Capitol Beat

Each spring starts the annual appropriations process in the U.S. House and Senate. Both the U.S. House and Senate Appropriations Committees have 12 subcommittees that are tasked with compiling legislative bills that provides funding for operations, personnel, equipment, and activities.  

ANA monitors the entire appropriations process and advocates for nursing priorities to be inserted into the Labor Health and Human Services (LHHS-ED) legislation. The LHHS-ED Subcommittee has jurisdiction under the following: the U.S. Department of Education; the U.S. Department of Health and Human Services; the U.S. Department of Labor; and many related agencies.

The House LHHS-ED released its Fiscal Year (FY) 2021 Report and the Full Committee Markup is this week. Upon reviewing the information, ANA was pleased to see several items, including:

• $10 million increase to Title VIII Nursing Workforce Development Programs for a total of almost $270 million. 
• $1.454 million increase to National Institute of Nursing Research for a total of $170.567 million in FY 2021.  
• In January 2017, the Occupational Safety and Health Administration (OSHA) committed to developing and issuing a workplace violence standard, but the agency has not yet completed a required small business review, and there is no estimated date for the issuance of a proposed or final rule. The Committee believes issuing a workplace violence standard to protect workers in health care and social services should be a top priority for the Department of Labor. It has required for OSHA to report to Congress on its progress within 90 days of passage of the appropriations legislation.
• The Committee provides $5 million to make grants to establish or expand optional community-based nurse practitioner fellowship programs that are accredited for practicing postgraduate nurse practitioner in primary care or behavioral health.  
• The Committee included $41.7 million for the Mental and Substance Use Disorder Workforce Training Demonstration program – a $15 million increase. This program supports training for medical residents and fellows in psychiatry and addiction medicine, nurse practitioners, physician assistants, and others, to provide SUD treatment in underserved communities. It includes an additional $15,000,000 for new grants to expand the number of nurse practitioners, physician assistants, health service psychologists, and social workers trained to provide mental and substance use disorder services in underserved community-based settings 
• The Committee asked the Substance Abuse and Mental Health Services Administration (SAMHSA), with the Department of Education, develop a standard for providing all school-based teachers and nurses with suicide prevention training to treat mental health challenges experienced by younger Americans.  
• Provides funding to strengthen Historically Black Colleges and Universities (HBCUs). This program provides grants to specified colleges and universities making a substantial contribution to graduate education opportunities at the Master’s level in mathematics, engineering, the physical or natural sciences, computer science, information technology, nursing, allied health, or other scientific disciplines.  
• $2 million dollar increase is included for the Minority Fellowship Program (MFP), for a total of $16.169 million in both the Center for Mental Heath Services and the Center for Substance Abuse Treatment. The MFP aims to improve behavioral health care outcomes for racial and ethnic populations by growing the number of racial and ethnic minorities in the nation’s behavioral health workforce. The program also seeks to train and better prepare behavioral health practitioners to more effectively treat and serve people of different cultural and ethnic backgrounds.

As appropriations work continues in the U.S. House and Senate this summer, ANA Government Affairs staff will continue to monitor its progress and will keep you updated. 

June has traditionally been celebrated in the United States as LGBTQ+ Pride month. This annual celebration commemorates the Stonewall riots, which began at the Stonewall Inn in Greenwich Village in New York City on June 28, 1969 and sparked the modern LGBTQ+ rights movement. Like most else in 2020, this year’s Pride celebrations have taken on a different feel due to the ongoing COVID-19 pandemic, as well as the nationwide protests demanding racial and social justice in the wake of George Floyd’s murder in Minneapolis on May 25 (ANA adopted a Resolution on Racial Justice for Communities of Color on June 20). It is important to note that the LGBTQ+ rights movement and the racial justice movement are intertwined in complex ways (the civil rights movement is rightly credited for leading the way for the LGBTQ+ rights movement) and that many of this year’s Pride observances have occurred in support of and in solidarity with these nationwide protests.

This year’s Pride month also brought an unexpected bright spot for the LGBTQ+ movement. On June 15, the U.S. Supreme Court ruled in a 6-3 decision that Title VII of the Civil Rights Act of 1964 protects LGBTQ+ individuals from discrimination in the workplace; individuals can no longer legally be fired from their jobs due to their sexual orientation or the fact that they are transgender. This Supreme Court decision was a long-sought victory for the LGBTQ+ movement and signifies the hard-fought progress that has been made over the course of the past 50+ years.

Despite this progress, however, the LGBTQ+ community still faces significant barriers, particularly with respect to access to comprehensive healthcare. One need look no further than the administration’s June 12 finalization of a rule that rolls back healthcare protections for transgender individuals under Section 1557 of the Affordable Care Act. The administration finalized this rule despite the fact that LGBTQ+ populations experience a significant rate of discrimination in healthcare settings, and experience increased negative health outcomes compared with the overall population. The reasons for this are complex and varied, but many stem from a pattern of societal stigma and discrimination exacerbated by the historical designation of homosexuality as a mental disorder, the onset of the HIV/AIDS epidemic, religious prejudice with respect to homosexuality^, and government policy such as Don’t Ask, Don’t Tell.

Negative health outcomes that disproportionately impact LGBTQ+ individuals include: increased instances of mood and anxiety disorders and depression, and an elevated risk for suicidal ideation and attempts; higher rates of smoking, alcohol use, and substance use; higher instances of stigma, discrimination, and violence; less frequent use of preventive health services; and increased levels of homelessness among LGBTQ+ youth. Men who have sex with men (MSM) and transgender women also experience significantly higher rates of HIV/AIDS infections, complications, and deaths; this burden falls particularly heavily on young, African-American MSM and transgender women. As noted above, this disease burden is itself known to contribute to discrimination against LGBTQ+ individuals. Transgender individuals also face particularly severe discrimination in healthcare settings.

Although Pride month draws to a close today, it is important to celebrate LGBTQ+ communities year-round and to remember that these communities experience unique health disparities 365 days a year. As the Code of Ethics for Nurses states, “The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” Nurses have often been on the frontlines of providing compassionate care to LGBTQ+ individuals – most notably at the outset of the HIV/AIDS crisis – and will no doubt remain in the vanguard of that care to ensure that these disparities are eliminated.

For additional resources on providing care and other health resources to LGBTQ+ individuals, please explore this guide from Drugwatch: https://www.drugwatch.com/health/lgbtq/

Photo Credit: Matt Charnock/SFist