GOP Steers Away From Obamacare Repeal, Replace; Is Cigarette Prohibition on the Horizon?; Barbara Bush’s End-of-Life Decision Makes Waves

April 23, 2018 by Chris Pirschel ONS Staff Writer/Producer, and Alec Stone MA, MPA, Former ONS Director of Government Affairs and Advocacy

GOP Steers Away From Obamacare Repeal, Replace

After a flurry of proposed legislation to repeal and replace Obamacare—the unofficial name for the Affordable Care Act (ACA)— the GOP has shifted its focus to other policy issues (https://www.washingtonpost.com/). In fact, many Republican senators and congressional representatives have removed any mention of the healthcare law from their websites. With the 2018 midterm elections approaching, GOP lawmakers are seemingly breaking with the Trump administration’s stance on the healthcare law, recognizing that their constituents may be in favor of the ACA’s many protections.  

Throughout 2017 and into early 2018, the repeal and replace effort was a popular rallying cry for the GOP. However, public opinion polling showed that Americans from both major political parties wanted to keep the essential elements of the law (http://thehill.com/policy/healthcare/331696-poll-voters-want-protections-for-pre-existing-conditions). Voters enjoyed the protections for pre-existing conditions, portability, and inclusion of coverage for children up to age 26. Replacing the law has proven difficult for President Trump and his administration. As Republicans go into the 2018 midterm elections, fatigue is setting in for healthcare repeal, leading most to focus on other policy areas. Access to affordable, quality cancer care (http://send.ons.org/link.cfm?r=PaiK6-5zhDkSR0zw_2KlyA~~&pe=9Q7kaFD7fWeIBsUMSigVkYZcfT-B73IrwFH21jrUQXUBxRkYZgn6goIS98aKhQsizhy1EpVuCfFE_Q_WGYCt7g~~&t=K3bEmrBVgXcYLLLGVHHwZw~~) is one of ONS's central advocacy tenets. The Society will continue that conversation—among many others—with lawmakers and elected officials. 

Is Cigarette Prohibition on the Horizon?

Nicotine addiction and tobacco abuse have been huge public health concerns for decades. Although smoking rates continue to fall, lung cancer still impacts hundreds of thousands of Americans every year (https://www.cdc.gov/cancer/lung/statistics/index.htm). The U.S. Food and Drug Administration (FDA), in its latest efforts to address tobacco use, has issued a proposed rule to limit the level of nicotine in cigarettes to low- or below-addictive levels (https://www.federalregister.gov/documents/2018/03/16/2018-05345/tobacco-product-standard-for-nicotine-level-of-combusted-cigarettes). The agency hopes that removing the addictive properties could lead to millions of smokers finally kicking the habit.

FDA Commissioner Scott Gottlieb has already taken a strong stance against tobacco products during his short tenure and continues to put up barriers to big tobacco's interest. The proposed rule is the latest step in the FDA’s authority (https://www.realclearhealth.com/articles/2018/04/12/prohibition_all_over_again__this_time_for_cigarettes_110778.html) to regulate the marketing, sale, and distribution of tobacco-related products, especially to minors. Tobacco use and addiction are clear public health issues, and the FDA is standing strong to reduce the number of smokers. ONS is an active organization in the smoking cessation conversation, providing both policy statements (http://send.ons.org/link.cfm?r=PaiK6-5zhDkSR0zw_2KlyA~~&pe=a7EmwmUYBp7PCjJiyVviGhO-cURizpQ6qbbGLWphsDf7nVm7IPg_VwCLGGLetfsxmAlgcH9ro22F3pu4CWwhUw~~&t=K3bEmrBVgXcYLLLGVHHwZw~~) and expert testimony through research (http://send.ons.org/link.cfm?r=PaiK6-5zhDkSR0zw_2KlyA~~&pe=M9gkNRJvQoCSJ3EqoBKE05XZsulKuhg3IoZ8r5p2f27uswtPI5tj6IS39lHt1qVVe8wLL5qTK9m3Vp8KtSUeTw~~&t=K3bEmrBVgXcYLLLGVHHwZw~~).

Barbara Bush’s End-of-Life Decision Makes Waves

Just days before Barbara Bush’s death on April 17, 2018, her family released a statement indicating she no longer wished to continue medical treatment and sought comfort care in her final days (https://khn.org/news/barbara-bushs-end-of-life-decision-stirs-debate-over-comfort-care/). Her announcement stirred debate among healthcare professionals and organizations: many applauded the former first lady for having made her treatment wishes known, but some felt that using the phrase “comfort care” in direct opposition to medical treatment may have muddied the waters for public understanding of palliative and end-of-life medical care. Palliative care professionals suggested the announcement may have furthered the misunderstanding that palliative care means no medical care for dying patients—a misconception that the field has been working to correct.

Ultimately, the family’s statement about comfort care added another voice to the discussion about end-of-life care, hospice care, and the importance of making difficult decisions. For ONS and oncology nurses, the commitment to patient-centered care is crucial to providing quality care, and supporting patients' decisions to move from active to comfort care is in line with that. Healthcare providers are key to educating patients, families, and the public about what comfort care really means, including information about the scope of palliative and hospice care. As such, ONS will continue to advocate for legislation for palliative and hospice care education and training (http://send.ons.org/link.cfm?r=PaiK6-5zhDkSR0zw_2KlyA~~&pe=SCObMb75BufZL_tr2FHzQGMpgMDLm3XdPaFctepnWSQ5JKYdPatG7TF-AcS0uOijTnRM5zaX-VCWMOz-fUAhrQ~~&t=K3bEmrBVgXcYLLLGVHHwZw~~).


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