A Way to Honor Fallen Heroes on #GoldStarSpousesDay

  

By Brian Davis and Matthew Fitting

Today is Gold Star Spouses Day, a time to honor the husbands and wives of fallen servicemembers who take up the courageous task to keep their loved ones’ memories alive. As we thank them for their service and sacrifice on this #GoldStarSpousesDay, there are several ways to honor fallen heroes of our country and celebrate those loved ones they leave behind. One way to honor those nurses who paid the ultimate sacrifice in service to their country is through recently introduced legislation.

The bi-partisan United States Cadet Nurse Corps Service Recognition Act (H.R. 2056/S. 997) was recently introduced in both houses of Congress by Congresswoman Cheri Bustos (D-IL), Congressman Greg Gianforte (R-MT), Senator Elizabeth Warren (D-MA) and Senator Susan Collins (R-ME). The U.S. Cadet Nurse Corps served in World War II and are the only uniformed corps members from that war who haven’t been recognized as veterans. The United States Cadet Nurse Corps Service Recognition Act would correct this and ensure that these nurses’ service to their country is never forgotten.

This remarkable group of nurses didn’t just make a difference by serving – they revolutionized the nursing profession for decades to come. By ensuring that there were trained healthcare professionals at home and abroad during World War II, the Cadet Nurse Corps paved the way for how nursing and nurse training evolved in the US by professionalizing the practice and teaching methods that would serve as the backbone of our nation’s recovery for generations. As a result of federal funding for the program, nursing schools across the country were able to upgrade their facilities and equipment, ensuring better care for all patients, not just those serving in the military. The program also made positive steps toward expanding access to minority and low-income students who might not have considered entering the profession otherwise.

In honor of #GoldStarSpousesDay, we’re asking you to take action and tell your Member of Congress to not only support these bills, but to ensure passage. This common-sense legislation has been introduced 11 times, but has yet to become law. As we commemorate #GoldStarSpousesDay, it is long overdue that these brave Nurses who served our nation with dignity in its time of need are properly recognized as veterans.

Congress Aims to Keep Campaign Promises on Health Care as Courts Continue to Review Administration Policies

  

By: Gregory Craig and Matthew Fitting

Following a midterm election cycle in which voters consistently listed health care as their top issue priority, members of the 116th Congress have wasted no time in proposing, introducing, and debating several measures that would significantly impact the way Americans receive and pay for health coverage.

Health Care Legislation in the U.S. House of Representatives

Most recently, Rep. Frank Pallone, Jr. (D-NJ), the Chairman of the House Energy and Commerce Committee, on March 26, 2019 introduced H.R. 1884 – the “Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019”. This legislation would strengthen many of the consumer protections and pre-existing conditions provisions of the Affordable Care Act (ACA), promote individual health insurance enrollment on the ACA Marketplace, and roll back regulatory actions that the administration has implemented since January 2017. Some of the specific provisions would:

  • Expand income-based eligibility for premium tax credits used to purchase individual health insurance coverage and increase tax credits for all income brackets, allowing more individuals to purchase subsidized health insurance coverage;
  • Fix the so-called “family glitch” to make it easier for low- and middle-income individuals to purchase subsidized family coverage;
  • Rescind the administration’s final rule expanding the availability of Association Health Plans (AHPs) that can circumvent many of the ACA’s consumer protections, specifically those involving Essential Health Benefits (read ANA’s comment letter on AHPs here);
  • Rescind the administration’s final rule expanding the availability of short-term, limited duration insurance plans, which are not required to comply with any of the ACA’s consumer protections (read ANA’s comment letter on short-term, limited duration insurance here);
  • Require the Department of Health and Human Services to conduct marketing and outreach for open enrollment with $100 million in annual appropriations (read ANA’s plan year 2018 open enrollment report here);
  • Establish a state-based reinsurance program that would allow states to set up their own reinsurance programs, or to use the funds to provide premium subsidies or cost-sharing support, with a federal reinsurance program as a backstop.

ANA has publicly supported many of the provisions in H.R. 1884 and has consistently promoted a bipartisan proposal – similar to the reinsurance proposal included in H.R. 1884 above – that Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) introduced in the previous Congress that would have established a similar program and restored cost-sharing payment reductions that help low-income individuals afford co-insurance and deductible costs (the Administration canceled these payments in October 2017).

The proposal that has arguably grabbed the most headlines, however, is “Medicare for All,” a general campaign slogan that was recently introduced as legislation by Rep. Pramila Jayapal (D-WA) with a Senate bill soon to follow to be introduced by Sen. Bernie Sanders (I-VT). The bill would implement an expanded government-run Medicare program and do away with much of the private insurance system currently in place (well over half of Americans currently receive health insurance through their employer or in the Marketplace).

While the legislation is consistent with ANA’s support for universal access to health coverage, there are several provisions that could negatively impact the nation’s four million registered nurses, as well as the patients for whom they provide care. Some of these include:

  • A fee-for-service program that could significantly reduce payment rates and have a trickle-down effect on Advanced Practice Registered Nurses (APRNs), who are currently reimbursed at 85% the rate that Medicare reimburses physicians for the same work;
  • A Medicare Trust Fund that could lead to uncertainty around payments and impact access to care should beneficiary access to services exceed the fiscal year budget;
  • The establishment of regional offices charged with recommending changes in provider reimbursement and establishing quality assurance mechanisms for their regions, which could lead to a patchwork of coverage and tempt providers to practice where reimbursement rates are higher.

Federal Courts Reviewing ACA Provisions

The Department of Justice on March 25 unexpectedly sent a letter to the Fifth Circuit Court of Appeals to state that the Administration fully supports the December 2018 U.S. District Court decision in Texas v. Azar that would invalidate the entire Affordable Care Act (the U.S. District Court decision was stayed pending appeal; the Administration had previously only supported striking down parts of the ACA, including pre-existing conditions provisions). This case will likely make its way to the U.S. Supreme Court for a final decision, though that decision would probably not come until 2020 or later. Invalidating the entire ACA with no plan to replace it would be extremely disruptive to the U.S. health care system and would result in enormous insurance coverage and financial losses.

On March 27, the Federal District Court for the District of Columbia threw out Medicaid work requirements in both Kentucky and Arkansas. This is the second time that Kentucky’s Medicaid work requirements have been blocked in federal court. Arkansas’ work requirements were implemented in June 2018 and have resulted in 18,000 individuals losing coverage. The same federal court on March 28 issued a ruling that rejects the administration’s final rule that expands the availability of Association Health Plans. ANA has consistently opposed expanding the availability of these plans, as they represent an end-around of the ACA’s essential health benefits requirements for insurance coverage.

ANA’s Commitment to Universal Access to Quality Health Care

ANA is committed to a pragmatic approach to ensuring universal access to quality, affordable, and accessible health care for all Americans, particularly vulnerable populations and those with pre-existing conditions. As ANA stated in a recent press release: “Universal access to a standard package of essential health care services for all citizens and residents is of paramount importance to the American Nurses Association. Nurses have a critical voice in this debate, and ANA is committed to advancing policy initiatives that provide and expand access to affordable coverage and quality care for all.”

This is the latest chapter in the decades-old health care debate – we expect that many proposals will be offered before the 2020 election. ANA will continue to be involved and actively advocate for nurses and the patients for whom they provided care.

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.