President Trump Deals Yet Another Critical Blow to Healthcare System


Yesterday President Trump dealt yet another critical blow to the healthcare system established under the Affordable Care Act by announcing his administration would end critical Cost-Sharing Reduction (CSR) payment subsidies. These payments – projected to total roughly $9 billion in 2018 and $100 billion over the next 10 years – are made to help offset costs of co-payments, co-insurance, and deductibles for low-income Americans who enroll in individual health insurance coverage under the ACA’s exchanges.

The decision to end these payments will result in higher costs for low- and middle-income Americans and will threaten the ability of these individuals to afford coverage. The administration has treated these payments as a political bargaining chip for months; ending them, in combination with yesterday’s Executive Order on association health plans, will have an immediate and negative impact on Americans’ ability to access critical healthcare services. ANA reiterates: the Trump administration is making a deliberate attempt to undermine the system put in place by the ACA for political gain, at the expense of some of the most vulnerable Americans.

Individuals enrolled in health insurance coverage through the ACA’s individual marketplace with household income between 100% ($12,060 for an individual and $24,600 for a family of four) and 250% ($30,150 for an individual and $61,500 for a family of four) of the Federal Poverty Guideline are currently eligible for cost-sharing reductions. CSRs reduce the amount that low-income individuals pay out-of-pocket for co-payments, co-insurance, and deductibles. In effect, these cost-sharing reductions currently make it more likely that these individuals get critical preventive and other healthcare services and avoid more serious and/or chronic health issues long-term.

The Commonwealth Fund reported in March 2016 that as many as seven million individuals might have plans that are aided by  CSRs, representing a significant portion of the individuals who signed up for coverage through the individual exchanges under the ACA. This Commonwealth Fund report also noted that – according to government data – out-of-pocket healthcare spending declined significantly in 2014 (the year the ACA was implemented). In short, it is abundantly clear that the ACA’s cost-sharing reductions have in fact helped low-income individuals receive critical healthcare services.

We will continue to urge Congress and the administration to work toward market stabilization and to strengthen the existing system – which has resulted in coverage for tens of millions of Americans since 2014 – and to put an end to these attempts to sabotage Americans’ healthcare for political gain. ANA is committed to working with Congress and the administration on legislation and policy which aligns with our four core principles of health system transformation. The President’s actions this week fly in the face of ANA’s principles and will cause significant harm to millions of American families.

(Photo: Matt Rourke/AP)

American Nurses Association Stands Behind Assaulted Utah Nurse


The video is disturbing, and underscores the need for federal officials in OSHA to take steps to protect healthcare workers from violence. In it, Utah nurse Alex Wubbels calmly tells a detective that she cannot draw blood from an unconscious patient without a warrant, an arrest, or some form of consent (e.g. from the patient or a medical power of attorney). A hospital administrator can be heard on her speakerphone, backing up nurse Wubbels and asking the detective to not get angry at the messenger.

The detective snaps, pushes nurse Wubbels outside, and arrests her as she screams for help.

Perhaps the most disturbing part about this story is that Wubbels did everything right. “Alex Wubbels did everything correct,” said Aimee McLean, President of the Utah Nurses Association. “She stepped away from her patient’s unit, she deescalated, she followed hospital policy and procedure. This never should have happened.”

Indeed, touching a patient, performing a procedure, or drawing blood from a patient without their consent is assault and battery and is contrary to a patient’s right to privacy. Wubbels followed her hospital policy, her obligations under her nurse practice act to advocate for her patient, and her ethical duty under provision 3.1 of the Code of Ethics for Nurses to protect the privacy and confidentiality of her patient.

She did so calmly and professionally, and with the backing of her administration. And she was arrested for it.

So what’s the lesson to be learned here? For one, that Alex Wubbels is a hero to her patient, to her hospital and to nurses across the country. Two, even when nurses do everything right, we oftentimes still face repercussions. Rightfully refusing an unsafe assignment sometimes leads to discipline. Rightfully speaking out about unsafe patient care conditions sometimes leads to termination. And, taken to an extreme, doing everything exactly right in advocating for the rights of your patient apparently sometimes leads to arrest.

But, make no mistake about it: nurses will do what’s right in the interests of advocating for our patients, regardless of the situation.

The upshot here? Nurses are closing their ranks around Alex Wubbels. Across the country, we are speaking up online, in the media, and as professional organizations to decry what happened to nurse Wubbels and to call for accountability and changes to ensure this never happens again. We hope the public and the federal government will join us.

Alex Wubbels, ANA has your back. #Nursesunite

12 Days in September

Photo: Getty Images
Photo: Getty Images

President Trump joined with congressional Democrats yesterday to clear three major items from a jam-packed congressional agenda. The stopgap agreement will raise the nation’s debt limit, keep the government open through the end of the calendar year, and provide hurricane relief for the communities and states hardest hit this hurricane season. In doing so, however, Trump and congressional leaders have ensured that an even bigger debate awaits them in December, with an unclear outlook on how it will resolve itself.

The House also passed nearly $8 billion in disaster aid in response to the devastation wrought by Hurricane Harvey. But with Hurricane Irma bearing down on Puerto Rico and Florida, lawmakers may be called on to pass additional funding soon.

Meanwhile, lawmakers still face an overflowing agenda. Here’s a quick rundown of what else to expect this September:

  • Tax reform: The President and his administration have long signaled that they hope to pass tax reform legislation before the end of the calendar year. Their failure to pass health care reform legislation this summer, however, coupled with a long list of competing priorities, makes this increasingly unlikely.
  • Health care reform: Though congressional leaders have appeared to move on to other, more pressing issues, President Trump continues to indicate he wants lawmakers to take one more shot at repealing and replacing the Affordable Care Act.
  • Immigration: Following the President’s decision to rescind the policy of Deferred Action for Childhood Arrivals (DACA) in the event that Congress fails to craft a solution in the next six months, lawmakers on both sides of the aisle are searching for a legislative fix. Democratic leaders have asked Speaker Paul Ryan (R-WI) and Senate Majority Leader Mitch McConnell (R-KY) to bring the Development, Relief, and Education for Alien Minors (DREAM) Act to the floor for a vote, and have suggested they will attempt to attach the bill to other priority items to force leadership’s hand. Though widely championed by progressives, the legislation could face difficulty garnering bipartisan support.

Meanwhile, the Senate HELP committee will be holding a series of hearings to determine the best path forward on creating stability in the individual health insurance markets. Democrats are certain to use this forum to put a spotlight on the administration’s recent decision to slash funding used to promote the Open Enrollment period that starts November 1st. We’ll have an additional update for you later this week on these and other health care-related items.