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McCain votes no, derails “skinny repeal” in marathon session

This article appeared on Kaiser Health News on July 28, 2017.

By Michael McAuliff

WASHINGTON — Sen. John McCain (R-Ariz.), who interrupted brain cancer treatment to return to Capitol Hill and advance the health law repeal efforts, cast the dramatic and decisive “no” vote in the early morning hours that upended the Republican effort to repeal the Affordable Care Act.

The Senate struggled late into the night to craft and then vote on a “skinny repeal” of the health law, but came up empty as the bill was defeated in a 51-49 vote that prompted gasps in the chamber. McCain’s vote was unexpected and ends — for now — the Republican Party’s effort to kill Obamacare.

Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) cast the two other Republican “no” votes in a cliffhanger drama that ended just before 2:00 a.m. Friday.

Earlier, a group of Republican senators trashed the new measure, widely dubbed a “skinny repeal,” saying it would only worsen the health care system, and they demanded unprecedented promises from their House colleagues to change it.

“The skinny bill in the Senate doesn’t even come close to honoring our promises of repealing Obamacare,” said Sen. Ron Johnson (R-Wis.). “Virtually nothing we’re doing in any of these bills and proposals are addressing the challenges, the problems, the damage done [by the Affordable Care Act].”

Staff of Senate Majority Leader Mitch McConnell (R-Ky.) crafted the new bill, which was under discussion all afternoon and posted publicly late Thursday evening.

The slimmed-down version of the Senate bill — The Health Care Freedom Act, which the White House refers to as the “freedom bill” — included an end to key elements of the health law. Among them were rollbacks of the mandates for individuals and employers to buy health insurance, changes to waivers available under Section 1332 of the ACA that would give states more leeway to alter essential benefits in insurance plans, and a repeal of the medical-device tax.

It was not immediately clear how the bill achieved savings similar to $133 billion in the House’s version of repeal legislation. An equal or better level of savings is required under the arcane budgetary process that is being used to advance the bill, known as reconciliation.

Budget reconciliation allows the measure to pass the Senate on a simple majority vote, but requires that all of its provisions pass muster with the Senate parliamentarian as budget-related. The text of the bill posted publicly at 10 p.m. The CBO report on it began circulating on Twitter around midnight and the vote finally closed around 1:45 a.m. Friday.

One provision that had been restored after the parliamentarian initially struck it was an attempt to defund Planned Parenthood for a year. The new provision took in at least one additional abortion provider, and was expected to survive. The funding for Planned Parenthood was to be shifted to community health centers.

Keeping the attack on Planned Parenthood solidified Murkowski and Collins’ opposition to the vote.

This new iteration of the repeal comes after two versions failed to win over the 50 GOP senators needed. But even with all the rewriting and behind-the-scenes negotiation, four senators called a press conference to declare they will not vote for this “skinny repeal” unless House Speaker Paul Ryan (R-Wis.) promises not to merely pass the measure but send it to a conference committee between the two chambers, where it can be substantively altered.

The four senators slammed the trimmed-down compromise.

“I am not going to vote for a piece of legislation that I believe is not a replacement, that politically would be the dumbest thing in history to throw this out there,” said Sen. Lindsey Graham (R-S.C.).

He said that he, Johnson and McCain and Sen. Bill Cassidy (R-La.) would not vote for the skinny repeal until Ryan pledges to “go to conference,” where Graham can include a measure to shift current Obamacare funding into a block-grant program for states.

His fear, Graham said, is that the House might simply take up and pass the skinny repeal in order to be done with it and notch a win in their seven-year battle against Obamacare.

Graham referred to estimates that said the repeal of the ACA mandates would “collapse the individual market” and leave the GOP to “own the problem at a time when Obamacare is collapsing.”

Ryan did release a statement with a conditional promise to take the bill to conference. Initially, it did not satisfy Graham or McCain. Graham and Johnson were persuaded, however, after a phone conversation with Ryan. McCain was not.

For their part, Democrats uniformly panned the GOP’s efforts.

“We’ve had one bad bill after another. There is no bill that is a good bill,” said Sen. Dianne Feinstein (D-Calif.). “Every bill takes people off health care. Every bill makes you pay more for less. There’s a race to the bottom, so to speak.”

Sen. Chris Murphy (D-Conn.), hammered the entire process: “This is nuclear grade bonkers.”

ANA continues to oppose Senate health care bill

The American Nurses Association (ANA) weighed in last week on the potential cuts to Medicaid and Essential Health Benefits in the proposed Senate bill.

In a press conference on June 22, ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN outlined the harmful effects of eliminating the Essential Health Benefits used by millions in the U.S. The draft health care proposal from Senate GOP would make drastic cuts to Medicaid and increase the number of uninsured Americans by 22 million, according to the most recent Congressional Budget Office (CBO) estimate.

“In addition to eliminating the (essential health) benefits, the Senate Republican draft health care bill’s changes to Medicaid would be disastrous for our nation’s most vulnerable,” Cipriano said. “Medicaid is the safety net for tens of millions of children, as well as the poor and disabled. We’re nurses, and we’re here because we are very worried about our patients. We won’t stop fighting for them. We can do better and Americans truly deserve a better plan.”

The ANA has consistently spoke out against cuts to health care and Medicaid, voicing strong opposition to the American Health Care Act passed by the House of Representatives in May. ANA members, area nurses, and nursing students also participated in an “Emergency White Coat Fly-in,” and hopes to meet with Republican senators from key states that would be hurt the most by this bill and persuade them to protect health care.

Find more information on the ANA’s official website.

American Nurses Association express dissapointment with American Health Care Act

Yesterday, the House of Representatives narrowly passed the American Health Care Act, which is aimed to undo much of the bulk of the legislation of the Affordable Care Act. The American Nurses Association expressed disappointment with its passage. releasing the following statement:

The American Nurses Association (ANA) strongly opposed the American Health Care Act (AHCA) and is deeply disappointed with the passage of this legislation by the United States House of Representatives. 

ANA, which represents the interests of more than 3.6 million registered nurses, has expressed serious concerns throughout negotiations about the critical impact the AHCA would have on the 24 million people who stand to lose insurance coverage if the bill becomes law.

“Over the past several weeks, nurses from across the country expressed their strong disapproval of this bill which would negatively impact the health of the nation,” said ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Today, Congress not only ignored the voice of the nation’s most honest and ethical profession and largest group of health care professionals, it also ignored the almost 15 million people in the United States with pre-existing conditions who will now have no protection from insurer discrimination.”

As it is currently written, the AHCA would cut Medicaid funding by $880 billion over 10 years, dramatically increase premiums on seniors, restrict millions of women from access to health care, weaken the sustainability of Medicare, and repeal income-based subsidies that have made it possible for millions of families to buy health insurance. In addition, states would have the option to waive essential health benefit protections that prevent insurance companies from charging individuals with pre-existing conditions significantly more for coverage. Even worse, insurers could decline coverage for substance abuse treatment, maternity care, and preventive services. Late efforts to stabilize the bill’s risk pools for more than 15 million people with pre-existing conditions were wholly inadequate and will leave the nation’s sickest vulnerable.

As this legislation moves to the United States Senate, ANA urges the Senate to allow for opportunities for thoughtful, public feedback in the face of reforms that would have such a far-reaching and personal impact across the nation.

ANA asks the Senate to oppose AHCA in its current form, and stands ready to work with Senators to protect and improve health care access, quality and affordability for all.

Nurse takes on the role of Surgeon General

Rear Adm. Sylvia Trent-Adams, a registered nurse, becomes one of the first nurses to serve as Attorney General.

Surgeon General Vivek H. Murthy was replaced on Friday by his deputy, Rear Adm. Sylvia Trent-Adams. Serving on an interim basis, Admiral Trent-Adams becomes the second nurse to have served in this position, and the first non-physician to take the job.

Admiral Trent-Adams worked as a nurse officer in the Army, and served as a research nurse at the University of Maryland, where she received her PhD. In 1992, she joined the Commissioned Corps of the Public Health Service, where she served in the HIV/AIDS bureau of the Health Resources and Services Administration before joining the surgeon general’s office.

Surgeons general have limited staff and direct influence, but they often use their position to call attention to important public health priorities. Dr. Murthy, Adm. Trent-Adams predecessor, used his platform to speak out against gun violence, labeling it as a threat to public health. It is unclear why Murthy was relieved of duty; the Department of Health and Human Services said that the Trump administration asked him to step down after “assisting in a smooth transition,” but Dr. Murthy’s wife, Alice Chen, said that her husband was fired after he refused to resign.

Nursing strike cost Allina Health $149 million

Last year was a tumultuous one for Allina Health in Minneapolis and its nursing staff. After a week-long walkout in June, Allina nurses went on strike in the fall as part of ongoing contract negotiations centered around the elimination of union-backed health plans. After a six-week strike, both sides finally reached an agreement that ended the strike and sent the nurses back to work.

As part of its 2016 earnings report, Allina Health reported that while revenue increased over the year, operating income dropped, thanks in part to expenses related to the nursing strike. Allina recorded a $30 million operating loss, a significant $179-million-dollar swing from the $149 million operating gain Allina posted in 2015. As part of its report, Allina cites a $149.3 million of strike expenses, which included hiring 1,400 replacement nurses to cover for the striking staff.

For more information on nursing strikes, check out the Strategies for Nurse Managers Reading Room.

Trump: for every new healthcare regulation, two must be removed

On January 30, President Trump signed a new executive order declaring a “one-in, two-out” rule for healthcare regulations. Under the executive order, for a new healthcare regulation to be implemented two older regulations will have to be eliminated.

http://www.modernhealthcare.com/article/20170130/NEWS/170139994

“If you have a regulation you want, number one, we’re not going to approve it because it’s already been approved probably in 17 different forms,” Trump said during the signing. “But if we do, the only way you have a chance is we have to knock out two regulations for every new regulation. So if there’s a new regulation, they have to knock out two.”

http://www.nbcnews.com/politics/politics-news/trump-signs-executive-order-reduce-regulations-n714151

The order also sets an annual cap on the cost of new regulations and cuts the regulatory budget for fiscal year 2017 to zero. This means the only way to afford new regulations issued between now and September 30, 2017 is by repealing existing regulations.

While each agency will decide which regulations they think can be cut, the White House will ultimately decide which ones to gut. Regulations dealing with national security, foreign affairs, and the organization, management, or personnel of federal agencies are exempt.

Hospitals trying out Pokemon Go in a clinical setting

Check out this article from Health Leaders Media:

A trial at the University of Washington Medicine Burn Center aims to find out if the game is more stimulating and engaging than the pain patients are experiencing.

Hospitals and health systems have been grappling with how to deal with Pokémon Go since the mobile gaming phenomenon hit earlier this summer.

Massachusetts General Hospital banned staff from playing the game on its campus, warning of possible privacy violations, and Allegheny Health Network asked the game’s maker to remove all of its locations from the app.

But some hospitals are finding that there are upside to patients using Pokémon Go.

Getting Patients Out of Bed

C.S. Mott Children’s Hospital in Ann Arbor, MI, has been urging its young patients to play the game in an effort to get them out of bed and socialize with other kids.

“It’s a fun way to encourage patients to be mobile,” J.J Bouchard, the hospital’s digital media manager and certified child life specialist, told USA Today. “This app is getting patients out of beds and moving around.”

A trial that University of Washington Medicine Burn Center researchers are conducting at Harborview Medical Center in Seattle, WA, is looking at how playing Pokémon Go may help keep patients moving while also taking their minds off the pain.

“Our challenge is to find something that’s more stimulating and engaging than pain they’re experiencing, so something like virtual reality that’s new or Pokémon Go that’s new, it’s more exciting and takes attention away from the pain,” Shelley Wiechman, attending psychologist in the Burn and Pediatric Trauma Service and Pediatric Primary Care Clinic at Harborview, told the local media.

The Pokémon Go trial isn’t the first time the hospital has tested augmented and virtual reality games for pain management, but it’s the first that allows patients to use their legs and keep their infected areas mobile.

Weichman said if patients using the game continue to show progress, the staff may begin using Fitbits to track patients’ steps.

So what do you think? Can mobile games help patients in your hospitals? Let us know what you think in the comments below!

Editor’s Pick: Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, 2e

The American Nurses Association (ANA) has recommended the second edition of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, by Kathleen Bartholomew, RN, MN, in its official position statement on Incivility, Bullying, and Workplace Violence as a resource for nurses. Now in its second edition, the cornerstone work has just been released as an eBook and offers 4 continuing education credits (CEU).

Ending Nurse-to-Nurse Hostility, Second Edition

The first and most respected book showing new and experienced nurses how to build a better workplace by facing and overcoming horizontal hostility is now updated.

Find out why this book is a best-seller and how it’s empowered thousands of nurses to create positive change for themselves and their peers!

Revised to reflect current research on horizontal hostility in the nursing field (also known as lateral violence), Ending Nurse-to-Nurse Hostility, Second Edition, provides staff nurses and their managers with techniques to create a workplace that promotes team relationships and career development while preventing burnout.

Ending Nurse-to-Nurse Hostility provides staff nurses and their managers with the knowledge they need to:

  • Identify verbal abuse, bullying, and other detrimental behaviors
  • Develop responses to defuse or head off such behaviors
  • Create positive alternatives to hostility

These skills support the success of the individual nurse, the unit, and patient care quality at a time when healthcare systems are publicly ranked on patient experience and outcomes.

Horizontal hostility, also known as bullying or lateral violence, is a major factor in nursing attrition rates. Healthcare organizations that don’t proactively create a healthy workplace face the expense of finding, hiring, and training new nurses to replace burned-out staff.

This book provides the following benefits:

  • Skills: Nurses will learn skills for identifying and responding to verbal abuse, bullying, and other detrimental behaviors that undermine individual nurses, the unit, and the quality of patient care.
  • Real-world examples: Gain insightful reflections from individual nurses who have experienced horizontal hostility, presented in their own voices.
  • Author voice: Kathleen Bartholomew is a beloved nursing author who is authoritative yet approachable and always respectful.
  • Scholarship: Extensive references draw on the latest empirical and theoretical literature concerning horizontal hostility.
  • Culture change: Improve nurse retention, nurse productivity, and hospital rankings with an improved environment for patient care.

For more information or to order, visit the HCPro Marketplace.

Featured webcast: Drug Diversion in Healthcare: Improve Security and Avoid Fines

Phcpro_live_webcast-iconreventing the theft of controlled substances at hospitals continues to be an tremendous issue even with increased security measures. Failed drug diversion programs in hospitals have led to record fines and in the midst of heightened scrutiny over drug security, hospitals must improve their processes to avoid litigation.

On Thursday, April 26 from 1–2:30 p.m. Eastern Time, join us for a live webinar with expert speaker Kimberly New, JD, a nurse, attorney, and consultant who specializes in helping hospitals prevent, detect, and respond to drug diversion.

During this program, New will discuss drug diversion by healthcare personnel and present specific steps facilities can take to minimize the risk of patient harm. She will discuss fundamental components of a diversion prevention, detection, and response program through an overview of the scope of the problem, including case studies. New will also review regulatory standards and best practices relating to controlled substance security and diversion responses. She will additionally provide tips on how to promote a culture in which all employees play a significant role in the deterrence effort.

At the conclusion of this program, participants will be able to:

  • Identify risk factors and signs of employee drug diversion
  • Fully comply with regulatory requirements of the DEA and other accrediting organizations
  • Train staff on how to report suspected abuse and who to report it to
  • Create a culture of accountability and develop an effective drug diversion prevention plan

Don’t miss this opportunity to hear practical advice and have complex regulations simplified in this program suitable for your whole organization. For more information or to order the webcast on demand, call HCPro customer service at 800-650-6787 or visit the HCPro Marketplace.

California nurses seven-day strike ends in stalemate

On March 15, the newly unionized nurses of Kaiser Permanente Los Angeles Medical Center arranged a seven-day strike in hopes of getting their first collectively-bargained contract.

Last summer, 1,200 nurses voted to join the California Nurses Association (CNA), and the walkout was their first major action since joining the union. Negotiations for a new contract have been taking place since September, and this timed strike is part of the negotiation process. The union hopes to improve the conditions both for the RNs and their patients; the nurses report being understaffed, often having to cover units outside of their specialties, and seek economic improvements to attract and retain qualified nurses. Another concern brought up by the union is the hospital’s plans to open a medical school in the next few years, which will put additional strain on the hospital and its staff. The combination of factors led to the strike.

Kaiser Permanente expressed disappointment at the nurse’s tactic, and claims that they made a fair offer last month that went without a response. Additionally, Kaiser notes that their nurses are among the highest paid in the region, and their new offer would keep them there.

All of this is happening among growing concerns about healthcare coverage, as demand has spiked over the past few years.

The striking RNs have gone back to work after seven days of picketing, and negotiations between the two sides are still ongoing.