Buyer Beware: Ted Cruz Goes Pro-Choice


The concept of the Trojan horse is familiar to us all. After a 10 year siege of Troy, the invading Greeks pretended to sail away—but left behind the infamous horse with a group of elite soldiers hidden away inside of it. The Trojans pulled the horse into the city as their victory trophy, and the rest, as they say, is history.

But to understand why the Cruz amendment to the Senate healthcare bill is a Trojan horse that will wreak havoc on the individual insurance market, it’s necessary to understand a more complicated concept: adverse selection.

For health insurance markets to function normally there must be a mix of healthy and sick people that purchase any given product. Adverse selection occurs when purchasers of insurance recognize that they are healthier or sicker than the average consumer, and therefore buy either more or less health insurance.

This becomes a problem when sicker consumers all self-select into one health insurance product, and healthy consumers all self-select into another health insurance product. In that instance, an adverse selection problem has occurred, and the product purchased by the sicker consumers is destined for a turbulent ride as premiums skyrocket and only the sickest of the sick continue to pay them. This is the ominous “death spiral” we so often hear about.

Put in this context, it’s easy to see why the Cruz amendment to the healthcare bill presents an adverse selection problem. The Cruz amendment, as you know, will allow insurers to sell non-compliant health insurance plans alongside compliant plans. These skimpier non-compliant plans will cover fewer maladies, have higher deductibles and copays, will be exempt from requirements to provide preventative care at no out of pocket cost, and will undoubtedly be much cheaper than compliant health insurance plans.

Those who are not yet sick will flock to these plans. And the sick will stick to those that actually provide coverage. But without the benefit of a healthy mix of consumers in the compliant plans, they will be in for a turbulent ride.

If you’re healthy, this may seem like a great deal. The only change you’ll notice at first will be an increase in the number of go-fund me pages you see on Facebook for those who purchased non-compliant plans and made the mistake of getting sick, having a heart attack, or coming down with cancer. But sooner or later, we all make the change from healthy to sick, from subsidizer to subsidized—that’s life, and that’s health insurance. And when we do, we’ll all be a lot better off if we don’t fall for the Trojan horse of the Cruz amendment to the healthcare bill.

Protect Your Practice: Healthcare Bill will have Profound Impact on Nursing, Nurses, Patient Care


To many nurses around the country, the talk about healthcare reform in the nation’s capital is just that: a whole lot of talk. But if the current healthcare bill being considered by the Senate passes, are you ready for how it will impact your practice and the nursing profession as a whole?

Take hospital funding, for example. Love it or hate it, it’s a fact that “Obamacare” (or the  Affordable Care Act, “ACA”) drastically reduced the amount of money hospitals spend annually on uncompensated, or “charitable,” care.

In one state alone, Minnesota, hospitals have seen their uncompensated care costs decline by 17% since the implementation of the ACA, saving hospitals in the state about $53 million annually.

Such numbers are far from uncommon, and are probably similar where you live. The reason is simple: when more people have insurance, more people are able to pay their hospital bills. Unfortunately, the healthcare changes being considered by the Senate would leave 49 million people across the US without health insurance, once again increasing the need for hospitals to provide enormous (and enormously expensive) amounts of charitable and otherwise uncompensated care.

These increased costs will need to be accounted for in hospital budgets and will likely impact nurse staffing and care delivery—a critical issue which ANA recently addressed in a widely co-signed letter to the Center for Medicare Services.

But the healthcare bill will also impact nurses outside of the hospital setting. According to a recent survey of school administrators, over seventy percent of school districts turn to Medicaid to pay for the health professionals and school nurses needed to care for special education students. Since the senate healthcare bill would cut Medicaid spending by almost $800 billion and impose a cap on the amount of Medicaid-funded services any child could receive, school nurses and administrators are staunchly opposed to the bill.

Even if you don’t work in a hospital setting, and even if you don’t have children in school, it’s likely you will still be impacted by the healthcare bill being considered by the Senate. For example, we all have a vested interest in the health of our nation’s veterans. But of concern to veterans, VA nurses, and Veterans groups, 1.75 million vets stand to lose their Medicaid coverage under the healthcare bill, which in turn would impact the VA as more veterans seek care in that already overloaded and underfunded system.

Since Medicaid pays for most of the 1.4 million Americans in nursing homes, elderly Americans and nursing home nurses are also gravely concerned by the impact of the healthcare bill. The same goes for rural nurses and citizens, whose safety-net hospitals are projected to lose eighty-three percent of their net income by 2026 under the new bill.

The list goes on: whether or not you realize it, this healthcare bill will impact you and your practice, perhaps in ways that are unforeseen or unintended. That’s why the American Nurses Association is calling for a more thorough, nuanced, and bipartisan process for healthcare reform.

We urge the Senate to step back and approach this herculean task in a way that works for all Americans. For the sake of nurses and their patients, we can’t afford to get this one wrong.

And Here’s What You Missed On Healthcare!


On Monday – The Congressional Budget Office – a nonpartisan group that calculates the impact of proposed legislation – said the so-called Better Care Reconciliation Act would leave tens of millions more Americans without coverage in the next decade, but it would also save the government a lot of money. That didn’t help convince any Democrats to back it. But – surprise – many GOP senators aren’t pleased either.

On Tuesday – The Senate delayed the vote on its healthcare plan until after the July 4th break. As a reminder, the plan includes things like a cap on federal funding for Medicaid and a temporary freeze on Planned Parenthood funding. It keeps the rule that insurance companies can’t arbitrarily raise prices for people with pre-existing conditions, but has a caveat that could still increase certain healthcare costs for them. Some say the bill doesn’t do enough to roll back Obamacare. And others are worried cutting funding for things like Medicaid and Planned Parenthood would hurt the Americans who need it most.

On Thursday – Senate GOP lawmakers are adding some extra money to their healthcare bill to help fight the opioid crisis. In recent years, the number of people in the US who have become addicted to opioids (think: heroin and prescription painkillers like oxycodone) has gone way up. Especially in rural parts of America. Cutting how much money states get for Medicaid would mean less money to spend on helping people fight addictions. Many Senators from both sides of the aisle – especially from states hard hit by the opioid crisis – are not down with this. So now, the GOP’s adding $45 billion to their bill specifically for substance abuse treatment. Governors on both side of the aisle say this isn’t enough.

Today – GOP Senators are going back to the drawing board, with new amendments and negotiations, some of which include a repeal and replace-later plan. Which means they’ll wait for another CBO review before putting version 2.0 to a vote.

Now – Senators are heading home for a week of recess, aka district work period, and they need to continue to hear from you.

The Senate made a last-minute decision to delay the vote – all because of nurses like YOU, joining with others across the country, calling every single day to speak out for your patients and the 22 million people at risk of losing their health care.

But a delay isn’t a victory. And your patients deserve a victory.

Even if you’ve already called – even if you already know where your Senators stand – we need EVERYONE to call again.

We’ve seen what can happen when they think we’re not watching: when this bill was in the House, there was a delay just like this week’s delay in the Senate, and lawmakers saw that the calls were slowing down. Just when their constituents let up on the pressure, they rushed their bill through to pass by the thinnest margin.

We absolutely cannot let that happen again!