Becker's Hospital Review

24 POPULATION HEALTH POPULATION HEALTH 24 CEO/STRATEGY Federal judge in Texas rules ACA is unconstitutional: 8 things to know By Kelly Gooch A federal judge in Texas has ruled the entire ACA is unconstitu- tional, and a fight against the rul- ing is expected to ensue, according to e New York Times. Here are eight things to know: 1. e Dec. 14 ruling is based on Texas v. United States, a lawsuit filed by 20 states seeking to undo the ACA. States joining the lawsuit with Texas are Alabama, Arkansas, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Ne- braska, North Dakota, South Carolina, South Dakota, Tennessee, Utah, Wisconsin, and West Virginia. 2. U.S. District Judge Reed O'Connor in his ruling said the individual mandate requiring people to have health insurance "can no lon- ger be sustained as an exercise of Congress' tax power," according to the Times. e judge said that "the individual man- date is unconstitutional" and the rest of the ACA is invalid. 3. e case centers on the involved states' claim that the ACA is unconstitutional be- cause the tax law signed by President Don- ald Trump in December 2017 eliminates the ACA's individual mandate penalty. In 2012, the Supreme Court ruled the individual man- date penalty was a tax. Since the mandate to have health insurance stands, but the "tax" was eliminated, the states argue the mandate is unconstitutional. e lawsuit also argues that the entire ACA is unconstitutional be- cause the mandate is not severable from the rest of the law. 4. e U. S. Justice Department said in June it would not defend major provisions of the ACA, including the individual mandate and provisions guaranteeing coverage for people with pre-existing conditions. Subsequently, 16 states and the District of Columbia re- ceived permission to intervene in the case and defend the health law. 5. California Attorney General Xavier Bec- erra, who initiated the coalition, pledged to "continue the fight" aer the Dec. 14 ruling. "Today's ruling is an assault on 133 million Americans with pre-existing conditions, on the 20 million Americans who rely on the ACA for healthcare and on America's faithful progress toward affordable healthcare for all Americans," he said. "e ACA has already survived more than 70 unsuccessful repeal attempts and withstood scrutiny in the Su- preme Court. Today's misguided ruling will not deter us: Our coalition will continue to fight in court for the health and well-being of all Americans." 6. Texas Attorney General Ken Pax- ton praised the Dec. 14 ruling: "Today's ruling halts an unconstitutional ex- ertion of federal power over the American healthcare system," he said. "Our lawsuit seeks to effectively repeal Obamacare, which will give President Trump and Congress the opportunity to replace the failed social ex- periment with a plan that ensures Texans and all Americans will again have greater choice about what health coverage they need and who will be their doctor." 7. e legal path of the case moving forward remains unclear, according to e Washing- ton Post. Timothy Jost, a health law expert who is a professor emeritus at Lexington, Va.- based Washington and Lee University, told the publication that since Judge O'Connor granted summary judgment in the case and not an injunction, "it's unclear whether this is a final judgment, whether it's appealable, whether it can be stayed." 8. e White House issued a statement say- ing, "We expect this ruling will be appealed to the Supreme Court. Pending the appeal process, the law remains in place." n Nurses fill less than 25% of leadership roles at most healthcare organizations By Emily Rappleye N urse leaders are critical to hospital care, but too few nurses enter the leadership pipeline, according to an NEJM Catalyst survey. The online survey was conduct- ed in August 2018 among more than 650 clinicians, clinical leaders and executives of U.S. healthcare delivery organizations. Here are five key findings: 1. Most respondents (79 percent) said their organizations had chief nursing officers. However, it appears nurse leadership is often sparse be- yond that. Sixty-three percent of re- spondents said less than 1 in 4 lead- ership roles are held by nurses at their organizations. 2. Fifty-eight percent of respondents said the lack of nurse leadership may stem from a lack of interest among nurses. The survey authors noted nurses may not want to leave the bedside for leadership roles, or that the pathway to leadership may be unclear. 3. Respondents ranked the four big- gest barriers to nurse leadership as follows: • It's nontraditional — 37 percent • Education — 31 percent • Perception of nurses as "doers," not "strategists" — 25 percent • No clear path to leadership — 25 percent 4. However, 64 percent of respon- dents said they felt the path to lead- ership for nurses was clear at their organizations. Forty-six percent of respondents said their organizations offer continuing education for nurse leadership and 40 percent offer men- torship. 5. Most respondents (72 percent) felt nurse leaders should be seen as phy- sician leaders' equals when it comes to care delivery. n

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