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.

For months, bipartisan lawmakers have worked together to build an opioid package aimed to tackle the nation’s abuse epidemic. After rounds of revisions and finally making it through both chambers of the House and Senate, the legislation is on its way to the president’s desk. The bill focuses funding efforts on addiction recovery programs and cracking down on the illegal medication trafficking.

The financial toxicity associated with cancer care is becoming a widely known side effect of cancer treatment. Beyond the disease's physical impact, patients are suffering from overwhelming medical costs, high prescription drug prices, and unforeseen, expensive complications. Those issues, often coupled with the inability to work, are leading to many patients quickly depleting their savings or slipping into debt.

Like all great adventures, it began as an idea. What if the United States could make huge advancements in the fight against cancer in a short amount of time? How could that be accomplished? What are the metrics? How much would it cost? Who could direct such an effort? 

Millions of Americans depend on the Affordable Care Act (ACA) marketplace for their health insurance. In the past, costs have been unstable, seeing insurance premiums rise and competition flee. However, new reports estimate that Americans who receive health coverage from ACA will only see moderate increases to their premiums for 2019. During earlier repeal and replace efforts of Obamacare—otherwise known as ACA—the healthcare marketplace was volatile for consumers. Some insurers pulled out of the marketplace, leaving those that remained able to sharply increase premiums.

One of the biggest challenges in medical practice is finding a way to spend enough time with each patient amid all the regulatory paperwork. To streamline workflows and encourage better provider-patient relationships, the Centers for Medicare and Medicaid Services (CMS) proposed new reforms to roll back certain regulatory efforts that were saddling clinicians with cumbersome paperwork. As part of those efforts, CMS reevaluated some of its reimbursement methods to improve efficiency with its required paperwork.

As a hematology and oncology nurse, I’ve seen countless patients in treatment and recovery, and I’ve seen some lose their fight against cancer. In June 2018, I had the privilege to represent ONS as the sole nurse selected to advocate for palliative care with one of ONS’s coalition partners, the Patient Quality of Life Coalition (PQLC), where I was able to share my perspective and the many aspects of my role as a nurse with congressional staff. As the sole practitioner in the five congressional meetings, I provided insight about how nurses interact with patients, particularly during cancer treatment.

As the opioid epidemic ravages American lives, every federal agency with an opportunity to review access is stepping up efforts to find appropriate lines between offering proper care and potentially enabling abuse. In a recent statement, U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb, MD, acknowledged the challenge of balancing quality care efforts with overprescribing medications and the potential ease of access to opioids.

As the Affordable Care Act is challenged in court, 12 Republican Senators signed a letter insisting that pre-existing conditions be covered in any new healthcare laws moving forward. Despite initial praise for the GOP, many patient advocacy groups, including the American Cancer Society Cancer Action Network, have voiced concerns about the efforts being far too little and far too late. On September 4, 2018, more than 25 patient advocacy groups came together and released a statement condemning a recent Republican bill stating it didn’t provide enough protections for pre-existing conditions, compared to what’s currently covered under the ACA. The advocacy groups noted the bill's outlying weaknesses and pushed for stronger reassurances.

Under the Affordable Care Act (ACA), each state has the right to create its own basic healthcare system within its own jurisdictions. Currently, only New York and Minnesota have made such systems available to residents who are just over the limit to qualify for Medicaid. Those individuals receive their health care from the state—until the Trump administration eliminated certain aspects of ACA that provided federal funding for these programs. After suing to overturn the administration’s ruling, the Department of Health and Human Services announced a settlement that would pay close to half a billion dollars to New York and Minnesota to support the affected plans.

As an oncology nurse, I’m grateful to work alongside so many colleagues who bring dedication, grace, and skill to their work. No other industry in the world shares the same frustrations or emotional tolls as nursing, but we continue to bring enthusiasm, optimism, and devotion to our daily work. Nurses strive to ensure the best for their patients. It’s the call to patient advocacy that is at nursing’s core.

The rising price of prescription drugs is an ongoing priority for the Trump administration. As part of the president’s blueprint to lower drug costs, the Department of Health and Human Services (HHS) secretary, Alex Azar, elevated the prescription cost issue throughout many federal agencies to help determine a new course of action.

A cancer diagnosis at a young age can lead to serious hardship after completing treatments and moving into survivorship. Such was the case for Matthew Zachary after his cancer diagnosis at age 21. An interesting component to Zachary’s story—and that of many others like him—is that despite the higher number of insured Americans after the Affordable Care Act, costs and complications still plague patients. Access to health care can be a double-edge sword. It means more people are seeing providers, but it doesn't mean that people can afford those treatments.

Senator John McCain’s (R-AZ) family announced on August 24, 2018, that McCain has elected to stop treatment for his glioblastoma, a rare and aggressive form of brain cancer. Although his health had surpassed his original prognosis for many months, “the progress of disease and the inexorable advance of age render their verdict. With his usual strength of will, he has now chosen to discontinue medical treatment,” his family explained.

In May 2018, I participated in the American Cancer Society’s (ACS’s) Cancer Action Week in my role as a legislative volunteer for ACS’s Cancer Action Network (CAN). In this role, I advocate on the state level for various key legislative efforts for people with cancer in New Jersey.

With more states legalizing medical aid in dying options for patients, the process is often vague and misunderstood. One patient, Aaron McQ, shared his story as he prepared to self-administer his life-ending medication. His story explains the nurse's key role in education and shared decision making to address the concerns of the patient.

Healthcare reform has been a hot political topic since before the introduction of the Affordable Care Act. Potential changes in the American healthcare system will be at the hands of which party controls the House of Representatives and the Senate. The upcoming midterm elections in November 2018 could determine a shift in power and potentially add further Medicaid expansion to the list of incoming health care changes.

’Tis the season. Well, at least in DC, it’s an exciting time. A political year. A long summer recess. A host of bills that are on the verge of passing. We are all aflutter with anticipation of the possibilities. But legislators need to remember who sent them to Washington and for what reason. Advocacy begins at home, and elected officials are heartened by what their constituents request, especially when that legislation is bipartisan and emotional and can affect people’s lives.

The Kaiser Family Foundation released a report stating that coverage for pre-existing conditions ranks highest among healthcare campaign issues for American voters. According to the report, the issue cuts across all parties, including Democrats, Republicans, and voters living in battleground states. Since attempting to repeal and replace the Affordable Care Act, 58% of those polled say that President Trump’s administration and the Republicans in Congress are responsible for problems with the healthcare law moving forward.

As of July 16, 2018, the Agency for Healthcare Research and Quality (AHRQ) through the U.S. Department of Health and Human Services ceased maintenance on guideline.gov, the website that housed the National Guideline Clearinghouse. The website had been a resource for healthcare providers for more than 20 years.

On July 23, 2018, the U.S. House of Representatives passed by voice vote two ONS priority bills that would provide palliative care training, awareness, and research and funding to build the nursing workforce.

On July 16, 2018, Kevin Brady (R-TX), House Ways and Means Committee chair, announced that he’s working with the Trump administration to restore funding to key Affordable Care Act (ACA) payments. Previously, the White House suspended more than $10.4 billion in payments to insurers, which brought criticism from Democrats and stern warnings of rising healthcare premiums.

In response to the U.S. Food and Drug Administration’s (FDA’s) Advanced Notice of Proposed Rulemaking (ANPRM) on setting a tobacco standard for nicotine levels in combusted cigarettes, ONS submitted comments urging the agency to lower nicotine levels in combusted cigarettes and all tobacco products. Specifically, ONS recommended lowering the level of nicotine to a maximum of 0.4 mg or lower and that the ratio of tar to nicotine stay around 1 to reduce addiction. ONS pointed out that even lower levels of nicotine are harmful to health. ONS also cautioned the agency about the harm of additives in tobacco, including sugar, that counteract reduced nicotine levels.

ONS shared the perspective of nurses caring for patients who may struggle to afford cancer drugs in comments submitted to the Department of Health and Human Services (HHS) on its Prescription Drug Reform Request for Information.

Health care is arguably the top domestic policy issue and of major concern to most Americans. Coverage, access, and, most importantly, affordability are not abstract political concepts discussed in elite coffeehouse circles but rather are real-world problems that people struggle with daily. Do I need to see a physician for this problem? What impact will a diagnosis have on my life? Can I afford the medication?

Previously, reports had emerged that the Trump administration was considering cuts to funding for Affordable Care Act (ACA) outreach groups whose aim has been to educate and assist Americans interested in enrolling in the healthcare program. On July 10, 2018, the administration officially announced funding cuts to the outreach programs, reducing their funding from $36 million to $10 million for 2019.