Public Policy Updates

News from the APSNA - Choosing Wisely Announcement

Senate passes bill to provide funding for Title VIII Nursing Workforce Development Programs
Last evening, the Senate passed the Defense/Labor Health and Human Services-Education (LHHS-ED) minibus by a vote of 85-7. For the first time in over a decade, the Senate’s LHHS-ED appropriation bill went to the floor. It provides level funding, or $249 million, for the Title VIII Nursing Workforce Development programs and $163 million for the National Institute of Nursing Research (a 3.9% increase from FY 2018 funding).

Letter to Appropriators Regarding the Continuing Resolution
The NCC sent a letter to the House and Senate Appropriations Committees urging them to fund each of the Title VIII programs and NINR in Fiscal Year 2018 with at least the levels proposed by the Senate’s LHHS Appropriations Subcommittee bill, totaling $234.472 million for Title VIII programs and $155.210 million for NINR in FY 2018.

CHIP Day of Action
The National Association of Pediatric Nurse Practitioners has teamed up with other children’s health providers to create a day of action on January 10, 2018. The Children’s Health Insurance Program (CHIP) provides coverage to 9 million children and pregnant women with comprehensive and affordable health care coverage.

2017 Year in Review
This year, the NCC has overwhelmingly increased the number of letters and statements being released, as compared to 2016. This is testament to the effectiveness of the new structure approved by the coalition that charged the Steering Committee to quickly respond as issues of importance arise. In addition, the number of events hosted by the NCC was at a record high and our social media presence continues to grow, increasing by 67% over the past year.

NIWI: Lois Capps Scholarship Fund
Last year, the Nursing Community Coalition started the Lois Capps Scholarship Fund to offer the opportunity to attend the Nurse in Washington Internship (NIWI) hosted by the Nursing Organizations Alliance. Applicants must be a nurse or nursing student, belong to an NCC member organization, and preference will be given to applicants applying from the Honorable Lois Capps’s home state of California.

NCC Statement on AMA Resolution

Nursing Community and the Issues
Learn About the Title VIII Nursing Workforce Development Program, which addresses critical nursing concerns such as continuing education, nurse shortages, and workplace improvement. ARIN is proud to be a member of the Nursing Community coalition, and encourages you to become an advocate of the nursing profession in making a difference in healthcare.

115th Cong HR1628 Better Care Reconciliation Act

2017 NC Statement Commitment to America's Health

Overview of the Senate Republican Health Care Discussion Draft

Legislative News

June 2017

The Nursing Community coalition represents the cross section of education, practice, research, regulation, and executive leadership within the profession. Our organizations are committed to the patient, the family, the community, and the populations our members serve. We embrace being part of and leading transdisciplinary teams today and the opportunities in the future to achieve the national goals of greater access and improved quality through cost-controlling measures that make care more affordable. Innovation, teamwork, and commitment are at the heart of this transformation.

Since 2009, when the Nursing Community was formally established, our goal has been to build consensus and advocate on a wide spectrum of policy issues. The Nursing Community is proud to represent the largest segment of the healthcare workforce comprised of nearly four million Registered Nurses (RNs) and Advanced Practice Registered Nurses (APRNs). It is our collective voice that has allowed us to convene, measure, and propose solutions as well as evaluate proposals.

As the Administration and Congress address health reform, our coalition stands ready to support the following ideals that are at the forefront of the national dialogue:

• Ensure patients have access to quality health care with affordable coverage options, regardless of their pre-existing conditions;
• Uphold the principles of essential health benefits, including providing patients with access to ambulatory care, emergency services, hospitalization, maternity and newborn care, mental health services and addiction treatment, prescription drugs, rehabilitative services and devices, laboratory services, preventive services, wellness services and chronic disease management, and pediatric services;
• Uphold Medicaid expansion.

Additionally, we are concerned with the pace at which Congress and committees of jurisdiction are moving legislative proposals. We believe that thoughtful debate and due process are essential to addressing a policy of this magnitude.

Healthcare transformation cannot be solely addressed by insurance reforms. There must be a conscious endeavor to support the infrastructure and the workforce. We believe that the healthcare delivery system should be one that promotes wellness, advances innovation through scientific discovery, and provides timely access to care. These are the pillars of nursing care and create long-term savings to the healthcare system that translate to a healthier nation. The Nursing Community pledges to work with Congress to draft legislation and with the Administration to modify regulations that:

Support Provider Choice, Innovation, Prevention, and System Efficiencies

• Protect patients' access to receive health care delivered by the provider of their choice, including advanced practice registered nurses, which include nurse practitioners, clinical nurse specialists, certified nurse-midwives, and certified registered nurse anesthetists, and ensure this care is covered by their insurer;
• Create greater efficiency in the Medicare system by retiring barriers to practice and eliminating duplication of healthcare providers' efforts, for example, the ability of certain APRNs to certify home health services;
• Retain and adopt healthcare provider non-discrimination policies;
• Advance models of care that include the full expertise and clinical practice of RNs and APRNs;
• Recognize and reimburse care in a manner consistent with other health professions;
• Support effective collection of standardized, evidence-based performance information that will accurately measure quality and enable transition to a value-based payment system that engages all providers in quality measurement development;
• Increase investment in nursing and biomedical research.

Advance Comprehensive Workforce Development

• Invest in and reauthorize the Nursing Workforce Development Programs (Title VIII, Public Health Service Act (42 U.S.C. 201 et seq.));
• Support innovations in interprofessional education, training, and practice;
• Conduct timely and comprehensive analysis of nursing and health professions workforce data.

Signed on behalf of the following fifty-two organizations:

May 2017

As we expected, based on the Administration"s Budget Blueprint released in March, President Trump"s FY 2018 Budget Proposal recommends to Congress steep cuts to HHS programs overall. Released officially today, the proposal suggests, that the Title VIII Nursing Workforce Development programs be decimated by 64% taking the funding level from $229.472 million in FY 2017 down to $82.977 million. To put this in context, this is slightly more than the programs received back in FY 2001. Essentially, what the budget recommends is to only fund the NURSE Corps (Loan Repayment and Scholarship program-*note 0.19% decrease from the Omnibus, not the CR as reported in the justification) and eliminates the funding for the following Title VIII programs:

• Advanced Nursing Education Grants (ANE), ANE Traineeships, and Nurse Anesthetist Traineeships
• Nurse Education, Practice, Quality, and Retention Program
• Nurse Faculty Loan Program
• Nursing Workforce Diversity Grants
• Comprehensive Geriatric Education Grants

As it relates to the NINR, the cuts propose taking the funding levels back to approximately what NINR received 16 years ago. The President recommends a 24% reduction to NINR— taking the funding from $150.273 million in FY 2017 down to $113.668 million (See the attached funding chart). For all of NIH, the recommended cut is approximately 21% taking the funding from $32.084 billion to $26.9 billion. (Please note, the President"s Budget compares the CR levels and not the final FY 2017 Omnibus).

While Title VIII and NINR are the two programs of interest for the coalition, there are some other highlights. For example, the budget recommends consolidating the Agency for Healthcare Research and Quality into NIH by creating the National Institute for Research on Safety and Quality and suggests maintaining its funding at $272 million. For a full list of the proposed reductions, eliminations, and increases, please see the following:

• Budget of the U.S. Government: A New Foundation for American Greatness FY 2018
• OMB Details
• Department of Health and Human Services
• HHS Budget in Brief (see page 23 and 36 of pdf)
• HRSA Budget Justification

Thank you to the 48 organizations that signed onto the Nursing Community statement that opposes the President"s FY 2018 Budget proposal. This is now posted on the NC website, was tweeted, and will be sent shortly to the House and Senate Budget and Appropriations committees as well as the House and Senate LHHS-ED appropriations subcommittee.

During Nurses Week, we were on the Hill educating Congressional staff about the importance of Title VIII and NINR and will continue during the Congressional appropriations process. We have tremendous champions in the House and Senate who will help support these programs. The President"s Budget is only recommendations and not enforceable by law so we look to Congress to fund these programs and in turn support America"s health.

Nursing Community Expresses Deep Concern Over President"s Budget
FY 2018 President"s Budget

A letter from ARIN Leadership Regarding Public Policy:

Dear Colleagues,

Nurses, especially those belonging to ARIN, need to become more involved in public policy issues related to nursing and health care. Newly developed radiologic equipment and software, interventional radiologic procedures, the use of contrast media, and tests performed on the minimally injured patient to the complex elderly patient in the radiology arena make our participation necessary to maintain optimum nursing standards.

Today, performing Excellent Patient Care is only one responsibility included in the radiologic and imaging nurse’s role. Each day when we go home to our families, we listen to the daily news and hear of the many medical issues that are not beneficial to our patients, family and community, whom are in need of our professional input. Some of these issues we observe within our present employment, other issues are those brought to us by friends and family seeking assistance in navigating within the healthcare arena.

Many patients are not informed of their rights. Patients should be made aware of the risks and the benefits of these tests and procedures, including the medications and contrast medias they are to receive, but in the rush to get the patients in-and-out, these formalities are missed.

The public assumes that outpatient care centers are “doing the right thing”, while in fact, they are not always practicing with the required regulations and guidelines and thus, jeopardizing patient care. Professionals, although aware of their actions, sometimes find the almighty dollar a greater goal. A patient will receive an order from their cardiologist for a Cardiac CTA and be referred to an outpatient facility. To prepare for this exam the patient receives two prescriptions. One drug is ordered to be taken prior to the test to “slow down their heart rate” so that the test can be completed. The other pill is to be taken when the CT technologist instructs the patient to take the pill. The patient is placed on a cardiac monitor during the scan, but does not see a nurse or physician, and no one takes their blood pressure. The patient is sent home being told the doctor will be getting the results. Is this the care we advocate for our patients?

Sometimes the impending healthcare issues are either not fully discussed or improperly thought out, in need of nursing advice. A recent Sunday newspaper had an article relating to the new stipulation put forth by Congress requiring patients taking controlled pain medications to see their ordering physicians monthly to obtain their prescribed pain medications. This new requirement was put into place to prevent the many controlled pain medication overdoses, but does not consider the already overly booked physician, the financially strained patient who now has to pay another co pay, the overwhelmed family caregiver who has to transport the patient to the physician who is fully aware of the patient’s chronic or cancer pain. We, as nurses, may be able to devise a plan to assist the patients and remain in compliance with federal regulations.

The Affordable Care Act was brought into existence to provide health care to the many that were rejected or who could not afford health care insurance for themselves or their family. However, businesses and insurance companies are willing to fight to avoid providing affordable health care. An example of this is the unwillingness to pay for birth control medications based on the company’s religious convictions despite the reasoning for the birth control medications.

Today, it is imperative that nurses occupy positions of leadership and decision-making. The American Nurses Association encourages us, in ARIN, to join the thousands of other nurses from across the country in becoming grassroots nurse advocates, contributing to health care issues in efforts to help everyone, and ensuring effective and safe health care policies are approved.

YOUR HELP IS NEEDED!!

Beth Hackett
ARIN Board of Directors