Inside the Beltway – June 2023 - NAPNAP

Inside the Beltway – June 2023

Inside the Beltway – June 2023

The Intersection of Policy & Media: Preparing Nurse Practitioners for Engagement

Contributed by Former Health Policy Committee member and
GW Health Policy & Media Fellow Danielle Altares Sarik, PhD, APRN, CPNP-PC

Media – TV, radio, online stories, posts & blogs – surround us every day. Whether we consciously engage in media consumption, the truth is that we are bombarded with messages at all times. However, who has a voice in media? When you think about the expert advice highlighted or the individuals who are given a platform to engage in media, what comes to mind?

Several studies examining who is featured as an expert in the media point to some surprising results. Authors in a 2018 study found that the amount of media coverage that highlights the work and voice of nurses remains low – merely 2% of healthcare articles quoted nurses, as compared to 21% that quoted physicians. In articles that focused on health policy topics, arguably an important area for all healthcare professionals, the authors found that no nurses were quoted. When compared to a 1997-98 study examining similar trends, the percent of nursing-related coverage actually decreased in the past decade. This points to an opportunity for nurse practitioners to increase their media engagement in a meaningful way.

However, barriers exist for nurse practitioners who would like to engage in the media space. These barriers include a lack of formal training, potential rules against media engagement set by an individuals’ clinical setting, discomfort with the process, and marketing and media teams reflexively identifying physicians as experts for news stories. Despite these challenges, nurses are well-positioned to share data, educate, and connect with the public. Nurses are consistently identified as highly ethical, well-liked across the political spectrum, and widely respected. Therefore, nurses and nurse practitioners are in a unique position to use their voice and expertise to advocate for policies that support the well-being of our patients and families.

For nurses who are interested in learning how best to learn and grow in this area, the George Washington School of Nursing has a Health Policy and Media Fellowship available to nurses. This one year fellowship aims to increase health policy knowledge and increase the visibility of nurses in the media. Additionally, most professional nursing associations (including NAPNAP!), have either a health policy or advocacy committee. For nurses who want to gain some more experience with the world of policy, and perhaps learn how to use tools like the media to engage effectively around topics of importance, consider these opportunities. For those nurse practitioners who work in a health system with a media team, consider setting up a meeting to introduce and share areas where you can contribute to news stories. Ask if there are any opportunities to highlight the work of nurses in your setting, or to contribute stories that help to underscore the need for policy change or action.

Whether you are a novice with media and advocacy, or a seasoned expert voice, your experience and pediatric knowledge are needed. Finding ways to elevate the nursing voice in media is one way that nurse practitioners are experts in pediatrics, and advocates for children.

Supreme Court Preserves Right to Protect Benefits

In a 7 to 2 ruling June 8, the Supreme Court upheld the ability of individuals to sue if federally-funded programs like Medicaid aren’t fairly administered. The court rejected a bid to prevent the family of an Indiana nursing home resident from challenging his care at a government-run facility, upholding a lower court’s ruling in Health and Hospital Corp. v. Talevski. The family claimed that the facility violated the patient’s rights under the Federal Nursing Home Reform Act, which places limits the use of physical or chemical restraints and on transferring patients and brought the case under an 1871 statute known as Section 1983 that gives people the power to sue in federal court when state officials violate their constitutional or statutory rights.

NAPNAP joined the American Academy of Pediatrics, the Children’s Hospital Association and other children’s health groups in filing an amicus brief in the case outlining the importance of the case in preserving children’s access to Medicaid and CHIP services. The Biden administration also urged the justices to reject a broad limitation on lawsuits pursued under the law.

Lawmaker Introduce Bill to End Federal Barriers to APRN Practice

Leaders of the House Nursing Caucus led a bipartisan group of 11 legislators in April in introducing the “Improving Care and Access to Nurses (ICAN) Act” (H.R. 2713), a bill aimed at increasing access to services provided by advanced practice registered nurses by eliminating outdated practice barriers in the Medicare and Medicaid programs. The legislation would authorize nurse practitioners to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for accountable care organizations under the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities and more. Sen. Jeff Merkley (D-OR), the chair of the Senate Nursing Caucus, is planning to introduce a companion measure in that chamber in the coming weeks.

NAPNAP is urging members to contact their Representatives and urge them to cosponsor the “Improving Care and Access to Nurses Act.”  Members can simply go to the NAPNAP Advocacy Center, enter their information for the ICAN campaign, click “Next” to review or customize their email to their legislator and click “Submit” to send it.

Federal Advisers Endorse RSV Vaccine, Treatment for Infants

The Food and Drug Administration’s independent advisers voted unanimously June 8 to recommend approval of a new treatment to offer infants protection against respiratory syncytial virus during their first year of life. Nirsevimab, a monoclonal antibody from AstraZeneca and Sanofi, would be administered to babies ahead of their first RSV season as a single shot at a routine pediatric visit. The antibody isn’t a vaccine because it doesn’t cause infants to produce their own immune response, but it appears to safely prevent severe disease caused by RSV. In one late-stage trial, there were 25 cases of RSV requiring a medical examination among 969 who received nirsevimab after six months among infants who were born between 29- and 35-weeks’ gestation compared to 46 out of 484 who received placebo.

The FDA Vaccines and Related Biological Products Advisory Committee last month agreed that the agency should approve the first vaccine that protects infants against respiratory syncytial virus. In late-stage clinical trials, the vaccine candidate from Pfizer was more than 80 percent effective at preventing severe RSV for newborns up to 3 months old and about 70 percent effective at preventing severe disease in babies up to 6 months old. It is administered to pregnant individuals in their second or third trimester and generates antibodies against the virus that can be passed on to the baby. Some members of the panel expressed concerns about the potential of increased risks of pre-term births from the vaccine.

White House, Congress Reach Debt Limit Deal

President Joe Biden on June 3 signed into law a controversial agreement to suspend the limit on the federal government’s $31.4 trillion debt just two days before it would have defaulted, imposing caps on domestic spending that could impact funding for nursing education, workforce development and research for the next two years. While it comfortably passed both chambers of Congress, the deal angered both right-wing Republicans and progressive Democrats, leaving House Speaker Kevin McCarthy facing a backlash from conservatives that could threaten his ability to lead the party.

The 99-page the agreement suspends the debt limit for two years to Jan. 1, 2025, beyond the next presidential election, while limiting overall spending on discretionary non-defense domestic programs except for veterans programs at essentially current levels and allowing that spending to increase by one percent in fiscal 2025. If lawmakers don’t complete all 12 appropriations bills by the end of the fiscal year, the agreement would automatically extend funding with a 1 percent cut to current spending levels. It won’t be clear how the spending caps will affect nursing programs until appropriators allocate the discretionary spending levels to individual agencies and programs.

The deal would also claw back roughly $30 billion in unspent coronavirus funds and impose new work requirements to for some applicants to qualify for Supplemental Nutrition Assistance Program (SNAP) benefits – not for Medicaid coverage, as originally proposed. It would also restart collection of federal student loan payments and interest for millions of Americans after Aug. 30, ending a payment pause that had originated as a response to the pandemic.

Congress Prepares to Start Fiscal 2024 Appropriations Process

Facing new pressure imposed by the debt limit agreement, House and Senate appropriators are planning to advance their fiscal year 2024 spending plans through their committees this month, with floor votes on most measures excepting before Congress takes its traditional August recess. However, leaders have yet to agree on the specific allocations for individual agencies, departments and programs, and Republicans angered by the debt limit’s allocation for defense spending are pushing to pass spending bills that provide even less funding for discretionary domestic programs than those spending caps allow.

House Appropriations Committee Chair Kay Granger (R-TX) plans to begin subcommittee and full committee markups on Republicans’ spending bills for veterans, Agriculture-FDA, Homeland Security, and the Legislative Branch in the coming weeks, with the bill funding the Department of Health and Human Services likely to be among the last to move forward. Senate Appropriations Committee Chair Patty Murray (D-WA) is working with the panel’s top-ranking Republicans, Sen. Susan Collins of Maine, to allocate funding levels and start voting on their versions of the spending bills.

In Other News…

Administration Proposes Aid For School-Based Medicaid
The Department of Education released a notice of proposed rulemaking Wednesday May 17 intended to help schools tap more public assistance dollars for students with disabilities by scaling back parental consent requirements in federal special education regulations. Schools would no longer have to obtain parent approval before accessing Medicaid or Children’s Health Insurance Program benefits to finance special education services for students with disabilities, according to the proposal, marking a significant change that advances President Biden’s aspirations to improve student access to mental health care on campus in accordance with the Bipartisan Safer Communities Act.

Under the proposal, parents and families must still consent to having their children evaluated for special education services and disclosing personally-identifiable information to states for Medicaid billing purposes. But the agency no longer believes disabled students’ families should have to sign separate paperwork that allows schools to tap public benefits or insurance.

Biden Vetoes Plan to Block Student Loan Forgiveness
President Joe Biden vetoed a resolution June 7 that would have canceled his plan to forgive tens of thousands of dollars in student loan debt. The measure passed both chambers of Congress on bipartisan votes, but with narrow majorities that are unlikely to override Biden’s veto. The recent agreement on the debt limit restarted collection of payments and interest on outstanding loans but didn’t touch the administration’s program to forgive as much as $20,000 in student debt per borrower. Nonetheless, the debt forgiveness plan still isn’t secure. The Supreme Court is reviewing a legal challenge that could eliminate the program, and a decision is expected in the next month.

Biden Set to Name Mandy Cohen As CDC Director
White House officials signaled Thursday (6/1) that President Biden intends to select former North Carolina health secretary Mandy Cohen to lead the Centers for Disease Control and Prevention, replacing Rochelle Walensky when she steps down at the end of the month. A formal announcement is expected later this month after Cohen’s paperwork. A Yale- and Harvard-trained internal medicine physician and public health expert who is now a health-care executive, Cohen worked closely with White House Chief of Staff Jeff Zients and other senior Biden officials during the Obama administration.

The position of CDC director does not require Senate confirmation, but the agency’s next leader will face close scrutiny from Congress. House Republicans, who have launched a flurry of probes into the beleaguered agency, held a contentious hearing June 7 focusing on what they characterized as the “CDC’s failures in fulfilling its mission” and mishandling of the coronavirus pandemic.

Appeals Court Questions Halting Preventive Services Mandate
A three-judge panel of the federal 5th Circuit Court of Appeals court panel raised questions June 6 about blocking the Department of Health and Human Services from enforcing the Affordable Care Act preventive services coverage mandate and urged parties in the Braidwood Management v. HHS case to try to find a workable resolution. Both sides in the case concurred that the individual Texas businesses that sued over the mandate should be shielded from it while the litigation makes its way through the courts, but they disagreed on whether more harm would be caused by keeping the current coverage rules intact for everyone else in the country or by suspending them nationwide – a move the Biden administration warned would threaten access to a range of services for millions of people on employer-sponsored insurance and individual health plans.

The Fifth Circuit agreed to a temporary stay last month that will last until the panel rules on the motion. Attorneys representing the Texas employers and individual workers challenging the policy argued that because the U.S. Preventive Services Task Force is made up of outside experts who are not Senate-confirmed or overseen by Senate-confirmed government employees, their recommendations of what preventive services should be covered by insurance must be “set aside” and can’t be enforced. The government is due to submit its principal brief on June 20 and asked the court to approve a briefing schedule that lasts through Nov. 3.


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