Category: Congress

Large health care investments cap off eventful 2020 as we look ahead into 2021

  

What a historic year it has been on so many levels. Leaving behind the first year of a new decade that saw struggles which we could not have foreseen in January 2020, and going into a holiday season that looks vastly different from years passed and a future that is still unclear – it’s easy to focus on the negative. However, despite the trials and tribulations of this year, it is important and inspiring to recognize all of the ground-breaking work that ANA and nurses have done in the policy, government affairs and advocacy spaces, as we look towards what is on the horizon in 2021.

At the time of publication, Congress is in the process of passing a year-end package that will avert a government shutdown, include money for vaccines and COVID-19 aid to frontline workers, boost the economy, and include language to protect patients from surprise billing for health care. ANA has been working with our allies in Congress, and advocating to get these items addressed. Please be on the lookout for further details on the year-end package by visiting ANA’s new advocacy page. In the meantime, let’s acknowledge the progress made throughout 2020, which was necessitated by the COVID-19 public health emergency (PHE).

Earlier this year, the U.S. Congress and the President signed into law the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Included in the law is language that reauthorizes Title VIII Nursing Workforce Development Programs and authorizes Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) to order home health care for their patients. These are longtime ANA federal legislative priorities, and we applaud Congress and the administration on their passage in the early stages of the pandemic. Advanced Practice Registered Nurses (APRNs) like NPs and CNSs are key to COVID-19 care and maintaining access to non-COVID-19 care throughout the crisis.

By summer, ANA was becoming a regular voice for nurses as Congress sought additional solutions to PHE challenges in the healthcare system. ANA President Ernest Grant testified at a hearing before the Senate Finance Committee, “Part 2: Protecting the Reliability of the U.S. Medical Supply Chain During the COVID-19 Pandemic.” Dr. Grant was there to answer the many questions Senators had about the impact of COVID-19. Questions ranged from what more the federal government could do to strengthen the supply chain, to the needs of nurses on the ground.

ANA also responded on behalf of nurses to proposals outlined in a white paper released by the Senate Health, Education, Labor, and Pension (HELP) Committee. The Committee requested input on what the U.S. had learned from the past 20 years of public health preparedness and response, and how we can better prepare for future pandemics. ANA’s response focused on how to rebuild and maintain state and federal stockpiles, improving public health capabilities, and increasing medical supply surge capacity and distribution. 

ANA has been consistently present with effective advocacy on personal protective equipment (PPE), which has been in short supply all year. As a result, the enterprise was tapped as leadership of a broad-based the coalition that will be a united voice to Congress and the administration on PPE and supply chain issues, to improve public health.

As we pivot to start working with the incoming administration, ANA has hit the ground running, providing substantive recommendations to transition leaders, and applauding the appointment of a registered nurse to President-elect Biden’s COVID-19 Task Force. We have communicated the many ways in which ANA and nurses can be a resource to the transition and the upcoming administration. We continue to solidify relationships to ensure that ANA will maintain a strong voice in the White House and key agencies in the months ahead.

Like the rest of the Policy and Government Affairs team, the ANA Political Action Committee (ANA-PAC) experienced a very successful year in 2020 despite the multitude of challenges it faced at the start of the pandemic. For starters, the PAC continued its winning streak with a 95 percent win rate in the 2020 general election for the nearly 100 candidates the PAC supported based on their pro-nursing agendas. Members of ANA drove their support unlike in years passed to the tune of over 5,600 contributors to the PAC which was an increase of 34 percent over 2019 and counting! And it doesn’t stop there: the financial strength of the PAC continues to improve as receipts are up 3 percent over last year and this number only continues to grow as we head toward the year end. Policy and GOVA will be spending the early part of 2021 strategizing our support for our existing nursing champions and starting new outreach efforts to those new freshman members of Congress. Stay tuned for updates in the next ANA-PAC quarterly newsletter.

ANA advocacy on federal regulatory policy has also strengthened nurses and demonstrated the power of nurses’ voices. With the COVID-19 PHE extended until March 2021, Medicare payment flexibilities gained in 2020 will continue. A number of these provisions expand access to APRNs for non-COVID-19 care as well as COVID-19 care, which has been a boon to patients and their providers throughout the pandemic, especially in rural areas.

The readiness of the Centers for Medicare and Medicaid Services (CMS) to remove regulatory barriers to practice has come as a result of direct advocacy over the years by ANA and partner organizations. The voices of frontline nurse providers were also heard, as CMS gathered first-hand accounts and created space to share this information on regular conference calls with nurses about the impacts of COVID-19 on their practice.

The pandemic has demonstrated the value of APRNs across the health care system, and CMS’ actions tell us that Medicare leaders are hearing us. The future is indeed bright, as CMS continues to review unnecessary barriers and craft regulatory relief. ANA policy leaders are right there, urging specific changes, and making a powerful case for making permanent changes to expand access to APRNs. We saw some success in the physician payment rule for 2021, which removed federal restrictions on APRN supervision of diagnostic tests.

CMS was not the only agency hearing nurses’ voices as important decisions were made. Early and often, ANA repeatedly called for steps to improve protections for frontline providers, including a return as soon as possible to pre-pandemic standards for PPE.

We made our case to the Occupational Safety and Health Administration, the Office of Minority Health at HHS, the Department of Veterans Affairs, Federal Emergency Management Agency, Government Accountability Office, and the White House Economic Advisors. ANA has become the “go to” organization for agency staff when they hear about events happening on the ground to work together to improve conditions for nurses. 

The pandemic made ANA’s presence even more valuable with the American Medical Association’s (AMA) RUC and CPT committees, which are the driving force for health care reimbursement. ANA CPT advisors were at the table when the CPT codes for both the Pfizer and Moderna vaccines were developed. In a separate process, ANA advisors were consulted to account for increased practice expenses incurred during the pandemic. Throughout, ANA engaged feedback and comment from the nursing community. All of these accomplishments could not be done without the loud impassioned voice of our ANA members and RNAction advocates. This united voice sent nearly 460,000 letters to Congress, responded to public comments and engaged in several surveys where the results were presented to Congressional offices across Capitol Hill. All of the input from nurses, our nation’s most trusted profession for 18 straight years, directly impacted legislation and policy throughout the year. We have you to thank for that – your efforts on the frontlines, your expertise and your advocacy do not go unnoticed. With over 200,000 RNAction advocates, we are poised to improve the profession of nursing and conditions for your patients again in 2021.

Looking forward to this year’s #ANAHillDay

  

In just under three weeks ANA members and registered nurses from across the country will gather on Capitol Hill to demonstrate the power of nurse advocacy firsthand. As we prepare for our annual #ANAHillDay on June 20th, we wanted to offer some helpful tips and reminders for those attending and encourage those who might still be on the fence to register before it’s too late. With momentum building around a number of bills in Congress that will help advance the nursing profession, now is the perfect time to join us for our biggest advocacy event of the year.

Prior to arriving in Washington for the big day, please take some time to get to know the lawmakers with whom you’ll be meeting (your federal representative and both Senators). In particular, determine whether they’re already supportive of the legislation we’ll be discussing in our in-person meetings. That includes:

  • Workplace violence legislation in the House and Senate;
  • Title VIII nursing workforce development reauthorization in the House and Senate, and;
  • Home health legislation for APRNs in the House and Senate.

For additional background on these bills, please visit our RNAction issues page. If you’re unsure who represents you in the House, please find out here. Rest assured, we’ll be going into greater detail on all these bills at our morning breakfast briefing before you head up to Capitol Hill for your meetings. We’ll also be hearing from ANA leadership as well as the newest nurse in Congress, Rep. Lauren Underwood (D-IL-14).

Once you’re on the Hill, you and members of your state delegation with whom you’ll be paired will have the unique opportunity to share your professional perspective on why each of these bills matters to you. While it’s important to know what these bills are working to accomplish and how they would do so, it’s just as important for your representatives and their staff to hear your firsthand account on how you’ve encountered these issues in your job. Representatives and staff will always respond better when you are able to make a personal attachment to the issue at hand. Please spend some time thinking about if and how these issues have impacted your work, and decide which ones you feel most confident speaking to during your meetings.

And if you can’t join us here in our nation’s capital, rest assured you’ll still have plenty of opportunities to join through our virtual Hill Day campaign. To ensure you’re getting these and other timely nurse advocate updates, please sign up for our RNAction updates.

To watch our Facebook briefing with additional information on everything Hill Day-related, please click here. And if you’re interested in attending but still haven’t registered, please do so here. 

Congress Aims to Keep Campaign Promises on Health Care as Courts Continue to Review Administration Policies

  

By: Gregory Craig and Matthew Fitting

Following a midterm election cycle in which voters consistently listed health care as their top issue priority, members of the 116th Congress have wasted no time in proposing, introducing, and debating several measures that would significantly impact the way Americans receive and pay for health coverage.

Health Care Legislation in the U.S. House of Representatives

Most recently, Rep. Frank Pallone, Jr. (D-NJ), the Chairman of the House Energy and Commerce Committee, on March 26, 2019 introduced H.R. 1884 – the “Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019”. This legislation would strengthen many of the consumer protections and pre-existing conditions provisions of the Affordable Care Act (ACA), promote individual health insurance enrollment on the ACA Marketplace, and roll back regulatory actions that the administration has implemented since January 2017. Some of the specific provisions would:

  • Expand income-based eligibility for premium tax credits used to purchase individual health insurance coverage and increase tax credits for all income brackets, allowing more individuals to purchase subsidized health insurance coverage;
  • Fix the so-called “family glitch” to make it easier for low- and middle-income individuals to purchase subsidized family coverage;
  • Rescind the administration’s final rule expanding the availability of Association Health Plans (AHPs) that can circumvent many of the ACA’s consumer protections, specifically those involving Essential Health Benefits (read ANA’s comment letter on AHPs here);
  • Rescind the administration’s final rule expanding the availability of short-term, limited duration insurance plans, which are not required to comply with any of the ACA’s consumer protections (read ANA’s comment letter on short-term, limited duration insurance here);
  • Require the Department of Health and Human Services to conduct marketing and outreach for open enrollment with $100 million in annual appropriations (read ANA’s plan year 2018 open enrollment report here);
  • Establish a state-based reinsurance program that would allow states to set up their own reinsurance programs, or to use the funds to provide premium subsidies or cost-sharing support, with a federal reinsurance program as a backstop.

ANA has publicly supported many of the provisions in H.R. 1884 and has consistently promoted a bipartisan proposal – similar to the reinsurance proposal included in H.R. 1884 above – that Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) introduced in the previous Congress that would have established a similar program and restored cost-sharing payment reductions that help low-income individuals afford co-insurance and deductible costs (the Administration canceled these payments in October 2017).

The proposal that has arguably grabbed the most headlines, however, is “Medicare for All,” a general campaign slogan that was recently introduced as legislation by Rep. Pramila Jayapal (D-WA) with a Senate bill soon to follow to be introduced by Sen. Bernie Sanders (I-VT). The bill would implement an expanded government-run Medicare program and do away with much of the private insurance system currently in place (well over half of Americans currently receive health insurance through their employer or in the Marketplace).

While the legislation is consistent with ANA’s support for universal access to health coverage, there are several provisions that could negatively impact the nation’s four million registered nurses, as well as the patients for whom they provide care. Some of these include:

  • A fee-for-service program that could significantly reduce payment rates and have a trickle-down effect on Advanced Practice Registered Nurses (APRNs), who are currently reimbursed at 85% the rate that Medicare reimburses physicians for the same work;
  • A Medicare Trust Fund that could lead to uncertainty around payments and impact access to care should beneficiary access to services exceed the fiscal year budget;
  • The establishment of regional offices charged with recommending changes in provider reimbursement and establishing quality assurance mechanisms for their regions, which could lead to a patchwork of coverage and tempt providers to practice where reimbursement rates are higher.

Federal Courts Reviewing ACA Provisions

The Department of Justice on March 25 unexpectedly sent a letter to the Fifth Circuit Court of Appeals to state that the Administration fully supports the December 2018 U.S. District Court decision in Texas v. Azar that would invalidate the entire Affordable Care Act (the U.S. District Court decision was stayed pending appeal; the Administration had previously only supported striking down parts of the ACA, including pre-existing conditions provisions). This case will likely make its way to the U.S. Supreme Court for a final decision, though that decision would probably not come until 2020 or later. Invalidating the entire ACA with no plan to replace it would be extremely disruptive to the U.S. health care system and would result in enormous insurance coverage and financial losses.

On March 27, the Federal District Court for the District of Columbia threw out Medicaid work requirements in both Kentucky and Arkansas. This is the second time that Kentucky’s Medicaid work requirements have been blocked in federal court. Arkansas’ work requirements were implemented in June 2018 and have resulted in 18,000 individuals losing coverage. The same federal court on March 28 issued a ruling that rejects the administration’s final rule that expands the availability of Association Health Plans. ANA has consistently opposed expanding the availability of these plans, as they represent an end-around of the ACA’s essential health benefits requirements for insurance coverage.

ANA’s Commitment to Universal Access to Quality Health Care

ANA is committed to a pragmatic approach to ensuring universal access to quality, affordable, and accessible health care for all Americans, particularly vulnerable populations and those with pre-existing conditions. As ANA stated in a recent press release: “Universal access to a standard package of essential health care services for all citizens and residents is of paramount importance to the American Nurses Association. Nurses have a critical voice in this debate, and ANA is committed to advancing policy initiatives that provide and expand access to affordable coverage and quality care for all.”

This is the latest chapter in the decades-old health care debate – we expect that many proposals will be offered before the 2020 election. ANA will continue to be involved and actively advocate for nurses and the patients for whom they provided care.