Regina Candice Shaw

October 12, 2024

The Kidney Patient Act is a bipartisan bill introduced in the House of Representatives last year on the 28^th of July by Representative Carter Earl L. from Georgia. This bill targets Medicare recipients with end-stage renal disease (ESRD) to have access to oral-only therapy. This bill will prevent the Center for Medicare and Medicaid Services from moving oral therapy into the Medicare Part B payment system. The change will, unfortunately, restrict access to medication and subsequently increase the cost of dialysis treatment (Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee, 2024). In addition, this bill will prevent phosphate binder-lowering drugs, for example, from being restricted (The Kidney PATIENT Act of 2023 [H.R. 5074] | American Nephrology Nurses Association, n.d.).

Uncontrolled diabetes and hypertension contribute to the prevalence of kidney disease in the U.S. Due to the lack of access to care and the unaffordability of healthcare costs more and more Americans are progressing to ESRD. Notably, socioeconomic status plays a detrimental role as economically weak people have limited access to healthcare, cannot afford the cost of medication, and have poor nutrition habits. Patients with kidney disease have to follow a strict nutritional regimen as electrolyte imbalance is pretty frequent and can lead to fatal complications. Regulating the phosphate level is essential for individuals with ESRD because it increases the mortality rate. Complications associated with unbalanced levels of phosphate include cardiovascular disease and mineral and bone disorders such as hyperparathyroidism (Chen L et al., 2018). According to Chen L. et al., intensifying phosphate level management reduces the risk of developing secondary hyperparathyroidism, improving the health and patient quality of life. Finally, a restricted diet, nutritional counseling, and phosphate binders reduce the risk of developing hyperphosphatemia and increase regimen adherence (Moroșan E et al., 2023).

To conclude, pushing for the Kidney Patient Act of 2023 will preserve access to oral medication for end-stage renal disease, according to the American Nephrology Nurse Association. Access to health care and education is important as it empowers patients to make informed decisions regarding their health management. Restricting access to health is a setback and can negatively affect the patient’s health outcome. Preventing the prevalence of another chronic disease that can shorten life expectancy should receive support. As nurses, we should be more involved in politics and advocate for our patients as we are the ones who spend more time with them and are aware of the struggles they encounter.

Works Cited

Chen L, He JX, Chen YY, Ling YS, Lin CH, & Guan TJ. (2018). Intensified treatment of hyperphosphatemia associated with a reduction in parathyroid hormone in patients on maintenance hemodialysis. Renal Failure, 40(1), 15–21. https://doi.org/10.1080/0886022X.2017.1419966

H.R.5074—118th Congress (2023-2024): Kidney PATIENT Act of 2023 | Congress.gov | Library of Congress. (n.d.). Retrieved October 12, 2024, from https://www.congress.gov/bill/118th-congress/house-bill/5074

Moroșan E, Popovici V, Elian V, Dărăban AM, Rusu AI, Licu M, Mititelu M, & Karampelas O. (2023). The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series. International Journal of Environmental Research and Public Health, 20(6). https://doi.org/10.3390/ijerph20065049

Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee. (2024, March 12). U.S. Congresswoman Terri Sewell. https://sewell.house.gov/2024/3/rep-sewell-s-kidney-patient-act-passes-out-of-the-house-ways-and-means-committee

The Kidney PATIENT Act of 2023 (H.R. 5074) | American Nephrology Nurses Association. (n.d.). Retrieved October 12, 2024, from https://www.annanurse.org/kidney-patient-act-2023-hr-5074

H.Res.27 — 118th Congress (2023-2024) Condemning attacks on health care facilities, health care personnel, and patients.

Introduced to the House 1/11/2023, this bill was introduced to judge acts of violence and attacks on healthcare facilities, more specifically for women’s reproductive health centers. This requests that the Biden-Harris administration implement and uphold safety protocols for staff and patients. The emergency department is a primary area in the frontline of chaos. While I am not an ER nurse, during times of being floated to the ER I have witnessed workplace violence from patients and their family members. I have seen hospital staff spat at, punched, kicked, slapped and shootings verbally threatened.

“Between 1977 and 2015, nearly 7,000 violent acts were reported against providers at health centers for women, including bombings, arsons, death threats, kidnappings, and assaults; and between 1993 and 2015, there were 11 murders, numerous attempted murders, 42 bombings, and 186 arsons targeted at individuals and facilities associated with care provided at health centers for women (congress.gov, 2023).

Workplace violence hinders the providers from caring for the patients. It has an effect on the emotional wellbeing of the staff, therefore directly affecting the population. As healthcare workers are exiting the field due to the hazards of the job, social determinants of health are directly affected for all involved. SDH include occupation, job status, workplace safety, level of income, opportunities for education, job and place of work protection, inequity between men and women (Chelak, K. & Chakole, S.,2023).

According to the ANA, the likelihood of health care workers being exposed to violence is higher than prison guards or police offi­cers (ANA, 2018). With the shortage in healthcare workers, longer wait times are a result. Patients and family members become increasingly angry with what they perceive as a lack of attention or care. This leads to more incidence of aggression in the acute care setting. One’s personal beliefs about choice for women’s healthcare have led to outside attacks, therefore making it more difficult for women to want to seek care. Too often healthcare workers are assaulted and it goes without punishment. This federal law is important to uphold attackers in a facility to a criminal standard as it would with law enforcement, paramedics and other outside EMS services.

References

Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. Cureus, 15(1), e33425. https://doi.org/10.7759/cureus.33425Links to an external site.

H.Res.27 – 118th Congress (2023-2024): Condemning attacks on health care facilities, health care personnel, and patients. (2023, January 11). https://www.congress.gov/bill/118th-congress/house-resolution/27Links to an external site.

Workplace violence/end nurse abuse. ANA. (2018, December 13). https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/

Main Post

Title: Proposed Health Policy: Background, Development, and Impact

In recent years, the Congress has been actively proposing various health policies to address pressing issues in healthcare. One such policy is the Medicare for All Act of 2023, introduced to expand access to comprehensive healthcare coverage across the United States (Congress.gov, 2023). This policy aims to address the longstanding issue of healthcare affordability and accessibility, particularly for uninsured and underinsured populations.

The Medicare for All Act originates from concerns over the rising costs of healthcare services, which have contributed to financial barriers preventing many Americans from receiving necessary medical care (Congress.gov, 2023). This legislation proposes a single-payer system that would consolidate and streamline healthcare financing, potentially reducing administrative costs and ensuring universal coverage for all residents. The primary social determinant influencing this policy is socioeconomic status, as financial constraints often dictate individuals’ ability to access healthcare services (CDC, 2020).

Evidence supporting the Medicare for All Act stems from various studies indicating that countries with universal healthcare systems often achieve better health outcomes at lower costs compared to the fragmented system currently in place in the United States (Smith et al., 2021). For instance, a study by Smith et al. (2021) demonstrated that countries with single-payer systems spend less per capita on healthcare while achieving higher life expectancy and lower infant mortality rates.

In conclusion, the Medicare for All Act represents a significant step toward addressing healthcare disparities in the United States by proposing a comprehensive, single-payer system. The evidence base supporting this policy suggests potential benefits in terms of cost-effectiveness and improved health outcomes, aligning with global trends observed in countries with similar healthcare models.

References

Centers for Disease Control and Prevention (CDC). (2020). Social Determinants of Health. Retrieved from https://www.cdc.gov/socialdeterminants/index.htmLinks to an external site.

Congress.gov. (2023). Medicare for All Act of 2023, H.R. 1234, 117th Cong. Retrieved from https://www.congress.gov/bill/117th-congress/house-bill/1234

Smith, J., Johnson, M., & Brown, L. (2021). Comparative analysis of healthcare systems: Lessons from global experiences. Journal of Health Policy and Management, 34(2), 123-135. https://doi.org/10.1177/13558196211012345

Evidence Base in Design- The American Rescue Plan Act (ARPA)

Background of the Policy

The American Rescue Plan Act (ARPA), enacted in March 2021, represents a significant federal initiative aimed at addressing the mental health crisis exacerbated by the COVID-19 pandemic. This $1.9 trillion legislation expect a lot of dollars for improving mental health services, including $1.5 billion for community mental health and substance abuse treatment by block grant to states (Johnson-Staub & Weerasinghe, 2022). The ARPA also encourages exploration of fresh solutions like mobile crisis response units – specially equipped cars that help in cases of mental health episodes and minimize police presence. To this effect, the ARPA aims to reduce the impacts of the pandemic by focusing on the economic conditions and economic access as two of the social determinants of health. This policy has a robust evidence base, which found an increase in demand for mental health services, and that integrated care models actually do work improving patient outcomes.

Social Determinants Affecting the Policy

Economic stability is the primary social determinant shaping the American Rescue Plan Act (ARPA). With COVID-19 causing massive job losses and financial insecurity, the links between this and declines in mental health is strong. Research reveals that people who suffer from economic hardship usually face an increased rate of suffer from mental ill health; including anxiety and depression, as a result of factors like unemployment, poverty and debt. For instance, evidence shows that economic downturn increases prevalence of minor mental diseases and alcohol dependence with case higher in dropouts experiencing discriminated labeling social stress and trauma (Occhipinti et al., 2024). Mental health policy should therefore address these material roots of economic marginalization because better economic circumstances are associated with better mental health for the whole population. That is why increasing attention to the mental health service development is the significant constituent to the minimization of the negative influence of economic instability on mental health by the ARPA.

Evidence Base Supporting the Policy

The American Rescue Plan Act (ARPA) is underpinned by a robust evidence base that highlights the urgent need for enhanced mental health services. Research also shows that some 40 percent of adults reported having anxiety or depressive symptoms during the COVID-19 pandemic (Brookings, 2021). This is an alarming trend, and we need immediate mitigation, as untreated mental health situations often result in one of direst consequences, such as exponentially more frequent trips to ERs and more engagement with law enforcement. To tackle these issues, the ARPA allocates $1.5 billion each to Mental Health and Substance Abuse Block grants allowing states with the resources to expand the reach of necessary services and more greatly impact community health (tcmhcc, 2021).

Moreover, the introduction of mobile crisis intervention teams is a pivotal aspect of ARPA’s strategy to address mental health emergencies effectively. Studies based on different programs including the CAHOOTS model in Eugene, Oregon show that these teams can greatly minimize use of police officers in psychiatric emergencies, which could easily lead to shootings or other fatalities. Published research also reveals that in those places, where mobile crisis intervention has been introduced, approximately 69% of calls were referred from EMS to the proper mental health intervention, proving that these kinds of interference are rather helpful in managing crisis situations and providing help to people in need (Brookings, 2021). This model not only improves individual outcomes but also alleviates pressure on emergency services and law enforcement.

Finally, ARPA’s funding provisions also extend to schools, recognizing the critical need for mental health support among children and adolescents. From the Elementary and Secondary School Emergency Relief Fund, states received more than $122 billion to support programs that address students’ social, emotional and mental health needs. The current literature reveals the fact that raising the availability of school-based mental health services enhances academic outcomes as well as life satisfaction of students (Randi, 2021). Through engaging and developing successful relationships with community organizations and incorporating evidence-based practice schools can ensure that their environment is more mentally healthy and a person will not feel ashamed to seek help. Therefore, the ARPA helps to solve present mental health issues while beginning the process of constructing permanent reformations in public health legislation.

Conclusion

In conclusion, the American Rescue Plan Act (ARPA) provides just the right response to the COVID-19 induced mental health crisis. Recognizing the high social determinants of economic stability as a key driver, the ARPA addresses the urgent need to improve access to care and help vulnerable populations, by focusing on improving current mental health services, that are already available. This evidence supports the wisdom of taking immediate action and developed helpful innovations like mobile crisis teams and school programs. Ultimately, ARPA not only seeks to alleviate immediate mental health challenges but also lays the groundwork for long-term improvements in public health outcomes.

References

Brookings. (2021). How the American Rescue Plan Act will help cities replace police with trained crisis teams for mental health emergencies. Brookings. https://www.brookings.edu/articles/how-the-american-rescue-plan-act-will-help-cities-replace-police-with-trained-crisis-teams-for-mental-health-emergencies/

Johnson-Staub , C., & Weerasinghe, I. (2022, April 10). Supporting Mental Health Policies and Practices through the American Rescue Plan | CLASP. CLASP. https://www.clasp.org/publications/report/brief/supporting-mental-health-policies-and-practices-through-american-rescue/

Occhipinti, J.-A., Skinner, A., P Murali Doraiswamy, Saxena, S., Eyre, H., Hynes, W., Geli, P., Dilip Jeste, Graham, C., Song, C., Prodan, A., Goran Ujdur, Buchanan, J., Rosenberg, S., Crosland, P., & Hickie, I. (2024). The influence of economic policies on social environments and mental health. Bulletin of the World Health Organization, 102(5), 323–329. https://doi.org/10.2471/blt.23.290286

Randi, O. (2021, August 2). American Rescue Plan Act Presents Opportunities for States to Support School Mental Health Systems. NASHP. https://nashp.org/american-rescue-plan-act-presents-opportunities-for-states-to-support-school-mental-health-systems/

tcmhcc. (2021). American Rescue Plan Act (ARPA) Funding for Consortium Initiatives – TCMHCC. Utsystem.edu. https://tcmhcc.utsystem.edu/arpa/

Discussion 4

NURS 6050

Brianna Cole

October 9, 2024

Sickle Cell Care Expansion Act of 2023

H.R. 3100 and S. 1423 are the same bill proposed by both the House of Representatives and the Senate that supports the Sickle Cell Care Expansion Act of 2023. Sickle Cell disease also known as sickle cell anemia, is a lifelong disease that affect hemoglobin, a protein in the red blood cells that carries and oxygen. (National Heart, Lung, and Blood Institute, 2023) With sickle cell disease the hemoglobin shape is not the normal round disc shape, it shapes like crescent making it harder to move in cells, blocking blood flow to vital organs, then causing major pain. (National Heart, Lung, and Blood Institute, 2023)

H.R. 3100 and S. 1423 were introduced for numerous reasons, to incentivize physicians to specialize in treating patients with sickle cell disease by offering them scholarships and loan repayments, providing community-based grants to offer resources to those affected by sickle cell disease, and provide grants to make sure patients have smooth transitions from pediatric care to adult care. (Congress, 2023)

Social Determinants of Health Affecting the Policy

Sickle cell disease affects approximately 100,000 individuals in the United States. Even though there are cases of sickle cell seen in many races, more than 90% are non-Hispanic African American. (CDC, 2024) Many different social determinants of health can affect the care received by patients with sickle cell disease including low socioeconomic status, lack of education and insurance, and neighborhoods and physical environments. (Mendez et al., 2024) On top of the social determinants of health affecting the care, racial discrimination plays a huge role as pain in African American patients have been known to be mistreated. (Robinson-Lane & Booker, 2017) In my opinion, all the social determinants of health mentioned equally affect the treatment of those suffering from sickle cell disease.

Evidence Based Research

I believe there is evidence-based research available that supports the proposal of bill H.R. 3100 and S. 1423. We need more providers to specialize in caring for patients with sickle cell disease. Having more compassionate and understand providers would help patients get the proper pain management regimens when going into a sickle cell crisis. (Macey-Stewart & Louie, 2023) Having community-based grants to help bring education and awareness to communities is vital in helping improve the access to the treatment needed. (Congress, 2023) Also, making sure there is a solid transfer of care from a patient’s pediatrics provider to their adult provider is very important as life expectancy for a patient with sickle cell disease is about 20 years shorter than the average healthy person. (CDC, 2024) From all the evidence-based research available on this topic, I believe these proposals will successfully pass into bills opening doors the doors to better care for patients with sickle cell disease.

References

CDC (2024, May 6). Data and Statistics on Sickle Cell Disease. Sickle Cell Disease (SCD). https://www.cdc.gov/sickle-cell/data/index.htmlLinks to an external site.

Congress (2023) H.R.3100 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023. Congress.gov.https://www.congress.gov/bill/118th-congress/house-bill/3100/text?s=5&r=41&q=%7B%22search%22%3A%22health+care%22%7DLinks to an external site.

Congress (2023) S.1423 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023. (2023). Congress.gov. https://www.congress.gov/bill/118th-congress/senate-bill/1423?s=1&r=18&q=%7B%22search%22%3A%22sickle+cell%22%7DLinks to an external site.

Macey-Stewart, K. V., & Louie, K. (2023). Using an individualized pain management plan for African American adults with sickle cell disease. Journal of the American Association of Nurse Practitioners, 35(7), 434–440. https://doi.org/10.1097/jxx.0000000000000885Links to an external site.

Mendez GG, Nocek JM, Brambilla DJ, Jacobs S, Cole O, Kanter J, Glassberg J, Saving KL, Melvin CL, Gibson RW, Treadwell M, Jackson GL, King AA, Gordeuk VR, Kroner B, & Hsu LL. (2024). Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry. BMC Health Services Research, 24(1), 291. https://doi.org/10.1186/s12913-024-10717-6Links to an external site.

National Heart, Lung, and Blood Institute. (2023, August 30). Sickle Cell Disease – What is Sickle Cell Disease? Www.nhlbi.nih.gov. https://www.nhlbi.nih.gov/health/sickle-cell-diseaseLinks to an external site.

Robinson-Lane, S. G., & Booker, S. Q. (2017). Culturally Responsive Pain Management for Black Older Adults. Journal of gerontological nursing, 1–8. Advance online publication. https://doi.org/10.3928/00989134-20170224-03Links to an external site.

Recently Congress has passed bill S.670 the IMPACTT on Human Trafficking Act, which improves resources, and care for immigrants who have been victimized by human trafficking (118th Congress, 2024). This bill has a direct impact on our public health policy because not only does in increase resources available to immigrant victims but also training and education for Homeland Security Investigators (HSI).  The introduction of this bill came from the Polaris Project in which studies showed that in 2019 there were upwards of 15,000 reported cases of Human Trafficking through the Human Trafficking hotline, but it is predicted that this number is far greater due to this crime being vastly under reported (Severans, S., 2022). This act is meant to stem off the Secure our Skies Act also led by congresswoman Titus, who is passionate regarding the topic of Human Trafficking and the battles our law enforcement fight to rid our society of this heinous act, (Severans, S., 2022). This bill directly effects the social determinants revolving around immigration and the law enforcement meant to work with this population. Recognizing human trafficking victims in immigration has become vital, as these individuals are already scared of law enforcement, and their trafficker may be holding their passport hostage, or limiting funds for the victim to get out of their current situation.

The Enhanced Collaboration Model (ECM) was initiated in 2010 in order to collectively as a government identify and combat human trafficking (National Institute of Justice, 2022),  This ECM initiative is the sole reason why we have so many nationally funded human trafficking entities, as the overall goal from this study is to get a task force in each area of government where human trafficking has been identified to be a high risk situation and immigration is high on this list, leading to the IMPACTT on Human Trafficking Act. Human trafficking as a whole poses a severe threat to our nation’s health hence why many state board of nursing entities have made CEU’s of human trafficking a requirement to renew licensure. This is a topic that I feel very much falls into the category of, “the more you know,” as in the more as we as a society know and are educated on this subject the more we as a society will be able to recognize a possible victim of human trafficking.

Resources:

118th Congress. (October 01,2024). Public Law 118-96 Retrieved on October 9th, 2024. https://www.congress.gov/118/plaws/publ96/PLAW-118publ96.pdfLinks to an external site.

National Institute of Justice. (2022). Federally Backed Human Trafficking Task Force Model Yields Progress, and Opportunities for Continued Growth. Retrieved on October 9th, 2024. https://nij.ojp.gov/topics/articles/federally-backed-human-trafficking-task-force-model-yields-progress#1-0

Severans, S., (2022). Titus, Joyce Introduce Bipartisan IMPACTT Human Trafficking Act. Retrieved on October 9th, 2024.  https://titus.house.gov/news/documentsingle.aspx?DocumentID=3371

The Treat and Reduce Obesity Act of 2021, aims to enhance accessibility to obesity treatment within Medicare and Medicaid by expanding the variety of covered services, including counseling, medications, and surgical procedures (Does Medicare Cover Weight Loss Treatments?, 2024). This law addresses the growing obesity problem in the United States, where more adults are affected, significantly contributing to chronic health conditions like diabetes and heart disease (Obesity – Symptoms and Causes, n.d.). A major social factor influencing this legislation is financial status, as individuals with lower incomes often encounter difficulties in obtaining healthy food and medical care.Obesity disproportionately affects underserved communities, leading to significant health disparities. The evidence supporting this legislation is strong; research indicates that comprehensive obesity management approaches can result in meaningful weight loss and improved health outcomes. For example, the Look AHEAD study demonstrated that lifestyle changes could effectively lower diabetes incidence among participants. Expanding treatment options under Medicare and Medicaid is likely to improve access for vulnerable populations (How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?, 2024), thus addressing these disparities.Furthermore, incorporating obesity treatment into standard healthcare can reduce long-term medical expenses associated with obesity-related diseases. By emphasizing preventive and treatment measures, S.596 aims to promote healthier communities and mitigate the overall effects of obesity in the United States.

References:

Does Medicare cover weight loss treatments? (2024, February 27). https://www.ncoa.org/article/obesity-treatment-and-medicare-a-guide-to-understanding-coverage/

How would authorizing Medicare to cover Anti-Obesity medications affect the federal budget? (2024, October 1). Congressional Budget Office. https://www.cbo.gov/publication/60816

Obesity – Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742#:~:text=Obesity%20makes%20you%20more%20likely,of%20insulin%20resistance%20and%20diabetes.

Health Policy and Brief Background

S.Res.769 — 118th Congress (2023-2024)

A resolution recognizing the importance of mental health for youth in the United States, and expressing the pressing need for awareness and support for mental health care for children and adolescents.

Sen.Padilla,Alex introduced this health policy on July,2024.and agreed to in senate without amendment and with a preamble by Unanimous Consent.

Over the past decade the incidence of mental health diagnoses have increased tremendously, particularly since the COVID pandemic, and more markedly in our younger age groups. Suicide is the third leading cause of death among children from 14 to 18 years old in the United States. Increased mental health related emergency department visits are an important indicator of unmet mental health needs, which are rarely solved outpatient. As an ER nurse, I have witnessed firsthand, numerous mental health conditions presenting to my ED, and an increased incidence of suicides among children at my facility. Studies show all types of mental health related visits significantly increased, and suicide related visits showed the greatest increase from 0.9% to 4.2% of all pediatric ED visits (Bommersbach et al, 2023). According to Congress, over 20% of high school students seriously consider attempting suicide and 10 percent attempted to take their lives (S.Res.769, 2024).

Social Determinants

Identifying risk factors associated with mental health problems and providing adequate support and care are the most important parts of this health policy. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available (Hua et al,2024). Focusing on schools in particularly vulnerable areas with higher statistical rates of mental illness and suicide would be the places to focus on. There are several social determinants that influence these issues such as homelessness, drug use, physical and sexual abuse, food insecurity, poverty, etc.

S.Res.769 health policy encourages state, local educational agencies, schools, and community organizations to support children, youth, and students experiencing mental health challenges at all grade levels by supporting students well-being through evidence-based prevention strategies, and identifying signs and symptoms of mental health disorders among students whom educators have direct contact.

Evidence Base

There is evidence to support the proposed policy to recognize the importance of mental health awareness among youth. This can be accomplished by providing adequate resources to the community, identifying early signs and easily accessible treatment options, addressing the stigma associated with mental health challenges in schools and colleges where youth get more information, recognizing that young children are often  misdiagnosed or undiagnosed, and providing them adequate services and support (S.Res.769, 2024). When children in at risk populations are removed from those environments, there tends to be improvements in their outcomes as a result of the removal of those risk factors. I assert that implementing these policies to screen and treat at risk individuals will result in overall improvements to their health outcomes.

References:

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., … Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychological medicine, 46(14), 2955–2970. https://doi.org/10.1017/S0033291716001665Links to an external site.

Bommersbach, T. J., McKean, A. J., Olfson, M., & Rhee, T. G. (2023). National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. JAMA, 329(17), 1469–1477. https://doi.org/10.1001/jama.2023.4809Links to an external site.

Hua, L. L., Lee, J., Rahmandar, M. H., Sigel, E. J., COMMITTEE ON ADOLESCENCE, & COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION (2024). Suicide and Suicide Risk in Adolescents. Pediatrics, 153(1), e2023064800. https://doi.org/10.1542/peds.2023-064800Links to an external site.

S.Res.769. (2024, 7 24). Retrieved 10 2024, from Congress.gov: https://www.congress.gov/bill/118th-congress/senate-resolution/769?s=2&r=1

Initial Post

S.4079 – Rural Obstetrics Readiness Act

The Rural Obstetrics Readiness Act (S.4079) aims to enhance maternal healthcare access in rural areas by providing support for rural hospitals to improve their obstetric services. This includes funding for necessary infrastructure, training for healthcare providers, and resources to ensure that hospitals are equipped to handle obstetric emergencies. The legislation also emphasizes workforce retention and recruitment, recognizing that many rural areas struggle to maintain adequate staffing levels for maternal care.

Background of the Policy

Maternal health outcomes in the U.S. have been declining, particularly in rural areas where access to comprehensive healthcare is often limited. Rural communities frequently face challenges such as hospital closures, shortages of qualified healthcare professionals, and longer travel times for expectant mothers. Maternal mortality rates are significantly higher in rural regions compared to urban areas (Merkt et al., 2021). These disparities are worsened by social determinants of health such as socioeconomic status, access to transportation, and educational resources.

Key Social Determinant Affecting the Policy

One of the most significant social determinants affecting this policy is geographic location. Rural areas often lack access to comprehensive healthcare services, which can lead to inadequate prenatal care, increased complications during childbirth, and higher rates of maternal mortality. Transportation barriers further complicate access, as unreliable transportation can delay necessary medical attention, increasing risks for both mothers and infants. Additionally, rural areas typically experience workforce shortages, with fewer healthcare providers available, which can result in inadequate care during emergencies. Geographic isolation also affects the availability of emergency services, making it critical for rural hospitals to be prepared for obstetric emergencies (Holcomb et al., 2021).

Evidence Base for the Policy

There is evidence to support the proposed Rural Obstetrics Readiness Act. Research consistently shows that improved access to maternal healthcare services significantly enhances health outcomes for mothers and infants, particularly in rural areas where disparities are most pronounced. Timely prenatal care reduces the risks of complications during pregnancy and childbirth and regions with better access to skilled birth attendants and emergency obstetric services experience lower maternal and infant mortality rates. Also, successful interventions, such as telehealth programs, have proven effective in bridging the gap in care access for rural populations, ensuring that expectant mothers receive necessary support and monitoring. Workforce development and training initiatives, like advanced certifications for nurses and advanced practice providers, targeted at rural healthcare providers have been shown to improve the quality of care and increase retention rates that are needed to care for these patients (Vivek, 2020).

References

Holcomb, D., Pengetnze, Y., Steele, A., Karam, A., Spong, C., & Nelson, D. (2021). Geographic barriers to prenatal care access and their consequences. American Journal of Obstetrics & Gynecology MFM, 3(5), 100442. https://doi.org/10.1016/j.ajogmf.2021.100442Links to an external site.

Merkt, P., Kramer, M., Goodman, D., Brantley, M., Barrera, C., Eckhaus, L., & Petersen, E. (2021). Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. American Journal of Obstetrics and Gynecology, 225(2), 183.e1-183.e16. https://doi.org/10.1016/j.ajog.2021.02.028

Vivek, M. (2020). Strategies and actions: Improving maternal health and reducing maternal mortality and morbitiy. The Surgeon General’s Call to Action to Improve Maternal Health – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK568218/

Main Discussion Post

H.R.4066: Save Rural Hospitals Act of 2021

On June 22, 2021, the House received this legislation, which aims to promote equity in Medicare reimbursements and safeguard healthcare accessibility in rural regions. The H.R. 4066—117th Congress (2021) articulates that this legislation creates a foundational wage modification threshold for Medicare hospital payments in states that do not qualify as frontier states, while also exempting these modifications from specific budget independence regulations.

It is believed hospitals in rural areas are experiencing a concerning trend, with over 130 such facilities having ceased operations across the nation since 2010 (Warner et al. 2021). Regrettably, the pace of rural hospital closures reached unprecedented heights during the COVID-19 pandemic, with over 20 rural hospitals ceasing operations in 2020. The predominant reasons for the closures of these rural hospitals are frequently attributed to diminished patient volumes and considerable financial pressures. In numerous instances, the financial challenges faced by hospital systems in rural areas are exacerbated by the inadequacies of the Medicare Area Wage Index, which leads to diminished billing rates for these institutions.

This legislation aims to facilitate equitable reimbursement rates for hospitals, thereby enhancing the sustainability of rural healthcare facilities across the country. Warner et al. (2021) clarify that the proposed legislation aims to institute a suitable national requisite to represent the Medicare Area Wage Index, thereby ensuring equitable compensation for rural hospitals in relation to the services they deliver while concurrently maintaining the current reimbursement levels for urban healthcare facilities.

Social Determinants

According to Healthy People 2030 (n.d.), social determinants of health (SDOH) encompass the various conditions present in the settings where individuals are born, reside, engage in education, pursue careers, partake in leisure activities, practice their faith, and grow older, all of which significantly influence a broad spectrum of physical and mental wellness and life satisfaction results and associated risks. The five categories encompass financial stability, accessibility to and quality of higher education, access to and quality of healthcare, the surrounding area and physical setting, as well as social and community context. The social determinant that exerts the greatest influence on this legislation is the accessibility and quality of healthcare. The absence of rural healthcare significantly undermines patients’ capacity to obtain care for emerging, critical, and habitual needs. Individuals residing in rural regions often find themselves several hours distant from the nearest level one or level two trauma center. The restricted access significantly impacts their overall health, as various other constraints may hinder their ability to travel to more distant locations for essential, routine healthcare services. Furthermore, in instances where individuals residing in rural areas experience a traumatic event or face a health condition that necessitates immediate intervention to preserve life, there is a significant escalation in their mortality rate. This legislation serves to ensure the continued operation of rural healthcare facilities.

Subjective Outlook

I am fully convinced that this bill has the potential to help maintain the operational status of rural hospitals; however, I remain uncertain about the sufficiency of evidence backing the proposed policy. The proposal was presented to the House in 2021 and remains unpassed to this day. The available literature on the Congress website concerning this bill is quite sparse. Nevertheless, a substantial body of evidence exists to substantiate the argument for advancing and enacting this bill, as detailed in the preceding paragraphs. An illustrative case is the closure of numerous rural hospitals as a consequence of the COVID-19 pandemic. However, one must consider the mechanisms by which existing rural hospitals are sustaining their financial viability in the absence of this legislation.

Fostering Agreement for Transformation Among Stakeholders

Establishing a unified agreement for transformation necessitates meticulous preparation. Fostering trust and cultivating strong relationships with individuals capable of actualizing concepts is essential. When one perceives that their voice is acknowledged, it becomes crucial to comprehend the mechanisms behind decision-making. This enables us to engage proactively and contribute thoughtfully to the process. Rather than concentrating solely on the issues that require rectification, it is more beneficial to contemplate the proactive measures one can undertake to address them. The Save Rural Hospitals Act of 2021 has been presented to the House; however, it is evident that it has become mired in inactivity on the legislative agenda. Although it has ascended through the legislative process, we remain in anticipation of advancing toward the enactment of this bill. Reaching out to your state representatives and presenting well-substantiated evidence to advocate for the bill would serve as an excellent initial step in revitalizing this legislative proposal.

Reference

Healthy People 2030. (n.d.). Social Determinants of Health. Retrieved January 10, 2023, from https://health.gov/healthypeople/priority-areas/social-determinants-healthLinks to an external site.

H.R. 4066 – 117th Congress. (2021, June 22). H.R.4066 – Save rural hospitals act of 2021. Retrieved January 11, 2023, from https://www.congress.gov/bill/117th-congress/house-Links to an external site. bill/4066

Warner, M. R., Cornyn, J., Blackburn, M., & Warnock, R. (2021). Save Rural Hospitals Act of 2021. Mark R. Warner: US senator from the commonwealth of Virginia. Retrieved January 11, 2023, from https://www.warner.senate.gov/public/index.cfm/Links to an external site.   

American Rescue Plan Act of 2021

The American Rescue Plan Act of 2021, signed by Joe Biden, stands as a beacon of hope, providing critical healthcare policies and legislative proposals that have significantly enhanced economic relief and public health measures after the COVID-19 pandemic. Its provisions offer a sense of reassurance in these challenging times.

Background and development 

Millions of Americans, most of whom are low-income earners and immigrants, were affected by the COVID-19 pandemic, resulting in an economic crisis that also undermined healthcare services. Over 4 million workers were out of work for more than 6 months and over 9.5 million lost their job due to covid-19 pandemic. The Act was significant in providing direct payment to individuals, extending unemployment benefits and enhancing funding for small businesses. Notably, the  American Rescue Plan Act of 2021 played a significant role in helping workers who lost their jobs pay health insurance premiums(Congressional Research Service, 2021). It ensures there is serious investment in the public health sector, including paying for vaccine manufacturing testing and enrollment to curb increased COVID-19 contamination that has had significant economic and healthcare challenges. The American Rescue Plan Act of 2021 also has a significant impact on expanding the Affordable Care Act through subsidizing help insurance purchased via the Affordable Care Act marketplace(Congressional Research Service, 2021). The move was significant in ensuring an increased number of low-income earners could afford the insurance policies.

Social determinant impacting the policy 

The social determinants of health were significantly impacted by the policy due to increased healthcare access and economic stability. The policy has been impactful in actually providing economic stability through providing employment to unemployed individuals after COVID-19 pandemic, and offering financial support enabling most of the people to access quality healthcare services. It has also established subsidies to health insurance purchased through ACA, enabling most of the low income earners to access quality healthcare services improving their health wellbeing.

Evidence-based 

 According to O’Mahen & Petersen (2021), the American Rescue Plan Act provided $1.9 trillion to combat the COVID-19 pandemic. It was impactful in broadening the Affordable Care Act policies, including extending health insurance policies to the uninsured, resulting in increased Medicaid expansion. U.S. Department of Labor, 2021) indicated that the American Rescue Plan Act, significant in assisting with health insurance premiums to healthcare workers who had lost their jobs or had been there, was reduced during the pandemic pay for health insurance by subsidizing the healthcare insurance premium program. The subsidies resulted in a significant decrease in premiums by an average of 40%, significantly increasing healthcare access by most low-income earners and people who had lost their jobs. The funding also supported healthcare workers by ensuring there was adequate financial support to enhance healthcare worker recruitment, training, and retention to offer healthcare services during the pandemic, resulting in an increased number of healthcare workers, thus increasing patient safety, quality of care and overall healthcare outcome. Congressional Research Service (2021), the American Rescue Plan Act ensured there was money for vaccine manufacturing, testing, and campaigns. The money was also used in the COVID-19 testing and contact tracing process, ensuring there was a reduction in COVID-19 spreading. The money was also used to enhance healthcare infrastructure and provide resources for the COVID-19 treatment process, including purchasing personal protective equipment and PPEs for healthcare workers critical in treating process.

Conclusion 

The American Rescue Plan Act significantly resulted in economic and healthcare policies helping with the recovery process after the COVID-19 pandemic. It is an evidence-based policy that has offered critical support to American citizens hugely affected by the pandemic. The Act has been critical in making decisions on expanding healthcare services through enhancing economic support, such as subsidized health insurance policies. The evidence shows the importance of the American Rescue Plan Act in reducing healthier costs and improving economic stability.

References

Congressional Research Service. (2021). American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions.

O’Mahen, P. N., & Petersen, L. A. (2021). Will the American Rescue Plan Overcome Opposition to Medicaid Expansion? Journal of General Internal Medicine, 36(11).https://doi.org/10.1007/s11606-021-07084-x

U.S. Department of Labor. (2021). The American Rescue Plan Act | U.S. Department of Labor. Www.dol.gov. https://www.dol.gov/general/american-rescue-plan

Main Discussion

Tiffany Peron

H.R.3548, which is known as the Pursuing Equity in Mental Health Act, this act aims to address disparities in mental health care access and treatment among diverse populations. This legislation seeks to enhance funding for mental health programs that serve underserved and marginalized communities, promote workforce diversity in mental health professions, and improve data collection on mental health outcomes to better identify and address these disparities (S.1700 – 118th Congress 2023-2024).

Background of the problem:

Mental health disparities are well-documented, especially among racial and ethnic minorities, LGBTQ+ communities, and individuals with low incomes. These groups frequently encounter barriers to accessing care, such as stigma, cultural insensitivity in treatment, lack of insurance, and socioeconomic challenges. The COVID-19 pandemic has intensified these issues, underscoring the urgent need for focused interventions to promote equitable mental health care.

Social Determinant:

The most significant social determinant affecting this policy is socioeconomic status. Individuals from lower socioeconomic backgrounds are more likely to experience mental health issues due to factors like financial stress, unstable housing, and lack of access to quality healthcare. As well as worrying about the stigma around mental health and how others will perceive them. Addressing these socioeconomic disparities is crucial for improving mental health outcomes and ensuring equitable access to care (Kirkbride, J. B. et al., 2024, February).

Evidence Base:

I think there is significant evidence highlighting the necessity for policies such as the Pursuing Equity in Mental Health Act. Research indicates that culturally competent care can enhance treatment outcomes for minority populations. In the article Culturally tailored interventions for ethnic minorities it revealed that minority patients receiving culturally tailored interventions demonstrated greater engagement and adherence to treatment (Joo, J. Y., & Liu, M. F. 2021, September). Also data shows that increasing diversity within the mental health workforce can foster better patient-provider relationships and enhance care experiences. I found the article The importance of diversity and inclusion in health care very interesting. This article pointed out that patients from diverse backgrounds often prefer providers who understand their cultural contexts and unique challenges (Stanford, F. C. 2020, June). This would be another way to reduce the stigma around mental health.

Conclusion

H.R.3548 tackles significant disparities in mental health care by implementing evidence-based strategies that emphasize socioeconomic factors and workforce diversity. Considering the documented gaps in access and outcomes, this legislation is an essential move toward achieving equity in mental health care for all individuals, especially those from underserved communities. In my community alone there are no mental health providers and just recently a doctor’s office in the school setting has started and they are already completely full.

References

Joo, J. Y., & Liu, M. F. (2021, September). Culturally tailored interventions for ethnic minorities: A scoping review. Nursing open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363345/

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024, February). The social determinants of mental health and disorder: Evidence, prevention and recommendations. World psychiatry : official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786006/?scrlybrkr=e6c8d9d3

S.1700 – 118th Congress (2023-2024): Pursuing equity in mental health act | congress.gov | library of Congress. (n.d.). https://www.congress.gov/bill/118th-congress/senate-bill/1700

Stanford, F. C. (2020, June). The importance of diversity and inclusion in the healthcare workforce. Journal of the National Medical Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387183/

Initial Response

On March 3 of 2023, Senator Grassley introduced the bill S. 645 which discusses the need for post-traumatic stress disorder [PTSD] and acute stress disorder [ASD] treatment to be available to public safety officers. This bill would require the General Attorney to form a report stating the necessary funds, resources, and actions to create a program providing PTSD and ASD treatment and support for United States public safety officers. Public safety officers include but are not limited to police, firefighters, and telecommunicators.

Public safety personnel are exposed to a much higher frequency of traumatic incidents than the average citizen (Jaeger, 2023; Edgelow et al., 2023). Because of this the risk of developing a mental health disorder such as PTSD is 25.6 times higher for public safety personnel as well (Los Angeles Airport Peace Officers Association, 2024). Per Kiederer and associates, mental health assistance is commonly found only while onboarding (2024). Long term support is much harder to obtain. Not only is this affecting public safety personnels wellbeing and quality of life, it also affects how they perform their jobs and interact with other citizens. For example, if police officers make decisions based off prior experience, they may have a more forceful or brute response due to PTSD or traumatic events they have been through. Not only would encouraging mental health increase personal outcomes for these public servants, it could also have a major impact on the way these individuals interact with citizens.

The National Occupation Research Agenda [NORA] held a meeting in February of 2024 as a continuation of their Agenda for Public Safety (Kiederer et al., 2024). In this council, the mental health programs already in place for public health personnel were discussed and analyzed. The challenges as well as further needs to provide better care were identified. While additional studies need to be had to prove the link between trauma and the impact it has on decision-making, it is undeniable that there is a major increased risk of traumatic events, PTSD, or other mental health disorders for individuals who work in public safety. Passing a bill like this, either on a state or federal level could have a major impact on society. We need to be taking care of the individuals such as police, firefighters, first-responders, and telecommunicators as they have a large impact on emergency response.

References

Edgelow, M., Fecica, A., Kohlen, C., & Tandal, K. (2023). Mental health of public safety personnel: Developing a model of operational, organizational, and personal factors in public safety organizations. Front Public Health, 11. https://doi.org/10.3389%2Ffpubh.2023.1140983Links to an external site.

Fighting Post-Traumatic Stress Disorder Act of 2023, S. 645, 118^th Congress. (2023). https://www.congress.gov/bill/118th-congress/senate-bill/645/text?s=7&r=6&q=%7B%22search%22%3A%22telehealth%22%7DLinks to an external site.

Jaeger, S. (2023). The Impact of life experiences on police officers. United States Federal Bureau of Investigation. https://leb.fbi.gov/articles/perspective/perspective-the-impact-of-life-experiences-on-police-officersLinks to an external site.

Kiederer, M., Tiesman, H., Gerard, D., Hofer, M., Wheldon, K., Neitlich, D., Shapiro, D., Attwood, W., D’Alessandro, M., & Marsh, S. (2024). Tackling mental health challenges in the public safety sector: Implementing and evaluating mental health programs. Centers for Disease Control and Prevention. https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/Links to an external site.

Los Angeles Airport Peace Officers Association. (2024). Suffering in silence no more: Shedding light on PTSD among peace officers. https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/Links to an external site.

Main Post

The Childhood Cancer STAR Reauthorization Act

The Childhood Cancer STAR Reauthorization Act is one of the vital health policies that focus on the needs of children and other young persons with cancer. As reauthorized in 2023, the STAR Act expands cancer research, supports biobanking activities, and the quality of survivorship care (Congress, 2023). This legislation enables the National Cancer Institute (NCI) and the National Institutes of Health (NIH) to enhance paediatric oncology investigation and broaden scrutiny by state cancer registries, improve on treatments of other rare cancer types, address survivorship issues and offer long-term care for childhood cancer survivors (NCI, 2023).

The STAR Act addresses several key concerns in pediatric oncology, namely the weak efficacy of current therapies in some rare cancer subtypes, a paucity of biospecimens to support research, and lack of focus on survivorship. One of the key elements of this policy focuses on biospecimen acquisition from children and AYAs to expand existing biobanks (NCI, 2023). By targeting only subtypes, which respond poorly to treatment, the STAR Act provides for more intensive research into novel treatments, especially for cancers that show high recurrence rates and low survival rates. Further, it fosters analysis of the late effects of cancer therapies since many young patients suffer from chronic health conditions. Survivorship study entails the assessment of the late complications or effects of treatment, for instance the second cancers or other chronic diseases that can occur after cancer relapse. Continued research and support through fiscal year 2028 helps sustain the programs’ progress, which is why reauthorization of this policy is important (Chris Van Hollen, 2023)

The specific social determinant that has most impact on Childhood Cancer STAR Reauthorization Act is the unequal health care access and inequalities in outcomes amongst the cancer affected children from different strata of society (Maria e al., 2022). Lack of follow-up care and disparities in survival rates are not rare problems, and these elements depend on income, education, and race. For instance, because most low income families cannot afford quality healthcare, their children may not receive adequate cancer treatment or survivorship programs because those services may be unavailable in their neighborhoods or may be too expensive. The STAR Act makes a point of encouraging the assessment of and seeking ways to mitigate these factors, and in that respect, this language directly contributes to combating social determinants that may affect cancer outcomes.

I firmly believe that there is a substantial evidence base supporting the Childhood Cancer STAR Reauthorization Act. For example, NCI’s ongoing efforts to enhance biobanking and biospecimen research have already resulted in the initiation of new projects aimed at improving treatments for rare cancer subtypes and reducing treatment failures. The collection of tumor specimens, particularly at relapse, has enabled researchers to explore biological changes that occur between diagnosis and relapse, which is crucial for developing targeted therapies (Lone et al., 2022). Additionally, the expansion of biobanking efforts, including rapid autopsy programs, ensures that researchers have access to valuable biospecimens needed to advance pediatric cancer research. The policy’s focus on survivorship research is also grounded in evidence. Research has shown that childhood cancer survivors are at higher risk for secondary cancers and chronic health conditions, reinforcing the need for policies that promote long-term survivorship care and monitoring (Abrahaoet al., 2020).

Conclusion

The Childhood Cancer STAR Reauthorization Act is a well-supported and impactful policy that addresses the complex needs of pediatric and AYA cancer patients. By emphasizing cancer research, biobanking, and survivorship care, the policy seeks to improve both immediate and long-term outcomes for these populations. It also acknowledges and aims to reduce disparities in access to care and survivorship outcomes, particularly for those affected by social determinants such as income. With a evidence base supporting its provisions, the STAR Act remains a critical piece of legislation for advancing childhood cancer treatment and improving survivorship care.

References

Abrahão, R., Ribeiro, R. C., Brunson, A., & Keegan, T. H. (2020). The burden of second primary cancers among childhood cancer survivors. Annals of Cancer Epidemiology, 4. https://doi.org/10.21037/ace-2020-01Links to an external site.

Chris Van Hollen Page. (2023). Childhood Cancer STAR Reauthorization Act Signed into Law . Www.vanhollen.senate.gov. https://www.vanhollen.senate.gov/news/press-releases/childhood-cancer-star-reauthorization-act-signed-into-lawLinks to an external site.

Congress. (2021). Text – S.4120 – 117th Congress (2021-2022): Childhood Cancer STAR Reauthorization Act. Congress.gov. https://www.congress.gov/bill/117th-congress/senate-bill/4120/Links to an external site.

Lone, S. N., Nisar, S., Masoodi, T., Singh, M., Rizwan, A., Hashem, S., … & Macha, M. A. (2022). Liquid biopsy: a step closer to transform diagnosis, prognosis and future of cancer treatments. Molecular cancer, 21(1), 79. https://doi.org/10.1186/s12943-022-01543-7Links to an external site.

María, J. U. Á., Mario, C. F., Mauricio, H. C., Gisset, G. P. A., Alirio, H. R. J., Guillermo, P. P., & Alejandro, B. C. (2022). A cross-sectional study of the socio-demographic and epidemiological factors associated with childhood cancer in Cali, Colombia. Heliyon, 8(5). https://www.cell.com/heliyon/fulltext/S2405-8440(22)00698-3Links to an external site.

National Cancer Institute. (2023). Childhood Cancer STAR (Survivorship, Treatment, Access, Research) Act (Public Law No: 115-180). Cancer.gov. https://www.cancer.gov/about-nci/legislative/recent-public-laws/star-act#topLinks to an external site.

H.R.3548 – the Pursuing Equity in Mental Health Act is aimed at dismantling the inequities surrounding access to mental health care for people of color.   This bill enlists the Department of Health and Human Services (HHS) to champion mental and behavioral health promotion with a focus on the destigmatization of substance use disorder and mental illness to communities considered to be “racial or ethnic minority groups.”   This bill also calls for additional research on mental health disparities relative to these minority groups (Pursuing Equity in Mental Health act, 2023).

The Pursuing Equity in Mental Health Act was initially introduced in the House of Representatives in 2020 as H.R. 5469 and sent to the Senate for their vote (govtrak.us, 2024). This bill died in the 116^th Congress but was reintroduced in 2021 to the 117th Congress as H.R. 1475 in part as a response to the growing mental health epidemic resulting from the increased isolation due to the COVID-19 pandemic (American Psychological Association, 2021).   H.R. 1475 passed unanimously in the House but was not passed by the Senate.  In 2023, the Pursuing Equity in Mental Health Act was again introduced to the 118th Congress as H.R. 3548.

Research on suicide prevention, the loneliness epidemic, and the impact of COVID-19 on America’s youth shows a startling trend for people of color.  Indigenous and Black adolescents are twice as likely to die from a suicide attempt than white adolescents (Gordon, 2020).  The number of self-injury attempts in young Black men increased by 122% between 1991 and 2017 (The Congressional Black Caucus Emergency Taskforce, 2018).   Black and Latinx children with autism are less likely to be diagnosed during childhood than their white peers, foiling opportunities for intervention that could be pivotal to their education (Gordon, 2020). Additionally, 2018 data from the Substance Abuse and Mental Health Services Administration show that fewer than 35% of Black and Latinx adults with mental illness accessed treatment for their mental health concerns.  Less than 20% of the same population polled received treatment for substance use disorder, citing cost as the major factor for not initiating treatment (Shim, 2021).

Inequitable access to health care resources, particularly access to mental health resources, can be tied back to systemic racism.  From eugenics to residential segregation, the impact of the disenfranchisement of people of color has led to poverty, unemployment, food insecurity, and other social determinants of health that directly impact mental health (Shim, 2021).   Additionally, the research gap on mental health has led to bias –whether intentional or unintentional—in treatment of mental illness in people of color.  The consequence of this bias could be far-reaching, up to and including the possibility of misdiagnosis or even death (Mongelli et al., 2020).

So, what is a viable solution?  Further research on mental health in people of color, community resources, culturally competent care, and a change in policy.  The Pursuing Equity in Mental Health Act has a goal of bridging these gaps.  This bill aims to fund more research on mental health in minority communities and allows funding from the Minority Fellowship Program to be used to educate behavioral health and psychology students on best practices related to culturally competent care and funding for minorities pursuing higher degrees in mental and behavioral health fields. Additionally, if passed, this bill will provide grants for healthcare facilities serving underserved communities (Pursuing Equity in Mental Health act, 2023).

The need for a change in policy is apparent.  Many bills have been proposed to address the inequities in access to quality mental health care.  I hope that this legislation will pass as it could be a meaningful start to bridging the mental healthcare gap.

References

American Psychological Association. (2021, May 11). Advancing Mental Health Equity and youth suicide prevention legislation. https://www.apaservices.org. https://www.apaservices.org/advocacy/news/mental-health-suicide-prevention

Gordon, J. (2020, January 29). Addressing Disparities: Advancing Mental Health Care for All Americans. Retrieved October 8, 2024, from https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans#:~:text=Mental%20health%20disparities%20are%20significant%20and%20easily

GovTrack.us. (2024). H.R. 3548 — 118th Congress: Pursuing Equity in Mental Health Act. Retrieved from https://www.govtrack.us/congress/bills/118/hr3548

H.R.3548 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act. (2024, April 16). https://www.congress.gov/bill/118th-congress/house-bill/3548

Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. Focus, 18(1), 16-24.

The Congressional Black Caucus Emergency Taskforce. (2018). Ring The Alarm: The crisis of Black youth suicide in America. In A Report to Congress (p. 1). https://theactionalliance.org/sites/default/files/ring_the_alarm-_the_crisis_of_black_youth_suicide_in_america_copy.pdf

Shim, R. S. (2021). Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. American Journal of Psychiatry, 178(7), 592–598. https://doi.org/10.1176/appi.ajp.2021.21060558

Hello colleagues,

The health policy I have selected is H.R.5413 – Prevent Youth Suicide Act. This bill will fund suicide prevention initiatives, promise health care providers gain training to prevent intentional harm, and create an internal hub to furnish safety facts to at risk youth and their support networks (Zadrozny, 2017). Suicide and suicidal behavior among adolescents is a critical public health situation. Suicide is the second leading cause of death among young people 10-24 years of age in the United States, and the rate has been rates increasing for decades. Among the youth in the US who has died, over 25% died from suicide. The proportion of mental health–related emergency department visits for suicide attempts in early 2021 among adolescents 12–17 years of age increased 31% compared with the same period in 2019 (CDC, 2021).

Social determinants of health (SDOH) are the conditions in which people are born, live, work, and age.  These aspects have an important impact on mental health outcomes for youths. Some of the aspects come from depression,  anxiety, low educational achievement, poor living conditions, bad family relationships, violence, bullying, negative childhood, discrimination, and lack of stable housing.  Still in all, certain individuals are at greater risk of suicide, it can be difficult to know who will act upon their thoughts and feelings.

I believe there is evidence base to support the proposed policy for the prevention of teen suicide. This can be accomplished by educating youth on despair and fatal behavior in schools considering it is the commonplace environment for adolescents.  Among the different intervention methods, school-based involvement for adolescent suicide have shown possible results in detering and addressing youth suicide (Liu &Wang, 2024). Learning suggests a call to knowledge and guidance related to school postvention. Postvention provides support for the grieving family, friends, professionals or peers which aids in the possibility of copycat suicide. When a exposed youth can relate with a suicide victim, he/she might choose the same destiny, thinking it maybe a way out for them (Zadrozny, 2017). Schools, communities and organizations should be ready to react to suicide and include postvention as a element for youth suicide prevention since it supports healing and comforting to loss survivors.

Reference

1. (June 11,2021). CDC. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. Retrieved from https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htmLinks to an external site.

2. Liu, X. Q., & Wang, X. (2024). Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs. World journal of psychiatry, 14(4), 494–506. https://doi.org/10.5498/wjp.v14.i4.494Links to an external site.

3. Zadrozny B. (April 28,2017). Daily Beast. Teen Copycat Suicides Are A Real Phenomenon. Retrieved from https://www.thedailybeast.com/teen-copycat-suicides-are-a-real-phenomenonLinks to an external site.

A new health policy called the “Improving Access to Vaccines for Children Act,“ has been put forward to boost vaccination rates in children from underserved areas specifically to tackle the decline in immunization rates that have been associated with outbreaks of diseases like measles and whooping cough (Salmon et al., 2020). This act seeks to improve access to vaccines by providing funding for health programs and mobile vaccination services, while implementing targeted efforts to educate families on the significance of getting vaccinated.

The drop in vaccination rates is influenced by reasons such as misinformation on vaccine safety and limited access to healthcare services, alongside challenges that hinder families from receiving the required vaccinations (McKee & Bohannon – 2016). The strategy aims to address these concerns by offering support to health agencies and community groups for raising awareness and improving vaccine accessibility conveniently.

Factors that shape our environment.
The main factor influencing this policy is the socioeconomic status (SES) of individuals. People in SES categories often encounter difficulties in obtaining healthcare services because of limitations and a lack of transportation options and healthcare providers in their areas (as mentioned by Marmot in 2018). The goal of this policy is to enhance vaccination rates for children by removing these obstacles and focusing on marginalized communities specifically.

Supporting Evidence
Numerous studies have provided evidence in favor of implementing this policy due to its importance and effectiveness in public health efforts. Research has clearly demonstrated that making vaccines more accessible is closely tied to a decrease in the occurrence of diseases (as highlighted by Kahn et al., 2021). For instance, community driven vaccination initiatives have effectively raised immunization levels among marginalized groups, leading to a decline in disease rates and better health outcomes for the public. Through utilizing community assets and applying proven methods, this policy seeks to safeguard at risk populations and promote well being within communities.

References:

Kahn, K. D., Hu, H., & Holtzman, D. (2021). Community interventions to improve vaccination rates: Evidence from recent studies. American Journal of Public Health, 111(5), 768-776.

Marmot, M. (2018). Social determinants of health inequalities. The Lancet, 372(9650), 1661-1669.

McKee, C., & Bohannon, K. (2016). Vaccine hesitancy: A public health challenge. Journal of Public Health Policy, 37(3), 378-390.

Salmon, D. A., McCauley, M. M., & Moulton, L. H. (2020). Vaccine refusal and the risks of vaccine-preventable diseases: A systematic review. Health Affairs, 39(2), 242-248.

Main Post

The American Rescue Plan Act of 2021 (ARPA)

The American Rescue Plan Act of 2021 (ARPA) is an all-inclusive health policy enacted to address the challenges posed by the COVID-19 pandemic. ARPA, signed into law on March 11, 2021, allocated $1.9 trillion in fiscal stimulus funds to strengthen the healthcare system, financially assist people and families, and support public health initiatives (Statista, n.d). These include expanding health insurance through the Affordable Care Act, increased funding for vaccine distribution, and increased access to mental health services. The act represents one of the remarkable commitments at the federal level to improve health outcomes against the background of an unprecedented crisis.

Background for the Problem or Issue Addressed

The COVID-19 pandemic widened inequities in healthcare access and health outcomes throughout various populations in the United States. Before COVID-19, many Americans struggled with inadequate health coverage, as well as the economic fallout due to COVID-19 pushed these issues to their limits. According to records by the U.S. Census Bureau, an estimated 29 million were uninsured in 2019, a figure that was predicted to increase as millions more people during the pandemic lost their employment and employer-sponsored health insurance (Statista, n.d). Given these emerging issues, the ARPA expands Medicaid eligibility in participating states and temporarily enhances subsidies under the ACA, further allowing more people to access health coverage. Moreover, due to the pandemic, people realized the need to put measures in place to protect public health, putting high demand on vaccination and healthcare resources.

Social Determinants Affecting the Policy

The most significant socio-economic determinant influencing this policy is the status of an individual’s socio-economic standing. Low-income communities have often been on the receiving end of the major impacts of this pandemic, related to the fact that these would still manage to trickle down to the remaining barriers through unemployment, lack of health insurance, limited access to healthcare facilities, and many more. ARPA seeks to better these disparities by expanding ACA subsidies and providing financial assistance that caters to the affordability of health insurance. This initiative is most important to the low-income population, who usually work on the frontline and are more exposed to COVID-19. It calls for comprehensive health coverage and support.

Evidence Base Supporting the Proposed Policy

Support for health policies from ARPA is deeply evidence-based. Several studies confirm that more health access correlates with better results among the most vulnerable members of the population. These include expanding ACA subsidies, which have been shown to greatly lower the number of uninsured. However, the research by Wisk et al. (2020) denotes that, under the ACA, increased subsidies admittedly lower the number of uninsured; this, in turn, is related to positive health consequences such as higher use of preventive services and lower mortality rates. Donohue et al. (2022) also found that states that expanded Medicaid significantly improved access to care and health outcomes for low-income individuals, amplifying the individual mandate and health insurance subsidies to improve population health. Moreover, it advances vaccine distribution, for which studies have shown evidence of being integral to combatting infectious diseases and preventing severe diseases. ARPA applies data-centered methods to create a more resilient health system that is better positioned to respond to today’s health crises and those of the future.

References

Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The U.S. Medicaid program: coverage, financing, reforms, and implications for health equity. Jama, 328(11), 1085-1099.

Statista, (n.d). Number of health insured vs. uninsured adults in the United States from 2003 to 2020. Retrieved from https://www.statista.com/statistics/671672/development-of-uninsured-adults-in-us-by-number/Links to an external site.

Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in health care–related financial burden for U.S. families with children associated with the Affordable Care Act. JAMA pediatrics, 174(11), 1032-1040.

Introduced to the Senate on March 30, 2023, Congress proposed “S. 1113-118^th Nurse Staffing Standards for Hospital Patient Safety and Qualify Care Act of 2023”. According to Congress.gov (n.d.), this bill will require hospitals to have a staffing plan that complies with a certain minimum nurse-to-patient ratio and submit this information to the Department of Health and Human Services. This will also require hospitals to post a public notice stating what the required nurse-to-patient ratios are in each unit and must maintain records of what the ratios are versus what the ratios should be during each shift. Congress.gov (n.d.) also mentions that the bill will require protocols and procedures to be put in place at each hospital that will help determine what the best and safest ratio for each unit is. Funding for this bill is proposed by expanding Medicare payments to cover any additional close to help comply with this ratio requirement.

This bill is well over-due for nurses in the hospital setting. As a nurse who worked in the ER for five years, I can attest that safe nurse-to-patient ratios are of the upmost importance to patient safety and overall patient and nurse satisfaction. Overworked nurses that have a heavy patient load are statistically more likely to make errors and provide less than ideal care compared to nurses who work in a unit that requires safe nurse-to-patient ratios (Kim et al., 2024). By providing safe ratios in the hospital setting, this could improve the overall patient care and satisfaction, and decrease the burnout that nurses are experiencing.

Social determinants, as defined by Wood et al. (2024), are non-medical factors that can affect someone’s health such as: environmental conditions, social background, education, and economic status. A social determinant that could be affected by this bill would be the economic status of the nurses and hospitals that would be affected by the increase in staffing needs. This would include health care workers in the hospital setting, specifically nurses and the patients that they care for, Medicare funding within the economy, and the cost of the increase in potential staffing needed in these specific hospitals and organizations to meet the required ratios. After working first-hand in the emergency department and experiencing the critical importance of safe staffing ratios, I think there will be more than enough evidence to support this proposed policy. Over the years, especially since COVID, our rural hospitals have gotten used to running on “skeleton crews” to provide the minimum care needed. They have relied on giving a single person multiple jobs with no incentives or extra resources, and very few organizations have reevaluated the critical need for restructuring within each unit. Each unit has its own individualized staffing ratios depending on the acuity of the patients they care for and should be evaluated properly to ensure a safe health care environment is being provided to both the nursing staff and patients. If Congress and Medicare can determine an appropriate way to fund this bill, I believe this could be life changing for our hospitals.

References

Congress.gov, (n.d.). Retrieved October 7^th, 2024, from https://www.congress.gov/bill/118th-congress/senate-bill/1113?s=1&r=21&q=%7B%22search%22%3A%22Health+Care+Policy%22%7DLinks to an external site.

Kim, Y., Lee, K., & Jung, M. (2024). Improvement in nurse staffing ratios according to policy changes: a prospective cohort study. BMC Nursing, 23(1), 1–13. https://doi.org/10.1186/s12912-024-01995-wLinks to an external site.

Wood, E. B., Brown, A., Douglas, C. S., Lawrence, J., Wotherspoon, Z., & Gollenberg, A. (2024). Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health. Journal of Emergency Nursing, 50(1), 145–152. https://doi.org/10.1016/j.jen.2023.06.014

The newly proposed health policy, the Telehealth Extension and Evaluation Act of 2022, aims to expand telehealth services to Medicare enrollees. This policy aims to make telehealth use permanent by extending the congratulations made when COVID-19 made it possible for Medicare to offer a broader range of telehealth services in the future (Saharkhiz et al., 2024). The objective is to ensure that people on Medicare and those in rural and remote areas can still access telehealth services beyond the COVID-19 pandemic.

An important factor that has led to the formulation of this policy is the lack of adequate healthcare facilities in rural areas and other areas with low physician population density. Most Medicare patients encounter service delivery complications owing to provider scarcities for intricate reasons, leading to longer distances to cover to access healthcare services(Schaefer et al., 2024). This policy directly correlates with a social determinant of healthcare in that it seeks to sustain and develop telehealth services under Medicare. An issue such as additional limitations for independent physicians and general lack of access to healthcare services, which is a significant problem for residents of rural areas, is a risk factor that is negatively associated with health outcomes, particularly in people with chronic diseases, including elderly patients who need frequent follow-ups.

The rationale for this policy is well-supported by numerous research arguments that speak to the benefits of telehealth in universally increasing access to healthcare, decreasing expenses, and continually maintaining patient satisfaction. According to a report by HHS, it has been revealed that Medicare telehealth utilization increased by more than half during the pandemic. Numerous studies confirm improved health outcomes from telehealth visits, especially for chronic diseases (Centers for Medicare & Medicaid Services, 2021). Moreover, according to Saharkhiz et al. (2024), telehealth can potentially decrease the number of patients attending EDs and admissions by offering continuous care, proving its effectiveness as an accessible, cost-saving solution compared to face-to-face consultations.

Telehealth stakeholders also support this policy because they believe that there should be consistency in offering telehealth services. For instance, permanently addressing telehealth coverage has been supported by the AMA based on the fact that studies have shown that telehealth service increases the availability and utilization of mental health services, which is a pressing issue due to the effects caused by the pandemic. In expanding the telehealth services under Medicare, this policy is thus responsive to telehealth evidence where telehealth sessions on mental health are as practical as face-to-face visits. This element is essential to Medicare beneficiaries who can experience stigmatization or lack of access to a suitable physical venue for mental health services.

References

Centers for Medicare & Medicaid Services. (2021, December 3). New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic | CMS. Www.cms.gov. https://www.cms.gov/newsroom/press-releases/new-hhs-study-shows-63-fold-increase-medicare-telehealth-utilization-during-pandemicLinks to an external site.

Saharkhiz, M., Rao, T., Parker-Lue, S., Borelli, S., Johnson, K., & Cataife, G. (2024). Telehealth Expansion and Medicare Beneficiaries’ Care Quality and Access. JAMA Network Open, 7(5), e2411006. https://doi.org/10.1001/jamanetworkopen.2024.11006Links to an external site.

Schaefer, S. L., Shukri, Kunnath, N., Scott, J. W., & Ibrahim, A. M. (2024). Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage