BBB and the future of nursing

Mrsexylegs · Jul 16, 2025

My general thought is just don't get sick. I'm not saying from a nurse side but general population.

Lawmakers have every opportunity to make things better even on a state level. But also give a lot of slack.

I will use ny state as an example where they say a facility needs enough staff to perform duties. (Going to use long term care as an example) where each resident is to receive at least so much care from CNA and LPN or RN a tour. Then if they don't meet said requirements they get X fine. But then immediately in the next paragraph gives the facility an exemption if there is a shortage of nurses or CNA in the area (and newsflash there is a country wide shortage). So it allows these organizations to have 1 nurse for like 45+people needing to do med pass, notes, treatments, ext and 3 cnas.

And no I'm not talking about in rural areas where there is a one way drive to the nearest hospital might be a 3 hour drive. But in more urban and suburban areas where your 20-30 from a hospital shouldnt be exempt in the same way.

Yes this thing with Medicare and Medicaid is also giving them excuses to layoff staff and operate beyond a safe operating level for nurses and patients. You have these bigger organizations and insurance companies have people at that top making big decisions who have 0 Medical experience.

Editorial Team / Admin · Jul 16, 2025

Mrsexylegs said:

(and newsflash there is a country wide shortage)

No, there isn't. There are pockets where there are shortages and there are pockets where there is oversupply.

**CalicoKitty, BSN, MSN, RN** · Aug 1, 2025

I see patients that have a hard time getting labelled as "disabled", even when they become paralyzed. Heck, my brother took a long time after a car accident left him with back pain that limits his ability to do anything (can't sit or stand for periods of time). I've seen young able bodied persons (who may or may not be working, but are uninsured), that end up in the hospital with things like DKA (which could be prevented with routine care). I've seen people that cannot afford any medications from the pharamacy (blood pressure pills, antibiotics) and end up back in the hospital. But, some working people, especially the "gig economy" such as delivery persons, and people working in massive companies that intentionally do not give enough hours to qualify for insurance, are still working but are somehow considered unworthy of health care due to our system, and with even fewer safety nets, our society will continue to bottom the charts for health and wellbeing.

Trauma Columnist · Aug 1, 2025

As a nephrology APP, many of my pts are on Medicaid. Starting in January 2027, there will be up to a $35 charge for each dialysis treatment. When trump was in office the first time, he made a statement that he wanted 80% of all dialysis pts to be doing a form of home dialysis by 2025. Well....that didn't happen so this seems to be the next best thing from trump. Here's some info:

The "One Big Beautiful Bill" Healthcare Cuts and What It Means for CKD, ESKD, Dialysis & Transplant Patients | National Kidney Foundation

Big Beautiful Bill is Downright Ugly for K... - Kidney Dialysis

Better make sure you stay on top of your HTN and DM2....

**CalicoKitty, BSN, MSN, RN** · Aug 2, 2025

traumaRUs said:

As a nephrology APP, many of my pts are on Medicaid. Starting in January 2027, there will be up to a $35 charge for each dialysis treatment. When trump was in office the first time, he made a statement that he wanted 80% of all dialysis pts to be doing a form of home dialysis by 2025. Well....that didn't happen so this seems to be the next best thing from trump. Here's some info:

The "One Big Beautiful Bill" Healthcare Cuts and What It Means for CKD, ESKD, Dialysis & Transplant Patients | National Kidney Foundation

Big Beautiful Bill is Downright Ugly for K... - Kidney Dialysis

Better make sure you stay on top of your HTN and DM2....

My coworker (a nurse) was doing home dialysis for her husband (until she injured her hand). The requirements are a machine to purify water (if your water can be used), a dialysis mahcine, a clean place to do it, a person trained to do it, and a ton of supplies that are delivered monthly (many gallons of fluid, many more if the household water cannot be used) - so need the space to house a month's (plus "spare") worth of stuff.. Really not something most dialysis patients have if they are already living on a fixed income. It took several hours including prep, dialysis, and cleanup.

subee, MSN, CRNA · Sep 3, 2025

FullGlass said:

I am not aware of Medicaid cuts. There are work requirements for able-bodied individuals, along with other efforts to cut fraud and abuse.

The elderly also have Medicare, and that is not getting cut that I am aware off.

Perhaps you are referring to some states will have their cost share of their state Medicaid program increase, in other words, federal funding of Medicaid may be reduced for some states. In that case, it is up to the individual states to figure out what to do. Medicaid is already administered at the state level.

I'm not aware of any nursing homes closing. And the budget bill has nothing to do with the supply of medical, nursing, or other related professionals.

My point is that it is too soon to come to dire conclusions because we do not yet have enough information. It will take time for all this to be sorted out and for us to know how this will be implemented and when.

I don't know how you are unaware of Medicaid cuts. This is trouble for rural hospitals who have already cut their OB services because it's not profitable and they can't attract specialists to come to a rural area. Been there and done that. When CAT scanners were the newest thing out there (and not every hospital was permitted to even have one), trying to recruit a doctor was impossible if you didn't have one. 41% of the deliveries in my state are Medicaid patients. They mostly live in rural areas and having a baby in a hospital OB unit is problematic. Don't even bother to tell me that they shoukd be cut off Medicaid. Michigan tried to cut people off but quickly realized that it cost more to police it than they could net in savings. BTW, people on the ACA pay for their insurance. Some of them pay thousands of dollars a month. Even our federal looney Republicans know that the program is popular so they lay low so they don't have to speak up mornings value. They know the retribution could kill their careers...for life.

Red Shirt 6, CNA · Sep 4, 2025

FullGlass, BSN, MSN, NP · Sep 16, 2025

subee said:

I don't know how you are unaware of Medicaid cuts. This is trouble for rural hospitals who have already cut their OB services because it's not profitable and they can't attract specialists to come to a rural area. Been there and done that. When CAT scanners were the newest thing out there (and not every hospital was permitted to even have one), trying to recruit a doctor was impossible if you didn't have one. 41% of the deliveries in my state are Medicaid patients. They mostly live in rural areas and having a baby in a hospital OB unit is problematic. Don't even bother to tell me that they shoukd be cut off Medicaid. Michigan tried to cut people off but quickly realized that it cost more to police it than they could net in savings. BTW, people on the ACA pay for their insurance. Some of them pay thousands of dollars a month. Even our federal looney Republicans know that the program is popular so they lay low so they don't have to speak up mornings value. They know the retribution could kill their careers...for life.

You are confusing Medicaid cuts with Medicaid expansion with problems of rural hospitals.

1. Rural hospitals - my first NP job was in a very remote, rural area with one tiny rural hospital and a primary care clinic system. No, they simply could not afford to have an OB on staff. They could not even justify a FT WHNP. Same thing for a pediatric primary care provider - tried it but had to d/c due to lack of demand (in the clinic). The hospital had to d/c their L&D services except in emergencies. Women in labor had to go to the nearest city, which was about 50 miles away, to give birth in a hospital. Hospitals have to be financially viable and if there is low demand for a service, then they can't offer it. This is true even in countries with national health insurance. There was a big uproar in a Scandinavian country (I think it was Sweden) b/c rural hospitals were having to close their L&D wings due to lack of demand.

2. The BBB possible Medicaid cuts do not take effect until the end of 2026.

3. Medicaid expansion is at the state level. Some states did not agree to that. This is not a Federal issue.

4. I am well aware that ACA plans are not free.

I am disappointed in the GOP for not addressing healthcare. Frankly, this could cost them elections. The cost of healthcare is a huge issue. We also have a lot of people with no healthcare insurance. Trump is not a traditional conservative, but a populist. Healthcare is ripe for a populist solution.

What can be done is that individual states can do a lot to address healthcare issues in their state. California, where I live, does this. Voters should be advocating to their State representatives to take action where needed.

subee, MSN, CRNA · Sep 17, 2025

FullGlass said:

You are confusing Medicaid cuts with Medicaid expansion with problems of rural hospitals.

1. Rural hospitals - my first NP job was in a very remote, rural area with one tiny rural hospital and a primary care clinic system. No, they simply could not afford to have an OB on staff. They could not even justify a FT WHNP. Same thing for a pediatric primary care provider - tried it but had to d/c due to lack of demand (in the clinic). The hospital had to d/c their L&D services except in emergencies. Women in labor had to go to the nearest city, which was about 50 miles away, to give birth in a hospital. Hospitals have to be financially viable and if there is low demand for a service, then they can't offer it. This is true even in countries with national health insurance. There was a big uproar in a Scandinavian country (I think it was Sweden) b/c rural hospitals were having to close their L&D wings due to lack of demand.

2. The BBB possible Medicaid cuts do not take effect until the end of 2026.

3. Medicaid expansion is at the state level. Some states did not agree to that. This is not a Federal issue.

4. I am well aware that ACA plans are not free.

I am disappointed in the GOP for not addressing healthcare. Frankly, this could cost them elections. The cost of healthcare is a huge issue. We also have a lot of people with no healthcare insurance. Trump is not a traditional conservative, but a populist. Healthcare is ripe for a populist solution.

What can be done is that individual states can do a lot to address healthcare issues in their state. California, where I live, does this. Voters should be advocating to their State representatives to take action where needed.

So, the negative effects are OK because they are posponed until 2026. That is happening in 3 months. I have worked in a very rural toy hospital. I was the DON and know of which I speak. If healthcare is so ripe for a populist situation, they why hasn't it happened? He did have a full-term previous to this in which health wasn't even mention or attempted . Where are his solutions now? I don't think Trump caused the problem not is the issue of his ignorance on the issue a problem. It's better that he keeps his fat equity firm buddies out of health care entirely. Why are a mass of high school graduates asked to solve this condition when he can't even be solved by people who actually LIVE the consequences of what we have now? MAGA nonsense.

FullGlass, BSN, MSN, NP · Sep 23, 2025

subee said:

So, the negative effects are OK because they are posponed until 2026. That is happening in 3 months. I have worked in a very rural toy hospital. I was the DON and know of which I speak. If healthcare is so ripe for a populist situation, they why hasn't it happened? He did have a full-term previous to this in which health wasn't even mention or attempted . Where are his solutions now? I don't think Trump caused the problem not is the issue of his ignorance on the issue a problem. It's better that he keeps his fat equity firm buddies out of health care entirely. Why are a mass of high school graduates asked to solve this condition when he can't even be solved by people who actually LIVE the consequences of what we have now? MAGA nonsense.

What is a rural toy hospital? Is that in the land of broken toys? I'm not sure that fixing broken toys is a useful skill in providing healthcare to people.

1. If changes don't take place until the end of 2026, this provides time for possible solutions. I am also sick of people claiming the changes are effective now. They are not.

3. This is not all up to Trump. Much of the responsibility is at the state level. For example, I live in California. If the state had not blown billions on caring for illegals, there would be more money for things like rural hospitals. In addition, Newsome has called a special election which will cost over $250 million, just as a way to get publicity for his future presidential run. That money would save a lot of rural hospitals here.

4. We need a bipartisan solution to our messed up healthcare system. Neither party has done a good job of addressing our healthcare system issues. President Eisenhower considered national health insurance back in the 1950s. President Nixon was very serious about trying to pass national health insurance. Unfortunately, sleazebag Teddy Kennedy blocked it because he did not want a Republican to get credit for this, as he admitted later and called it one of the biggest regrets of his life. We could have had national health insurance 50 years ago!

5. Change takes work. So start advocating for your desired changes with your elected representatives at the local, state, and federal level. You could organize fundraisers for clinics and hospitals. Be part of the solution.

subee, MSN, CRNA · Sep 24, 2025

FullGlass said:

What is a rural toy hospital? Is that in the land of broken toys? I'm not sure that fixing broken toys is a useful skill in providing healthcare to people.

1. If changes don't take place until the end of 2026, this provides time for possible solutions. I am also sick of people claiming the changes are effective now. They are not.

3. This is not all up to Trump. Much of the responsibility is at the state level. For example, I live in California. If the state had not blown billions on caring for illegals, there would be more money for things like rural hospitals. In addition, Newsome has called a special election which will cost over $250 million, just as a way to get publicity for his future presidential run. That money would save a lot of rural hospitals here.

4. We need a bipartisan solution to our messed up healthcare system. Neither party has done a good job of addressing our healthcare system issues. President Eisenhower considered national health insurance back in the 1950s. President Nixon was very serious about trying to pass national health insurance. Unfortunately, sleazebag Teddy Kennedy blocked it because he did not want a Republican to get credit for this, as he admitted later and called it one of the biggest regrets of his life. We could have had national health insurance 50 years ago!

5. Change takes work. So start advocating for your desired changes with your elected representatives at the local, state, and federal level. You could organize fundraisers for clinics and hospitals. Be part of the solution.

You don't know what a rural hospital is? I was the DON for a 36 bed rural hospital. It is called rural because there aren't any large medical centers nearby because there aren't enough people to go to them. We had an OB unit and an ICU. Coming from a large tertiatary hospital in NYC to this place, I thought of it as a toy hospital. It was not the place for someone seriously ill. We used to fly sick people out until a couple of helicopter crashes forced us to transfer people via land ambulance. That hospital doesn't exist anymore because the population has increased dramatically. We don't have national health insurance because corporations rule here in the US. In fact, SCOTUS has ruled that a corporation is a person. so the for-profit healthcare system dooms us to an expensive, clumsy and unforgiving system. There is plenty of money going to waste to pay executives a life-time income in one year. We shouldn't have to have the users of hospitals have to fund raise to pay the basic bills to keep the hospital running. I'm sure it was a business decision to allow some illegals into the health care system. WE let them in for cheap labor so WE have a responsibility to care for them. There is no interest among the Republicans to do the really hard work of creating an immigration program that works for everyone. If the Republicans didn't vote down the reform bill, perhaps we would have made progress by now. This administration wants to destroy what we have but have no idea how to replace what was destroyed.

FullGlass, BSN, MSN, NP · Sep 24, 2025

subee said:

You don't know what a rural hospital is? I was the DON for a 36 bed rural hospital. It is called rural because there aren't any large medical centers nearby because there aren't enough people to go to them. We had an OB unit and an ICU. Coming from a large tertiatary hospital in NYC to this place, I thought of it as a toy hospital. It was not the place for someone seriously ill. We used to fly sick people out until a couple of helicopter crashes forced us to transfer people via land ambulance. That hospital doesn't exist anymore because the population has increased dramatically. We don't have national health insurance because corporations rule here in the US. In fact, SCOTUS has ruled that a corporation is a person. so the for-profit healthcare system dooms us to an expensive, clumsy and unforgiving system. There is plenty of money going to waste to pay executives a life-time income in one year. We shouldn't have to have the users of hospitals have to fund raise to pay the basic bills to keep the hospital running. I'm sure it was a business decision to allow some illegals into the health care system. WE let them in for cheap labor so WE have a responsibility to care for them. There is no interest among the Republicans to do the really hard work of creating an immigration program that works for everyone. If the Republicans didn't vote down the reform bill, perhaps we would have made progress by now. This administration wants to destroy what we have but have no idea how to replace what was destroyed.

I have never heard the term "toy" hospital used. Small, rural hospital is sufficient. Why would you expect other people to understand what a "toy" hospital is? I envisioned something like Santa's Workshop.

At any rate, this is not the place for a political discussion. There is another are on Allnurses for that. But I will say that you blatantly ignored the historic fact that the Democrats are the reason we do not have national health insurance now. That is a fact.

You also dodged the idea of taking positive, constructive action on this issue.

Good luck.