Shortage of Healthcare Workers Worsens Across United States

Houston, TX, Miami, FL, and Baton Rouge, LA, are three of the many (https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html) cities battling repercussions from the COVID-19 coronavirus pandemic. Most daunting is the perpetuated shortage of healthcare workers as the pandemic continues to ravage the United States.

Many institutions figured out ways to stretch limited material resources like recycling personal protective equipment and converting (https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html) surgery wards into specialized COVID units. However, stretching human workers needed to make the healthcare system work isn’t so easy.

A hospital’s typical response to disaster is to bring in help from neighboring areas. Many states, including Texas, signed a licensure compact (https://www.ncsbn.org/nurse-licensure-compact.htm), allowing nurses to practice across state borders. However, as the pandemic continues to escalate, that’s no longer a solution.

“The challenge right now is we are taxing the system all across the country,” Jennifer Banda, vice president of advocacy and public policy at the Texas Hospital Association, said (https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html).

Serena Bumpus, director of practice at the Texas Nurses Association, blames a lack of coordination among national and state officials for the shortage.

“It feels like this free-for-all,” she said (https://www.washingtonpost.com/national/houston-miami-and-other-cities-face-mounting-health-care-worker-shortages-as-infections-climb/2020/07/25/45fd720c-ccf8-11ea-b0e3-d55bda07d66a_story.html). “And each organization is just kind of left up to their own devices to try to figure this out.”

The pandemic has dramatically changed the way we understand and provide health care (https://voice.ons.org/advocacy/proposed-bill-would-expand-health-workforce-in-underserved-communities?utm_source=hl&utm_medium=email&utm_content=Advocacy_Health_policy&utm_campaign=articles_of_interest). And those on the frontlines—especially nurses—are seeing the biggest effects. COVID-19 is ravaging urban populations in waves and forcing all healthcare workers, even those whose area of expertise are not in communicable disease and virus epidemiology, to shift priorities and join the emergency effort. Oncology nurses are no exception and many ONS members have reported staffing reassignments and reallocations. Still, they are doing what nurses do and joining the effort (https://voice.ons.org/stories/once-a-nurse-always-a-nurse?utm_source=hl&utm_medium=email&utm_content=Advocacy_Health_policy&utm_campaign=articles_of_interest). Read ONS’s policy on staffing and care (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/access-quality-cancer?utm_source=hl&utm_medium=email&utm_content=Advocacy_Health_policy&utm_campaign=articles_of_interest) and staffing issues (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/principles-nurse-staffing?utm_source=hl&utm_medium=email&utm_content=Advocacy_Health_policy&utm_campaign=articles_of_interest).

Big Pharma Upset Over Trump’s Prescription Drug EOs

On first glance, the news that the White House issued executive orders (EOs) on drug pricing seemed like a breakthrough. However, top pharmaceutical executives responded with upset, refusing to attend (https://www.politico.com/news/2020/07/27/drugmakers-trump-meeting-canceled-382847) a meeting at the White House, slated for July 28, 2020, to discuss the EOs (https://voice.ons.org/advocacy/trump-uses-executive-orders-to-lower-drug-pricing?utm_source=hl&utm_medium=email&utm_content=Advocacy_Health_policy&utm_campaign=articles_of_interest) with President Donald Trump.

"The president’s plan to import policies from socialized healthcare systems abroad is disrupting our work on COVID-19 therapies and diverting our focus away from those life-saving efforts," a PhRMA spokesperson said in a July 24, 2020, statement. (https://www.phrma.org/en/Press-Release/PhRMA-Statement-on-Drug-Pricing-Executive-Orders) "We remain willing to discuss ways to lower costs for patients at the pharmacy counter. However, we remain steadfastly opposed to policies that would allow foreign governments to set prices for medicines in the United States."

The EO at the center of this conflict would order health officials to create a plan linking Medicare payments for certain medicines to lower costs paid abroad, commonly referred to as the most-favored-nations rule.

Neither the private pharmaceutical sector and the patient advocacy community also felt that the multiple presidential executive orders would actually raise prices and limit access to the very drugs needed to save lives.

Drug lobbies were reluctant (https://www.politico.com/news/2020/07/27/drugmakers-trump-meeting-canceled-382847) to send representatives because they were given little information about the most-favored-nations rule and whether Trump would include it in the EOs. BIO, the lobby representing small biotechnology companies, said the most-favored-nations rule would hit its members the hardest.

On July 24, 2020, Trump announced that drug companies have one month (https://www.fiercepharma.com/pharma/as-trump-pledges-lower-drug-prices-pharma-ceos-voice-skepticism-his-plans) to provide an alternative to his EOs and, if they can present a better option, “We may not need to implement the fourth executive order, a very tough order.”

The White House and prescription drug industry are working (https://www.politico.com/news/2020/07/27/drugmakers-trump-meeting-canceled-382847) to reschedule another meeting to discuss the most-favored-nation rule further. This is the opening salvo in an election year meant to curry favor with voters, and more will be revealed as the situation unfolds. Read ONS’s position on affordable prescription medication (https://www.ons.org/make-difference/ons-center-advocacy-and-health-policy/position-statements/cancer-pain-management).

HHS Demands Congressional Action to Combat Surprise Billing

The U.S. Department of Health and Human Services (HHS) released (https://www.hhs.gov/about/news/2020/07/29/hhs-secretary-report-calls-for-congressional-action-to-combat-surprise-billing-and-promote-price-transparency.html) the HHS Secretary’s Report on Addressing Surprise Billing on July 27, 2020, which outlines critical steps to protect patients from surprise billing. Patients with insurance go in for surgery, expecting their insurance to cover the procedure, but later receive a bill from a provider who is outside their network. The patient did not consent to that provider, often not even knowing about that person or their fee, which is not covered by insurance because that provider is outside of network (https://voice.ons.org/advocacy/nci-budget-boost-ending-surprise-medical-billing-supreme-court-aca-hearing).

The report (https://aspe.hhs.gov/pdf-report/hhs-secretarys-report-addressing-surprise-medical-billing), required per Section 7 of President Trump’s Executive Order 13877, Improving Price and Quality Transparency in American Healthcare to Put Patients, calls for Congressional action and includes the following principles to eliminate surprise billing (https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-wants-protect-patients-families-surprise-billing/):

• Patients receiving emergency care should not be forced to shoulder extra costs billed by a care provider but not covered by their insurer.
• Patients receiving scheduled care should have information about whether providers are in or out of their network and what costs they may face.
• Patients should not receive surprise bills from out-of-network providers they did not choose.
• Federal healthcare expenditures should not increase.

“Research shows that 41% of insured adults nationwide were surprised by a medical bill in the past two years alone, and that two-thirds of adults worry about their ability to afford an unexpected medical bill,” HHS reported on July 29, 2020 (https://www.hhs.gov/about/news/2020/07/29/hhs-secretary-report-calls-for-congressional-action-to-combat-surprise-billing-and-promote-price-transparency.html). “Sound surprise billing legislation will not only protect patients but will encourage a fairer, more transparent, patient-centered healthcare system that benefits all Americans.”

The pandemic has consumed nearly every legislative issue since it was declared a national emergency. However, the very political, bipartisan issue of surprise billing (https://voice.ons.org/advocacy/us-cancer-costs-projected-to-increase-to-245-billion-by-2030) is still a hot-button issue with elected officials (https://voice.ons.org/advocacy/healthcare-for-all-is-a-competing-idea-in-the-2020-us-presidential-election). Constituents are reaching out to their representatives for action, and great bipartisan support combined with a presidential executive order has empowered HHS to implement restrictions—in an election year—to curtain the practice. Learn more about ONS’s advocacy and how you can get involved (https://voice.ons.org/advocacy/get-involved).