Author: Samuel Hewitt

President Biden Releases $1.9 trillion COVID-19 Relief Plan

  

On January 14, President Biden’s transition team unveiled the administration’s first COVID-19 relief plan—the American Rescue Plan. The $1.9 trillion plan would roll out in two steps: rescue and recovery.

The President’s plan is broadly aimed at shoring up the economy, but the proposal does address workforce issues of particular interest to nurses and other frontline health care workers, as well as teachers. President Biden is calling on Congress to provide $350 billion in emergency funding for state, local, and territorial governments to ensure their ability to keep front line public workers on the job. A key selling point for this aid is that it would bolster state capacity to effectively distribute COVID-19 vaccines, scale testing, reopen schools, and maintain other vital services.

In order to address health care coverage needs of patients, President Biden is calling on Congress to subsidize continuation health coverage (COBRA) through the end of September. The plan also directs Congress to expand and increase the value of the Premium Tax Credit to lower health insurance premiums and set a cap of no more than 8.5 percent of patient income for coverage.

Tragically, mental health issues and substance use disorders continue to be major consequences of the pandemic for many people, including frontline health care workers and first responders.  President Biden has called on Congress to appropriate $4 billion to enable the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration to expand access to services for more Americans.  ANA supports these broader mental health investments, as well as targeted efforts to address nurses’ mental health.

Acknowledging the economic hardships brought on by the pandemic, the plan includes $1,400 in additional direct aid for those with incomes below $75,000 and $400/week in enhanced unemployment insurance payments. The plan also includes funds for state work-sharing programs and would continue the moratorium on evictions through September 2021 for those struggling to pay their rent or mortgage. The plan would allocate $5 billion for combatting homelessness, provide a 15 percent increase in Supplemental Nutrition Assistance Program benefits, and a $3 billion increase in Special Supplemental Nutrition Program for Women, Infants, and Children. The plan also proposes to raise the federal hourly minimum wage to $15 per hour.

In addition to including benefits for the unemployed and underemployed, the proposed plan would provide hazard pay—going forward and retroactively—to essential workers who have taken on extra risk during the pandemic by working on the front lines. ANA supports recognition of frontline health care workers and continues to advocate for hazard pay for the nurses integral to combatting the COVID-19 pandemic.  Additional support for families includes $25 billion for child care centers, expansion of child care tax credits and the Earned Income Tax Credit, and $1 billion in cash assistance for Temporary Assistance for Needy Families programs.

Last, President Biden is calling on Congress to allocate $3 billion for the Economic Development Administration (EDA). Grants from EDA provide resources directly to state and local government entities, tribal institutions, institutions of higher education, and non-profit organizations to fund initiatives that support localized economic development. This funding—double the amount provided by the CARES Act last year—would support the broad range of financial needs in communities across the country as they continue to respond to and recover from the COVID-19 pandemic.

As Congress and the administration work to see the policies contained in the American Rescue Plan signed into law, ANA continues to work with lawmakers to address the needs of nurses and patients in more targeted ways. ANA’s legislative agenda calls for specific steps to address nurses’ mental health needs, provide hazard pay, institute a moratorium on nurses having to use paid time off when they contract COVID-19, and investing the public health infrastructure and workforce.

What Does Trump’s New Executive Order Mean for Nurses?

  

President Trump signed a new executive order (EO) on October 3 relating to new policies the administration intends to implement in the Medicare program. The EO on Protecting and Improving Medicare for Our Nation’s Seniors builds upon a previous EO from October 2017, Promoting Healthcare Choice and Competition Across the United States, and the subsequent report, Reforming America’s Healthcare System Through Choice and Competition. The EO is intended to reform the Medicare program overall. The policy proposals address Medicare Advantage plans which are granted more flexibility under law in determining coverage and payment, as well as the traditional fee-for-service program.

Section 5 of the EO affects advanced practice registered nurses (APRN) and physician assistants (PA) in significant ways that the administration hopes will allow patients to spend more time with their providers. This section directs the Secretary of Health and Human Services (Secretary), within one year, to propose reforms to the Medicare program that would:

  • Eliminate excessive supervision requirements that prevent APRNs and PAs from delivering appropriate diagnosis and quality care;
  • Provide equal pay for equal work, with Medicare reimbursing APRNS and PAs at the same level as physicians for the same procedures;
  • Remove certain unspecified conditions of participation (CoP) requirements; and
  • Enable APRNs and PAs to practice to the full extent of their education and clinical training.

EO’s are typically broad and don’t get into the finer details of what is being proposed or the actions that will be taken. While we can make logical assumptions with some instructions in the EO, there are others that are less clear and we will work with the administration to clarify these issues as proposals are developed.

The subsections of the EO that would eliminate the unspecified supervision requirements, conditions of participation requirements, and licensure requirements in Medicare that limit clinicians from practicing at the top of their profession, would be done through the federal regulatory process. This involves the Secretary writing a “proposed rule” (i.e. regulation) and allowing for a 60-day public comment period. After which, the Secretary will publish a “final rule” and the new regulations will move into the implementation process. ANA will be engaging with the Secretary throughout the process to get the best regulatory results for nurses.

The third subsection dealing with pay disparities between physicians and other clinicians only instructs the Secretary to conduct a comprehensive review of regulatory policies.  Currently, the Medicare statute stipulates that nurse practitioners and clinical nurse specialists are paid at 85 percent of the physician fee amounts that are set annually by CMS for fee-for-service. Based on previous actions and communications with the Secretary, we expect he will do what he can to eliminate pay disparities in certain parts of Medicare through regulation and also advise Congress to eliminate the pay disparities through legislation.   Any legislation would need to be introduced and go through the normal legislative process.

One wild card in this proposal is the elimination of unspecified CoP requirements. CoP are federal regulations that certain health care facilities must comply with in order to be reimbursed by Medicare and Medicaid. While we would like to see some CoPs go, like the one that requires a certified registered nurse anesthetist to be supervised by a physician, there are others that positively benefit nurses and patients alike.

ANA is pleased that the Administration recognizes the value of APRN services to health care consumers and the Medicare program. We look forward to working with the Administration and Congress on on the development and implementation of these policies through the regulatory and legislative processes.

Senators Rubio and Warren reintroduce bill to protect student loan borrowers

  

By Janet Haebler and Sam Hewitt

Last week, Sens. Marco Rubio (R-FL) and Elizabeth Warren (D-MA) reintroduced the Protecting JOBs Act (S. 609). Under the bill, any state that receives federal funding through the Higher Education Act would be barred from denying, suspending, or revoking an occupational license or a driver’s license “solely” because a borrower defaulted on their federal student loans.

As early as the 1990’s, states were urged by the U.S. Department of Education and select member organizations representing government, to adopt laws requiring regulatory boards to suspend professional licenses, and even driver’s licenses, if the board received notice informing them an applicant held outstanding student loans. Around 2010, at the height of this legislative trend, roughly half of states had some form of license suspension for default in place.

Although several states rescinded laws seizing or suspending licenses, barriers remain for some license holders. As of 2018, the National Conference of State Legislatures (NCSL) reports at least eight states—Alaska, Georgia, Hawaii, Iowa, Kentucky, Massachusetts, Tennessee and Texas—maintain laws requiring all occupational boards to revoke licenses for defaulting on any type of federal or state education loan. Louisiana will only revoke a license if the professional has defaulted on an education loan issued by the state. An additional five states—Arkansas, California, Mississippi, Minnesota and Florida—revoke only the licenses of health care professionals for defaulting on education loans. In Arkansas and Mississippi, the laws are more narrow, applying only to state health care education loans and scholarship agreements. Two states—Iowa and South Dakota—revoke all state-issued licenses, including driver’s and recreational hunting licenses.

According to the Institute for College Access and Success, 8.9 million federal student loan borrowers now in default with over 1 million borrowers added each year. With a continued increase in the percentage of Americans working in occupations requiring licensure, approximately 25%, combined with rising student loan default rates, there has been renewed interest. The Protecting JOBs Act is a bi-partisan effort at the federal level to address this counterproductive policy.

Watch for ANA updates and requests for grassroots efforts in the interest of advancing this policy. You can read more about this issue at Forbes.