Capitol Beat

It’s clear that the November 6th midterm elections were a successful day for the nursing profession and health care more broadly. The American Nurses Association Political Action Committee (ANA-PAC) paid dividends for its members and the profession by spending more than $422,000 to help elect longstanding champions of nursing like Reps. David Joyce (R-OH-14) and Frank Pallone (D-NJ-6), as well as Sens. John Barrasso (R-WY) and Tom Carper (D-DE) while helping usher in fresh faces for the 116th Congress like Rep. Elects Joe Morelle (D-NY-25) and Dusty Johnson (R-SD-At-Large).

Rep. Elect Morelle has collaborated with the American Nurses Association-New York during his time in the state assembly and consistently helped secure legislative victories to advance the nursing profession, including passage of a bill that strengthens education requirements for future nurses and establishing a commission to evaluate and report on barriers to entry into the nursing profession in New York while Rep. Elect Johnson was responsible for overseeing the South Dakota State Employee Health Care Plan in his capacity as chief of staff to Governor Dennis Daugaard, where he heard and implemented input from health care professionals across the state, including nurses. He is dedicated to bringing stability to a health care market that has experienced a great deal of uncertainty in the past year and a half.

On a particularly great note, registered nurse Lauren Underwood achieved victory as the next Member of Congress representing the Illinois 14th congressional district. Besides being a fellow nurse, she also earned the distinct honor of being elected the first congresswoman from her district. Lauren will join registered nurses Reps. Karen Bass (D-CA-37) and Eddie Bernice Johnson (D-TX-30) in the 116th Congress.

If there was ever any proof ANA knows how to support the correct candidates it’s this: of the more than 120 candidates for federal office supported by ANA-PAC, an impressive 94% have won their election. A total of 96% of incumbents, 91% of those running in open seats and 90% of candidates running against a sitting federal lawmaker won their elections while 93% of those candidates the PAC endorsed were elected. This showcases ANA staff’s ability to identify candidates who are both invested in moving nurses forward and are likely to run successful campaigns that are responsive to their voters’ broader interests, including the need for increased access to affordable health care.

Not surprisingly, ANA staff are already evaluating the political landscape on Capitol Hill and strategizing for the 116th Congress. A Republican-controlled Senate and a Democratic-controlled House is just one of the many factors being considered in terms of how best to advance ANA’s legislative and regulatory agendas. Whether the issue is safe staffing, nursing scope of practice or safe patient handling, staff are determined to find new ways to build and enhance bipartisan support of our issues.

This cycle, ANA’s members helped the ANA-PAC achieve and exceed its fundraising goal by raising more than $500,000 since January 1, 2017 (remember: no ANA dues money is ever used to support political candidates). Staff, along with the ANA-PAC Board of Trustees, will be utilizing these contributions to continue cultivating relationships on both sides of the  political aisle, and maintaining our non-partisan presence on Capitol Hill. Stay tuned to Capitol Beat for more updates as the legislative agenda for the 116th Congress develops.

To learn more about ANA-PAC, check out of FAQs and see who the PAC supported in your state please check out the ANA-PAC website.

An extraordinary 114 million voters cast ballots Tuesday and delivered the House of Representatives back into the hands of the Democratic party, while voters in more conservative states chose to oust several Democratic incumbents to ensure that the Senate remains under Republican control for the 116th Congress. While some races have yet to be called, turnout was the highest it’s ever been for a midterm election, and the outcomes ensure that lawmakers will have to find a way to reach bipartisan consensus to achieve any meaningful health policy outcomes before the next national election in 2020.

In the Illinois 14^th congressional district, registered nurse Lauren Underwood successfully unseated her incumbent opponent, ensuring that the 116^th Congress will benefit from the perspective and insights of a member of America’s most trusted profession. Endorsed by ANA-PAC, Underwood focused her campaign messaging on the need to improve health policy and is likely to make it a major component of her agenda once in office.

Similarly, Democratic candidates across the country put health care at the center of their campaigns, and the new House majority is widely expected to tackle issues like market stabilization once the 116th Congress convenes, as well as other measures to shore up the Affordable Care Act (ACA). As with all issues in the new Congress, getting a bill on the President’s desk for signature will require bipartisan cooperation with Sen. Mitch McConnell (R-KY) and his now expanded majority.

Despite uncertainty around how fruitful any such cooperation might be, divided control of Congress ensures that any subsequent attempts to repeal and/or replace additional elements of the ACA will be dead on arrival, particularly given the prominence of protecting patients with pre-existing conditions in Democratic campaign messaging. House Democrats will also likely consider legislation to bring back the ACA’s mandate that individuals attain health coverage, which was eliminated in the tax package congressional Republicans passed late last year.

While more progressive candidates tended to focus on the need for a single-payer health care system, most commonly referred to as Medicare for All, this approach will be a non-starter in the Republican Senate, increasing the likelihood that more incremental reforms will be the focus on Capitol Hill. Despite this, single-payer proponents will continue to push both incumbent lawmakers and those who challenge them on the left to embrace Medicare for All, in the hopes of eventually electing a Congress that can pass it.

In post-election press conferences, both President Donald Trump and current Democratic Minority Leader Nancy Pelosi (who is widely expected to attempt to regain the title Speaker of the House) indicated that they would seek to find common ground on a number of issues, including legislation that would reduce prescription drug costs, though details on how to accomplish this shared goal are unclear.

On the ballot initiative front, three states voted to do what their governors and state lawmakers had so far refused to do: expand access to Medicaid. Voters in Idaho, Nebraska, and Utah all approved measures to allow adults and their families to receive coverage via this federal program. States will now be required to submit a State Plan Amendment that outlines how they will implement these programs, with deadlines arriving either in early March or April of next year, depending on the state. Other states that have held off on Medicaid expansion are likely to consider similar initiatives going forward.

The open enrollment period to purchase individual health insurance coverage on the federal and state health insurance exchanges began on Wednesday, November 1^st and runs through Saturday, December 15^th. 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 15^th 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 6^th. 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.