As the first month of what we hope will be a better year comes to a close, we’re looking back on how the challenges of our past and present are building a springboard for change going forward. NNCC works at the intersection at public health and primary care, connecting communities and health care providers, and sharing lessons learned “on the ground” to better inform policy and practice. In 2020, the nation was focused on survival and resiliency. Our nurses and practices adapted quickly, policies changed rapidly, and the outlook was dire. Although the change won’t be immediate, we have every reason to believe 2021 can be a year of healing and recovery. Emulating the role nurses play as the backbone of their health systems and communities, NNCC is aligning with advocates for public health and justice as we forecast areas where we hope to bring positive social change in 2021.
Since our nation's founding, structural racist violence has had devastating impacts on communities of color. In 2020, the effects of systemic racism reached renewed visibility, exacerbated by the global pandemic and accompanying recession, as well as continued police violence against Black Americans. The effects of this legacy of racist policies are especially striking in the healthcare setting, as people of color continue to suffer worse health outcomes than their white counterparts, limited access to care, and significantly higher rates of COVID-19 incidence and death. We are hopeful that 2021 will bring renewed focus on these crucial issues and innovative policy solutions to begin to dismantle racism embedded in the structure of our society.
The Biden administration has already begun to work towards this end, with an executive order designed to aid federal branches and programs to identify and remedy systemic racial barriers within their work. The administration has also created the COVID-19 Health Equity Task Force, which will be chaired by Dr. Marcella Nunez-Smith, to insure that all aspects of the federal pandemic response are formed with an equity lens. Dr. Nunez-Smith says her vision for the task force is a broad one, including "conversations about housing stability and food security and educational equity, and pathways to economic opportunities and promise."
In Congress, the Improving Social Determinants of Health Act (of which NNCC is an endorsing organization) was recently re-introduced for the new session by Congresswoman Nanette Diaz Barragán. The legislation would create a social determinants of health program to address non-medical factors in health outcomes, which are often driven by systemic inequalities.
While no single policy or piece of legislation can eradicate racism in our health system, we are optimistic about these and other efforts and remain committed to developing an anti-racist lens for all our advocacy work.
After a national victory in developing effective vaccines against COVID-19 within an unprecedented timeline, the vaccine rollout has faced numerous delays. The challenge of distributing the vaccine is twofold: the logistical hurdles of prioritization, equitable distribution, storage, and supply present difficulties alongside a need to build public trust in the safety and efficacy of the available vaccines. The newly announced Biden-Harris COVID relief proposal contains plans for a robust, $20 billion national vaccination program. Recognizing the importance of Community Health Centers (CHCs) to public health, President Biden's vaccination plan includes partnering CHCs with mobile clinics to expand vaccine distribution.
Without a sufficient percentage of the population vaccinated against COVID, the disease will continue to spread. From growing fringe movements spreading misinformation about vaccine safety to justified distrust among Black communities who have long experienced medical racism at the hands of the government and other entities, building public confidence in the safety and effectiveness of the COVID vaccines will be a public health policy priority in 2021. NNCC has joined the COVID-19 Vaccine Education and Equity Project to promote the impact of the vaccine and provide education on the benefits of getting vaccinated.
According to a 2020 report from the Commonwealth Fund, the United States has the highest maternal mortality ration among wealthy countries even when the data is limited to just white birthing parents. For women of color, especially Black women, the picture is much more dire. The same report shows data that the maternal mortality rate for Black mothers was 2.5 times greater than for white mothers, the same gap that existed in the 1940s. Those disparities remain when controlling for education and other socioeconomic factors. Medical racism at a systemic and individual level continues to endanger the lives of Black women in the U.S. every day.
Strategies to combat maternal mortality in 2021 will need to range from community-based interventions to large-scale federal policy overhauls. In all efforts, an anti-racist lens is crucial. The Biden administration has promised to implement a successful public-private partnership from California nationwide. Last session, advocates partnered with the Black Maternal Health Caucus, co-led by Representative Lauren Underwood, a nurse, to introduce the Black Maternal Health Momnibus. This package of nine bills would have addressed numerous facets of the maternal mortality crisis, including investments in social determinants of health, improved data collection and quality measures, expanded maternal mental healthcare, support for incarcerated women, and more. While several of the bills saw movement in the House last session, they stalled in the Senate. Advocates are optimistic that the legislation can be reintroduced in the new 117th Congress.
As the COVID-19 pandemic continues to devastate communities across the country, access to high quality, affordable healthcare is more essential than ever. A straightforward, bipartisan strategy implemented by many states is to legislate full practice authority for nurse practitioners (NPs), allowing these highly trained professionals to provide care to the full extent of their licensure, education, and training. Several governors nationwide gave executive orders in 2020 to expand scope of practice for the duration of the COVID-19 pandemic. At the onset of 2021, Massachusetts enshrined these changes in law, becoming the 23rd state to extend full practice authority to NPs. NNCC is advocating in other jurisdictions, including our home state of Pennsylvania, for new scope of practice legislation in 2021.
The importance of quality, stable, and affordable housing to public health cannot be understated. In a time when staying home is an essential public health measure, the impact of housing on health has increased dramatically. While federal COVID relief packages have included rental assistance, aid for houseless populations, and eviction moratorium provisions, more aid will be necessary in 2021 to ensure that people can remain in their homes.
President Biden made extending the eviction moratorium a priority during his first day in office, and new CDC Director Rochelle Walensky announced on January 20 that the moratorium would be in effect until at least March 31, 2021. The current moratorium contains loopholes and has been loosely enforced. NNCC and its partners will continue to advocate for improvements and updates to its scope and enforcement in the coming months.
An eviction moratorium alone will not be enough to keep struggling families afloat through the duration of the pandemic. Along with other housing advocates, NNCC has pushed for $100 billion in emergency rental assistance, at least $11.5 billion in homeless assistance, and $26 billion for new Housing Choice vouchers. The Biden-Harris administration's initial COVID relief proposal falls short of these measures, and includes an extended eviction and foreclosure moratorium, $30 billion in rental and utility assistance, and $5 billion in homeless assistance. NNCC will continue to advocate for more relief this year.
Community Health Centers (CHCs) have continued to serve uninsured, underinsured, and low-income patients regardless of their ability to pay throughout the pandemic. One crucial function of CHCs is providing affordable prescription drugs to patients through the 340B drug pricing program, which requires drug manufacturers to provide medicines to CHCs and their patients at discounted rates. In 2020, pharmaceutical companies stopped providing the discount to prescriptions filled at contract pharmacies, for what many advocates say are illegal and illegitimate reasons. On December 30, 2020 the Department of Health and Human Services (HHS) issued an advisory opinion stating that "a drug manufacturer in the 340B Program is obligated to deliver its covered outpatient drugs to those contract pharmacies and to charge the covered entity no more than the 340B ceiling price for those drugs." Because advisory opinions do not carry the force of law, litigation is ongoing to determine the future of the 340B program. NNCC will continue to join other advocates in pushing to ensure that low income and marginalized patients are still able to access the care they need at a cost they can afford.
Sarah Hexem Hubbard, Esq., is the Executive Director of the National Nurse-Led Care Consortium and the Pennsylvania Action Coalition.
MaryGrace Joyce, MS, is the Policy Specialist of the National Nurse-Led Care Consortium.