Whether you are a seasoned political aficionado or a legislative novice, it is likely that you have considered the implications of the new presidential administration's priorities on our neonatal patients and their families and how top cabinet officers and key executive agencies will implement policy visions with respect to nursing education and practice. Notably, a new presidency will bring resolution to the vacant Supreme Court seat. With more than 60 freshmen members of Congress on their way to Capitol Hill following the 2017 inauguration, we also anticipate considerable adjustments for the 115th Congress.
National Association of Neonatal Nurses (NANN) remains committed to advocating for optimal care and health outcomes for neonates and their families. NANN will continue to impact nursing practice regulation and policy by fostering member engagement and collaboration with other healthcare-related groups to shape legislative and regulatory issues at the federal and state levels. Here are some relevant policy and advocacy topics to watch in the coming months.
APRN SCOPE OF PRACTICE
The call for utilizing advanced practice registered nurses (APRNs) to the full extent of their knowledge and competence is coming from many places. In 2015, bills were introduced in the House and Senate to allow full practice authority for APRN's in veterans' administration facilities. On December 14, 2016, the Department of Veterans Affairs published a landmark rule granting veterans and their families direct access to care by nurse practitioners, certified nurse midwives, and clinical nurse specialists who work in the Veterans Health Administration. This ruling is expected to be an impetus for states to further remove barriers to scope of practice for APRNs. The American Academy of Nurse Practitioners provides an up-to-date interactive map of practice environment details, including licensure and regulatory requirements, for all 50 states at http://www.aanp.org/legislation-regulation/state-legislation/state-practice-envi.
ACA, MEDICAID, AND THE STATE CHILDREN'S HEALTH INSURANCE PROGRAM
In March 2010, President Obama signed comprehensive healthcare reform, the Patient Protection and Affordable Care Act (ACA), into law. The ACA refers to 2 separate pieces of legislation-the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act-that together expand Medicaid. Medicaid provides coverage for health and other related services for the nation's most economically disadvantaged populations, including low-income children and their families. The ACA also makes numerous improvements to the State Children's Health Insurance Program (CHIP). CHIP has been widely credited with helping to reduce the number of uninsured children in the United States from 10 million in 1997, when the program was enacted, to 3.3 million by 2015. Without congressional action, states will not receive any new federal funds for CHIP beyond September 30, 2017. The Medicaid and CHIP Payment and Access Commission (MACPAC) is a nonpartisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress. In March, MACPAC will be reporting to Congress on Medicaid and CHIP, and presenting a core recommendation to extend federal funding for CHIP through fiscal year 2022. Congressional support of this recommendation will ensure the stability and continuity of health insurance coverage for more than 8 million low- and moderate-income children. For more information, visit http://www.macpac.gov.
WOMEN'S MARCH
On January 21, over 5 million people worldwide, and over 1 million in Washington, District of Columbia, participated in the Women's March on Washington. This woman-led civic activism brought together people of all genders, ages, races, cultures, political affiliations, and backgrounds with particular interest in celebrating diverse communities and protecting women's rights. The movement evolved out of concern that the 115th Congress and White House could undesirably affect women's rights, thereby significantly impacting the well-being of infants, children, and families. Among the issues that this group is following are the impact of a new Supreme Court justice on a woman's right to abortion, funding for Planned Parenthood, which provides education and health services primarily to women, and contraception coverage provisions under the ACA.
RESEARCH AND PROGRAM FUNDING
The National Institutes for Health continues to recognize the need for high-quality, evidence-based palliative care as a critical component of maintaining quality of life at any stage of illness. Federal and other funding is expected to continue to prioritize examination of palliative care issues such as relieving symptoms and suffering, understanding decision making by patients, families, and providers, and development of effective models for pediatric palliative care.
It is also expected that the United States Department of Health and Human Services, as well as other funders, will continue to expand programs to study opioid abuse and pain management practice, including programs to study neonatal abstinence syndrome. In particular, there will be significant funding to support development of neonatal abstinence syndrome surveillance and reporting systems, as well as to support research that seeks to establish best practices for identifying and treating these vulnerable patients.