Trump Administration Continues Work to Undermine Americans’ Health Care

  

While Congress has thus far in 2018 declined to take up legislation that would dismantle affordable access to health care that was a hallmark of their 2017 agenda, the Trump administration continues to move forward with a number of regulatory initiatives that will continue to advance this misguided approach and cost more Americans the coverage they need.

One plan the administration is currently discussing would allow for wider availability of short-term, limited-duration insurance plans that cover patients for less than a year; another would permit the self-employed and small business employees to make use of association health plans. In both cases, coverage offered would not be required to meet the list of essential health benefits that the Affordable Care Act (ACA) currently requires.

As a result, a vast majority (more than 95%) of healthcare groups that submitted comments on President Trump’s recent plan to scale back these protections said that such an approach was a mistake.

Meanwhile, many of those same groups have come out in opposition of a proposal that would weaken Medicaid by creating work requirements for certain adult recipients who have benefited from Medicaid expansion. While specific efforts to implement such requirements are being led by state governments, it was the administration’s decision to allow such proposals in the first place that has enabled them to do so.

The administration’s argument, however, is disingenuous at best, as that Medicaid expansion 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 in 10 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 health care.

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.

Finally, last year’s tax bill, which included a repeal of the ACA’s individual mandate, continues to wreak havoc on insurance premiums. The Congressional Budget Office (CBO) recently revised its estimates and determined that this repeal will lead to a premium increase of at least 10% in 2019. Premium increases are expected to be finalized state-by-state in early October, roughly a month prior to November’s general elections.

A Budget to Nowhere

  

 

The good news is that the budget unveiled Monday by the Trump administration is dead on arrival. The two-year agreement reached by Congress last week makes this budget even less relevant than most presidential budgets, and more importantly the congressional spending deal funds a number of crucial health programs that were in danger of losing funds. The bad news is that the President’s budget seeks to normalize policy proposals that would either cripple or eliminate altogether a number of crucial federal programs that provide critical aid for nurses and their patients.

Nursing Workforce Development Programs covered under Title VIII of the Public Health Service Act would be particularly hard hit, with cuts of almost 65% at a time when nurses nationwide desperately need this funding to continue providing quality care. The budget slashes $145 billion overall, eliminating all but one program under Title VIII (the NURSE Corps Loan Repayment and Scholarship Program, which would be funded at $83 million). As a result of this drastic and misguided approach, the Nursing Community Coalition (of which ANA is a member) announced their strong opposition earlier today.

Even when the President’s budget takes one step forward by allocating new funds, it simultaneously takes two steps back, as with funding to combat the opioid crisis. While the budget proposal would allocate $13 billion, experts estimate that at least $32 billion is needed to address this lethal epidemic. This new funding would also come at the expense of the Centers for Disease Control and Prevention (CDC), which would lose $1 billion and suffer particularly deep cuts to programs aimed at reducing chronic disease, bolstering public health preparedness, and overseeing occupational safety and health.

Perhaps most alarmingly, the budget embraces the approach of the already-rejected Graham-Cassidy legislation to repeal and replace the Affordable Care Act. This approach would implement massive cuts to Medicaid and eliminate its state-based expansion (which 33 states to date have chosen to embrace). It would also end the subsidies that help a vast majority of Americans who obtained health coverage under the ACA-implemented marketplace pay for their premiums.

Rather than promoting a misguided and out-of-touch budget, ANA urges the administration to instead focus on more pressing priorities, including helping Congress reach an agreement on those affected by the Deferred Action for Childhood Arrivals (DACA) program, as well as efforts to stabilize the health insurance marketplace following the repeal of the individual mandate late last year. Too many of the ideas included in this budget have been rejected by bipartisan congressional majorities. Like those ideas, this budget should similarly be put aside.

Time is Up on Nurse Abuse

  

This guest post is by ‘Nurse Alice’ Benjamin, MSN, RN, ACNS-BC.

As a nurse for nearly 20 years, I have witnessed and experienced physical, verbal and emotional abuse while caring for patients. I once cared for a patient who threw objects at me, yelled obscenities and racial slurs, spat on me and made unreasonable demands even though I was providing the best care possible.

Last month in Arkansas, a nurse was bitten and punched in her head repeatedly. In another incident, a nurse was choked and sexually assaulted. A majority of the time, nurses who have either been a victim or witnesses to physical and verbal abuse don’t receive news coverage. Thanks to technology and media, we have been able to highlight the magnitude and urgency of the matter, but still not intensely enough to end abuse altogether. As a nurse and media health expert, I make sure to discuss this issue on national television. I truly believe that these senseless acts of violence and abuse demand immediate attention and swift action.

Sadly, all nurses face similar, unsafe situations every day. And at times, unwarranted acts of violence are committed against us. That’s why I am proud to support the #EndNurseAbuse initiative – a national call-to-action led by the American Nurses Association urging nurses, healthcare professionals, patients and all concerned individuals to get involved. Sign a pledge to support zero tolerance when it comes to violence against nurses; report abuse whenever possible; and share the pledge with others asking them to sign too.

The clock has run out on harassment, sexual assault, and inequality in the workplace.

Across all industries and professions, women and men are speaking up to make it clear that time is up.

As we launch ANA’s Year of Advocacy, please join me by taking the pledge to #EndNurseAbuse today.