Health care is a top domestic issue for U.S. voters, and the president is speaking more and more about his administration’s plans to find accessible, affordable healthcare options for millions of Americans. Speaking this summer at the Better Medicare Alliance in Washington, DC, Department of Health and Human Services Secretary Alex Azar outlined three key points where the Trump administration plans to improve health care.

A patient is rushed to the emergency room, diagnosed, and taken to surgery immediately. The patient recovers, but weeks later a bill arrives beyond any expectation, and too often ability, to be paid. This practice has become so routine that it has its own name: balance billing or, more commonly, surprise medical billing. It strikes many Americans with the burden of their ailment once again. 

Surprise medical bills—a long-time problem for patients and consumers—was not on the legislative radar until recently. In short order, the issue has quickly moved through the House Energy and Commerce Committee, one of the most powerful on Capitol Hill, to offer some hope for consumers. Part of the committee’s mark up added an amendment allowing for arbitration to address specific medical charges if hospitals disagreed with the agreed-upon rate. Some committee members felt that without it, providers would have limited recourse in special circumstances.

When the Affordable Care Act (ACA) was first implemented, the government encouraged private insurance companies to participate in the health insurance marketplace to increase competition and keep prices low for patients. According to several private insurers, the government committed to reimbursing companies if the cost of their healthcare claims exceeded premiums charged in the first three years. To date, no payments have been made between the government and private insurance companies, and a new lawsuit is making its way through the judicial system.

Candidates in the first Democratic presidential debate spent some time addressing issues related to healthcare access. In point-blank questions, they were asked what they might do in support of Medicare for All, especially whether they’d be in favor of eliminating private insurance companies. Many were supportive of the overarching legislation, some were wary of eliminating insurance companies outright, and others flat out opposed it.

Since 2016, then-candidate Trump promised he was going to bring healthcare costs under control. In a White House announcement on June 24, 2019, the president took steps to add transparency to the process by requiring insurance companies, hospitals, and physicians to identify fees and costs in public and simple ways for patients to see in advance and to understand.

Health care is driving domestic policy agenda, and voters have shown it’s a crucial component in their decision making. The money associated with healthcare costs has been a driving factor in politics year after year. Public opinion polling found that health care is the most important factor when it comes to financial burden for Americans, reports from 2018 indicated that Americans spent more than $88 billion on health care alone.

Washington is the first state in the country to offer a public insurance option to its residents after Governor Jay Inslee signed the bill into law on May 13, 2019. Is it any coincidence that Inslee is also running for president? Coming from a traditionally “blue” state with a strong progressive legislature allowed this Democratic candidate to deliver on a particularly interesting policy.

Through a combination of expert clinical knowledge, relationship-building skills, and routine selection as the most trusted profession in the United States, nurses are one of the most impactful healthcare professionals when it comes to addressing patient issues. Challenges—like financial toxicity and limited access to care—are central to nursing advocacy efforts, and oncology nurses know firsthand the negative impacts they have on patients with cancer.

Trying to find a path forward is a common theme among elected officials in Washington, DC, and drug pricing appears to be a bipartisan initiative. In that vein, Senator Chuck Grassley (R-IA)— working with representatives from both sides of the aisle—announced his plan to release a drug pricing proposal by the beginning of summer 2019.

In a bold move, Senate Majority Leader Mitch McConnell (R-KY) announced on Thursday that he would put forward a bill to raise the national age for tobacco product purchases to age 21. It’s a remarkable move on many levels, not the least of which is that McConnell is from Kentucky—a region of the country that produces tobacco products. More importantly though, McConnell made a public statement about the rise in youth consumption through vaping.

According to a Gallup Poll released on April 2, 2019, Americans borrowed approximately $88 billion to pay for health care in 2018. At a National Academies of Science healthcare conference on April 4, the main takeaway was that many Americans surveyed reported that they could not afford to have a serious illness like cancer. The cost of care, even with insurance, is more than many can financially withstand. Oncology nurses know how patients must maneuver through the system to defer costs, sometimes resulting in delayed or alternative approaches to care.

In a move that echoed the Department of Justice’s (DOJ’s) previous stance on the Affordable Care Act (ACA), the Trump administration’s DOJ announced it was siding with a lower court’s ruling that stated ACA was invalid and unconstitutional. Siding with conservative state attorneys general who sued and won a lower federal court judgment on the constitutionality of law, DOJ issued a terse, two-sentence letter supporting the judge’s decision to strike the law down.

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.

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.

Debates like the one facing the constitutionality of the Affordable Care Act (ACA) are what American democracy is built on. Checks and balances for each branch of government—often with authority undulating back to state governments—provide numerous opportunities for policy issues to change and develop through legislative, regulatory, and judicial review. Recently, U.S. Senator Patty Murray (D-WA) and Senator Maria Cantwell (D-WA) have reintroduced a resolution that authorizes Senate Legal Counsel to defend Americans with preexisting conditions against a Republican Attorneys General lawsuit facing the ACA.

Short-term insurance plans were developed as an attempt to circumvent the Affordable Care Act (ACA) and the rising costs for its health plans after deep funding cuts to the law. But, in doing so, the Trump administration has allowed new, seemingly unregulated temporary insurance plans to emerge that appear to prey on vulnerable policyholders, offering limited coverage at high prices. On January 8, Democrats pressed the president for further answers on short-term insurance plans.

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.

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.

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.

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.

To Rally Voters, Democrats Focus on Health Care as Their Closing Argument

Although many states are already collecting early votes, Tuesday, November 6, 2018, will tell the full tale of the midterm elections. Many Democrats are emphasizing their focus on health care in the final days and hours before the election. By most measurable public opinion poll, health care remains the most important domestic issue for voters.

Addressing the high cost of prescription medications has been an ongoing focus for the Trump administration. Its latest move, requiring drug companies to list their product’s market price on consumer ads, is an added level of transparency that didn’t exist before. Whether the decree will have an impact remains to be seen, but it may add some trust to the process.

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.

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.

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.

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.

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.

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.

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.

An initial proposal from the Trump administration might cut funds for outreach related to the Affordable Care Act (ACA). As of yet no decisions are finalized and funding may still remain consistent, but limiting funding for outreach of the ACA, known to most as Obamacare, isn't a new move for the current administration. In 2017, it cut funding for navigators who educated and enrolled Americans in the ACA marketplace, leading to confusion among potential applicants and lower enrollment numbers. If funding is cut again this year, new or returning enrollees are unlikely to find success when looking for coverage.

Through tremendous bipartisan support, the House of Representatives passed comprehensive opioid legislation to address the national abuse epidemic in the United States on June 22, 2018. For many healthcare advocates, an opioid legislation package has been a long time coming. The opioid crisis has been in the news since before the 2016 presidential election but was brought to the forefront during that campaign.

With hopes for more than 1 million participants, the National Institutes of Health (NIH) has launched the All of Us initiative, a radical precision medicine campaign to amass a collective gene pool data repository. The NIH is aiming to shrink our differences and expand on the similarities found in our genetic data. For some, compiling genetic data of an entire country’s citizens may sound very reminiscent of Big Brother from the book 1984. But the amount of information that could be shared and learned from such a massive health database is remarkable.

Earlier in 2018, the Trump administration proposed a new rule that would permit Americans to buy short-term health insurance for up to 12 months, breaking from an Obama-era regulation that limited short-term health plans to a maximum of three months. To some, the proposed extension would potentially extend coverage to Americans interested in insuring themselves and their families. However, the America’s Health Insurance Plans group is on the other side of the argument, insisting that temporary plans—for any length of time—are no substitute to real coverage. Short-term plans are not covered by Affordable Care Act regulations, and it could lead to patients with pre-existing conditions being charged more for temporary insurance.

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. 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.  

An estimated 14.4 million Medicare recipients were prescribed some form of opioid treatment in 2016, paid for by their Medicare benefits. In an attempt to help curb the national opioid epidemic, officials from the Center for Medicare and Medicaid Services (CMS) announced that Medicare would no longer pay for long-term, high-dose prescription pain medication. Unsurprisingly, the plan received flak from patient and provider advocacy groups alike. Opponents to the CMS announcement decried the efforts, citing barriers to crucial medications needed for patients in chronic or severe pain—including those with cancer.

In 2016, former President Obama signed the Comprehensive Addiction and Recover Act (CARA) into law. Since then, some aspects of drug addiction have been decriminalized and refocused as medical issues, helping to remove some of the stigma associated with addiction. Although CARA is a start when tackling addiction issues, several senators—both Republican and Democrat—want to take it a step farther in the national fight against opioid abuse.

President Trump signed an executive order ending key payments to insurers selling plans in the Affordable Care Act (ACA) marketplace. The GOP has attempted to repeal and replace ACA, known as Obamacare, several times in 2017 with little success. Trump’s move is seen as the most recent attempt to dismantled Obamacare without the need for legislation. The Trump administration released a statement citing the legality of the funding as reason to withhold payments of more than $7 billion to health insurers as part of ACA’s cost-sharing reduction payments.

Senator Bernie Sanders (I-VT) recently gave an interview for The Nation to discuss his announcement and subsequent push for a single-payer healthcare system in the United States. During his 2016 presidential bid, Sanders campaigned for universal health care and gained significant support from the public. However, many on Capitol Hill were still unsure of a “Medicare-for-all” plan. Despite the initially tepid response, Sanders recently outlined a new single-payer healthcare bill he plans to introduce, and he’s gaining surprising support from several senators in Washington, DC.

Former Speaker of the U.S. House of Representatives Tip O’Neill was fond of saying, “All politics is local.” What he meant was, if an elected official took care of the constituents back home, then whatever happened in Washington, DC, wouldn’t matter as much. Whatever issues most affected voters in the legislative district, then that is where members of Congress should spend their time.

Nursing isn’t always just about treating illness. At times, patients are unruly, combative, and even downright dangerous to staff. Nurses are the ones standing front and center when an upset patient erupts, and it happens more often than the uninitiated public may think. A recent article in the Washington Post, catalogs some of the harrowing violence nurses have seen in the line of duty, dubbing it one of the most dangerous professions in the United States. Patients aren’t always the sole source of danger either—as illustrated by the recent assault of a Utah nurse, Alex Wubbels, by a Salt Lake City police detective.

Summer 2017 saw several attempts to repeal and replace the Affordable Care Act (ACA), none of which were successful. Now that the dust has started to settle—and Congress is slowly moving on to other issues—many are still dealing with the uncertainty left in the wake of the nation’s healthcare debate. This includes many concerned governors who are lobbying for funds to address their states’ current needs.

The Affordable Care Act (ACA), better known as Obamacare, is likely here to stay. After previous attempts to repeal and replace the nation’s healthcare legislation, the Senate has finally moved on to other issues. However, this hasn’t stopped President Trump from attempting to undercut some of the financial components of the ACA. Recently, former Health and Human Services (HHS) secretaries from both the Democrats and Republicans urged Trump to support ACA subsidies that could affect the cost of more than 10 million American’s healthcare plans.

Experts currently estimate that opioid addiction kills nearly 100 Americans every day, and the scale of the problem is continuing to grow. In response, President Trump to unofficially declared the opioid crisis a national emergency during a public statement from his golf resort in Bedminster, NJ, on August 10, 2017.

After failing to garner support for the GOP’s healthcare bill in the Senate—known as the Better Care Reconciliation Act of 2017—Senate Majority Leader Mitch McConnell (R-KY) noted that the next strategy for repealing and replacing the Affordable Care Act (ACA) would be to repeal the legislation without any concrete healthcare bill to replace it. In 2015, the Senate already successful voted to repeal the ACA, but it was vetoed by former President Obama. According to McConnell, the 2017 repeal effort would provide a two-year window to ensure a stable transition.

On June 22, 2017, Republican senators unveiled their version of the bill repeal and replacement bill for the Affordable Care Act, known to most as Obamacare. The Senate bill looks similar to the House-backed healthcare bill passed in May 2017. Central to the Senate’s bill are proposed cuts to Medicaid expansion, along with eliminating a net investment income tax that impacts higher earners. The proposed bill provides more tax subsidies for lower-income individuals than its sister bill from the House of Representatives, but it’s still expected to raise costs for poorer Americans.

In Washington, DC, the healthcare debate rages on. Currently, Republican senators are working behind closed doors to modify and change the House-passed American Health Care Act (AHCA). As it stands, the AHCA is the replacement plan for the Affordable Care Act (ACA), known to most Americans as Obamacare. While legislators continue to debate in Washington, the insurance marketplace carries on. United Healthcare recently announced its departure from the ACA’s marketplace exchange, another in list of insurance companies that have chosen to leave.

With an increasing number of baby boomers—both leaving the nursing profession and finding themselves in need of care—a workforce shortage is continuing to challenge the nursing industry. Recent reports have also indicated that educators in nursing programs have dropped off, leading to fewer nursing graduates. Some educational institutions are seeking accelerated programs to meet the demands of the growing healthcare market.