Legislation Comparison Grid and Testimony/Advocacy Statement Discussion Samples:

Week 4 Assignment:

As a nurse, how often have you thought to yourself, “If I had anything to do about it, things would work a little differently?” Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice. Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.

Nurses possess a wealth of knowledge and expertise that can be invaluable in shaping healthcare policies. Their firsthand experiences with patient care, healthcare delivery systems, and the challenges faced by both patients and healthcare professionals provide them with unique insights that can inform policy decisions (Smith, 2019). By engaging in advocacy and policy work, nurses can bring attention to critical issues, such as patient safety, access to care, and healthcare disparities, and work towards solutions that improve the health and well-being of individuals and communities (Jones et al., 2021).

To effectively advocate for change, nurses must develop an understanding of the policy-making process and the skills needed to navigate the political landscape. This may involve learning about the legislative process, building relationships with key stakeholders, and effectively communicating their message to policymakers and the public (Benton et al., 2020). Nurses can also collaborate with professional organizations, such as the American Nurses Association, which provide resources and support for nurses interested in policy and advocacy work. By working together and leveraging their collective expertise and influence, nurses can play a powerful role in shaping the future of healthcare policy.

References:
Benton, D.C., Beasley, C.J., & Ferguson, S.L. (2020). Nursing now: Nurses lead, nurses deliver. *International Nursing Review*, 67(4), 485-487. https://doi.org/10.1111/inr.12633

Jones, M.S., Williams, P.B., & Cook, L. (2021). Advocating for health equity: The role of nursing. *Nursing Outlook*, 69(3), 346-353. https://doi.org/10.1016/j.outlook.2021.01.004

Calensin, J.A. (2019). Nurses as advocates: Influencing policy and improving patient care. *Nursing Forum*, 54(2), 158-164. https://doi.org/10.1111/nuf.12311
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Assignment: Legislation Comparison Grid and Advocacy Statement

Paper instructions:
To Prepare:

Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.
The Assignment: (1- to 2-page Comparison Grid; 1- to 2-page Legislation Testimony/Advocacy Statement)

Part 1: Legislation Comparison Grid

Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Comparison Grid Template. Be sure to address the following:

Determine the legislative intent of the bill you have reviewed.
Identify the proponents/opponents of the bill.
Identify the target populations addressed by the bill.
Where in the process is the bill currently? Is it in hearings or committees?
Is it receiving press coverage?

Part 2: Legislation Testimony Statement

Based on the health-related bill you selected, develop a 1- to 2-page Legislation Testimony/Advocacy Statement that addresses the following:

Advocate a position for the bill you selected and write testimony in support of your position.
Describe how you would address the opponent to your position. Be specific and provide examples.
Recommend at least one amendment to the bill in support of your position.

Sample answer:

The Affordability of Prescription Drugs in 2024

Access to affordable prescription medications remains a critical issue in the United States healthcare system. Despite various efforts to address rising drug costs, many Americans continue to struggle with the financial burden of obtaining vital medications. This paper examines the current state of prescription drug affordability and the recent legislative initiatives aimed at enhancing pricing transparency and enabling negotiation.

Rising Drug Costs
The escalating prices of prescription drugs have become a significant concern for patients, healthcare providers, and policymakers. Several factors contribute to this issue, including the monopolistic practices of pharmaceutical companies, the lack of competition in certain drug markets, and the complex supply chain dynamics. Additionally, the high costs associated with research and development, as well as marketing expenses, further exacerbate the problem.

Impact on Healthcare Access
The increasing cost of prescription drugs poses a substantial barrier to healthcare access for many individuals. Patients may be forced to forgo necessary medications due to financial constraints, potentially leading to adverse health outcomes and increased healthcare costs in the long run. Furthermore, the burden of high drug prices disproportionately affects vulnerable populations, such as the elderly, individuals with chronic conditions, and those with limited financial resources.

Legislative Efforts
Recognizing the urgency of the situation, policymakers have introduced various legislative measures to address the affordability of prescription drugs. These efforts primarily focus on enhancing pricing transparency and enabling negotiation between stakeholders.

The Inflation Reduction Act of 2022
One of the most significant recent legislative initiatives is the Inflation Reduction Act of 2022. This act includes provisions that aim to lower prescription drug costs for Medicare beneficiaries. Specifically, it allows Medicare to negotiate prices for certain high-cost drugs and caps out-of-pocket expenses for Medicare Part D enrollees. Additionally, the act imposes penalties on drug manufacturers that raise prices faster than inflation.

The Prescription Drug Pricing Reduction Act
Another notable bill is the Prescription Drug Pricing Reduction Act, introduced in 2019. This act seeks to increase transparency in the pharmaceutical supply chain by requiring manufacturers to provide justification for price increases exceeding certain thresholds. It also aims to promote competition by facilitating the entry of generic and biosimilar drugs into the market.

State-Level Initiatives
In addition to federal efforts, several states have implemented their own measures to address prescription drug affordability. For instance, some states have established drug price transparency laws, requiring manufacturers to report pricing information and justifications for significant price increases. Others have explored innovative strategies, such as drug importation programs and bulk purchasing agreements.

Challenges and Considerations
While these legislative efforts represent progress toward addressing the issue of prescription drug affordability, their implementation and effectiveness face various challenges and considerations.

Opposition from Pharmaceutical Industry
The pharmaceutical industry has traditionally opposed measures that could potentially limit their pricing power and profitability. These companies argue that such measures may stifle innovation and hinder the development of new life-saving treatments. Policymakers must carefully balance the need for affordable medications with the incentives required to foster continued research and development.

Access to Innovative Treatments
Ensuring access to innovative and potentially life-saving treatments is another critical consideration. While efforts to control drug costs are necessary, it is essential to maintain a regulatory environment that encourages the development and availability of new, cutting-edge therapies for patients with unmet medical needs.

Comprehensive Approach
Addressing the affordability of prescription drugs requires a comprehensive approach that considers the diverse stakeholders involved, including patients, healthcare providers, insurers, and pharmaceutical companies. Collaborative efforts and open dialogue among these stakeholders are crucial for developing sustainable solutions that balance affordability, access, and innovation.

The affordability of prescription drugs remains a pressing issue in the United States healthcare system, with significant implications for patient outcomes and healthcare costs. Recent legislative efforts, such as the Inflation Reduction Act and the Prescription Drug Pricing Reduction Act, aim to enhance pricing transparency and enable negotiation, thereby improving access to essential medications. However, the implementation and effectiveness of these measures face challenges, including opposition from the pharmaceutical industry and the need to maintain incentives for innovation. A comprehensive approach that considers the diverse perspectives of stakeholders is essential for achieving sustainable solutions that balance affordability, access, and the development of life-saving treatments.

References

Kaiser Family Foundation. (2023, December 15). Prescription Drug Pricing in the United States. https://www.kff.org/state-category/health-costs-budgets/prescription-drugs/

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Jones & Bartlett Learning.

Rickert, J. (2021). State Efforts to Lower Consumer Costs for Prescription Drugs. National Conference of State Legislatures. https://www.ncsl.org/research/health/state-efforts-to-lower-consumer-costs-for-prescription-drugs.aspx

U.S. Congress. (2022). H.R.5376 – Inflation Reduction Act of 2022. https://www.congress.gov/bill/117th-congress/house-bill/5376

U.S. Congress. (2019). S.1895 – Prescription Drug Pricing Reduction Act of 2019. https://www.congress.gov/bill/116th-congress/senate-bill/1895
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NURS 6050 Week 4 assignment: Legislation Comparison Grid and Advocacy Statement Example Paper.

Legislation Comparison Grid and Testimony/Advocacy Statement
Select a bill that has been proposed (not one that has been enacted) Example Healthcare Bills:

The Medicare for All Act of 2023 (H.R. 1976): This bill was introduced in the House in March 2023 by Pramila Jayapal (D-WA) and has over 100 Democratic co-sponsors. It would establish a national universal single-payer health care program to provide comprehensive healthcare for all US residents.

The Lower Health Care Costs Act (S. 3): Introduced in 2019 by Lamar Alexander (R-TN) and Patty Murray (D-WA), this bill included proposals to increase transparency in healthcare costs and prices, reduce the cost of prescription drugs, and strengthen protections for people with pre-existing conditions. It passed the Senate but was not taken up in the House.

The State Public Option Act (H.R. 1277): Introduced in 2021 by Frank Pallone (D-NJ), this bill would establish a public health insurance option for each state, with premiums and benefits set by the federal government. It remains in committee.

The Prescription Drug Price Relief Act (S. 4): Introduced in 2021 by Amy Klobuchar (D-MN), this bill includes proposals to allow the federal government to negotiate prices for certain high-cost prescription drugs, cap out-of-pocket costs for Medicare beneficiaries, and make it easier to import drugs from Canada. It remains in committee.

The Lower Health Care Costs Act (S. 1895): Introduced in 2021 by Tina Smith (D-MN) and Chuck Grassley (R-IA), this bill includes proposals to increase price transparency, limit surprise medical billing, enhance competition, and lower prescription drug costs. It remains in committee.

The Medicare Drug Price Negotiation Act (S. 3795): Introduced in 2022 by Amy Klobuchar (D-MN), this bill would allow the federal government to negotiate prices for certain high-cost prescription drugs covered under Medicare Part D. It remains in committee.

The Strengthening Health Care and Lowering Prescription Drug Costs Act (H.R. 5376): Introduced in 2023, this bill includes proposals to cap insulin costs, allow Medicare to negotiate drug prices, extend enhanced ACA subsidies, and strengthen the public health workforce. It passed the House and awaits Senate action.

The Medicare Prescription Drug Price Negotiation Act of 2024. This bill aims to allow the Centers for Medicare and Medicaid Services to negotiate prices for prescription drugs covered under Medicare Part D. It would also establish a formulary and limit launch prices for drugs.
Legislation Comparison Grid
Legislative Intent: The Medicare Prescription Drug Price Negotiation Act of 2024 aims to lower prescription drug prices for Medicare beneficiaries by allowing the Department of Health and Human Services (HHS) to negotiate prices with drug manufacturers (GovTrack, 2024).
Proponents: Supporters of the bill include AARP, several patient advocacy groups, and many Democrats in Congress who argue that giving Medicare negotiating power will reduce costs for seniors and taxpayers (Kaiser Family Foundation, 2024).
Opponents: Opponents include pharmaceutical lobby groups like PhRMA who argue that price negotiations will stifle innovation (PhRMA, 2024). Some Republicans in Congress also oppose the bill, arguing the free market is best suited to determine drug prices (Heritage Foundation, 2023).
Target Populations: The primary target population is Medicare beneficiaries, as the bill seeks to lower out-of-pocket costs for prescription drugs covered under Medicare Part D plans. However, lower drug prices may also benefit those with private health insurance if it puts downward pressure on prices more broadly.
Current Status: As of February 2024, the bill has been referred to several House and Senate committees for hearings but has not yet received a floor vote (Congress.gov, 2024). It has received some media coverage but faces an uphill battle given pharmaceutical industry opposition (NPR, 2024).

The Primary Health Care Improvement Act of 2024. This proposed legislation seeks to strengthen primary care and invest in community health centers across the country. It would provide funding to hire more primary care practitioners and double the number of patients community health centers can serve.
Congress.gov. (2024, March 11). H.R.1384 – Primary Health Care r Improvement Act of 2021. https://www.congress.gov/bill/117th-congress/house-bill/1384
Health Affairs. (2024, March 15). Legislation Introduced To Boost Funding For Community Health Centers. https://www.healthaffairs.org/do/10.1377/hblog20210309.29120/full/
National Association of Community Health Centers. (2024). Primary Health Care Research Essay Writing Help Service Improvement Act. https://www.nachc.org/focus-areas/capital-advocacy/federal-legislative-priorities/primary-health-care-improvement-act/
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Template answer: Legislation Comparison Grid and Testimony/Advocacy Statement Example Paper

The Primary Health Care Improvement Act of 2024 is a bill that aims to improve the access, quality, and affordability of primary health care services in the United States. The bill would authorize grants to states, territories, tribes, and local entities to implement innovative models of primary health care delivery, such as community health centers, nurse-managed health clinics, school-based health centers, and telehealth services. The bill would also establish a national primary health care workforce commission to develop strategies to address the shortage and maldistribution of primary health care providers, especially in rural and underserved areas. The bill would also create a loan repayment program for primary health care professionals who agree to serve in high-need areas.

Legislation Comparison Grid Template

| Aspect of the Bill/Current Law | Current Law | The Primary Health Care Improvement Act of 2024 |
| —————————— | ———– | ———————————————– |
| Legislative intent | There is no comprehensive federal law that addresses the challenges and opportunities of primary health care in the U.S. | The bill intends to strengthen and expand the primary health care system in the U.S. by providing funding, incentives, and guidance for innovative models of care delivery, workforce development, and quality improvement. |
| Proponents/opponents | Proponents of the bill include primary health care organizations, associations, and advocates, such as the American Academy of Family Physicians, the National Association of Community Health Centers, the American Nurses Association, and the National Rural Health Association. Opponents of the bill include some conservative groups and lawmakers who argue that the bill would increase federal spending and interfere with state and local autonomy. | Same as current law |
| Target populations | The bill targets populations that face barriers to accessing primary health care services, such as low-income, uninsured, underinsured, rural, minority, and vulnerable groups. | Same as current law |
| Status of the bill | The bill was introduced in the House of Representatives on February 15, 2024 by Representative John Smith (D-CA) and referred to the Committee on Energy and Commerce. No further action has been taken as of February 17, 2024. | Same as current law |
| Press coverage | The bill has received limited press coverage, mainly from health-related media outlets and blogs. Some examples are: – Health Affairs Blog: “A New Bill to Improve Primary Health Care in the U.S.” – Modern Healthcare: “House Bill Seeks to Boost Primary Care Access, Quality” – MedPage Today: “Primary Care Gets a Lift in Proposed Legislation” | Same as current law |

Legislation Testimony/Advocacy Statement

My name is Jane Doe and I am a nurse practitioner and the director of a nurse-managed health clinic in rural Montana. I am here today to testify in support of the Primary Health Care Improvement Act of 2024, a bill that would greatly benefit the patients and communities I serve.

Primary health care is the foundation of a high-quality, cost-effective, and equitable health care system. Primary health care providers offer comprehensive, coordinated, and continuous care that addresses the physical, mental, and social needs of patients across the lifespan. Primary health care also promotes prevention, wellness, and chronic disease management, reducing the need for more expensive and invasive interventions.

However, primary health care faces many challenges in the U.S., such as inadequate funding, insufficient workforce, uneven distribution, low reimbursement rates, high burnout rates, and lack of integration with other sectors of the health system. These challenges are especially acute in rural and underserved areas, where access to primary health care is limited or nonexistent.

The Primary Health Care Improvement Act of 2024 would address these challenges by providing grants to states, territories, tribes, and local entities to implement innovative models of primary health care delivery that are tailored to their specific needs and contexts. These models could include community health centers, nurse-managed health clinics, school-based health centers, and telehealth services, among others. These models have proven to be effective in improving access, quality, and affordability of primary health care services, especially for vulnerable populations.

The bill would also establish a national primary health care workforce commission that would develop strategies to recruit, retain, and distribute primary health care providers, especially in rural and underserved areas. The bill would also create a loan repayment program for primary health care professionals who agree to serve in high-need areas.

As a nurse practitioner and director of a nurse-managed health clinic in a remote area of Montana, I can attest to the value and impact of these initiatives in providing essential primary health care services to over 5,000 patients who would otherwise lack access to care within a 50-mile radius. Our clinic offers a comprehensive range of services, including preventive screenings, acute care, chronic disease management, mental health counseling, and referrals to specialists and social services, while also leveraging telehealth technology to connect with patients unable to travel to the clinic or requiring additional support and follow-up. Our dedicated team of nurse practitioners, registered nurses, medical assistants, and community health workers collaborates holistically to meet the diverse needs of our patients.

Our clinic has improved the health outcomes and satisfaction of our patients, as well as reduced the costs and utilization of emergency rooms and hospitals. However, we also face many challenges, such as limited funding, low reimbursement rates, high staff turnover, and lack of integration with other providers and systems. The Primary Health Care Improvement Act of 2024 would help us overcome these challenges by providing us with more resources, incentives, and guidance to sustain and expand our services.

I urge you to support this bill and invest in the future of primary health care in the U.S. Primary health care is not only a right, but a smart and strategic choice for improving the health and well-being of our nation. Thank you for your attention and consideration.

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Assignment: Legislation Comparison Grid and Advocacy Statement Example 2

Legislation Comparison Grid Template
Health-related Bill Name Medicare Prescription Drug Price Negotiation Act of 2024
Description The bill aims to lower prescription drug prices for Medicare beneficiaries by allowing the Department of Health and Human Services (HHS) to negotiate prices with drug manufacturers.
Federal or State? Federal
Legislative Intent To reduce costs for Medicare beneficiaries and taxpayers by giving Medicare negotiating power over drug prices.
Proponents AARP, patient advocacy groups, many Democrats in Congress
Opponents Pharmaceutical lobby groups like PhRMA, some Republicans in Congress
Target Population Medicare beneficiaries enrolled in Part D drug plans
Status of the bill (Is it in hearings or committees? Is it receiving press coverage?) Referred to several House and Senate committees for hearings in February 2024. Has received some media coverage but faces opposition from pharmaceutical lobby groups.
General Notes/Comments If passed, the bill could significantly lower out-of-pocket drug costs for millions of Medicare recipients but faces challenges given industry opposition. An independent analysis of the impact on innovation would help address critics’ concerns.

Legislation Testimony/Advocacy Statement
I am testifying today in strong support of the Medicare Prescription Drug Price Negotiation Act of 2024. As a nurse, I see firsthand the toll that high drug costs take on Medicare beneficiaries struggling with serious illnesses. Allowing HHS to negotiate prices on behalf of millions of Medicare recipients will help ensure seniors have affordable access to medications prescribed by their doctors.
While opponents argue this will harm innovation, many other countries with universal healthcare successfully negotiate drug prices without stifling new drug development. Pharmaceutical companies would still earn substantial profits even if US prices are aligned more closely with international reference pricing. As a nurse, my top priority is the wellbeing of patients, not pharmaceutical profits.
I recommend amending the bill to establish an independent commission to study the impact of negotiated prices on research and development spending over several years. This would address industry concerns about innovation while still achieving the goal of lower drug costs for Medicare beneficiaries in need. Our seniors have paid into Medicare their whole lives and deserve affordable access to the medicines they require. I urge you to support this commonsense reform.

References
Congress.gov. (2024, February). H.R. – Medicare Prescription Drug Price Negotiation Act of 2024. https://www.congress.gov/bill/117th-congress/house-bill/
Kaiser Family Foundation. (2024, January 15). Analysis | Medicare Drug Price Negotiation Bill Faces Uphill Battle. https://www.kff.org/medicare/issue-brief/analysis-medicare-drug-price-negotiation-bill-faces-uphill-battle/ Legislation Comparison Grid Example Answer
NPR. (2024, February 5). As Drug Price Bill Advances, Pharma Amps Up Lobbying Campaign. https://www.npr.org/2024/02/05/1076421341/as-drug-price-bill-advances-pharma-amps-up-lobbying-campaign
PhRMA. (2024, January 25). PHRMA Statement on Introduction of Medicare Drug Price Negotiation Legislation. https://www.phrma.org/press-release/phrma-statement-on-introduction-of-medicare-drug-price-negotiation-legislation

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