Courts Block Rules That Would Restrict Women’s Access to Reproductive Health Care Services

  

Federal courts this week blocked two Interim Final Rules (IFRs) from the U.S. Department of Health and Human Services (HHS) that would have significantly expanded the ability of employers to deny coverage of contraceptives for female employees on the basis of religious or moral objections.

On January 14th, the U.S. District Court for the Eastern District of Pennsylvania issued an order granting the motion for a preliminary nationwide injunction blocking the implementation of the two IFRs from HHS that would have expanded the ability of employers to cite moral and religious objections in seeking exemptions from the Affordable Care Act’s (ACA) contraceptive mandate. That mandate requires all employers that provide employer-sponsored insurance for their employees to cover contraceptives, with narrow exemptions (e.g., religious entities and closely held for-profit corporations).

The Pennsylvania ruling followed a January 13th ruling from the U.S. District Court for the Northern District of California also blocking the implementation of these two IFRs in the 13 plaintiff states in that lawsuit (California, Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, New York, North Carolina, Rhode Island, Vermont, Virginia, Washington), plus the District of Columbia; the judge in the Northern District of California prominently cited ANA’s amicus curiae brief in his order granting the motion for a preliminary injunction.

These IFRs would be particularly damaging given the administration’s proposed regulatory changes to Title X funding, which provides grants for critical family planning services for millions of Americans, particularly low-income women. HHS itself notes in its analysis of the blocked IFRs that they would result in over 125,000 more women relying on Title X programs for reproductive health care services, even as the administration has taken steps that would restrict the ability of Title X programs to provide those services.

These injunctions block HHS from implementing the two IFRs, which were supposed to go into effect on January 14th; the narrower Obama-era exemption policy remains in place during the injunction. It is worth noting that two nearly identical IFRs were also blocked in the same district courts in December 2017. Experts widely expect the defendants in these cases to appeal to the U.S. Courts of Appeals in the Third Circuit and the Ninth Circuit, respectively.

ANA firmly believes in universal access to comprehensive and affordable health care services for all Americans. Access to basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams is critical to the overall well-being of women of all ages and is an essential health benefit. ANA will continue to advocate for universal access to quality, affordable, and accessible health care services, including basic, preventive reproductive health care services, for all Americans.

White House Report Promotes Full Practice Authority for RNs and APRNs

  

The White House yesterday released a report entitled “Reforming America’s Healthcare System Through Choice and Competition” that describes the influence of state and federal laws, regulations, guidance, and policies on choice and competition in health care markets and identifies actions that states or the federal government could take to develop a better functioning health care market.

This report bears great news for RNs and APRNs. It recognizes and promotes the role that RNs and APRNs play in patient care and recommends that the federal government and state governments should allow RNs and APRNs (and other allied health professionals) to practice to the full extent of their education and training. The report makes the following recommendations regarding scope of practice:

  • States should consider changes to their scope-of-practice statutes to allow all healthcare providers to practice to the top of their licenses, utilizing their full skill sets.
  • The federal government and states should consider accompanying legislative and administrative proposals to allow non-physician and non-dentist providers to be paid directly for their services where evidence supports that the provider can safely and effectively provide that care.
  • States should consider eliminating requirements for rigid collaborative practice and supervision agreements between physicians and dentists and their care extenders (e.g., APRNs, physician assistants, hygienists) that are not justified by legitimate health and safety concerns.

The report also promotes the use of telehealth services, noting that, “telehealth has great potential to improve access in underserved locations, reduce costs, and generate improved short- and long-term health outcomes.” The report makes several recommendations regarding telehealth:

  • States should consider adopting licensure compacts or model laws that improve license portability by allowing healthcare providers to more easily practice in multiple states, thereby creating additional opportunities for telehealth practice.
  • States and the federal government should explore legislative and administrative proposals modifying reimbursement policies that prohibit or impede alternatives to in-person services, including covering telehealth services when they are an appropriate form of care delivery.
  • States generally should consider allowing individual healthcare providers and payers to mutually determine whether and when it is safe and appropriate to provide telehealth services, including when there has not been a prior in-person visit.
  • Congress and other policymakers should increase opportunities for license portability through policies that maintain accountability and disciplinary mechanisms, including permitting licensed professionals to provide telehealth service to out-of-state patients.

ANA’s comments to the Medicare Payment Advisory Commission (MedPAC) expressed our support to expand telehealth services to Medicare beneficiaries, especially in areas in which RNs and APRNs provide care, and ANA encourages the administration to continue to consider the role that RNs and APRNs – able to practice to the full extent of their education and training – play in providing primary care, telehealth, and other health care services to increase access to beneficiaries, also recognizing that reimbursement is necessary to not only provide the services, but to also fill the void in certain specialties and geographies.

ANA applauds the White House for recognizing through this report the crucial role that RNs and APRNs play in the U.S. health care system and for promoting innovative telehealth strategies that will better allow them to practice to the full extent of their education and training. ANA also commends the administration’s recent expansion – through the CY 2019 Medicare Part B Physician Fee Schedule final rule – of telehealth services for prolonged preventive health services and for purposes of treatment of a substance use disorder or a co-occurring mental health disorder. These common-sense strategies will allow RNs and APRNs to maximize their significant contributions to quality patient care and outcomes.

Open Enrollment for 2019 Coverage Begins as Healthcare Looms Large Over Midterms

  

The open enrollment period to purchase individual health insurance coverage on the federal and state health insurance exchanges began on Wednesday, November 1st and runs through Saturday, December 15th. The open enrollment period is the only opportunity for individuals to enroll or re-enroll in an existing exchange plan for coverage for calendar year 2019. All consumers can access federal and state exchanges via www.Healthcare.gov; most consumers will purchase health insurance on the federal exchange, though consumers in these 12 states will purchase health insurance on their state of residence’s exchange. Consumers enrolled in a plan in 2018 who fail to update their information by December 15th will be automatically re-enrolled in the same or similar plan for 2019 (and must pay their premium for January to maintain coverage); consumers who were not enrolled in 2018 and do not sign up for a plan for 2019 will be locked out of exchange coverage until 2020.

Like last year, the administration has scaled back its efforts to encourage consumers to sign up for individual health insurance plans on the exchanges. The U.S. Department of Health and Human Services (HHS) plans to spend $10 million on marketing and outreach, including email, text messaging and auto-dial messages, as well as targeting individuals who are uninsured – particularly young and healthy individuals. The amount that HHS budgeted for marketing and outreach matches the amount that it budgeted in 2017; however, this is roughly 10 percent of what was budgeted for previous open enrollment periods.

The administration has also added additional confusion regarding what constitutes an individual health insurance plan by promoting subpar health insurance coverage, such as association health plans and short-term, limited duration insurance. While these plans may offer low premiums, they do not provide the comprehensive coverage of pre-existing conditions required for plans sold on the exchanges and often come with high deductibles and out-of-pocket spending. The administration also ended cost-sharing reduction subsidies, though insurance plans on the exchanges are still required to provide cost-sharing reductions for individuals with household income at or below 250 percent of the Federal Poverty Level and this policy change will not impact these consumers’ out-of-pocket spending. And in December 2017 Congress repealed the individual mandate penalty for individuals who failed to purchase individual health insurance coverage.

Despite these headwinds, 11.8 million Americans enrolled in coverage for 2018 on the federal and state exchanges, representing only a 3.7 percent decline from 2017. ANA has joined with other consumer- and provider-based groups to ensure consumers are aware of their options and are well-positioned to make the best choices for themselves and their families. It is essential that nurses ensure consumers are aware of the current insurance marketplace landscape, the need to select plans that offer meaningful coverage and that the open enrollment period is the only time they’ll be able to select plans from the marketplace exchanges.

ANA developed a toolkit of materials that can be customized and tailored to reach your nurses. ANA sent this toolkit to the presidents and executive directors of its Constituent and State Nursing Associations and to the presidents and executive staff leaders of its Organizational Affiliates; the toolkit includes the following:

  • Sample Social Media Messaging to encourage nurses and health care consumers to visit Healthcare.gov and either obtain coverage or re-enroll in a previously selected plan.
  • Frequently Asked Questions pertaining to open enrollment and the current political environment.
  • Talking Points to offer clear and concise explanations for why ANA is committed to promoting open enrollment and ensuring health care consumers are aware of all their health coverage options.

Health care stands to play a pivotal role in the midterm elections next Tuesday, November 6th. Public polling throughout 2018 has consistently shown health care to be the most important issue on voters’ minds, and the open enrollment period underscores how important health care is to individual consumers. ANA-PAC recently finalized its list of congressional endorsements for the 2018 election cycle, supporting candidates from both parties who are committed to advancing the nursing profession and ensuring that nurses have substantive input when lawmakers are crafting health policy. To find your polling place, please visit our #NursesVote Action Center and make certain that your voice is heard on this pivotal Election Day.