Action Plan

The only person that responded back to the emails that we sent out was Senator Barack Obama. He stated that he was glad that we have joined him in the fight against our health care system. He encouraged us to read more about his health care plan and watch a video of his health care speech. Which can be viewed at this site. He is also encouraging us to take action to to inform other individuals about this act. He reminds us that he is committed to covering everyone and to learn more about his health care plan to view it on this website. As the Nurse Bloggers we plan to follow through with what Senator Barack Obama has asked us to do. This will be done by continuing to inform and educate others about this act.

Our Position and Action Plan; Key Stake Holders and Legislatures for the Bill

Our Position and Action Plan

We are in favor of the Prevention Through Affordable Access Act because of the positive effects it will have on health care as a whole and the people to whom it provides. Below is a list of the positive potential impacts of this bill, which includes improved length and quality of life. The first step in our political action plan is to support this act by creating this blog and utilizing it as a way of introducing this legislation, providing knowledge, and hopefully inspiring people to get involved. Next, we plan to contact legislatures and identify to them the importance of passing this bill and what it could mean to people in this country who are burdened with medication costs. Previously stated under "Evidence Based Need for Change," there are listed a few evidence-based articles; all of which conclude that better clinical outcomes are resulted when patients were provided adequate medication access at reasonable prices.

Key stakeholders include any health care consumers without insurance, those whose insurance does not cover prescription drug costs, and those who primarily use clinics or free health centers for primary care. Other stakeholders include doctors, nurses, pharmacists, pharmaceutical companies,insurance companies, and both democratic and republican candidates who address this issue in their campaign platforms.

Key legislators include Democractic Rep Joseph Crowley who introduced the bill to the house along with the support of the following:

Legislators in the house include Mr. Ramstad, Mr. Ryan of Ohio, Mr. Kirk, Mr. Schiff, Ms. McCollum of Minnesota, Mr. McDermott, Mrs. Lowey, Mr. Waxman, Ms. Slaughter, Ms. Clarke, Mrs. McCarthy of New York, Mrs. Boyda of Kansas, Mr. Meeks of New York, Mrs. Maloney of New York, Mrs. Tauscher, Mr. George Miller of California, Mr. Moore of Kansas, Mr. Nadler, Ms. Castor, Mr. Allen, Mr. Carnahan, Ms. Corrine Brown of Florida, Ms. Schakowsky, Mr. Michaud, Mr. Filner, Mr. Berman, Mr. Clay, Mr. Patrick J. Murphy of Pennsylvania, Mr. Blumenauer, Mrs. Davis of California, Mr. Lantos, Mr. Sires, Ms. Norton, Ms. Berkley, Mr. McNulty, Mr. Al Green of Texas, Mr. Van Hollen, Ms. Degette, Mr. Moran of Virginia, Mr. Mitchell, Ms. Delauro, Ms. Sutton, Mr. Grijalva, Ms. Hirono, Ms. Hooley, Ms. Matsui, Mr. Honda, Mr. Hinchey, Mr. Boucher, Mr. Farr, Mr. Cleaver, Ms. Loretta Sanchez of California, Mr. Courtney, Mr. McGovern, Mr. Pascrell, Mr. Israel, Ms. Baldwin, Mr. Ackerman, Ms. Linda T. Sanchez of California, Mrs. Napolitano, Ms. Moore of Wisconsin, Mr. Dent, Mr. Olver, Ms. Lee, Ms. Wasserman Schultz, Mrs. Capps, Mr. Wynn, Mr. Inslee, Mr. Payne, Ms. Giffords, Mr. Smith of Washington, Mr. Wu, Mr. Braley of Iowa, Mr. Kennedy, Mr. Towns, Mr. Loebsack, Ms. Solis, Ms. Schwartz, Ms. Roybal-Allard, Mr. Shays, Mr. Cohen, Mr. Ellison, Mr. Frank of Massachusetts, Mr. Serrano, Mr. Hall of New York, Mr. Bishop of New York, Mr. Defazio, Mr. Walz of Minnesota, Mr. Jefferson, Ms. Zoe Lofgren of California, Mr. Wexler, Mr. Jackson of Illinois, Mr. Kind, Mr. Yarmuth, Mr. Rothman, Mr. Miller of North Carolina, Mr. Hastings of Florida, Mr. Welch of Vermont, Mr. Kagen, Mr. Klein of Florida, Mr. Fattah, Mr. Gene Green of Texas, and Mr. Stark.

Senate supports include Democrat Barack Obama with support of the following legislators: Mr. Reid (for Mr. Obama (for himself, Mrs. McCaskill, Ms. Collins, Mr. Kennedy, Mrs. Murray, Ms. Stabenow, Mr. Bingaman, Mr. Wyden, Mrs. Feinstein, Mr. Kerry, Mr. Harkin, Mrs. Boxer, Mr. Leahy, Mr. Menendez, Ms. Klobuchar, Mr. Schumer, Mr. Brown, Ms. Cantwell, and Mrs. Clinton)

Robert C. Byrd (D-WV) is Chairman of the Senate Appropriations Committee who would be a key player in helping with funding for this bill. David R Obey (D-WI) is the chair of of the House Appropriations Committee and would also be an important point of contact(This committee has an HHS subcommittee). Virginia rep Dave Moran is also on this committee.

Edward Kennedy, chairman of the Senate Committee on Health, Education, Labor and Pensions is another important legislator. The bill has not yet been passed to this committee and its knowledge of this bill is a key piece to enacting this legislation.

Political Influences. Governmental Objectives, Potential Impact of Policy Change, and Evidenced Based Need for Change

Political Influences

U.S. Sen. Barack Obama, commented on the bill (Prevention Through Affordable Access Act) in a Planned Parenthood press release: "No woman should be turned away from university clinics and health centers because the cost of prescription drugs is out of reach. Access to contraceptives is essential to lowering the rate of unintended pregnancies in this country, and we need to make sure these drugs are affordable and accessible."
Senator Obama introduced this bill to Congress and is a presidential nominee along with Senator John McCain, who is also an influential person with this topic because of the presidential election coming up on Nov 4th(http://badgerherald.com/oped/2008/02/05/congress_must_fix_bi.php).

Both individuals have a different approach to resolving the health care issue within the states. Obama wants to "build on the existing system of employer-sponsored health care plan by creating and expanding government sponsored insurance programs until everyone who wants coverage has it. He would mandate that all children be covered and that all large businesses provide coverage or pay toward public insurance plans.

McCain on the other hand plans on using the "current employer-based system and stimulated the free market to create more affordable coverage for everyone." He would establish by introducing a new tax credit of $2,500 for individuals and $5,000 for families to be applied to the cost of a health insurance policy. There are currently 177 million individuals now covered by employer-sponsored health care would see those benefits taxed as income (http://www.newsday.com/news/local/politics/ny-liheal085875455oct09,0,1633930.story).

Congress, especially the Senate Finance Committee and House Appropriations Committee, are other political influences because they will decide whether or not to pass Prevention Through Affordable Access Act. Others influences include lobbyists, health care companies, legislature, senate, and registered voters.

Governmental Objectives

The primary governmental objective for this policy is to increase affordable access to medications, especially birth control, to students and lower income individuals. It is the intent of the political officials who support this initiative to ensure individuals are not forced to choose between two items that are necessary for a good quality of life. Louise Slaughter, a Democrat representative of New York, emphasized this point by stating that, “For low income women, the increase in price means deciding between feeding their families and buying contraception” ( http://crowley.house.gov/news/record.asp?id=1076)

This objective is the same for many Democrat and Republicans alike, as Republicans Jim Ramstad and Mark Kirk also support this policy. Kirk aims to explain the need for support for this legislation among all policy makers when he states, “This should not be a political debate – it should be a matter of restoring discounts to support women’s health” (http://crowley.house.gov/news/record.asp?id=1076)

An additional governmental objective includes not making the entire population pay more in order to support this policy. Adam Schiff, Democratic representative for California, called this bill “The best kind of commonsense legislation,” emphasizing that the policy “helps prevent unwanted pregnancies and reduce the incidence of abortion among college and low income women – at no cost to the American taxpayer” (http://crowley.house.gov/news/record.asp?id=1076).

Barack Obama, a co-sponsor of the Prevention through Affordable Access Act, also supports these governmental objectives in regards to this policy. His website indicates that he believes it is unfair to exclude college student and lower income women from available family planning methods (http://obama.senate.gov/news/071118-affordable_fami

Potential Impact of the Legislation on Nursing, Clients, and the Health Care System

Potential impact on:

Nursing:

-Will be able to be effective in education of medication knowing that their clients will be able to afford it when needed.

-Will decrease complications that patients may experience when not on the medication due to increased price, making nursing care geared toward improvement of patient health and not simply maintenance.

Clients:

-Will be more able to afford needed medications, improving physical condition of client.

-Also will improve stress level since the client won't be faced with impossible decisions such as paying rent vs. paying for essential medications.

-Improve length/quality of life.

-Will decrease potential side effects and complications resulting from clients opting to take less expensive forms of the prescribed medication that may not be regulated by the FDA. (For example, purchasing drugs from overseas companies online, which are not held to the same regulatory standards as U.S. pharmaceutical companies)

-Possibly more inspired to take other measures to improve lifestyle (such as cessation of smoking, diet of exercise) knowing that with the medication they have a much higher chance of succeeding their health goals versus feelings of defeat and hopelessness associated with the inability to afford the medication.

Health care system:

-Will improve quality of care because financial issues of the client will be less of an issue.

-Less "prioritizing" of the doctor/ health care provider of which medications to prescribe and which not to prescribe based on the financial status of the patient, and therefore less of a limit on potential patient improvement

-There will be more money to go around, and therefore more to disperse to fund other needs of the health care facility.

Evidenced Based Need for Change

A study of 163 indigent patients who had no medical insurance or whose insurance did not provide prescription drug coverage participated in this study. The patient aggregate, who had cardiovascular disease, received prescription drug assistance (free drugs) for 24 months. At the beginning, baseline labs were drawn including international normalized ratio (INR), blood pressure, and low-density lipoprotein cholesterol (LDL). Every 6 months, the patients' labs were drawn again to assess compliance with medication regimen. The number of hospital visits on account of cardiac distress over the 24 month period of drug assistance were also reported. After the 24 month period, all patients had significantly improved lab values and fewer hospital visitis had been made (p values less than 0.001). To learn more about this study go to: http://www.medscape.com/viewarticle/415070

The results of this study show that by improving access to drugs and making lower cost drug options available to those populations, unnecessary hospital visits can be avoided and patients have a higher compliance with their drug regimen if the drug is easily afforded. Better managing these high risk conditions such as cardiovascular disease, kidney disease, and diabetes can improve mortality rates and patient quality of life.

To view other evidence based studies involving diabetic and renal patients which had similar outcomes, please visit the following links:

American Journal of Health Systems-Pharmacy study on the effects of a medication assistance program in patients with Type II diabetes(http://web.ebscohost.com/chc/pdf?vid=10&hid=6&sid=b95125c7-83d3-49bf-b98c-2eeda37f76a9%40sessionmgr108)

American Journal of Health Systems-Pharmacy study on the effects of a medication assistance program in patients with renal failure (http://web.ebscohost.com/chc/pdf?vid=11&hid=6&sid=b95125c7-83d3-49bf-b98c-2eeda37f76a9%40sessionmgr108)

For more information on how university students have been affected by the rising costs of prescription drugs, please visit: http://health.usnews.com/articles/health/2007/10/11/the-pills-price-on-campus.html

Overview of Selected Health Policy

The Prevention through Affordable Access Act is a bill at Federal level. This has been introduced in the House (HR.4054) and the Senate (S.2347). It was introduced in the House of Representatives by Mr. Crowley, a democratic representative from New York, and he gained the support of 36 cosponsors from both parties. The purpose of this bill is to amend the Restoring of Nominal Pricing (section 1927) of the Social Security Act. The Senate proposal aims "to restore and protect access to discount drug prices for university-based and safety-net clinics." Mr. Reid introduced the bill for Senator Barack Obama, Democrat from Illinois, to the Senate. Currently Senator Obama sponsors the bill.

This is an issue because it will primarily affect individuals with inadequate access to health care including families with low incomes, university students that utilize their health center as their primary source of health care, and protects their providers from absorbing the increasing cost. In the future, this issue could affect the community as a whole, by providers using the most cost efficient instead of using the most efficacious drug for each patient. If the cost of drugs continues to inflate and is not stopped by this legislation then some health care consumers may not be able to afford drugs at all.