Personal Legislative Agenda & Action Plan

Context: As a geriatric nurse, I focus on ensuring the quality and safety of healthcare services delivered to elderly patients, often aged
60+ years. My scope of practice includes screening/diagnosing elderly patients, developing appropriate and tailored healthcare plans,
administering and monitoring these healthcare interventions (pharmacological and non-pharmacological), providing education to
patients and their families, and advocating for their welfare and rights through policy change. Specialized healthcare plans may
include rehabilitation, fall prevention, end-of-life/palliative care, counseling, and emotional support (Seesawang, 2020). In Florida and
countrywide, the most significant challenge senior patients with hypertension and other cardiovascular diseases face is affordability.
Most seniors need more appropriate insurance and financial resources to access quality and safe healthcare services.
Problem: Lack of stable income, unemployment, and poverty prevent seniors from accessing timely, safe, and quality healthcare
services to manage and treat hypertension and other chronic diseases effectively. At 65, most seniors find themselves retired,
unproductive, and unemployed. Unemployment means most seniors are ineligible for employer insurance coverage offered under the
Affordable Care Act. Additionally, seniors living in the ten non-Medicaid Expansion states (Wyoming, Wisconsin, Kansas, Texas,
Mississippi, Tennessee, South Carolina, Alabama, Georgia, and Florida) are unable to access health insurance and benefits that can
substantially assist them to afford specialized and subsidized services, equipment, procedures, and medication, including
hypertensives.
Proposed Federal Legislation: H.R. 5040: Helping Seniors Afford Health Care Act
My position: Support, Oppose, Amend, or Watch

Proposed
Legislation

Summary/
Description

Process &
Update

My Advocacy Actions Current
Status
of Proposed
Legislation

Next Steps

Federal: H.R.
5040: Helping
Seniors Afford
Health Care
Act

The bill proposes changes to
eligibility and related
procedures for multiple
programs offering cost-
sharing and premium aid to

08/17/201:
Introduced in the
House
08/17/2021:
Referred to the

Emailed Rep. Lisa Blunt Rochester of
Delaware (D-DE-At Large) to express
my gratitude for introducing and
sponsoring the bill in the House. I
addressed her as a member of the

Pending: The
bill is still in
the
Subcommitte
e on Health.

Since the bill has
stalled in the
Subcommittee on
Health since 17 th
August 2021, I

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low-income Medicare
beneficiaries, including 57
million older adults. Among
several suggestions, it
expands income eligibility
for the Specified Low-
Income Medicare
Beneficiary and the Qualified
Medicare Beneficiary
Programs to 200% and
135%, respectively
(Congress.gov, n.d.).

Committee on
Energy and
Commerce
08/18/2021:
Referred to
Subcommittee on
Health

American Nurses Association (ANA)
and the American Association of Nurse
Practitioners (AANP).
I also sent personalized emails to all
four cosponsors (Representatives Kim
Andy, Evans Dwight, Clarke Yvette,
and Eleanor Holmes) thanking them for
cosponsoring and supporting the bill. I
also detailed why their continued
support is necessary for the bill’s
passage and what it will mean to low-
income, senior Americans with chronic
diseases, such as hypertension, diabetes,
heart disease, and cancer.
I created Facebook and X (formerly
Twitter) social media accounts and
invited colleagues, ANA and AANP
members, other nurses and
professionals, and the public to join. I
have been updating the page regularly
regarding hypertension and chronic
diseases. I have also called on citizens,
lobby groups, businesses,
nongovernmental organizations, and
other stakeholders to support the H.R.
5040 bill.

contacted Rep. Brett
Guthrie (the
Subcommittee’s
chairman) to ask
about the
legislation’s
progress and the
Committee’s stand. I
have also emailed
the other 29
subcommittee
members requesting
them to support the
bill; I detailed why
its passage is critical
to saving seniors
with chronic
illnesses.
I have also
requested ANA and
AAPN leadership to
issue “policy
briefs,” voicing their
support for the bill.

Connecting Kingdon’s Theory of Policy Change to My Personal Legislative Agenda & Action Plan

Kingdon’s Three Streams Relevance to My Personal Legislative Agenda & Action Plan
Problem The problem is that most senior Americans, especially from minority communities (Hispanics and

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Blacks), with hypertension and other chronic diseases lack access to quality, safe, timely, and
appropriate healthcare services (Baxter et al., 2023). This is primarily perhaps due to unemployment,
low income, or poverty. Additionally, some states, such as Florida and Texas, have not expanded their
Medicaid coverage, denying seniors with chronic diseases the opportunity to access better healthcare
services to manage their conditions. Poor socioeconomic status and lack of federal/state aid expose
seniors with chronic conditions to adverse health outcomes, including high mortality and disability.
Politics The state politics in non-expansion states has, over the years, crippled efforts to implement
progressive healthcare reforms, such as the Affordable Care Act (ACA) Medicaid Expansion. Ideally,
the ACA Medicaid expansion has increased coverage to roughly all seniors and adults by over 138%
of the FPL and offered states improved FMAP. Florida’s governor, Ron DeSantis, has been heavily
criticized by the state and national media for vehemently opposing Medicaid expansion plus other
proposals to improve coverage.

Policy While several ACA provisions, especially the Medicaid Expansion and other legislation, provide vital
coverage and support to seniors with chronic diseases, no “specific” program and law offers tailored
and focused services to address chronic diseases and other issues adults face. If passed, the Helping
Seniors Afford Health Care Act will break the ceiling for healthcare funding and reforms for elderly
Americans nationally.

Likelihood of Policy Change H.R. 5040 is unlikely to be passed and implemented due to multiple factors, including the financial
burden it will impose on the already overwhelmed and stretched healthcare budget. Opponents of the
legislation also argue that the bill will duplicate functions already executed by the ACA.

Next Steps As a member of ANA and AANP, I recognize the greater advocacy responsibility bestowed upon me
by the two organizations. I plan to continue contacting involved Committee members about possibly
supporting and advancing the legislation to the next stage. This might include arranging a one-on-one
meeting with Rep. Brett Guthrie (the Subcommittee on Health’s chair) to discuss the bill’s potential
implications for seniors. I also plan to email other legislators, including my local Representative and
senator, to support the bill. I might also engage in grassroots campaigns, write op-ed pieces in local
newspapers, contact lobby groups, and join other nursing associations to assist in championing the
bill.

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References

Baxter, S. L., Zare, H., & Thorpe, R. J. (2023). Race disparities in hypertension prevalence among older
men. International Journal of Aging and Human Development. doi: 10.1177/00914150231172119
Congress.gov. (n.d.). H.R.5040 – Helping Seniors Afford Health Care Act 117th Congress (2021-2022).
https://www.congress.gov/bill/117th-congress/house-bill
Seesawang, J. (2020). Role of nurse on team-based care for improving blood pressure control in older
patients. Nursing Science Journal of Thailand, 38(4), 4–14. https://he02.tci-
thaijo.org/index.php/ns/article/view/241582