Nurses Can Make Politics More Healthy
Contributed by Health Policy Committee member Jennifer F. Flippo, DNP, CPNP
As we anticipate the midterm elections this November, there is a conspicuous absence of nurses on ballots across the country. Each seat in the U.S. House of Representatives is up for re-election, as is one-third of the U.S. Senate. Nurses occupy only three of the 535 seats in Congress, less than 1%. That statistic is even more startling given that there are more than 4 million nurses in the U.S. Since the beginning of the pandemic, nurses have been pummeled with workplace concerns including safety and burnout, and when those are not addressed, professional apathy abounds. We would hope that frustration might be a motivator for change, but the number of nurses seeking elected offices is not noticeably increasing.
Nurses experience barriers to seeking and holding office that other professions do not. Historically, elected officials come from education, business and law careers (Gordon, 2021). Often these occupations provide flexible scheduling and support to permit campaigning, time off while in session and mentorship. Many full-time nursing positions do not offer such flexibility, and as nurses have fewdecessors in state or federal elected offices, mentorship is rare. Additionally, nurses may lack financial resources needed to launch and maintain a campaign, which at the federal level can run into the millions.
Although women comprise 51% of our population, women hold only 28% of Congressional seats and approximately 31% of state legislature seats, resulting in under-representation in American politics. This prompts the question: how can women’s experiences in health care, as a provider or as a patient, be fairly addressed if the gender demographics of the governing body doesn’t reflect the general population? Studies show that women are as likely to win their elections as male counterparts; the problem is they do not run for office.
How can we change the system? Let’s start by getting nurses and nurse practitioners, like those reading this article, elected at the grassroots level. Nurses considering elected positions should join professional organization(s) and become involved in advocacy activities. Leadership development, advocacy and health policy training through professional associations can provide mentorship and improve acumen in the complex arena of politics. The next step on the leadership journey is running for local or state office – and letting your nursing and health care colleagues know so they can spread the word through their networks. Groups like Healing Politics are exclusively focused on inspiring, motivating, recruiting and training nurses and midwives to run for elected office.
Another important step in getting a seat at the legislative table is building public awareness about nurses’ and nurse practitioners’ education and experience to show constituents how these health care leaders can improve communities. When running for any office, you should network with local journalists, bloggers and podcast hosts to become a known health care expert and expand your reach and name recognition.
The public needs nurses and nurse practitioners in policy making positions. We are the connection between health care and the populace. We need mentors and resources, as well as intrinsic ambition to make change happen on the big stage.
Gordon, K. (2021). “Is there a nurse in the House? Or the Senate? Barriers and facilitators to pursuing elected office” Yale School of Nursing Digital Theses, 1114. https://elischolar.library.yale.edu/ysndt/1114
Lawless, J.L & Fox, R.L. (2008). Why are women still not running for public office? Issues in Governance Studies (18).
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Bill Introduced to Remove Federal APRN Practice Barriers
Two U.S. representatives introduced a comprehensive bill aimed at eliminating federal policies limiting nurse practitioners (NPs) and other advanced practice registered nursing from providing care at the top of their licensure. Reps. Lucille Roybal-Allard (D-CA) and Dave Joyce (R-OH) filed the “Improving Care and Access to Nurses (ICAN) Act” (H.R. 8812) that includes separate titles to deal with policies related to NPs, nurse anesthetists and nurse-midwives, as well as a title on general APRN issues.
Among the provisions affecting NPs, the bill would permit Medicare and Medicaid hospital patients to be under the care of NPs and to receive Medicaid outpatient clinic services under their direction. It would also authorize NPs to order and supervise Medicare cardiac and pulmonary rehabilitation services, certify therapeutic shoes for diabetic patients, and establish and review Medicare home infusion plans of care. And it would authorize NPs and clinical nurse specialists to refer patients to dieticians or nutrition professionals for medical nutrition therapy.
NAPNAP is joining other national nursing associations in urging U.S. representatives to cosponsor the “ICAN Act.” Members are encouraged to use NAPNAP’s Advocacy Center contact their House members to support the bill.
NAPNAP Joins Brief on Supreme Court Case
Children’s health advocates including NAPNAP, the Children’s Hospital Association, and the American Academy of Pediatrics are weighing in on a case before the U.S. Supreme Court that could affect individuals’ ability to ask courts to protect their rights under a broad range of federal programs including Medicaid and the Children’s Health Insurance Program. The Supreme Court is scheduled to hear oral arguments Nov. 8 in Health and Hospital Corp. of Marion County v. Talevski, a case involving a nursing home patient that could affect the rights of individuals to file federal civil rights claims. NAPNAP and other children’s health groups argue that rejecting the claims would weaken congressional protections for Medicaid-eligible children to receive early and periodic screening, diagnostic, and treatment (EPSDT) services and other care that parents and health care providers have had to right for.
Advocates are also watching a case in Texas federal courts that could overturn the Affordable Care Act’s requirement that insurers cover preventive services and screenings at no cost to patients. A district court judge ruled in Braidwood Management v. Becerra that a company couldn’t be required to cover a preventive treatment for HIV and AIDS through its employer health plan because of the company’s religious objections. The ruling could affect coverage of preventive screenings, vaccinations, immunizations, and counseling endorsed by the U.S. Preventive Health Services Task Force.
Year-End Measure Could Include Mental Health Policies
The chair of the Senate Finance Committee said on Oct. 5 that a year-end legislative package could include provisions to deal with mental health parity and building the behavioral health workforce. Sen. Ron Wyden (D-OR) said that he and Sen. Mike Crapo (R-ID), the panel’s top-ranking Republican, want to advance bipartisan mental health policies in the “lame duck” session, possibly including provisions of the committee’s discussion draft of legislation to address workforce shortages, including enabling nurse practitioners and clinical nurse specialists to receive 15 percent bonus payments for diagnosis and treatment of mental health or substance use disorders in mental health professional shortage areas.
The House passed legislation last month that would support behavioral health in schools and sent a bill to the President that would expand community health center grants to cover the creation of mobile health care units aimed at tackling access and workforce shortage issues. The House approved the “Mental Health Matters Act” (H.R. 7780), which would focus on building the school-based mental health care workforce and provide the Labor Department more resources and greater authority to ensure employer-sponsored group health plans comply with parity laws. Separately, representatives cleared the Senate-passed “Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act” (S. 958), which would allow community health centers to put federal funds toward creating mobile health centers.
Congress Delays Spending Decisions Until December
Having failed to reach a bipartisan agreement on the topline spending allocations for defense and domestic programs, Congress passed a short-term continuing resolution to avoid a shutdown at the end of the 2022 fiscal year and put off negotiations on a final deal on fiscal 2023 appropriations until a post-election “lame duck” session. The stop-gap extension funds government agencies through Dec. 16 and gives lawmakers additional time to negotiate an omnibus spending package.
Prior to passing the continuing resolution, Democratic appropriators in both chambers released spending plans including funding for the Department of Health and Human Services that proposed significant increases in nursing education and research. House appropriators offered a $44 million increase in Title VIII nursing workforce development programs under the Health Resources and Services Administration, up to a total of $324.47 million, while Senate appropriators proposed a $38 million increase. Both chambers joined the Biden administration in targeting funding to increase and diversify the maternal and perinatal health nursing workforce. The House also proposed to boost funding for the National Institute of Nursing Research by almost $28 million, for a total of about $208.6 million, while senators offered a $15.6 million increase.
HHS Extends COVID-19 Emergency Amid Enrollment Concerns
Health and Human Services Sec. Xavier Becerra on Oct. 13 extended the coronavirus public health emergency another 90 days until January 11, 2023, but states and health care advocates are worried that the eventual end of coverage protections and treatment flexibilities created during the pandemic will affect access to care for millions of Americans. The Biden administration estimated that more than 17% of Medicaid and Children’s Health Insurance Program (CHIP) enrollees – roughly 15 million individuals – could lose coverage when the emergency ends and states ramp up efforts to redetermine if people enrolled are still eligible as Medicaid programs lose enhanced pandemic funding. Policy experts are trying to help consumers and providers prepare for post-emergency health care rules. The Georgetown University Center for Children and Families created a “50-state Unwinding Tracker” with information on what each state is doing to handle enrollment redeterminations.
Providers are also worried that waivers increasing access to telehealth services will also expire when the emergency designation ends. The Biden administration has also started planning for the eventual shifting of COVID-19 vaccines into the commercial market, although concerns about availability and cost remain.
In Other News
Administration Issues Rules Fixing “Family Glitch”
The Biden administration released final regulations Oct. 11 to fix the so-called “family glitch” that prevents family members from receiving Affordable Care Act premium subsidies if a household member has access to an affordable employer-sponsored health plan. Employer coverage is deemed “affordable” by costing the employee 9.5 percent of his or her income for single coverage. But as written, previous rules didn’t take into account the increased premiums for adding family members to the plan, putting coverage for many families out of reach.
NAPNAP and many other health care advocacy groups have long pushed the Treasury Department to fix the definition. As a result of the change, nearly 1 million additional individuals and families will have access to the ACA premium assistance next year. Open enrollment for 2023 ACA coverage begins Nov. 1, so people signing up for coverage will be able to take advantage of the new policy.
White House Conference Highlights Nutrition Initiatives
Public officials and private stakeholders convened last month at the first White House Conference on Food, Nutrition and Health in 50 years to discuss how to address food insecurity and the increasing rates of diet-related diseases like type 2 diabetes, obesity, hypertension and certain cancers. Speakers highlighted joint initiatives to try to end hunger and increase healthy eating by 2030. Ahead of the event, the White House announced more than $8 billion in public-private partnerships to advance several of those incentives and unveiled a National Strategy on Hunger Nutrition and Health laying out how the administration plans to accomplish its goal to end hunger as well as increase healthy eating and physical activity, including letting Medicare and Medicaid cover medically tailored meals and expand access to nutrition and obesity counseling.
Separately, the Food and Drug Administration proposed a rule to update the definition of the term “healthy” for the first time since 1993, ensuring the definition falls in line with the current U.S. dietary guidelines and the FDA’s updated nutrition facts label requirements. The proposal rule would allow for more foods like higher fat fish and oils included in the Guidelines for Healthy Americans to use the claim “healthy.”
Survey Finds Youth Tobacco Use Remains High
Nearly 2.6 million middle and high school students in the U.S. reported current e-cigarette use in 2022, according to data from the National Youth Tobacco Survey released Oct. 6. The survey, which was administered from January to May, found that nearly 85 percent of students who reported use of e-cigarettes within the past 30 days used flavored e-cigarettes, with fruit, candy, mint and menthol being the most common flavors. More than 55 percent used disposable e-cigarettes and more than 25 percent used refillable pods or cartridges. The 2.55 million users who reported current e-cigarette use represent more than 14 percent of high schoolers and more than 3 percent of middle school students. More than 42 percent reported using e-cigarettes 20 or more of the past 30 days.
Meanwhile, e-cigarette maker Juul Labs said last month it had reached an agreement with 34 states and territories to pay $438.5 million to settle an investigation into how the company marketed vaping products to underage people. Under the tentative deal, the company agreed to stop youth marketing and sale of flavors not approved by the Food and Drug Administration, use of paid influencers. Restrictions on sales and distribution of products, such as where products can be displayed in stores and age verification, are also part of the landmark agreement.