BBB and the future of nursing

FullGlass, BSN, MSN, NP · 2025-07-08T21:41:42Z

The key word is "anticipated." That means it hasn't happened yet and it may not.

You have 34 years' experience, which is great. You should not have trouble getting RN jobs and assignments, given your experience.

UCSD laid off 230 workers; 22 were nurses. That is not a huge number of nurses. I could not find a breakdown for Sharp. However, Sharp released the following statement, and their actions do not appear to be related to the "BBB":

"The economic conditions in health care have dramatically changed over the last five years, and it has become increasingly clear that Sharp HealthCare is not immune to the related challenges. To navigate these changes and maintain Sharp's position as San Diego's health care leader for generations to come, the organization has made the extremely difficult decision to reduce its workforce. This includes the elimination of 315 employees (1.5% of the workforce) across all levels of the organization — including senior executive leadership — as well as reductions in hours and role adjustments for some positions. The vast majority of these positions are in nonclinical areas of the organization, resulting in minimal impact to direct patient care.

Additionally, senior executive compensation will be reduced by approximately 15%, and Chris Howard, Sharp HealthCare President and CEO, has elected to reduce his compensation by an additional 10%. Several expenses in mostly nonpatient care areas will also be reduced so that Sharp can continue to provide full-service, high-quality care to San Diegans."

CA has strict nurse to patient ratios, so that would prevent huge numbers of nurses being let go.

In every industry, sometimes lay offs happen. There is no reason for healthcare to be exempt from this.

FolksBtrippin, BSN, RN · 2025-07-08T23:35:24Z

Hopefully we are rescued from this insanity before grandma gets wheeled onto the sidewalk and told to... I don't know, get a job?

Nurses who can work will be fine. People who are disabled and old will not.

FullGlass, BSN, MSN, NP · 2025-07-08T23:57:56Z

Also, I am rather baffled that some nurses seem to think they are exempt from ever being laid off. Nurses are not exempt from this. Some hospitals have been struggling financially for many years. There have always been some hospitals that have to close. There are many reasons for this, but those are not related to a bill that was literally just passed a few days ago.

Nurses have a lot more job security than most people. I used to be a high tech management consultant, and most corporations lay people off every single year, even if the company is doing well! Many of those tech companies would announce a layoff, yet continue hiring certain types of people.

Professionals that are good, and have solid experience, are generally fine. Even if they are laid off, they will get another job. In my previous career I was laid off, even fired (for political reasons) several times, but with one exception, I always ended up with a better job. My advice is to maintain your skills, keep learning new ones, and keep your resume up to date.

FullGlass, BSN, MSN, NP · 2025-07-09T17:14:42Z

FolksBtrippin said:

Hopefully we are rescued from this insanity before grandma gets wheeled onto the sidewalk and told to... I don't know, get a job?

Nurses who can work will be fine. People who are disabled and old will not.

I am baffled by your comment "people who are disabled and old will not [be fine]." What is this statement based on?

jeanbeth, MSN, DNP, RN · 2025-07-09T20:48:29Z

FullGlass said:

I am baffled by your comment "people who are disabled and old will not [be fine]." What is this statement based on?

I'm not baffled. I read Josh Hawley's op-ED and the AARP article which expresses deep concern. https://www.aarp.org/advocacy/how-medicaid-changes-hurt-older-americans-2025/

FullGlass, BSN, MSN, NP · 2025-07-10T00:31:33Z

jeanbeth said:

I'm not baffled. I read Josh Hawley's op-ED and the AARP article which expresses deep concern. https://www.aarp.org/advocacy/how-medicaid-changes-hurt-older-americans-2025/

Those are opinions, not fact.

1. The Medicaid work requirements only apply to ABLE-BODIED, single adults w/o any dependents. Disabled people, by definition, are not able-bodied. This also applies to people with severe mental disabilities.

2. "The bill's broadest tax impact comes from making permanent the reduced income tax rates enacted during Trump's first term and initially set to expire after this year. Another key provision, backed by AARP, provides targeted tax relief for older adults." That seems good to me.

https://www.aarp.org/government-elections/budget-bill-older-americans.html

3. Also from above source: "Currently, the federal government funds the full cost of SNAP benefits. Starting in October 2027, most states will have to pay between 5 and 15 percent of the cost of the SNAP benefits their residents receive. States will also be responsible for 75 percent of the program's administrative costs, up from 50 percent." In other words, it is now going to up to each individual state. States are free to make up the difference. That makes sense, since the cost of living varies by state.

4. Also from above source: "About 5.5 million adults ages 55 to 64 get individual health insurance from ACA marketplaces, according to the health policy nonprofit KFF. But the legislation imposes new documentation and preenrollment eligibility verification for ACA coverage, changes that "will add even more red tape for enrollees and further drive down coverage,” AARP Chief Advocacy and Engagement Officer Nancy LeaMond wrote." Sorry, but adding more verification does not necessarily mean people who need the insurance can't get it. The government does not just give stuff away for free - there is always paperwork. I have plenty of poor, mentally ill patients who are doing a very good job of working the system.

5. Also from above source: "The legislation also allows enhanced tax credits for ACA coverage to expire, which KFF estimates will increase out-of-pocket premium payments for people with such plans by 75 percent on average. KFF and other health policy groups say these premium hikes are expected to hit older adults especially hard" Again, these are just estimates and we don't even know yet what will actually happen. And guess what? Health insurance premiums are going up for EVERYONE. That does indeed suck, but it speaks more to the need for a true overhaul of our crappy healthcare insurance system. I am strongly in favor of some sort of public option or system similar to Germany's (NOT the NHS).

6. From the source you provided, after a long sob story: "Requiring Medicaid enrollees ages 19 to 64 to report at least 80 hours of work, educational training or volunteering each month, or qualify for an exemption, to be eligible for coverage." So what? That is hardly onerous. Volunteering is personally therapeutic and good for the community. Able bodied adults w/o dependents SHOULD be working. And finally, someone could get some training which might help them get a paying job or they could just take some online class, easy peasy. Learning is always good and keeps the mind working well, especially important for seniors. It prevents cognitive decline. Family caregivers should be exempt, as they are WORKING by caregiving. At least in Calif, such caregivers can literally register as a home caregiver and GET PAID by the state. Yes, taking care of a family member can provide a paid job, through IHSS. Furthermore, we don't have all the details yet.

A bunch of dire "possible" predictions follow. The BBB was just passed a few days ago. We have no idea how this is going to actually play out. It will take time to establish the required infrastructure to support the work requirement, etc. That is not going to happen overnight. In addition, while Medicaid receives federal funds, it is administered by the individual states. That means each state will have a lot of influence on how the changes will be rolled out.

The most useful course of action is for concerned individuals to begin advocating to their Congressional reps and senators, and also to begin advocating at the state and local level.

Emergent, RN · 2025-07-10T13:51:16Z

I haven't followed the details of this bill. I'm a true crime junkie, not a political junkie. But, Social Security sent me an email that my retirement benefits are not going to be taxed now. So, that will help me, an older person. It really didn't seem fair to me that I was taxed on my income, and then they taxed me again when they give me back my money.