The results of the November 2014 elections will result in new leadership and membership of each committee and subcommittee of the U.S. Senate. Republican committee chairs will control which bills are considered, passed out of committee, and voted on by the full House or Senate.

The Affordable Care Act

The House of Representatives has voted more than 50 times to repeal portions of or the entire Patient Protection and Affordable Care Act (ACA).1 The Senate has never taken a vote on these bills. One change to the ACA that is widely anticipated to be debated is elimination of the 2.3% tax on medical devices, which includes pacemakers, magnetic resonance imaging, artificial joints, and even hospital beds. Implemented in 2013, the tax is estimated to generate $29 billion in government revenue over the next decade.2

Another aspect of the ACA that may be debated is the mandate for employers to offer insurance coverage to full-time employees, defined as those who work at least 30 hours a week, or incur a penalty. H.R. 2575 Save American Workers Act of 2014 passed the House of Representatives on April 3, 2014. The bill redefines "full time" as at least 40 hours a week.4 A comparable bill (S. 1188 - Forty Hours is Full Time Act of 2013), sponsored by Republican Senator Susan Collins of Maine and Democrat Joe Connelly of Indiana, has been introduced in the Senate.3 The President may be forced to negotiate, especially as some employers have announced a decrease in employees' hours to avoid having to offer health insurance.5

Medicaid expansion

The Medicaid expansion has been implemented in 27 states and the District of Columbia.6 Many reelected and newly elected Republican governors are in states that have not expanded Medicaid to cover individuals whose income is up to 138% of the federal poverty level.6 Some reelected governors, including those of Georgia, Kansas, Maine, and Wisconsin, have expressed opposition to the Medicaid expansion, leaving millions of eligible individuals uninsured. Other newly elected Republican governors in states that have expanded Medicaid, such as Arizona and Arkansas, may consider efforts to opt-out.7

Eliminating barriers

In 2015, nurse practitioners (NPs) will again introduce and lobby bills to eliminate scope of practice restrictions and increase access to care for patients at the state and federal level. For example, federal Medicare legislation must be passed to allow NPs to order home health and hospice care, conduct admitting exams and monthly patient assessments in skilled nursing facilities, and be reimbursed at the same rate as physicians for the same service. NPs with restricted scope of practice laws will continue their efforts to attain full, unrestricted practice. It is incumbent upon NPs to meet with elected officials to increase their understanding of the vital contributions NPs make to providing better care for individuals, better health for populations, and lower per capita costs.8 These nonpartisan goals can best be achieved by eliminating barriers to NP practice. Partner with your legislators to achieve them.

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