Building Relationships with Elected Officials
Contributed by: Former Health Policy Committee Chair and NAPNAP Member at Large Nancy Cavanaugh, CPNP-PC
It is an election year and more than ever your voice is needed! As pediatric-focused APRNs, you are experts in pediatric health care and valuable resources to elected leaders. Advocacy is an important role of being a nurse leader, and there are many issues of concern. The time could not be better for reaching out to your elected leaders and their staffs as nearly all meetings are virtual. Members of Congress and their staffs may be working remotely, and are likely to be more available than they normally are. You do not need a specific ask to contact your legislators. It is acceptable to call and introduce yourself and share a story or comment on an issue of importance to you. In fact, this is often a great way to start relationship building because you are not coming with a specific ask.
Some may ask, why relationship building is important. When you develop a relationship you are investing time and energy in the person and the issues. You are offering yourself as an expert with evidence-based knowledge you can share. Our elected officials and their staffs are knowledgeable about a lot of issues, however pediatric health care is not likely to be one of those areas. You can educate staff and perhaps even influence legislation.
You have a story to tell, and it is important to prepare in advance with a concise and compelling story that illustrates why an issue is important to you or to those you care for. This conveys your passion, impact and commitment to the health and welfare of children.
Visit your elected official’s website to book a meeting online. If that is not an option, call the office to request a meeting. Emails and calls are great, but there is nothing more powerful than a personal meeting to establish a relationship. Special tip: meeting with staff is often more productive, so don’t feel slighted if you end up meeting with a staffer!
Do your homework in advance of the meeting or call. Research the person you will meet with and see if they are likely to be a knowledgeable supporter or do they need to be educated on the topic? Be prepared for all options, but as a constituent you have a lot of power so be confident. Let them know you are actively involved with the National Association of Pediatric Nurse Practitioners (NAPNAP) and we are nearly 9,000 members strong!
As you finish your visit or virtual meeting, your relationship is just beginning. Follow it up with an article or handout as well as a thank you note. When you find new evidence that supports the issue be sure to forward to the staffer. Let the office know they are free to call you anytime they need help with research on this issue, but don’t wait for them to call. Every month reach out by email or phone to check-in. The key is to build an ongoing, frequent relationship and communication pattern.
NAPNAP members are experts in pediatrics and advocates for children. We put kids first! Use your passion and experience to become more active pediatric advocate.
Free Advocacy Resources for Members
Visit our easy-to-use Advocacy Center to look up information about your elected officials, key word search federal and state legislation and use the online system to send messages directly to your elected officials’ inboxes. This is a free member benefit so take advantage of this helpful tool.
As a NAPNAP member, you are also invited to participate in our Child Health Policy Learning Collaborative (CHPLC), a free monthly call at 8 p.m. ET on the first Monday of each month, September – May. Each month we have special guest speakers addressing key advocacy issues related to child health or advanced practice nursing and responding to members’ questions. Our 2020-2021 guest speakers will be listed on our CHPLC webpage.
Relief Talks Stall as Coronavirus Threat Continues
White House officials and Democratic congressional leaders signaled Aug. 12 that they couldn’t agree to resume face-to-face negotiations, much less move closer to a compromise, on a fifth coronavirus relief bill to address the dual public health and economic crisis – suggesting the stalemate could drag on past Labor Day. House Speaker Nancy Pelosi and Senate Minority Leader Chuck Schumer said there was no reason for further discussions since the White House refused to change its positions on numerous policy disputes that stalled the talks. Among the key issues is the overall price tag for the next relief package: the administration and Senate Republicans want to keep the cost around $1 trillion while Pelosi and Schumer initially pushed for the nearly $3.5 trillion the “HEROES Act” (H.R. 6800) passed by the House in May. The Democratic leaders offered to come down $1 trillion if the White House came up $1 trillion, but Treasury Sec. Steven Mnuchin and White House chief of staff Mark Meadows rejected that proposal.
On July 27, Senate Republicans released a package of measures collectively called the “Health, Economic Assistance, Liability Protection, and Schools (HEALS) Act” or “HEALS Act” that included another round of $1,200 direct payments to individuals, an unemployment benefits extension that reduced payments from $600 to $200 a week, and more money for employers through the Paycheck Protection Program – but leaving out any additional funding for state Medicaid programs.
President Trump on Aug. 8 signed orders to extend unemployment benefits, suspend payroll taxes, and offer federal eviction and student loan relief, taking unilateral action on shaky legal ground after negotiations with congressional Democrats stalled. Trump’s orders extended enhanced unemployment benefits but cut the amount from $600 to $400 a week and required states to cover a quarter of that amount. Another order allowed employers to defer payment of employee Social Security payroll taxes through the end of 2020 for workers earning less than $100,000 a year, with Trump saying he might forgive the deferrals and make permanent payroll tax cuts if he is reelected in November. Two other orders deferred student loan payments through the end of the year and sought to minimize evictions from federal housing, although it didn’t prohibit evictions.
President Signs Order to Expand Telehealth Services
President Trump signed an executive order Aug. 3 seeking to expand the use of telehealth services after waiving regulatory barriers to video and telephonic services when the coronavirus pandemic left many patients confined to their homes. The order called on the Department of Health and Human Services to issue rules within 60 days making some of the changes permanent, although it stopped short of mentioning the removal of practice barriers for nurses and professionals other than physicians.
The order also calls on HHS to propose a new model that can be tested for how Medicare will pay for some health services in rural areas, with the goal of improving care in rural areas. On Aug. 11, the Centers for Medicare and Medicaid Services released the “Community Health Access and Rural Transformation (CHART) Model,” an alternative payment model that will give rural communities money upfront to change how they pay for and deliver care to Medicare beneficiaries and provide operational and regulatory relief.
Medicare Payment Rule Addresses Telehealth, Diagnostic Tests
On Aug. 3 the Centers for Medicare and Medicaid Services released the proposed Medicare Part B fee schedule rule for 2021, calling for permanently adding some telehealth services to Medicare, including prolonged office visits – but failing to address the permanent removal of practice barriers for advanced practice nurses. The rule also proposes to make permanent the COVID-19 public health emergency policy allowing nurse practitioners, clinical nurse specialists, physician assistants and certified nurse-midwives to supervise the performance of diagnostic tests in addition to physicians.
The proposed conversion factor for the fee schedule would be decreased by $3.83, from $36.09 to $32.26 – a recommendation that immediately drew criticism from surgical specialties that would see average payment cuts of 5 to 9 percent. Nurse anesthetists would be among those seeing the biggest cuts at 11 percent, while nurse practitioners would see an 8 percent increase.
Appeals Court Narrows “Public Charge” Injunction
The federal 2nd Circuit Court of Appeals on Aug. 13 narrowed a lower court’s nationwide injunction temporarily blocking enforcement of the Trump administration’s “public charge” rules limiting immigration for people using public benefits, ruling that the prohibition only applied to New York, Connecticut and Vermont. A New York federal district judge imposed a nationwide ban on enforcing the rules July 29 based on concerns that immigrants would avoid seeking health care during the coronavirus pandemic. On Aug. 4, the same appeals court upheld a similar prohibition applying only to the three-state area imposed in a decision last October. The latest legal action comes after the Supreme Court refused to block enforcement of the policy during the pandemic but said legal challenges brought by immigrant rights groups could continue in lower courts.
Separately, a California federal district judge on July 27 refused to grant the administration an additional delay in the deadline she set for U.S. Immigration and Customs Enforcement to release immigrant children from family detention centers in Pennsylvania and Texas affected by the spread of the coronavirus, declaring that “there will be no family separation without parental consent.” In June, Judge Dolly Gee ordered the release of migrant children in three facilities, citing the severity of coronavirus outbreaks in the centers. Immigrant advocates said it remains unclear if ICE will comply with the court order.
In Other News…
House Passes Funding Increase for Nursing Workforce Programs
House Democrats approved a $1.3 trillion fiscal 2021 “minibus” spending package (H.R. 7617) July 31 that provides a $10 million funding increase for nursing workforce programs, for a total of $269.97 million, and includes $210 billion in emergency money to help federal agencies fight the coronavirus pandemic, along with other priorities. The bill also includes $5 million for the Nurse Practitioner Optional Fellowship program, funding grants for optional community-based nurse practitioner fellowship programs for practicing postgraduate nurse practitioners in primary or behavioral health care. The six-bill package, which includes the Labor-HHS-Education, Defense, Commerce-Justice-Science, Energy and Water, Financial Services, and Transportation-HUD funding bills, passed on a 217 to 197 mainly party-line vote and drew a quick veto threat from the White House.
The House bill is only a starting point for future negotiations with Senate Republicans, who have yet to advance any of their own fiscal 2021 spending bills as they struggle to agree on how to handle pandemic spending. Combined with election year politics, lawmakers appear to be headed to passing a short-term spending fix in September to keep the government open until a post-election “lame duck” session.
HHS Extends Provider Relief Funding
The Department of Health and Human Services announced July 31 that it was extending the application deadline for providers dependent on Medicaid and the Children’s Health Insurance Program (CHIP) to receive federal assistance from the coronavirus Provider Relief Fund until Friday, August 28. In making the announcement, HHS Sec. Alex Azar said, “Extending the deadline for Medicaid providers and giving certain Medicare providers another shot at funding is another example of our work with providers to ensure as many as possible receive the support they need.” The agency in June announced a $15 billion allocation that allowed eligible Medicaid, Medicaid managed care, CHIP and dental providers to apply for funding of up to 2 percent of reported revenue from patient care. The initial July 20 was extended to August 3 based on provider concerns about problems with submitting applications.
Lactation Bills Win Senate Approval
The Senate gave its unanimous consent approval July 29 to two lactation measures. The “Friendly Airports for Mothers Improvement Act” (S.2638) would extend requirements for a clean, private, non-bathroom space to be provided in small hub airport terminals for the expression of breast milk starting next year. The requirement already applies to large and mid-sized airports. A companion bill, the “Small Airport Mothers’ Rooms Act of 2019” (H.R.3362), passed the House last December and representatives are expected to clear the final legislation soon.
Senators also approved the “Traveling Parents Screening Consistency Act of 2019” (S. 2381), which would require the Comptroller General to conduct a review of the Transportation Security Administration’s implementation of the “Bottles and Breastfeeding Equipment Screening Act” and its effectiveness in ensuring clarity and consistency in screening protocols for formula, breast milk, purified water and juice for infants. The House, which approved a companion bill (H.R. 3246) last September, must now sign off on Senate changes to send the bill to the White House.