Proposed nursing shortage fix riles unions

Apr 30, 2024

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Driving The Day

A nurse sets up a new intravenous line for a patient.

A nursing shortage has prompted several states to consider joining a compact that lets licensed nurses practice in other participating states. | Damian Dovarganes/AP

NURSING COMPACT GAINS STEAM — A controversial solution could ease a nationwide nursing shortage, say its proponents. But it’s likely to upset a spate of powerful nursing unions, POLITICO’s Greg Svirnovskiy reports.

Legislators in nine states and Washington, D.C., have proposed joining the Nurse Licensure Compact — an agreement that could allow nurses licensed in one state to practice in any other participating state.

Connecticut has already taken steps toward joining, thanks to a push from its Democratic governor.

The opposition: But in many other states where lawmakers have proposed joining the compact, steadfast opposition from local nursing unions might help doom efforts.

The unions’ ability to stymie the legislation underscores the power the labor unions have and the pressure their policy positions can exert on public officials.

“It just has to pass in spite of union opposition,” said Republican State Rep. Mike Prax, who sponsored NLC legislation in Alaska. “And those things are tough battles.”

Why it matters: Their efforts come as a staffing crisis shows no signs of abating. The number of registered nurses shrunk by 100,000 in 2021, with young people leaving the profession at especially high rates. Many more nurses threaten to follow.

Nurses’ unions oppose the compact because they see it as a bandage that keeps lawmakers from considering longer-term solutions, like safe staffing laws and better wages. And some worry about the compact’s effects on collective bargaining.

“It has nothing to do with the supply of nurses,” David Schildmeier, public communications director at the Massachusetts Nurses Association, told Greg. “It’s that nurses are not willing to work under the conditions that the industry is trying to promulgate. And this is another way of them trying to get away from doing what they should be doing, which is investing in nurses.”

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In Congress

United Healthcare correspondence is seen.

Several health care-related committee meetings in Congress are slated for this week, including two that will feature testimony from United Healthcare's CEO. | Elise Amendola/AP

RECESS IS OVER — Lawmakers return from recess to a lot of health care work, including a pair of hearings Wednesday where United Healthcare CEO Andrew Witty will testify in the wake of the massive cyberattack at its subsidiary, Change Healthcare.

The Senate Finance Committee will kick off Witty’s grilling, followed by a House Energy and Commerce subcommittee hearing in the afternoon.

Additionally, the E&C Committee will hold a hearing this morning on a bevy of Medicaid-related bills, many of them bipartisan. That includes legislation that would bar HHS from implementing its mandatory minimum staffing proposal for nursing homes, finalized last week.

E&C Chair Cathy McMorris Rodgers (R-Wash.) and ranking member Frank Pallone (D-N.J.) have legislation that would expand access to home and community-based care. Daniel Tsai, director of the Center for Medicaid and CHIP Services, will testify.

Here’s a (non-exhaustive) list of other health care hearings scheduled for this week:

— The House Oversight Committee has slated EcoHealth Alliance president, Dr. Peter Daszak, to testify before the panel Wednesday in what will likely be a contentious hearing over Covid-19’s origins and gain-of-function research.

— The Senate Armed Services Personnel Subcommittee meets today on ensuring servicemember’s access to “safe, high-quality pharmaceuticals.”

— The Senate HELP Committee will meet Thursday on maternal health issues and a “severe shortage of minority health care professionals.”

— The Senate Veterans’ Affairs Committee will discuss the VA’s budget request Wednesday. The Senate Appropriations Committee will meet on the topic Thursday.

— The House Appropriations Labor-HHS-Education Subcommittee will have its member day hearing this morning.

— The House Appropriations Interior-Environment Subcommittee will discuss the Indian Health Service’s budget request Wednesday.

CBO BILL PASSES HOUSE — The House passed legislation by voice vote Monday that would make it easier for the Congressional Budget Office to get data from federal agencies like HHS.

The legislation from House Budget Committee ranking member Brendan Boyle (D-Pa.) and Chair Jodey Arrington (R-Texas) would give the scorekeeper more power by speeding up data-sharing from federal agencies. Currently, federal agencies have to hand over data unless it would be “a violation of the law.” The legislation would require CBO to keep the same level of confidentiality as agencies.

The CBO has said that while it “generally” can obtain information from the executive branch, questions about its authority can slow that access.

“Unfortunately, CBO … often faces delays and roadblocks in receiving the data they need to inform Congressional decision-making,” Boyle said in a statement after the bill advanced through the committee in February.

The CBO estimates that the legislation wouldn’t add to spending. HHS didn’t immediately respond to a request for comment.

The bigger picture: It’s the latest move from Budget Committee lawmakers to change how the CBO operates.

Last month, Congress passed legislation that would require the CBO to weigh whether a bill would save money over a 30-year budget window instead of 10 if Congress were to request it. That bill aimed to address concerns that the CBO’s scores don’t sufficiently reflect the benefits of preventive care.

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Abortion

OCR DEFENDS HIPAA CHANGES — Melanie Fontes Rainer, head of HHS’ Office for Civil Rights, defended the Biden administration’s moves Monday to safeguard patients’ abortion-related health information.

The administration finalized rules last week allowing HHS to use health privacy law to shield people seeking, obtaining or providing abortions.

Leading Democrats, including Sen. Ron Wyden (D-Ore.), chair of the Senate Finance Committee, had pushed the administration to go further in requiring warrants for law enforcement to access patients’ health information, but the administration set a lower bar. In finalizing the rule last week, HHS said doing so would be out of the rule’s scope.

Speaking at a Center for Democracy and Technology event in Washington on Monday, Fontes Rainer said she was aware of Wyden’s concerns and defended the rule.

“People think, ‘My information is protected by HIPAA. I’m safe,’” she said. “Before this rule goes into effect, that’s not always the case.”

Wyden said the rule didn’t go far enough, and he’d be “exploring additional avenues” to address the issue. Fontes Rainer said she's “excited to work with him on opportunities” to bolster HIPAA.

Provider view: At the event, Lisa Myers, senior Washington counsel at the American Medical Association, said the organization supports the rules’ objectives, but it will be a “significant implementation lift.”

Fontes Rainer said that since the rule won’t be enforced until December 2024, providers will have time to prepare and “there isn’t that much more to do.”

ANTI-DISCRIMINATION GUIDANCE — The Equal Employment Opportunity Commission finalized guidance Monday that strengthens nondiscrimination protections for workers based on sexual orientation or gender identity and abortion-related decisions.

Comments about an employee's decision to seek an abortion would be considered sex-based discrimination under the guidance, POLITICO’s Lawrence Ukenye reports. The EEOC pushed back on criticism it received, saying such guidance would inhibit free speech or religion in the workplace.

Comments about lactation and whether to use contraception would also be considered sex-based discrimination.

What’s next: Social conservatives and religious groups will likely challenge the guidance over First Amendment concerns after similarly criticizing abortion-related language in the final rule of the Pregnant Workers Fairness Act.

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Names in the News

Christina Pryor has joined the Levinson Group as senior director. She was previously senior adviser to DEA Administrator Anne Milgram.

Chantell Taylor is joining the American Academy of Physician Associates as its chief of public affairs and advocacy. She was previously vice president of government affairs and advocacy for UCHealth.

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A message from HCA Healthcare:

At HCA Healthcare, we integrate healthcare technology and leverage strategic collaborations with other organizations to advance our ability to deliver high-quality patient care.

One exciting development is HCA Healthcare’s collaboration with Google Cloud to use generative artificial intelligence (AI) to help care teams improve time-consuming tasks like documentation. HCA Healthcare has also developed advanced staffing and scheduling solutions for our nurses, enabling nurses to spend more time focusing on what they do best — caring for patients.

Furthermore, HCA Healthcare is implementing a new electronic health record system to create efficiencies for care teams, improving coordination of care for patients and powering innovation. All of this, and so much more, underscores HCA Healthcare’s commitment to show up for our patients, colleagues and communities.

Click here to learn more about the dynamic innovations at HCA Healthcare.