Category Archives: Public policy
The Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research program has selected projects and Investigators as a result of its 2013 application process. The program provides funding to highly qualified individuals undertaking broad studies of the most challenging health, health care, and health policy issues facing the country. Grants of up to $335,000 are awarded to investigators from a wide range of disciplines.
Eleven individuals have been selected to join the program. Their eight projects address race, ethnicity, and class in pharmaceutical marketing; mood and behavior disorders in children and adolescents; ethical and policy issues raised by living donor transplantation; resilience and recovery from disasters; and more. Grants to their institutions will be awarded on a rolling basis throughout 2014.
An interview with Sara Rosenbaum, JD, the Hirsh Professor in the School of Public Health and Health Services at the George Washington University, in Washington, DC, and a Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research recipient. She is the author of “The Enduring Role of the Emergency Medical Treatment and Active Labor Act,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: Your article discusses the past, present, and future of the Emergency Medical Treatment and Active Labor Act (EMTALA), adopted in 1986. Could you tell us a little about what moved Congress and the President to create the law, and what its purpose was?
Sara Rosenbaum: The law had several roots. To begin, it was the outgrowth of a good deal of law that came before it, embracing the notion that hospitals should provide emergency care, even without the expectation of payment. So that idea wasn’t unique to EMTALA, but by the early 1970s the expectation that hospitals would provide the community benefit of emergency services had revved up, partly because states had adopted that expectation under their own common law and statutes. So EMTALA was the culmination of a lot of legal precedent. But what prompted passage of the law in 1986 was two things: First, a substantial number of news stories about patient-dumping, particularly in California; and second, on the heels of Medicare payment reform a few years earlier, there was a lot of concern that hospitals would start discharging Medicare patients in an unstable state – sicker and quicker, as the saying went.
HCB: What are the law’s key components?
Rosenbaum: The one everybody knows best is the screening component: If somebody comes to an emergency department and requests an examination, hospitals must examine the patient to determine if there's an emergency medical condition. And if they find one, they must provide stabilization treatment. Or, if the patient has an emergency condition that the hospital is unable to stabilize, it can seek the cooperation of another hospital with more specialized capabilities, and transfer the patient. And then that second hospital has a separate obligation; it can’t just say “no.”
HCB: What’s your sense of how the law operates in the daily life of a hospital?
Kentucky Gov. Steve Beshear signed legislation last week that lifts a key limitation on advanced practice registered nurses (APRNs) and increases consumer access to health care.
The new law “allows more flexibility for nurse practitioners to provide accessible health care to Kentuckians,” Beshear said. “Nurse practitioners are a critical part of helping more Kentuckians get the medical care they need quickly and efficiently, and I am proud of the bipartisan effort to serve Kentucky’s health needs.”
In the past, APRNs were only allowed to prescribe medication with a physician’s written consent. The new law removes that requirement for APRNs who have four or more years of experience prescribing medication under a collaborative agreement with a physician or as an independent practitioner in another state, according to the Future of Nursing: Campaign for Action.
Federal health care workforce and research programs will receive modest funding boosts in this fiscal year under a new omnibus spending bill cleared in January by Congress, according to a summary released by the American Association of Colleges of Nursing (AACN). The programs affect nursing and other health professions.
Under the Consolidated Appropriations Act of 2014, signed into law on Jan. 17, two health care workforce agencies are slated for increases in fiscal year 2014.
The Health Resources and Services Administration will receive $6.3 billion, an 8 percent increase over the last fiscal year, and the Bureau of Health Professions will get $469.2 million, a 7 percent increase, according to AACN. Nursing workforce development programs under Title VIII of the Public Health Service Act will get $223.8 million in fiscal year 2014, a 3 percent increase.
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
The RWJF Health Policy Fellows program will celebrate its 40th anniversary this year. The program supports exceptional midcareer health professionals and behavioral and social scientists to actively participate in health policy processes at the federal level and gain exclusive, hands-on policy experience. Heralded as the “nation’s most prestigious fellowship at the nexus of health science, policy, and politics,” the Health Policy Fellows program provides health professionals the opportunity to work on Capitol Hill and in the Executive Branch, gaining front-line experience in federal health policy-making and an insider’s perspective on our country’s political process.
Founded in 1973, the program is supported by the Robert Wood Johnson Foundation (RWJF) and sponsored by the Institute of Medicine within the National Academies of Science.
Health Policy Fellows have become some of the nation’s most influential leaders in the health care field. As professors, deans, and presidents at major academic institutions, directors of voluntary health organizations and health professional societies, leaders in state and federal government, and experts at think tank and advocacy organizations, the Fellows are transforming the nation’s health care policy and practice.
Margaret Wainwright Henbest, RN, MSN, CPNP, is executive director of the Idaho Alliance of Leaders in Nursing and co-lead of the Idaho Nursing Action Coalition. She served in the Idaho state Legislature from 1996-2008.
I stumbled into politics in the midst of my nursing career. After serving as a nurse practitioner (NP) for two years in California and Oregon, I moved to Idaho in 1986. But it wasn’t until after the move that I discovered that I could not practice in my new home state unless a physician recommended me to the Idaho Board of Medicine (IBM) for licensure. That was not the only barrier to practice: To get my license, I had to interview with the IBM and win its approval.
I took a faculty position instead. But I soon met NPs all across the state who were seeking a change to this restrictive licensing requirement. I somehow wound up as the spokesperson for our eventual legislative effort, which was defeated after its first Senate hearing in the early 1990s.
That experience taught me that if something needs to be done, if a law needs to be changed, no one is going to do it for you; you have to do it yourself. Since I had a part-time job, I had the time to get active in local nursing organizations, and one thing led to another. I was approached to run for office and, after deliberating with family and friends, decided to make the leap. I won by seven votes in 1996. Every vote counts!
When I arrived at the state Capitol, I found that my perspective as a nurse was extremely valuable, especially during health care debates. I recognized prior to running that nurses were educationally and intellectually prepared for public office, and that we had little if any self-serving agenda in health care reform debates. We had a legitimate altruistic interest in patient and community health. This was readily apparent to policy-makers and the public.
Facing What May Be the Affordable Care Act’s Ultimate Challenge: The Gap Separating Evidence from the Policy-Makers Who Need It
David Grande, MD, MPA, is an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine, a senior fellow at the Leonard Davis Institute of Health Economics, associate director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and an alumnus of the RWJF Health & Society Scholars program. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
It’s a time of unprecedented upheaval in U.S. health care. Big changes are bursting through on virtually every front. Legislators and administrators in Washington and 50 state capitals struggle daily to reinvent their health care systems even as they lack an exact blueprint for the new things they’re supposed to be building.
This was nowhere more evident than at the recent AcademyHealth National Health Policy Conference, where state and federal officials and interest groups lined up to present long lists of policy questions that confront them as they grapple with implementation of the Affordable Care Act and mounting public budgetary pressures.
For instance, in the “Opportunities & Challenges for State Officials” session, New Mexico’s Medicaid Director Julie Weinberg described the unknowns surrounding how “churn” between private and public coverage will change and how new Medicaid eligibility standards will impact enrollment processes.
Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:
- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.
- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.
- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.
- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.
- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.
- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.
- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.
- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.
Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.
Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?
Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later. One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.
HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.
Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.