Author: ANA Capitol Beat

Congress Passes Bipartisan Spending Measure with Funding for Critical Health Programs

  

Following a brief, overnight government shutdown, President Trump this morning signed a spending measure and continuing resolution which reopens the government and provides funding through March 23rd while setting broad spending levels through FY 2019. The measure provides roughly $500 billion in additional funding over the next two years, including roughly $140 billion in additional non-defense domestic spending, a similar increase in defense spending, and roughly $90 billion in federal relief funding for Puerto Rico, the U.S. Virgin Islands, Texas, and Florida, which were pummeled by devastating hurricanes last summer, and for those impacted by the California wildfires. The bill also waives the debt ceiling until March 1, 2019.

Crucially, the spending bill provides additional funding for some of the nation’s most important public health programs. It provides $7 billion in funding for the nation’s 2,600 community health centers, which provided care to 26.5 million Americans in 2016; this was a critical need and the $7 billion in this bill represents roughly 2 years of federal funding for the nation’s centers.

The spending measure also extends the Children’s Health Insurance Program (CHIP) for another 4 years, meaning that the program will now be fully funded at the federal level for 10 years. CHIP provides healthcare coverage for roughly nine million American children and is a critical provider of healthcare services. The measure also provides an additional $2 billion in funding to the Department of Veterans’ Affairs to better manage their health system and prevents automatic cuts to Medicare and Medicaid, while eliminating the Independent Payment Advisory Board (IPAB). The measure critically provides $6 billion in funding over the next two FYs to fight the opioid epidemic.

With a large portion of the nation’s fiscal policy taken care of, the House and Senate have now cleared their plates to work on a solution to the Deferred Action for Childhood Arrivals Program, better known as DACA. The Trump administration plans on ending the DACA Program on March 5th, giving Congress roughly four weeks to come up with a solution to shield hundreds of thousands of young immigrants from deportation. ANA supports the DACA program and urges the House and Senate to quickly come to an agreement to keep these young Americans in the country. The Senate has already taken up a measure this morning to begin debate on the fate of DACA; ANA will continue to monitor this important issue.

We applaud Congress for coming to a bipartisan, long-term spending deal which ensures that several of the nation’s most important healthcare programs receive long-term funding. CHIP, the nation’s community health centers, and the VA all provide critical healthcare access to some of the nation’s most vulnerable populations, and Congress should be commended for recognizing their importance.

ANA also applauds Congress for providing additional funding to areas hit hard by this summer’s devastating hurricanes and by the wildfires in California; the American Nurses Foundation teamed with the Texas Nurses Association in August to raise donations for victims, and numerous nurses went down to Texas, Florida, and the Caribbean to help out. The spending measure signed into law this morning, however, only provides funding for the government through March 23rd; until then, members of Congress will continue to work to hammer out appropriations for federal agencies and programs for the remainder of FY 2018 and FY 2019. We strongly urge you to make your voices heard and let your member of Congress know that funding for the nation’s healthcare programs is critical to the overall health of the nation.

Photo Credit: Tom Brenner/The New York Times

Congress reopens the government and reauthorizes CHIP while HHS creates a Conscience and Religious Freedom Division

  

Earlier today the Senate announced a deal for a three week continuing resolution to reopen the government. While this is an important step, ANA continues to advocate for a long-term, bipartisan solution to provide Americans with a greater sense of stability. In particular, we encourage both chambers to find an equitable compromise for the Deferred Action for Childhood Arrivals (DACA) program.

Included in this deal was a six year reauthorization of the Children’s Health Insurance Program (CHIP). It’s been more than 100 days since this vital, bipartisan program, which provides health coverage to 9 million children and pregnant women, was fully funded, and many Americans across the country worried that their family’s health care could run out. Nurses were critical in securing this win and we can’t thank you enough for reaching out to your representatives in Congress demanding a long term solution.

The shutdown and CHIP reauthorization are not the only important issues developing in Washington. Last Thursday, the Department of Health and Human Services announced it was establishing a Conscience and Religious Freedom Division under the Office for Civil Rights. This new division is charged with enforcing current laws that protect nurses and other health professionals who refuse to provide care to which they have moral or legal objections.

While health care professionals are obligated to follow laws and the federal government has the obligation to enforce these laws, both parties have the important responsibility to ensure that all patients receive the care and treatment to which they are entitled. All health care professionals’ first priority should be the quality and equal access of care their patients need. That is one of the reason that several organizations, including the National Women’s Law Center, the American College of Obstetricians and Gynecologists and the Human Rights Campaign, have expressed concerns that this new division could cause increased discrimination among certain groups of patients.

There are also legitimate concerns that this new entity could hinder or even deny some patients the care or treatment options open to them. Far too often vulnerable populations experience discrimination when it comes to their health care. Patients rely on nurses to provide honest and professional medical advice and treatment during the course of care regardless of their own beliefs. It is vital that all patients, regardless of their beliefs, sexual orientation, gender or health care needs know they are receiving the most accurate and timely care.

This issue is extremely important to the nursing profession. In response to this announcement Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA), issued the following statement:

“The American Nurses Association Code of Ethics for Nurses with Interpretive Statements states that a nurse has a duty to care. It also states a nurse is justified in refusing to participate in a particular decision or action that is morally objectionable, so long as it is a conscience-based objection and not one based on personal preference, prejudice, bias, convenience, or arbitrariness. Nurses are obliged to provide for patient safety, to avoid patient abandonment, and to withdraw only when assured that nursing care is available to the patient. Nurses who decide not to participate on the grounds of conscientious objection must communicate this decision in a timely and appropriate manner, in advance and in time for alternate arrangements to be made for patient care. Nurses should not be discriminated against by employers for exercising a conscience based refusal.

However, we must take care to balance health care professionals’ rights to exercise their conscience with patients’ rights to access a full range of health care services. Discrimination in health care settings remains a grave and widespread problem for many vulnerable populations and contributes to a wide range of health disparities. All patients deserve universal access to high quality care and we must guard against erosion of any civil rights protections in health care that would lead to denied or delayed care.”

Discrimination, prejudice and bias have no place in the American health care system and no patient should have to worry they aren’t getting the timely or medically necessary treatment they need. Nurses will continue to advocate for their patients to prevent discrimination and ensure that all Americans receive the high quality care they are entitled to. As the Department of Health and Human Services moves forward with this undertaking we will continue to monitor not only the implementation of the Conscience and Religious Freedom Division but the activities coming out of it to ensure that patients and health care professionals are protected.

Trump Administration Continues to Undermine Healthcare for Low-Income Americans

  

The Trump Administration has picked up in 2018 where it left off in 2017 by dealing two more blows to the American health care system. The Department of Labor (DOL) on January 5th published a proposed rule which would expand the ability of groups of employers to create Association Health Plans (AHPs), while today the Centers for Medicare & Medicaid Services (CMS) sent a letter to state Medicaid directors indicating support for states to implement work requirements for “able-bodied” adult Medicaid beneficiaries. These moves threaten to restrict access to critical and comprehensive healthcare services for low-income Americans, even as the healthcare coverage of 9 million American children hangs in the balance as Congress continues to drag its feet on a long-term re-authorization of the Children’s Health Insurance Program (visit ANA’s CHIP action page here).

Association Health Plans

As I wrote in a blog post in October, AHPs currently exist and are used primarily by small businesses to purchase group health coverage, but are regulated under the provisions of the Affordable Care Act (ACA) in the same way as coverage purchased on the individual health insurance market. DOL’s proposed rule seeks to make it easier for employers to create AHPs by:  1) allowing AHPs to exist for the sole purpose of offering healthcare coverage and 2) broadening the definition of “commonality of interest” to allow for larger AHPs. This would in effect treat AHPs as large group health insurance plans and allow coverage under AHPs to be sold across state lines under certain circumstances.

Expanding the use of AHPs in this way exempts them from important provisions covered under the ACA. As a reminder, the ACA includes provisions on insurance plans sold on the individual market which:

  • Require plans to cover 10 Essential Health Benefits including reproductive and maternal health services and preventive services;
  • Forbid insurers from charging more to individuals due to pre-existing conditions;
  • Limit the amount insurance companies can charge to older individuals based on age.

While DOL notes that a non-discrimination provision within the proposed rule would prevent denying coverage on the basis of pre-existing conditions, AHPs could still select for younger, healthier individuals in other ways and could still charge higher premiums for older individuals, potentially leaving these individuals (who are statistically likely to be sicker) without a coverage option.

Furthermore, these insurance plans are ripe for instances of fraud, abuse, and insolvency. The Government Accountability Office (GAO) in 1992 issued a report which slammed similar small business insurance arrangements and noted that they left hundreds of thousands of enrollees with millions of dollars in unpaid claims, while widely failing to meet state insurance laws and regulations. The GAO report found that some plans tried to duck state insurance regulations entirely. This type of Wild West approach to insurance coverage does not offer the comprehensive level of coverage at a low price that the Trump administration claims. Based on the provisions of this proposed rule, we also expect several lawsuits to challenge this based on the legality under current federal law and on the insurance across state lines aspect.

Work Requirements for Able-Bodied Adult Medicaid Beneficiaries

CMS sent a letter on January 11th to state Medicaid directors announcing its support for states to implement waivers introducing work requirements for non-elderly, non-pregnant adult beneficiaries who are eligible for Medicaid on a basis other than disability. CMS bases its support for work requirements on what it describes as the health benefits of community engagement, including work and work promotion.

This latest attempt by the Trump Administration to restrict Medicaid eligibility is, however, nothing more than a straw man argument. Medicaid expansion ipso facto provides healthcare coverage to working, low-income Americans. According to a December 2017 Kaiser Family Foundation issue brief, roughly 6 in 10 of the 22 million non-disabled adults receiving Medicaid benefits are employed either full- or part-time, while 8 in10 of these adults live in a working family. Most of these individuals work either for small firms or in low-paying industries which do not offer healthcare coverage and thus rely on Medicaid for such.

Further, among those adults who are not working, most report a major barrier to employment such as illness, disability, or care-giving duties. According to the same Kaiser issue brief, Medicaid expansion has not negatively impacted labor market participation; in fact, some research demonstrates that Medicaid coverage supports work.

As such, Medicaid work requirements would likely have little to no positive impact on employment and could even negatively impact both access to healthcare and employment prospects for these Medicaid beneficiaries. From an empirical standpoint, the basis for imposing work requirements on Medicaid beneficiaries seems to stem less from a desire to assist low-income Americans to access critical healthcare services while simultaneously supporting employment, but rather from a preconceived notion as to the characteristics of the individuals who benefit from Medicaid.

The American Nurses Association opposes any action – legislative or executive – which threatens the ability of Americans to access and receive high quality healthcare. This is particularly true when it comes to the most vulnerable Americans. If 2017 showed us anything, it is that this administration is more concerned with scoring political points and reversing gains made in healthcare than it is about actually ensuring high quality healthcare coverage for all Americans; this seems to be the modus operandi in 2018 as well.

We urge the Administration and Congress to work toward finalizing a long-term Children’s Health Insurance Program (CHIP) re-authorization, toward a market stabilization package including cost-sharing reduction payment funding, and toward strengthening the existing healthcare system – which has resulted in coverage for tens of millions more Americans since 2014 – and put an end to these attempts to sabotage Americans’ healthcare for political gain. ANA is committed to working with Congress and the Administration on legislation and regulations which align with our four core principles of health system transformation. These moves, however, represent a major step backward from achieving those principles.