President Trump today signed into law a major $1.3 trillion omnibus spending bill which funds the federal government through the end of the fiscal year on September 30, 2018. This bill significantly increases both defense and domestic discretionary spending, and includes several important healthcare provisions critical to nurses.
ANA is pleased to note that this spending measure fully funds Title VIII Nurse Workforce Development Programs and includes a $20 million funding increase for such programs. We applaud Congress for recognizing the importance of a nursing workforce that is ready to meet the challenges of our current healthcare environment. ANA also applauds Congress for providing an additional $3 billion to fight the opioid crisis. As providers on the frontlines of this epidemic, nurses witness firsthand the devastation of addiction and overdose. We hope that this combination of workforce and opioid funding will enable the health care system – and nurses in particular – to put an end to this devastating scourge.
Congress also started to show signs of progress on gun violence prevention, as thousands of engaged Americans across the country prepare for this weekend’s March for Our Lives. Congress clarified that the Centers for Disease Control and Prevention (CDC) is permitted to engage in some gun violence prevention research, and laid the groundwork for an improved background check system. That said, much work remains to keep our children and nation safe from these senseless tragedies. Acknowledging the CDC’s authority to study the problem without actually allocating resources carries the same chilling effect on conducting research as an outright ban.
ANA is also very disappointed by Congress’s failure to ensure affordable and accessible healthcare coverage for all Americans. The omnibus spending measure notably did not include a measure or any funding intended to stabilize the individual health insurance markets. Without such market stabilization efforts, individual premiums will continue to skyrocket and many Americans will choose to forgo health insurance coverage altogether, exposing them to physical and financial risks. ANA continues to urge Congress to act toward implementing market stabilization measures.
ANA again applauds Congress for ending (for now) the familiar cycle of lurching from budget crisis to budget crisis with no long-term, bipartisan solutions to outstanding policy issues. While the provisions noted above – nursing workforce, opioids, gun violence prevention – are a start to solving some of these issues, they do not go far enough. We urge Congress to continue to work toward solving these critical policy issues, and to realize that continuing to play politics with the stability of the individual health insurance market hurts vulnerable Americans who rely on affordable and accessible health coverage.
Congress, government agencies, foundations, communities, and health care providers have been developing and implementing policies to turn the tide on the opioid epidemic for years. Nurses are on the frontline and in the trenches treating chronic pain, substance misuse, and mental health issues. Many health related policies and regulations are still ineffective in fixing the opioid epidemic, but we do know that using a criminal justice route to solve a public health problem will not succeed in its intent. But just this week, President Trump called for the death penalty, also known as capital punishment, for “certain drug dealers” in order to curb the opioid epidemic.
The American Nurses Association (ANA) opposes both capital punishment and nurse participation in capital punishment. Capital punishment and penalizing those convicted of certain classes of crimes by killing them violates the most basic human right, the right to life and liberty. The ethical standards of the profession obligates nurses to protect human rights and practice with respect for the inherent dignity, worth, and unique attributes of every. Instead ANA advocates for increasing access to Complementary Alternative Medicine (CAM) and Medication-Assisted Treatment (MAT), access to mental health services, and patient centered education.
The Trump administrations plan also includes a federally backed ad campaign to prevent non-prescribed opioid use. Education needs to extend past prevention measure to include safe use, storage, and disposal. Proper disposal of unused pills ensures that fewer opioids reach unintended persons and markets, and in turn, less misuse of narcotics.
Health care providers, public health officials, and law enforcement need to work together to implement proven policies that help all individuals and communities. Instead of taking a criminal justice path, such as the failed drug policies of the “just say no” campaign, which history has shown to perpetuate public health issues, officials need to take an interdisciplinary approach to address the underlying health, economic, social, and educational causes of drug use in both urban and rural communities. ANA is actively advocating for nurses through advising federal agencies, supporting federal legislation, and connecting members with their representatives to ensure the voices of nurses are heard.
The Trump Administration continues to create uncertainty in the U.S. healthcare system – uncertainty that has led states to take measures which could ultimately result in drastically disparate health outcomes, both across states and populations. In addition to repealing the individual mandate in December 2017’s tax legislation, the administration in the last several months has proposed several rules which could further exacerbate these divides (ANA will submit comment letters on all three of these proposed rules).
- The first of these rules was issued by the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) and would act to expand the ability of employers to offer health insurance coverage through Association Health Plans; ANA submitted a comment letter on this proposed rule on Friday March 2nd. This rule would facilitate the proliferation of insurance coverage that does not cover Essential Health Benefits, and would make it more difficult for older individuals and those with pre-existing conditions to purchase individual health insurance coverage while driving up prices in the federal and state health insurance exchanges.
- The second proposed rule comes from the U.S. Department of Health and Human Services (HHS) Office for Civil Rights and focuses on enforcing statutory conscience rights of healthcare workers – including nurses. ANA strongly supports the fundamental right of nurses and all healthcare workers to listen to their moral and ethical consciences; however, we also believe that this proposed rule as written opens the door for discrimination against marginalized groups, including LGBT individuals, which already experience lower quality health outcomes and would lead to further population health disparities.
- The third proposed rule comes from the U.S Department of Treasury’s Internal Revenue Service, EBSA, and HHS and focuses on expanding the use of short-term, limited-duration insurance. This rule would have an impact similar to that of the Associated Health Plan proposed rule described above.
These rules – in addition to the repeal of the individual mandate – threaten to fracture the national healthcare system framework established under the Affordable Care Act (ACA). This is not the first time this has happened since President Obama signed the ACA into law in 2010 – the King v. Burwell Supreme Court decision in 2012 ensured that not all states would provide the same level of Medicaid coverage, and as a result 17 states still have yet to expand Medicaid. The Trump Administration, however, has accelerated this fracturing, and states are increasingly taking measures to react to these federal policy decisions.
Some states – including California, New York, and Maryland – have seen proposals to pass their own state-level individual mandate, while others such as Oregon have created reinsurance programs to insulate insurance companies from the extremely high costs of covering patients with chronic and complex health conditions – thus helping to keep premium costs down for the overall population.
Other states – bolstered by the Trump Administration’s moves – have pushed the limits of what is allowable under the ACA. While the ACA allows states to experiment with their health systems under Section 1332 waivers, some states are arguably moving beyond what is allowed even under such waivers. Idaho, for instance, recently attempted to allow insurers to sell individual health insurance policies which do not comply with some of the ACA’s requirements, including the elimination of lifetime caps and the coverage of Essential Health Benefits. The Trump Administration, however, informed Idaho that this plan is non-compliant with federal statute and that the sale of such plans would not be allowed.
ANA strongly supports innovation and creative approaches to ensuring comprehensive, affordable healthcare coverage for all Americans. These proposals, however, would likely have the opposite effect by driving up premium prices, pushing individuals in at-risk populations out of the insurance market, and widening population health disparities. ANA reiterates its previously stated support for legislative proposals which shore up the individual health insurance marketplace and reinstate critical cost-sharing reduction payments to help low-income families pay for much-needed primary care and other healthcare services.
Photo: Evan Vucci/Associated Press