The day the administration releases the president’s budget, outlining funding levels for federal departments and their respective programs, has become an annual event around the Beltway. When that document was unveiled on March 11, 2019, it arrived on Capitol Hill like a lead zeppelin. Under the proposed budget, the National Institutes of Health’s (NIH’s) budget would see a 13% cut, and the National Cancer Institute (NCI) would have its budget reduced by 15%. The dramatic cuts in domestic spending on health, education, and welfare programs were so stark that patient advocacy and provider groups released statements individually and through coalitions to respectfully—or less so—inform decision makers that efforts will begin immediately to advocate for maintained funding levels.

In early January 2019, I had the opportunity to represent ONS before the Virginia State Senate Finance Committee on the growing epidemic of electronic cigarettes and vaping device use among youth. In Richmond, VA, I delivered testimony about the dangerous health ramifications of this newer trend of tobacco use.

Health care remains a top domestic policy issue for Americans. Across the board—regardless of political ideology—Americans are concerned about the quality of health care, access to providers, and rising costs associated with medications and treatment. In February 2019, the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary released a report outlining the projected growth in national health spending from 2018–2027.

Washington, DC, and the larger federal government are filled with dedicated professionals who toil quietly, often anonymously, in support of programs, initiatives, and agency work in service of the American public. Such is true for the Department of Health and Human Services’ (HHS) lesser-known leaders like Admiral Brett Giroir, MD, assistant secretary for health, who reflected on his time at HHS as he helped guide the department’s efforts in public health.

After the Institute of Medicine’s (IOM) 2010 report on the “Future of Nursing,” the nursing field made a concerted effort to encourage current and incoming nurses to achieve higher education through a Bachelor of Science Nursing (BSN) degree or higher. As lifelong learners, nurses are committed to providing the best care possible and consistently furthering their education is part of that commitment. According to a report from AARP and the Robert Wood Johnson Foundation, 56% of U.S. nurses hold a BSN or higher, an all-time high for the profession.

Although nurses are the number one trusted profession in the United States for the past 18 years in a row, they’re not necessarily the most protected sector. Hostile workforce environments and exposure to hazardous chemicals are still a part of too many nurses’ daily lives. Recently, the U.S. House Education and Labor Committee held hearings on workforce safety to better understand the what nurses and other healthcare workers endure.

For the past year, President Trump has championed efforts to lower drug prices for Americans to more accessible and affordable medications. Lowering soaring prescription costs is an issue with wide bipartisan support in Congress. To date, several Congressional committees have held hearings in early 2019 with pharmaceutical executives.

In a statement during the 2019 State of the Union address, President Trump proposed ending the HIV epidemic by reducing new infections by 75% in the next five years and 90% in the next decade. Department of Health and Human Services (HHS) Secretary Alex Azar hailed Trump’s statement as an important public health initiative.

Democrats control the majority of the House of Representatives, and it’s their responsibility to provide and pass a U.S. budget. As with any Congress, it’s always easier said than done. With a larger, more progressive freshman class interested in pushing more environmental, health, and welfare policy issues forward, costs will be a concern.

On January 25, 2019, President Trump announced a deal to end the longest U.S. government partial shutdown in history—35 days of closed public places and programs, furloughed or unpaid federal employees, and an apprehensive American nation. What was its impact on health policy and, more specifically, cancer care?

Rising prescription medication costs has been a major focus area for both the Trump administration and the 116th Congress. In January 2019, both the House and Senate committees of jurisdiction held public hearings on soaring drug costs. Despite constant media attention and mounting pressure from government officials, no pharmaceutical company executives chose to testify. Congress threatened to subpoena the industry if it happened again.

To improve access to new cancer therapies and provide national consistency in coverage, on February 15, 2019, the Centers for Medicare and Medicaid Services (CMS) announced a proposed plan of coverage with evidence development for CAR T-cell therapy. The public is invited to share comments for the next 30 days.

When heads of federal regulatory agencies are health and medical professionals with years of research experience, their background helps guide the mission and vision of the department along with the direction of thousands of staff and employees engaged in implementing health policy. U.S. Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, MD, is a clinician and activist, and he acts as a staunch advocate for public health issues—namely the dangers of tobacco use, especially among young Americans.

In an open letter to the research and advocacy community, National Institutes of Health (NIH) Director Francis Collins, MD, PhD, announced the Office of Disease Prevention’s (ODP) new strategic plan to “strengthen research through increased coordination and facilitation among NIH institutes, centers, and offices, including leveraging the power of new portfolio analysis tools, ensuring ongoing communications with stakeholders, and building trans-NIH partnerships to address gaps in prevention research.”

Efforts to curb the national opioid epidemic have taken shape in several ways, including redefined prescription guidelines. However, many insurers are now refusing to cover certain pain medications like the ones commonly prescribed to patients with cancer. For years, ONS has been meeting with congressional offices to advocate that access to prescription opioids for cancer survivors should be exempt from the strict limits assigned to other diagnoses. It’s always been a successful strategy, because ONS helps policy leaders understand that patients with cancer often struggle with issues related to severe pain management, quality of life, and end-of-life care.

The Health Resources and Services Administration (HRSA) announced $293 million in new funding through programs at the National Health Service Corps (NHSC) and Nurse Corps for the healthcare community to expand the clinician workforce. Strengthening care and support can help address gaps in care and limit growing socioeconomic disparities.

Targeted to healthcare providers, the Centers for Disease Control and Prevention (CDC) has released a new public service health campaign to call attention to the importance of regular screenings for breast, cervical, and colorectal cancers. The Screen Out Cancer campaign is designed to raise awareness to ensure that patients and providers know that prevention begins with knowledge.

Recognizing the continuing impact of the national opioid epidemic, the Department of Health and Human Services (HHS) has dedicated $1 billion in funding through a new awards program called the Five-Point Strategy to Combat the Opioid Crisis. The program will empower communities to implement strategies to curb opioid abuse and addiction.

The new 116th Congress has settled in, and a clearer picture of the diverse freshman class has come to light. In this case, nursing is present and accounted for among incoming congressional representatives. Lauren Underwood (D-IL) is an RN who ran on her support for health care, specifically to protect those with pre-existing conditions. She’s already a co-chair of the Congressional Nursing Caucus and has signed on to Title VIII nursing reauthorization legislation—something ONS has continually championed. Representative Eddie Bernice Johnson (D-TX)—the first nurse ever elected to Congress—is entering her 13th term in the chamber and continues to offer a veteran nursing presence on the hill.

How often have you gone to the mailbox, pulled out your latest issue of the Oncology Nursing Forum or Clinical Journal of Oncology Nursing, and excitedly read about some innovative study with game-changing outcomes that’ll revolutionize the delivery of health care—only to find that it never moves off the pages of the journal? What does it take to move research from the proverbial bench to the community? That was the focus of the Fourth Annual Meeting of the Patient Centered Outcomes Research Institute (PCORI), “From Evidence to Impact: Putting What Works into Action,” held from October 31–November 2, 2018, in Washington DC. 

For years, the human papillomavirus vaccination (HPV) has been recommended to young adult patients to help prevent certain forms of cancer. In a November 2018 report, the President’s Cancer Panel recommended increasing HPV vaccination efforts to further the United States’ goal to prevent cancer associated with HPV.

U.S. drug pricing systems are difficult for patients to understand, cumbersome to maneuver, and limited in access and affordability. In Medicare’s current structure, certain medications are designated as a protected class of drug, and Medicare Part D plans are obligated to cover them.

Congress has settled in after the shutdown, and new members have taken their place on committees to begin the real work in Washington, DC. This week, the House and Senate convened similar panels to discuss the bipartisan goal to lower soaring drug costs for all Americans. Patients and families provided emotional testimony about lost loved ones because of pricey prescription medications that were out of reach.

Race and economics are still driving cancer treatment and survivorship, ONS member Janice Phillips, RN, PHD, FAAN, explained in her article, “Unfair Diagnosis: Socioeconomic Gap Drives Cancer Outcomes,” published in January 2019 in Scientific American.

After a contentious 35-day-long shutdown, President Trump announced on January 25, 2019, plans for a temporary deal to reopen the government for a three-week period while talks continue on border security and immigration. Neither party seems optimistic that compromise can happen by the February 15 deadline, and the future is still uncertain.

On January 3, 2019, the newly elected, Democrat-controlled House of Representatives introduced legislation to reopen the federal government and end the current shutdown. It’s not about the money, which is usually the case; it’s about the blame. The border wall funding—in whatever capacity—is politically driving the shutdown. But Senator Mitch McConnell (R-KY) doesn’t want to take up a Democrat-sponsored bill that he knows the president will veto. Democrats want that to happen to force the president to either accept the blame for the shutdown or to cave without funding for the wall and reopen the government.

Election results may appear to be seismic shifts, jarring the foundations of the American political system to its core as voters stare in disbelief, attempting to translate the meaning of the public’s intent. But is that really the case?

Since 2016, ONS has gathered hundreds of nurse advocates in the nation’s capital to speak truth to power during its annual Hill Days conference. This two-day meeting brings more than 100 oncology nurses to Washington, DC, to learn about the Society’s health policy legislative agenda and to be trained in how to educate elected officials on the priority issues most important to ONS members.

Although the Democrats have yet not formally taken control of the House of Representatives, many are primed and passionate about holding the Trump administration accountable after the November midterm elections. Through involvement in committees and as incoming chairs of powerful oversight panels, lawmakers are questioning officials about healthcare policy.

As efforts continue to drive down the soaring costs of prescription medications, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) proposed a bipartisan bill looking to close loopholes used by pharmaceutical companies to drive up profits. The bill would give the Department of Health and Human Services the ability to address companies that misclassify products to pay lower rebates.

Nurses should initiate financial conversations with patients early and offer resources to improve access to cancer care, speakers at the ONS Center for Advocacy and Health Policy’s third annual policy summit on November 13, 2018, concluded. The event, held at the Hyatt Regency Hotel on Capitol Hill in Washington, DC, brought together nurses and industry and government experts to address the issue of financial toxicity in today’s cancer care.

As a staunch advocate for the advancement of cancer treatments, research, and patient care, President George H.W. Bush left an enduring legacy through contributions to the field of oncology and health care in the wake of his death on November 30, 2018. His continued support of healthcare professionals—including oncology nurses—spoke to his administration’s focus before, during, and after his tenure in Washington, DC.

With more than 70% of Americans supporting expanded Medicare, the single-payer Medicare for All rallying cry has gained significant support among progressives and moderates alike. A recent editorial report makes the case for its adoption with strong evidence from an economic point of view. During the November 2018 midterm election campaign, many incumbent Republicans—some of whom previously voted to repeal and replace the Affordable Care Act—now promised to uphold sections of the law, including protections for pre-existing conditions as their most important campaign commitment.

A billion dollars was once an astronomical amount of money to spend on one federal agency. But since the 1950s when Senator Dirksen (R-IL) was a leading voice for fiscal conservatives, the federal government’s budget has ballooned, with both political parties equally responsible for increases. During this time, great achievements have been made, and much of it in biomedical research at the National Institutes of Health (NIH), as what former Senator Arlen Specter (R-PA) often referred to as the crown jewel of the federal government.

Washington insiders weren’t surprised by the election’s outcome, and the next session of Congress will be something to watch in 2019. However, the current work of politics in a lame duck session can be interesting at best and potentially dangerous at worst. Members of Congress who lost their seats are now under no obligation to their districts, leadership, or party and often vote their conscience on late-session bills.

On October 25, 2018, U.S. Department of Health and Human Services (HHS) Secretary Alex Azar announced an advanced notice of proposed rulemaking (ANPRM) calling for a demonstration project to more closely align Medicare payment for certain Medicare Part B drugs and biologics with international prices, which an HHS analysis showed to be 1.8 times lower on average than in the United States. The proposal is a follow-up to the president’s prescription drug blueprint and HHS request for information to reduce patient out-of-pocket costs for prescription drugs. HHS estimates a savings of $17.2 billion over five years.

After an arduous campaign season, the midterm election results are mostly as anticipated. The Democrats gained seats in the House of Representatives, giving the party the majority in the lower chamber starting in January 2019. The Dems say their focus for the next congressional session will focus on health policy and high drug prices. Although the jury is still out over what the midterm elections meant, most experts agree that health care was the driving political issue for voters, regardless of party.

On September 12, 2018, I had the honor of attending the Nursing Community Coalition’s (NCC’s) 10th Anniversary Celebration as an ONS representative, joining members of ONS’s health policy staff. NCC is a 61-member coalition, working to further nursing education, training, and support through united advocacy efforts.

Budget season on Capitol Hill is always a complicated time. It’s a tug-of-war between funding priorities and fiscal responsibility. Often, budget debates end up in a stalemate and the government shuts down. However, for the first time in 22 years, the president signed the fiscal year 2019 Labor Department of Health and Human Services Appropriations package before the September 30 budget deadline.

Developed to combat the nation’s opioid crisis, a comprehensive opioid addiction bill has finally made its way to the president’s desk. On October 25, 2018, President Trump signed the opioid package into law. The new law allots more than $8 billion to address addiction, drug trafficking, and recovery issues. 

ONS, like so many membership organizations with dedicated healthcare interests, oils the gears that move the public policy machine forward. Each shift represents another opportunity for success. One such tactic is working in coalitions, and ONS is a vital member of health advocacy groups in Washington, DC, usually as the only nursing society at the table.

As this important midterm election approaches, my hope is that all ONS members recognize the importance of raising our collective voices as we elect our next leaders at the local, state, and federal level on November 6. In the words of former First Lady Michelle Obama, “It is more important than ever that we show up to vote, not just this year, but every year and in every election. Every voice must be heard, and every vote must be counted.”

Fighting the cost of soaring prescription medications is a winning issue with tremendous bipartisan support. And reigning in exorbitant drug prices means patients will be the real winners. Recently, President Trump lauded his administration’s work to fight against high prescription drug costs, citing new efforts to reduce other countries from taking advantage of drug pricing.

The breadth of understanding that can come from a face-to-face conversation is hard to underestimate. More than 100 oncology nurses discovered the power of advocacy, education, and one-on-one conversations during ONS’s 2018 Capitol Hill Days in Washington, DC.

When Senator John McCain (R-AZ) passed away in August 2018 from aggressive glioblastoma just one day after his family announced he stopped treatment, it put a poignant highlight in Washington on a need of which oncology nurses are far too aware: palliative care and hospice. Ideally, palliative care begins at the time of a cancer diagnosis and is aimed at managing symptoms throughout the cancer journey. Hospice begins when a patient’s prognosis is six months or less, yet in most cases, as McCain’s illustrates, patients begin hospice far too close to death. Many point to a lack of awareness and education—for patients and the public as well as oncology nurses and other palliative care providers.

Every federal agency is required to submit a plan and proposal to Congress outlining its budget for the next fiscal year—or years—as well as justifications for how and why the department needs the requested allotment. In September 2018, the National Cancer Institute (NCI) released its Annual Plan and Budget Proposal for Fiscal Year 2020.

During a recent speech at the 2018 Medicaid Management Care Summit, Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma expressed a continued commitment to Medicaid’s legacy of supporting Americans in need.