Congress reopens the government and reauthorizes CHIP while HHS creates a Conscience and Religious Freedom Division

  

Earlier today the Senate announced a deal for a three week continuing resolution to reopen the government. While this is an important step, ANA continues to advocate for a long-term, bipartisan solution to provide Americans with a greater sense of stability. In particular, we encourage both chambers to find an equitable compromise for the Deferred Action for Childhood Arrivals (DACA) program.

Included in this deal was a six year reauthorization of the Children’s Health Insurance Program (CHIP). It’s been more than 100 days since this vital, bipartisan program, which provides health coverage to 9 million children and pregnant women, was fully funded, and many Americans across the country worried that their family’s health care could run out. Nurses were critical in securing this win and we can’t thank you enough for reaching out to your representatives in Congress demanding a long term solution.

The shutdown and CHIP reauthorization are not the only important issues developing in Washington. Last Thursday, the Department of Health and Human Services announced it was establishing a Conscience and Religious Freedom Division under the Office for Civil Rights. This new division is charged with enforcing current laws that protect nurses and other health professionals who refuse to provide care to which they have moral or legal objections.

While health care professionals are obligated to follow laws and the federal government has the obligation to enforce these laws, both parties have the important responsibility to ensure that all patients receive the care and treatment to which they are entitled. All health care professionals’ first priority should be the quality and equal access of care their patients need. That is one of the reason that several organizations, including the National Women’s Law Center, the American College of Obstetricians and Gynecologists and the Human Rights Campaign, have expressed concerns that this new division could cause increased discrimination among certain groups of patients.

There are also legitimate concerns that this new entity could hinder or even deny some patients the care or treatment options open to them. Far too often vulnerable populations experience discrimination when it comes to their health care. Patients rely on nurses to provide honest and professional medical advice and treatment during the course of care regardless of their own beliefs. It is vital that all patients, regardless of their beliefs, sexual orientation, gender or health care needs know they are receiving the most accurate and timely care.

This issue is extremely important to the nursing profession. In response to this announcement Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA), issued the following statement:

“The American Nurses Association Code of Ethics for Nurses with Interpretive Statements states that a nurse has a duty to care. It also states a nurse is justified in refusing to participate in a particular decision or action that is morally objectionable, so long as it is a conscience-based objection and not one based on personal preference, prejudice, bias, convenience, or arbitrariness. Nurses are obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient. Nurses who decide not to participate on the grounds of conscientious objection must communicate this decision in a timely and appropriate manner, in advance and in time for alternate arrangements to be made for patient care. Nurses should not be discriminated against by employers for exercising a conscience based refusal.

However, we must take care to balance health care professionals’ rights to exercise their conscience with patients’ rights to access a full range of health care services. Discrimination in health care settings remains a grave and widespread problem for many vulnerable populations and contributes to a wide range of health disparities. All patients deserve universal access to high quality care and we must guard against erosion of any civil rights protections in health care that would lead to denied or delayed care.”

Discrimination, prejudice and bias have no place in the American health care system and no patient should have to worry they aren’t getting the timely or medically necessary treatment they need. Nurses will continue to advocate for their patients to prevent discrimination and ensure that all Americans receive the high quality care they are entitled to. As the Department of Health and Human Services moves forward with this undertaking we will continue to monitor not only the implementation of the Conscience and Religious Freedom Division but the activities coming out of it to ensure that patients and health care professionals are protected.

Trump, Congress can’t close deal as shutdown looms

  

 As the federal government appears headed toward its first shutdown since 2013, congressional leadership and Trump administration figures have engaged in an increasingly public back and forth over which side should be held most responsible for the high-stakes stalemate. Major sticking points remain around immigration, specifically Deferred Action for Childhood Arrivals (DACA), as well as the Children’s Health Insurance Program, which has now gone more than three months since its long-term funding expired (and after Congress kicked the can down the road before the holidays late last year).

While the House of Representatives was able to pass a short-term funding bill by a slim margin, Senate Democrats refuse to support any legislation that does not include long-term CHIP funding and a solution on DACA, which the President unilaterally decided to end last year, a move ANA condemned at the time.

While the House spending bill included a long-term funding solution for CHIP, it did not address DACA, and the President rejected a bipartisan immigration deal earlier this week. With 49 Democrats currently serving in the Senate, and any funding bill needing to enjoy filibuster-proof support of 60 votes, Democratic buy-in is necessary to keep the government open.

Additionally, while inclusion of long-term CHIP funding in the House bill is heartening to see, House Republican leaders have had ample opportunity to address CHIP long before this week. Moreover, due in part to the repeal of the individual mandate as part of last year’s tax reform legislation, the Congressional Budget Office (CBO) earlier this month revised its estimate of CHIP’s cost to the federal government and showed that it now stands at $800 million, down from $8.2 billion.

The President, largely via his Twitter feed, has repeatedly attempted to pin responsibility over a potential shutdown on congressional Democrats. Polling released Friday indicates he’s enjoying little success: 48% said they would blame the President and Republicans (who control every branch of government), with just 28% placing the blame on Democrats.

On Friday afternoon, Senate minority leader Chuck Schumer (D-NY) visited the White House to meet with President Trump, a meeting at which Speaker of the House Paul Ryan (R-WI) and Senate majority leader Mitch McConnell (R-KY) were not present. Following the meeting, Schumer indicated that progress was being made but that no agreement had yet been reached; nor was it clear what deal the President could reach with Schumer that would be acceptable to more conservative House Republicans, particularly those in the Freedom Caucus.

Regardless of the outcome, this episode is just the latest reminder for congressional leadership and the administration that a bipartisan, long-term budget is sorely needed, and that any such budget should include input from experts, including America’s nurses. Families who are affected by DACA or reliant on CHIP deserve better than what Washington has so far failed to deliver.

Congress can’t keep kids covered as 2017 comes to a disappointing end

  

Congressional Republicans immediately followed their passage of a tax bill that will have a devastating impact on public health by voting for an irresponsible spending stopgap that needlessly jeopardizes the roughly nine million American children who rely on coverage from the Children’s Health Insurance Program (CHIP). While regrettable, this sequence of events was a fitting conclusion to 2017 on Capitol Hill, where majority lawmakers showed a persistent and troubling desire to limit Americans’ access to health care.

While the stopgap bill passed by the House and Senate will fund CHIP through the end of March 2018, it continues to create reckless uncertainty as state officials who manage the program are forced to run it on a month-to-month basis. Despite the widespread bipartisan support the program has historically enjoyed, congressional leaders proved unable to reach an agreement on the usual five-year long-term spending approval that CHIP has received in the past.

Republicans also chose to punt to 2018 on health marketplace stabilization efforts that are even more urgent in the wake of the tax bill’s passage. While the proposals from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), as well as Susan Collins (R-ME) and Bill Nelson (D-FL) will not mitigate all the damage done by individual mandate repeal, they will help lessen the negative impact from President Trump’s unilateral and dangerous decision to end stabilization funding earlier this fall.

And though both measures would have an objectively positive impact on the health marketplace congressional Republicans seem intent on destroying, it remains unclear whether the measures – together or separately – could garner a majority of support in either chamber, particularly the House of Representatives where more conservative members enjoy increasing influence.

Despite these developments, almost nine million Americans reportedly signed up for coverage during this year’s Open Enrollment period that concluded on December 15, nearly matching last year’s total. This took place despite the administration’s efforts to limit enrollment, by cutting the sign-up period in half and slashing funding for promotional efforts to educate the public. The enrollment figures are a clear sign that Washington’s focus in 2018 must turn away from creating roadblocks to health care, and instead find new ways to help Americans get and stay covered.