Constitutional provisions, whose primary purposes are to create obstacles, govern the process that a bill goes through before it becomes law. The founders believed that efficiency was the hallmark of oppressive government, and they wanted to be sure that laws that actually passed all the hurdles were the well-considered result of inspection by many eyes.
Early civics lessons teach children about the three equal branches of government, with distinct and specific roles, enabling the executive (the president), the legislative (the Congress), and the judiciary (the courts) to maintain important checks-and-balances oversight. Myriad formal rules and informal traditions allow each branch to operate as independent yet coordinated organizations to maintain freedom through popular voting. But it’s still a fluid process and one that continues to be readjusted to reflect the people’s will.
How ONS Influences Legislation
ONS, like many other national specialty membership organizations, has a strong presence in Washington, DC. The Board of Directors creates and annually reviews ideas, issues, and urgencies to establish ONS’s health policy agenda, amending it as circumstances evolve. From palliative care and workforce safety to nursing education and cancer research, ONS is a leader in advocacy to raise awareness for the role of the nurse in healthcare. With congressional meetings, policy summits, and issue briefings, ONS experts testify before decision makers, helping to elucidate complex provider, oncology, and healthcare topics from the nurse’s perspective.
ONS Bills Pass U.S. House—But Will They Continue to Move Forward?
At the end of 2019, ONS was a coordinating organization that supported the passage of two major pieces of legislation. The Palliative Care and Hospice Education and Training Act (PCHETA) and the Title VIII Nursing Workforce Reauthorization Act both passed the U.S. House of Representatives with overwhelming bipartisan support, but it literally took years to reach that point. In previous congressional sessions, the bills also passed one chamber but were diverted through some of the very odd mechanisms that allow legislation to die. Groups like ONS must be proactive and return to elected officials with concrete reasons for support through future sessions.
As august as the U.S. Congress seems, Americans must remember that federal representatives work for those who elected them to office. According to the U.S. House of Representatives’ own authority:
“As per the Constitution, the U.S. House of Representatives makes and passes federal laws. The House is one of Congress’s two chambers (the other is the U.S. Senate), and part of the federal government’s legislative branch. The number of voting representatives in the House is fixed by law at no more than 435, proportionally representing the population of the 50 states.”
Across the United States, a finite number of representatives take priority issues from their constituents and work through committees and chambers to find consensus in support of common causes. The health policy issues ONS is advancing are not ideologic but do often cross into personal philosophies that have different interpretations. For example, when palliative care entered the Capitol Hill rhetoric, the nursing community was called on to educate policy experts about the definition and its difference from ancillary classifications like hospice care.
What’s on the Legislative Agenda for 2020
A few current issues remain priorities for the broader health community as ONS sets its the agenda for 2020, including:
- Drug pricing: It is a popular, bipartisan issue and a priority for House Speaker Nancy Pelosi, but most believe that the U.S. Senate does not have the votes to pass its version of the bill.
- Surprise medical billing: Both chambers have bills in some committees, but their payment models differ. Other committees are still holding hearings on the topic.
- Biosimilars: Several bills are before House and Senate committees, many relating to patents, timelines, ownership, and reimbursement. Some of the bills have been reintroduced for several congressional sessions and remain stalled.
- 340B drug pricing program: Any formal reauthorization and federal appropriations must be voted on by Congress, but under the current leadership, the U.S. House of Representatives is not taking the measure up for consideration.
Oral parity for cancer drugs, lymphedema sleeve reimbursement, flavored tobacco and vaping bans, and federal funding for nursing and cancer research are also ONS priorities. In Washington, DC, nurses are often asked for expertise in patient-centered care. Having that seat at the table is both a privilege and a responsibility.
Despite it being the top concern in today’s political environment, healthcare policy is entering a state of fatigue. Voters are interested in finding ways to maintain access to their preferred providers, with expert consideration for treatments, by using an affordable system.
The 2020 election is now in full swing. The entire House is up for re-election, as is one-third of the Senate, and the presidency tops the ballot. Americans have the opportunity to once again make their voices heard, and by doing so, send their priorities to Washington. Through its health policy agenda, ONS works diligently to raise awareness for oncology nurses and the patients they serve. As the year unfolds, championing research and evidence-based, quality care will require a concerted effort to make it the breakthrough message in the next U.S. Congress.