Photo: Susan Walsh, AP
Photo: Susan Walsh, AP

Following a dramatic late night vote that saw Senators reject Majority Leader Mitch McConnell’s (R-KY) so-called “skinny” bill repealing the Affordable Care Act (ACA), lawmakers from both sides of the aisle are publicly calling for a fresh approach to reforming health care that embraces bipartisanship and transparency, and actively seeks solutions from experts who know health care best, including America’s 3.6 million nurses.

Sens. Susan Collins (R-ME), John McCain (R-AZ), and Lisa Murkowski (R-AK) joined with all 48 Senate Democrats to vote against legislation that would’ve stripped the individual and employer mandates introduced by the ACA, among other harmful provisions, and which was intended to pave the way for a conference committee of representatives from both chambers, who would be responsible for crafting a bill that both could pass.

But House Speaker Paul Ryan (R-WI) seemed unwilling to guarantee that his chamber wouldn’t just skip the conference process and pass “skinny” repeal itself, prompting McCain and others to publicly withhold their support early yesterday evening. While subsequent assurances from Ryan and Vice President Mike Pence were enough to win back the support of some of those Senators, McCain ultimately came to the same conclusion as his colleagues from Alaska and Maine, and voted no.

The nursing community showed up like never before in this fight, driving thousands of calls and e-mails to Congress. Hundreds traveled all the way to Washington, DC last month to deliver our message face-to-face with our legislators: The only way our country can truly reform our healthcare system is by working together. No more closed doors. No more dead-of-night deals. No more decisions made without a single nurse consulted.

While this victory is heartening, we know there are those who will continue pushing lawmakers and the administration to undermine our health system and harm those who have gained coverage as a result of the ACA. If you haven’t yet, please join our RNAction community to learn more and get the latest updates on how you can help ensure that our representatives in Washington continue to protect our care and put patients first.

Congress and White House Continue to Threaten Americans’ Healthcare


The healthcare of millions of Americans is currently under threat from multiple branches of government. The non-partisan Congressional Budget Office (CBO) on July 13 released its analysis of President Trump’s proposed FY 2018 federal budget; it continues to threaten the healthcare access of the most at-risk populations of Americans. President Trump’s proposed cuts to Medicaid would result in a $610 billion reduction in Medicaid spending by 2027. This number presumably does not include the additional potential cuts to Medicaid – such as the Better Care Reconciliation Act of 2017 (BCRA) repeal of Medicaid expansion – included in the anticipated $1.25 trillion in spending reductions by 2027 associated with the repeal and replacement of the Affordable Care Act. The Trump budget would severely impact vulnerable populations’ access to vital health care services. These vulnerable populations include children and adults with disabilities, low-income elderly individuals, individuals with chronic conditions, individuals with mental health conditions and substance use disorders, and individuals who need long-term supports, such as home and community-based services and skilled nursing facilities. Medicaid is a critical source of funding for these services and it has broad public support. Such enormous reductions in Medicaid spending would inevitably force states to make tough decisions as to which services to provide to which of these vulnerable populations, ripping away from millions of Americans their only source of healthcare coverage.

Congress, meanwhile, has its own plans for reducing Americans’ access to critical healthcare services. According to the CBO, the Senate’s BCRA would also reduce Medicaid spending dramatically – by $756 billion through 2026. The plan would roll back Medicaid expansion and would create a per-capita cap on the amount of federal Medicaid funding states receive, limiting the amount of Medicaid funding available to states even beyond 2026. These reductions would impact vulnerable populations in a way similar to those under President Trump’s budget. Furthermore, the BCRA would reduce subsidies to pay for individual health insurance coverage by $396 billion by 2026. These changes would leave an additional 22 million Americans without healthcare coverage by 2026. The numbers are even worse for a straight repeal of the Affordable Care Act (ACA), which the CBO estimates would leave 32 million more American uninsured and cause insurance premiums to double through 2026. Meanwhile, the Republican Study Committee – the House Republicans’ conservative policy making arm – has released its budget priorities for the FY 2018 budget. These include a complete repeal of the ACA, a conversion of Medicaid into a block grant or per-capita cap program (see ANA’s policy primers on Medicaid block grants here), and phases in an increase in the Medicare eligibility age.

These developments are bad enough on their own. But they have also overshadowed the fact that the Children’s Health Insurance Program (CHIP), which provides healthcare coverage to 8 million American children, is up for reauthorization this year. If CHIP is not reauthorized by September, federal CHIP funds will not be available to states and current funds would run out within a year, thus putting healthcare access for those 8 million children at risk. CHIP reauthorization has been overlooked in the battles over healthcare reform in the House and Senate, and only one hearing on the subject has been held in either house during this Congress.

The Senate is still in the process of deliberating healthcare reform and the dismantling of the ACA. All of these healthcare reform proposals fly in the face of ANA’s 4 core principles of health system transformation and place our nation’s most vulnerable populations at risk of losing vital healthcare services. While the prospects for any bill to pass still look dim, ANA urges you to keep the pressure on your senators and representatives to ensure that they know that nurses do not support these reform efforts. Contact your elected officials today to let your voice be heard!

What No One Tells You About Torture


Prisoner being punished with cruel interrogation technique of waterboarding

Physical or mental torture against any person is never appropriate.  Torture is ineffective, unethical, and harmful. 

The United Nations (UN) Human Rights Office of the High Commissioner defines torture as “any act by which severe pain or suffering, whether physical or  mental,  is intentionally inflicted on  a person, for such purposes as obtaining from him or a third person information, or a confession, punishing him for an act he or a third person, has committed, or suspected of having committed, or intimidating or coercing him or third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by, or at the instigation of, or with the consent, or acquiescence of, a public official, or other person, acting in an official capacity.  It does not include pain or suffering arising only from, inherent and incidental to lawful sanctions.”

Why Does Torture Matter to Nurses? 

Nurses, as leaders, have the power to effectuate a positive movement in social justice and advocate for the health, welfare, and life of all persons, including persons subject to torture.  Nursing has a professional ethical obligation to care for all people.  The Code of Ethics for Nurses with Interpretive Statements holds, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”  It is not within the role of the nurse to judge an individual’s actions or to allow the actions of others to negatively influence the delivery of care.  Nursing care must be universal and delivered with compassion, comfort, skill, and competence that is unwavering for every person regardless of their actions accused or convicted.

Torture is inhuman, degrading, and contrary to the professional ethical obligations of nurses.  Nurses must act to minimize patient suffering and provide healing care.  The Code obligates nurses to always stress human rights protection and advocate for vulnerable populations, including refugees, prisoners, or those who are subjected to torture.  Torture is not limited to just the United States, but is widespread internationally.

In 2012, the International Council of Nurses (ICN) adopted a position supporting the UN Declaration of Human Rights and strongly affirming that “nurses should play no voluntary role in any deliberate infliction of physical and mental suffering”…  “To do otherwise is a clear violation of nursing’s ethical code of practice.”  ICN further obligates nurses all over the world to “provide the highest level of possible care to victims of torture and other forms of cruel, degrading, and inhumane treatment, and should speak up against and oppose any deliberate infliction of pain and suffering.”

In support of the ICN position, the American Nurses Association position statement on Capital Punishment and Nurses’ Participation in Capital Punishment states that, “The ethical standards of the nursing profession require that all members of the profession refuse to use their professional skills and capabilities to kill, torture, or degrade another human being.  In order to retain professional dignity and ethical stature, the nursing profession as a whole must agree not to do it.”

Nurses should not participate in torture and any allegations of torture should be investigated transparently to assure that human rights are being protected and valued.  The long-lasting physical, mental, and psychological effects of torture on an individual diminish the health and well-being of patients, families, communities, and the population as a whole.  When nurses are asked to participate in torture or inhuman procedures or treatment, we must adamantly refuse.  Nurses must stand up for patients and advocate for the health safety, welfare, and human rights or all patients, families, and communities.

Nursing has a contract with society to compassionately care for all patients, to protect the rights of all persons and positively influence the health of patients.  Torture is contrary to this societal contract and is never justified.  We encourage you to sign the Health Professionals’ Pledge Against Torture as a sign of solidarity against degrading, inhuman, inappropriate, and unethical actions against humans.  The pledge against torture from the Physicians For Human Rights also serves as declaration of support for health professionals who resist orders to torture or inflict harm.  We stand with our health professional colleagues in support of this pledge and we encourage you not only to sign the pledge, but to continuously keep human rights at the forefront of your practice and provide universal, unwavering, compassionate care to all persons.