When #NursesVote, Washington Changes

  

On Election Day, the old saying couldn’t be more apt: Decisions are made by those who show up. With healthcare reform and other nursing-related issues so prominent this campaign season, it’s more important than ever that Registered Nurses across the country show up on November 6 to ensure their voices are heard and their ballots are counted.

The fact that one in every 45 registered voters is a nurse underscores the impact of our collective voice. During the American Nurses Association’s (ANA) Year of Advocacy, we are working to make it as easy as possible for busy RNs to get out and vote this fall, in an effort to guarantee that elected officials understand that impact firsthand.

At the center of ANA’s 2018 Get Out the Vote (GOTV) efforts is our new #NursesVote Action Center. There you can find everything you need to have your vote count on Election Day, as well as instructions on how to update your information if your voter registration has lapsed.

Not sure if you’re registered? Our Action Center can help there, too, as well as provide information on how to find where your polling place is located, or vote early to accommodate your schedule on November 6. After you enter some basic information, the Action Center will do the rest to equip you to fulfill your civic duty in this dynamic campaign season.

When nurses vote, lawmakers in Washington, DC, and in statehouses across the country listen. Visit ANA’s #NursesVote Action Center today and help us make this the most meaningful election for nurses yet.

States and Trump Administration Push to Roll Back Health Care Gains

  

The Trump administration’s repeated dismissal of some of the most important provisions of the Affordable Care Act (ACA) – such as its protections for individuals with pre-existing conditions and its requirement for insurers to cover Essential Health Benefits – has been evident for some time. Now a Government Accountability Office (GAO) report places much of the blame for the dip in ACA enrollment last year at the feet of the administration.

8.7 million Americans enrolled in health insurance plans offered through the ACA’s individual health insurance marketplace in 2018, a five percent decline from the 9.2 million who enrolled in plans in 2017. The report attributes much of this decline to the administration’s failure to set enrollment targets, reduction in funding for outreach and enrollment, confusing messaging, and chaotic policy decisions – including the decision to end cost-sharing reduction payments.

ANA joined with other patient and provider groups in an attempt to fill some of this gap through its own Open Enrollment advocacy and outreach campaign in late 2017, which resulted in more than 40,000 visits to Healthcare.gov as well as local and national media visibility. GAO recommended that the administration set enrollment targets for 2019 to alleviate this decline, though given the administration’s repeated sabotage of the law – including its work with Congress to try to repeal it – this seems highly unlikely to happen.

Regardless of what happens at the federal level, states are still attempting to implement policies that erode access to quality, affordable health care. Three states (Arkansas, Indiana, and New Hampshire) have implemented CMS-approved 1115 Medicaid waivers that impose work requirements on certain adult Medicaid beneficiaries (Kentucky’s work requirements policy was recently invalidated in federal court). Several other states, such as Ohio, have pending 1115 Medicaid waivers that would allow them to impose work requirements on certain adult Medicaid beneficiaries.

Worryingly, some states such as Mississippi – which hasn’t expanded Medicaid – have also applied for waivers to impose work requirements, which would greatly restrict access to care for some of the most vulnerable Americans. And Tennessee has submitted a waiver request to the administration that would bar Planned Parenthood from participating in its Medicaid program – and in the process prevent hundreds of thousands of Tennessee residents from accessing critical health care services. All of these restrictive proposals, of course, require federal approval, which the Trump administration seems to be strongly inclined to grant.

ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. These recent moves by both the Trump administration and state governments fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services.

Healthcare stands to be a major issue in the 2018 midterm elections – 22 percent of respondents to a June 2018 NBC News/Wall Street Journal poll named healthcare as the most important factor in deciding their vote. These elections in November are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. We urge you to make nursing’s voice heard loud and clear by supporting candidates who align with ANA’s principles for health system transformation and who are proven to be advocates for nurses and their patients!

A bump in the road for APRNs and Patients: The Senate Opioid SUD Legislative Package

  

ANA and other associations representing advanced practice registered nurses (APRNs) have been lobbying for years to make permanent the authority for nurse practitioners (NP) to prescribe medication-assisted treatments (MAT) for opioid-addicted patients and to extend the authority to the other three APRN specialties. The latest Senate package does not include this policy. ANA government affairs staff has been informed there are Senators with “holds” on this package meaning it can’t move forward until there are more negotiations. While we are disappointed the package does not currently include this provision, we still have several more bites at the apple.

The Comprehensive Addiction and Recovery Act of 2016 (Public Law No: 114-198.), commonly referred to as CARA, included a provision that allowed NPs and Physician Assistants (PAs) to take 24 hours of training to prescribe MAT for opioid-addicted patients. (This is referred to as “DATA 2000 waved” or just “DATA waved” authority.) This prescribing authority sunsets in 2021. The reason the prescribing authority is set to expire in 2021 was developed as a budgeting gimmick by Congress to keep the overall projected cost associated with CARA low. This provision was never intended to be a demonstration project – it was because Congress couldn’t find a way to offset the projected cost for permanent prescribing authority.

In June, the U.S. House of Representatives passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (H.R. 6), or the “SUPPORT for Patients and Communities Act” for short. Section 3003 of this bill has an agreed upon compromise version of what we have been lobbying for. It permanently extends the MAT prescribing authority for NPs and PAs and allows the other three APRN specialties the authority for five years. It also instructs the Department of Health and Human Services to conduct a study on the efficacy of prescribing MAT, and possible associated narcotics diversion issues, on all providers, including physicians. This would give the opportunity to for us to have data showing how important it is to have more access points for patients and that APRNs are just as qualified to treat opioid substance use disorder as physicians.

While this latest development is disappointing, it’s not over. Both the House and the Senate need to come together to pass identical legislation before any of this is signed into law. We have a large coalition of bipartisan legislators in the House and Senate who all agree that this is good policy. The current disagreement is over how to offset the projected cost estimated by the Congressional Budget Office (CBO). The ANA, along with the other associations representing APRNs, are on top of this issue and will be fighting for the inclusion of Section 3003 into any final package. It’s not over.

Further Reading

The CBO’s scoring rules for determining the cost of legislation are very complicated, convoluted, and don’t always make logical sense. The U.S. Drug Enforcement Agency (DEA) isn’t held to CBO’s scoring rules, and in January 2018, published an economic impact study on CARA. They found that from when the DATA 2000 waiver began through February 21, 2017, there were 33,663 DATA-waived physicians compared to 1,247,716 total physicians. Since February 2017, when NPs could first obtain the DATA 2000 waiver until May 5, 2018, 5,649 NPs have obtained a DATA 2000 waiver compared to 248,000 total NPs. That means proportionately, in less than two years, NPs have received almost as many waivers as physicians received in 17 years (2.3 percent of NPs v. 2.7 percent of physicians).

The DEA estimates that the total economic burden of the opioid epidemic is $75.7 billion, which amounts to $41,000 per patient. They also estimate that the net economic benefit of authorizing NPs and PAs to provide MAT, primarily due to increased labor productivity and decreased healthcare and legal costs, will be $640-729 million dollars over five years. Based on the DEA’s estimate that 5,235 NPs and PAs would obtain the waiver, this amounts to an average costs savings of approximately $122,254-139,255 for every NP or PA obtaining the waiver.

ANA strongly believes that extending the prescribing authority to the other APRN specialties will only further the success of this policy. ANA advocates for all RNs and APRNs to practice to the full extent of their education and practice authority, allowing individualized treatment plans for all patients and increased access to health care services, including MAT.

For additional information or comments, please contact Sam Hewitt, ANA’s senior associate director for federal government relations at Samuel.hewitt@ana.org