TONL Monthly
December 2018

Updates from the Nursing Legislative Agenda Coalition Fall Meeting

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By Chase Pedersen, M.S.N., R.N., C.E.N., H.A.C.P., N.E.A.-B.C., CTONE president, assistant chief nursing officer, St. David’s North Austin Medical Center

The second Tuesday of 2019 marks the kickoff to the 86th Texas Legislative session. National trends have shifted to the left, and healthcare has taken a front-and-center position on the political agenda. On Nov. 10, Elizabeth Sjoberg and I represented TONE at the Nursing Legislative Agenda Coalition (NLAC) fall meeting.

For those of you unfamiliar with NLAC, it is the largest coalition of professional nursing organizations in the state of Texas and was initially established in 1989. The coalition is led by the Texas Nurses Association and works to be the consolidated voice for thousands of nurses by setting and supporting the nursing legislative agenda.

Midterm Election Recap

The meeting started with a high-level recap of the 2018 midterm elections. At the national level, voter turnout reached historical numbers, and checks and balances were restored to a very heated and hypersensitive political environment. While there are a few contested national races, we can safely say Democrats have secured a majority in U.S. House of Representatives, and Republicans have maintained control of the U.S. Senate. Personal politics aside, the facts speak for themselves, progressives made significant headway in diversifying what has traditionally been a male-dominated landscape. Out of the 277 congressional seats, 117 were won by women. This included two Native American women, two Muslim American women and two Hispanic women in the state of Texas. While many argue it was not the “blue wave” Democrats were expecting, it is a significant shift in congressional control and has many implications, including a new U.S. House Speaker and committee appointments. The U.S. races representing Texas remained relatively flat with Republicans retaining 22 of the 36 congressional seats. The highly publicized Senate race ended with Ted Cruz defeating Beto O’ Rourke by only 2 percentage points. It is important to note that voter turnout almost doubled in Texas over the prior midterms with over 8 million Texans casting ballots.

In the statewide races, Governor Abbot defeated Lupe Valdez by 13 points, which was less than polls predicted, but he did so with very little effort campaigning. Also in the winning column was Lt. Governor Dan Patrick, who in the 85th legislative session held the Texas Medical Board Sunset bill hostage insisting the House pass the widely debatable “bathroom bill.” Please Google it. In the Texas House of Representatives, Republicans maintained an 83- to 67-seat majority. However, this was a flip of 12 congressional seats, which shifted to Democrats in suburban areas around Dallas, Austin and Houston. The state Senate was a similar story with Democrats narrowing the Republican majority to 19 – 12.

Focusing back on the national results, there were multiple healthcare initiatives on the ballot that passed. They included legalization of medical marijuana in Michigan, Oklahoma and Utah and Medicaid expansion in Idaho, Nebraska, Utah and Oregon. In Massachusetts, a mandatory nurse-to-patient ratio initiative failed in large part due to efforts made by the Massachusetts Nurses Association.

Texas Political Environment

On paper, there does not seem to be much movement in regards to state congressional control. However, if you scratch the surface you will find the political dynamics have significantly changed. The Republican Party has been divided into two distinct factions – the moderate GOP caucus with 69 members and the very conservative Freedom caucus with 14 members. Traditionally, the GOP caucus has been closely aligned with the Texas Medical Association and has been more resistant toward NLAC initiatives. However, the growing Freedom caucus, which represents districts in many rural Texas areas, is much more accepting of nursing initiatives. This small but delicate balance of power offers a window of opportunity for nursing. By combining the historical backing NLAC has received from congressional Democrats and the Freedom Caucus, it is possible to achieve bipartisan support for nursing legislation.

The 86th session, in particular, is going to be a whirlwind of activity. The current Texas Speaker of the House, Joe Straus, did not seek re-election, and the key front-runner Republican, Dennis Bonnen, lost eight supporters in the 2018 midterms. While he is not out of the running, it has opened the door for other candidates to emerge. The appointment of a new speaker means new committee appointees and chairs. These positions hold significant leverage in Congress, as they control which bills can be set for a hearing. Committee appointments and a few other bureaucratic items will take several weeks and delay any bills from going to committees until late February. This means we have a very short session, and NLAC must take a targeted approach compiling and lobbying the nursing legislative agenda.

TNA Legislative Agenda

Multiple organizations shared their political agendas, but TNA provided what I believe will be the primary focus for NLAC initiatives. Below is the specific one-page summary they provided to NLAC.

APRN Full Practice Authority

The Texas Nurse Association will continue to pursue full practice authority for APRNs in the 2019 session through our membership in the APRN Alliance and our leadership of the coalition on Health Care Access. There have been multiple meetings with the Texas Medical Association and the Texas Academy of Family Physicians, and we are very close to finalizing those meetings leading up to session and moving forward through the CHCA to find a sponsor and file the bill.

Workplace Violence

The Texas Nurse Association will file a comprehensive workplace violence protection bill, which will require facilities across the spectrum to establish workplace violence prevention committees and develop policies and plans for preventing violence in the workplace with some minimal statutory requirements for the plans, including required annual training, mandatory reporting of incidents of violence internally and externally, a system for responding to and investigating incidents, and solicitation of input on the plan from providers.

Nursing Shortage Reduction Program

The Texas Nurse Association supports full funding of the Nursing Shortage Reduction Program and will work with institutions of higher education and the Texas Higher Education Coordinating Board to prioritize incentives for increasing pre-licensure graduates. Through our conversations with deans and directors, we anticipate that this will include increased flexibility in growth targets for schools so that they can more reliably depend on the funding to expand their programs.

Nursing Faculty Loan Repayment Program

TNA will file a bill with Senator Hinojosa to remove the single-year award amount maximum of $7,000 currently in law and allow the THECB to set the award maximum through rulemaking. We will also actively search for opportunities in the state budget to appropriate additional funding to the program, which will help more nurses and ease the faculty shortage in Texas.

Currently, the NFLRP is only available for nurses that have been employed full-time for at least one year as a faculty member of an eligible institution. This bill will also require that the fund be available for part-time faculty members as well and should be updated to allow part-time faculty to apply for a portion of the loan repayment funds.

Finally, we understand that through some confusion in the code, the faculty loans awarded under this program are considered additional income for federal tax purposes and unnecessarily increasing nurses’ taxes. This bill will seek to reclassify the loans to remove that possibility.

Nursing & Allied Health Tobacco Settlement Funds Rider

Years ago, the tobacco industry was sued by a number of states and settled out of court with the state plaintiffs. The settlement agreement required the tobacco companies to pay millions of dollars each year to the states in perpetuity for the burden that tobacco causes the states’ healthcare systems. Some of the tobacco settlement funds given to the state go toward Nursing & Allied Health ($10.8M) and periodically require an update to the rider to continue the funding into the near future. TNA will work with legislators to ensure that the rider is reauthorized in the state budget.

Texas Medical Association

Dan Finch and Troy Alexander, lobbyist for the Texas Medical Association, provided a lengthy presentation outlining a variety of issues TMA will be tackling in the 86th session. Priorities included the biennial budget, insurance coverage, opioid prescribing, maternal health, public vaccination rates, disaster preparedness and corporate practice of medicine. When asked about TMA’s stance on APRN full practice authority, TMA reaffirmed their prior position that the practice of medicine should remain under the supervision of a physician.

Unfortunately, it is very difficult to include all of the details I absorbed during the meeting, but I can assure you as the TONE representatives, Elizabeth and I will do our very best to keep you all up to speed with how session is progressing. Thank you for your support!

 

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