It is officially tax season on Capitol Hill, with the House of Representatives currently in the midst of marking up their tax reform proposal, Tax Cuts and Jobs Act. They contend that this tax reform bill will spur economic growth and cut taxes for the middle class. At ANA, we want to focus on a few provisions in this bill that could impact nurses and healthcare consumers. These provisions are as follows:
- Repeal of Medical Expense Deduction: Repeal of this provision would make it more difficult for low- and middle-income families to afford medical care. The current law allows a taxpayer to claim an itemized deduction for out-of-pocket medical expenses for themselves, a spouse, or a dependent. This is allowed only to the extent that the expenses exceed ten percent of the taxpayer’s adjusted gross income. This tax deduction is critical because it allows low- and middle-income families and those with complex and costly medical conditions to afford treatment without being financially crushed.
- Repeal of the Deduction for Interest Payments on Qualified Education Loans and Repeal of the Deduction for Tuition and Related Expenses: Current law allows an individual to claim a deduction for qualified tuition and related expenses incurred or for interest payments on qualified education loans for qualified higher education expenses of the taxpayer, their spouse, or dependents (a taxpayer can only claim one of these deductions). The repeal of these deductions could make it more difficult for nursing students and recent nursing graduates to pay off their student loans or could discourage individuals from nursing school. This is important considering the ongoing push for registered nurses to receive a BSN degree.
- Repeal of Credit for Expenditures to Provide Access to Disabled Individuals: Current law allows small-business taxpayers to claim a 50% credit per year for expenditures of between $250 and $10,250 for providing access to disabled individuals. The repeal of this tax credit could make it more likely that a small business would choose to defer the purchase of improvements, which would help disabled individuals access the business.
Senate Republicans have yet to release their tax plan, but it is expected to differ considerably from the House version. It is unclear whether the Senate version will include the tax code changes listed above. ANA will continue to monitor these developments and their potential impact on nurses and healthcare consumers.
Finally, even though the last Congressional attempt to repeal and replace the Affordable Care Act died in the Senate in late September, Congress is still considering a few other pieces of key healthcare legislation. Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) have not given up on their bipartisan attempt to strengthen the nation’s individual insurance system, though this effort has been put on the back burner now that Congress is in full tax mode.
Congress is also now in the process of reconciling the House and Senate versions of bills which would reauthorize funding for the Children’s Health Insurance Program (CHIP); funding re-authorization for this program expired on September 30th, though states have enough funding to pay their CHIP bills through the end of 2017 (with the caveat that the end of 2017 is fast approaching). Congress must pass CHIP legislation quickly in order for states to be able to fund their CHIP programs in 2018. ANA will continue to keep you updated on any healthcare developments on the Hill.
This guest post is by Alex Wubbels, RN.
Back in late July, I was arrested for following my hospital’s policy and protecting an unconscious patient who could not consent to a blood draw. I was wrongfully seized by force in the middle of the emergency department.
Even though my story made national news, most do not. Did you hear about the emergency department nurse who was stabbed by a patient in Massachusetts? Or the Arkansas nurse who was pushed down a flight of stairs? Or the two nurses in Illinois who were taken hostage (one of whom was beaten and raped)? Sadly, the list goes on and on. With one out of every four nurses reporting that they’ve been assaulted at work, you’ve either experienced this personally or know a colleague who has been abused.
The fact that we are more likely to experience violence on the job than prison guards or police officers is unacceptable, and we must work together to #EndNurseAbuse.
As an ANA member, I was fortunate to have the support of my organization, community, and a tribe of fellow nurses during this difficult time.
I truly believe that what happened to me can lead to positive change in our profession. That’s why I decided to speak out: to stop this abuse from happening to others. I’ve teamed up with ANA to ask you to sign our pledge and stop this culture of violence. I am committed to this goal so we are not put in situations where we have to fear for our safety, or have to choose between our jobs and our licenses.
By adding your name, you’re saying you support zero tolerance when it comes to violence against nurses; that you’ll report abuse whenever you safely can; and that you’ll share with others asking them to sign too.
Please join me by adding your name and taking the pledge.
Alex Wubbels, RN
Nurses see firsthand the devastating effects of the opioid crisis on their patients, communities, and perhaps even themselves or their families. ANA members have been forthcoming in their stories about access, treatment, and the pain they have dealt with each and every day working to fight this crisis. That’s why many are cheering the Trump administration’s work on the crisis, with the First Lady leading the administrative efforts for declaring it a national emergency, as nurses team with emergency responders, policymakers, law enforcement, and other stakeholders in the fight to turn the tide on the devastating effects of opioid abuse in local communities.
The statistics are sobering: 64,000 Americans lost their lives to drug misuse in 2016. The number of people misusing prescription opioids in 2015 is even more alarming, 12.5 million people. There is hope—however, a comprehensive approach is needed from the ground level all the way up through state and federal governments in order to address the crisis. ANA supports nurses who are facing this crisis head on through targeted continuing education, support of federal legislation that supports nurses to practice to the full extent of their training and education, and supporting/advocating for policies that allow APRNs to prescribe medication assisted therapy, which has proven effective in stemming substance use disorder.
Within the walls of Congress, there are currently over a hundred of bills aimed at addressing varying aspects of the opioid crisis. Two in particular are at top of ANAs priorities for opioid legislation. In the Senate ANA has signed on to support is Combating the Opioid Epidemic Act, introduced by Bob Casey (D-PA) and Ed Markey (D-MA). In the House, Reps. Paul Tonko (D-NY) and Ben Ray Luján (D-NM) introduced H.R. 3692, the Addiction Treatment Access Improvement Act with support from ANA and our nursing partners. The latter bill aims to build on the Comprehensive Addiction and Recovery Act in order to allow clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists to practice to the full extent of their training and education in prescribing buprenorphine.
Buprenorphine, however, is just one piece of the puzzle in treating opioid dependency. As with all medications used in Medication Assisted Therapies (MAT), it is just one part of a comprehensive treatment plan that includes addressing the underlying issues through counseling and participation in social support programs. Nurses play a primary role in comprehensive treatment plans and will continue to be integral in treating the most vulnerable populations throughout the country. ANA urges you to continue to voice your support in this fight by contacting your representatives and asking them to support H.R. 3692.