Rep. Jan Schakowsky voices support for minimum staffing requirements

Rep. Jan Schakowsky (D-Illinois) joins Modern Healthcare to discuss her recently reintroduced legislation that would set minimum nurse-to-patient ratios in hospitals and her hopes regarding rules for Medicare Advantage carriers.

Related: Skilled nursing and psychiatric facilities could see payment bump: CMS

You recently reintroduced a bill, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, with Sen. Sherrod Brown (D-Ohio) that would set minimum nurse-to-patient ratios in hospitals, among other provisions. Given the reported shortages of nurses in the health industry, how do you hope the bill would address ongoing staffing issues at hospitals?

There are about 4 million nurses who are certified to work right now, but only about 3 million are [employed in nursing]. Having talked to nurses … requirements that say that they don’t have to serve so many patients would encourage more to come back.

Many nurses have actually left nursing because they are so concerned: “Was I able to do everything I could for the patients that I had to take care of? Did I remember to turn Mrs. Jones? Were there any accidents I may have made because I’ve had so many people [to care for]?”

One of the things we included in the bill is ensuring that nurses themselves are engaged in figuring out what all those standards ought to be. It’s not just going to be the administrators. 

I know this is what patients want, too: “Is somebody gonna come when you push that buzzer? How long is it going to take?” 

Nurses want to be nurses, but they also want to have working conditions that ensure they can do their job effectively.

In March, you and Rep. Lloyd Doggett (D-Texas) led the publication of an open letter to the Centers for Medicare and Medicaid Services regarding the proposed fiscal 2024 payment rule for skilled nursing facilities. The agency said in April that it would release proposed regulations this spring regarding minimum staffing ratios at nursing homes. What changes are you still hoping to see from the agency when it comes to skilled nursing facilities? 

Most people don’t want to go to nursing homes. Sometimes there’s no other option. Part of the reason they don’t want to is because, for example, during the COVID-19 pandemic, more than 200,000 [long-term care facility residents and staff] died. The president of the United States, just over a year ago, said CMS [must release] a [proposed] rule [regarding] staffing standards for nursing homes. 

We sent a letter—and more than 100 members of Congress signed it with us—to say, “OK, time’s up. Now we want to see what you, CMS, will do to make it safe to be in a nursing home, because there will be more staff there.” The workers, the patients, the families all want to see that. Let’s face it: It’s going to have to be accompanied by an increase in the salaries that people are paid.

The nursing home industry has been opposing any kind of [requirements for] staffing standards. 

But the patients, the families and the nurses are on our side. We are standing not only with the patients in nursing homes, but with the workers. That goes for hospital nurses as well.

To that end, many in the industry have said federal staffing ratios for hospitals or nursing homes don’t guarantee a safe healthcare environment or would impact access to providers in rural settings. How would you respond to those concerns?

What we have seen is that corporations and people who want to make money have gotten more into ... healthcare in general. We need to make sure … more money is going to go into nursing itself. We’re going to make sure that the workers themselves are benefiting from that. 

I just worry about the corporatization of healthcare, and the delivery of healthcare, that we’re seeing at great rates. 

Unfortunately, there’s sometimes too much money and too much exploitation, I believe, from nursing home owners. [There’s] not enough scrutiny and not enough rules of the road, like having staffing standards.

Late last year, you pushed for the release of a proposed rule regarding the prescribing of controlled substances via telehealth. Now that the Drug Enforcement Administration has announced its proposed rule, what other actions need to be taken regarding telehealth flexibilities as the public health emergency comes to an end?

We certainly have to do everything we can to invest in telehealth. One of the things we learned during the pandemic ... is that people were able to continue with the care that they needed. They were able to get the prescriptions they needed, and they were able to have quality healthcare [and] to be in connection with their providers and with their pharmacies. 

We want to have all the protections in place, but we don’t want to diminish the opportunity for people to safely deal with telehealth. 

We have got to see that all the rules and regulations will continue to provide for that, even though there may be some changes.

Do you plan to introduce any other legislation regarding the business of healthcare?

Absolutely, and I have. One of the big issues has been Medicare Advantage. 

With a couple of my colleagues, I have already introduced the Save Medicare Act, which says that Medicare Advantage [carriers] actually cannot use the word Medicare [in plan titles or advertisements]. 

I am happy to see that CMS has taken a major step in cracking down on Medicare Advantage [carriers]. One of the things CMS has said is any Medicare Advantage [insurer] would be required to name [in advertising] the plan it’s actually using. 

Right now, about 48% of [eligible] Americans use Medicare Advantage. It isn’t traditional Medicare. The other thing [companies] have to do is they cannot use the [CMS] logo [in a misleading way]. They can’t have information that makes it seem like [the plan] is Medicare. 

My hope is that we could even go further: We could pass my legislation and say, “These private companies can do business, but they cannot use the word Medicare.”

This is a beginning at CMS. I’m going to be in contact with CMS and say, “Let’s see how this goes, because I think consumers are still going to be confused.”

The other thing we are concerned about [regarding] Medicare Advantage [is] they have networks. If your doctors are not in the network when you sign up, you may have to switch doctors. If you travel out of the state or go out of the network, you may have to pay on your own. 

Or they may require prior authorization.

This interview has been edited for length and clarity.