summer’s devastating hurricanes and by the wildfires in California; the American Nurses Foundation teamed with the Texas Nurses Association in August to raise donations for victims, and numerous nurses went down to Texas, Florida, and the Caribbean to help out. The spending measure signed into law this morning, however, only provides funding for the government through March 23rd; until then, members of Congress will continue to work to hammer out appropriations for federal agencies and programs for the remainder of FY 2018 and FY 2019. We strongly urge you to make your voices heard and let your member of Congress know that funding for the nation’s healthcare programs is critical to the overall health of the nation.

Photo Credit: Tom Brenner/The New York Times