NURS 8100 Week 5-7 Assignment Personal Legislative Agenda & Action Plan

Proposed Legislation

Summary/

Description

Process & Update

My Advocacy Actions

Current Status of Proposed Legislation

Next Steps

Federal:
The Health Equity and Access under the Law (HEAL) for Immigrant Families Act (H.R. 4104 / S. 2149)

An extensive piece of legislation intended to remove the 5-year Medicaid and CHIP waiting period for immigrants who are legally present in the United States (Rani & Yeatts, 2026).

It will make everyone eligible for federal health care programs regardless of their legal standing, including DACA and other legal statuses.

Eliminates discriminatory restrictions on access to Medicare, CHIP, and the ACA Marketplace. 

Introduced again in Congress by Rep. Pramila Jayapal and Sen. Cory Booker. 

This has garnered support from 55 members of Congress and more than 100 organizations fighting for health care and civil rights equality.

It is under pressure from the new H.R. 1 budgetary legislation.

· Contact local congressmen with personalized letters and emails about the specific consequences that this bill will have on clinical practice in the region. 

· From coalitions at the grassroots level consisting of local FQHCs and nursing associations. 

· Prepare op-eds based on clinical statistics and send them to local media.

· Referred to the relevant House and Senate subcommittee on health. 

· Delayed in committee as a result of the harsh limitations and budget cuts put in place by the signing of H.R. in July 2025.

Establish an automated alert system on Congress.gov for any hearings that are on the calendar.

Provide cost burden data to coalition members as to how expanded care will lead to lower ED utilization. Write expert testimony to give to committee members (Rani & Yeatts, 2026).

Proposed Legislation

Summary/

Description

Process & Update

My Advocacy Actions

Current Status of Proposed Legislation

Next Steps

State: State-Funded Protective Coverage Expansion Initiative (New York & California State Safety Net Models)

State legislative measures and budget allocations aimed at replacing federal funds for immigrants who become ineligible for federal Medicaid coverage due to H.R. 1. 

Increases coverage under the safety net program of state-funded health care to all income-eligible immigrants aged 55 years old and above irrespective of their documentation status.

Backed by state-level immigrant advocacy organizations, state nursing organizations, and public health care systems (Conduah & Ofoe, 2025). Adopted officially as part of the state’s fiscal budget cycle from 2026–2027 as a means of health equity protection.

Work directly with state representatives during the legislative period advocating for the protection of safety net funding. Coordinate efforts with state professional nursing associations in presenting a common front during public budget hearings. Carry out outreach education on state resources among marginalized immigrants (Goupil de Bouillé et al., 2025).

Actively engaged during state budget implementation for the 2026-2027 period. Repeatedly encountered opposition from state fiscal conservatives due to worries about long-term budget constraints (Dawes & Williams, 2020).

Monitor development and implementation factors via the State Legislature Online database. Partner with local health task forces in collecting information regarding preventable hospitalizations to show the financial success of the project (María Belén Martín-Sanz et al., 2025). Advocate for long-term safeguarding using block grants.

Kingdon’s Three Streams

Relevance to My Personal Legislative Agenda & Action Plan

Problem

There are severe yet unnecessary health inequalities in terms of low-income immigrants and older people due to the inability to access basic services of primary care. This crisis has been greatly exacerbated in recent times following the passing of H.R. 1 in July 2025 by the federal government, which risks denying healthcare to 1.3 million immigrants by 2026 (Goupil de Bouillé et al., 2025). This large uninsured population leads to an increase in utilization of emergency departments and preventable hospitalizations, making this clinical problem a social and economic problem.

Politics

Politics is highly polarized in light of the enactment of federal budget reconciliation constraints through H.R. 1. Yet, health equity coalitions, religious organizations, and nursing professional bodies such as the ANA offer a formidable response. Advanced practice nurses have an opportunity to wade into the political waters and serve as “policy entrepreneurs” by presenting immigrant health care access not through a polarized lens but as a fiscal and communal safety precaution.

Policy

The existence of technically feasible and evidence-based legislative policies at both the federal and state level is a reality. The HEAL for Immigrant Families Act at the federal level gives a ready tool that can be used to address the 5-year Medicaid waiting period (María Belén Martín-Sanz et al., 2025). Additionally, there are other alternative policies available through the state safety net that draw from California and New York frameworks, and funds for individuals who are 55 years old and above as a result of reduced federal policies.

Likelihood of Policy Change

The probability of effecting significant legislative changes at the federal level is presently low to moderate. The recent signing into law of H.R. 1 indicates a prevailing federal political environment bent on constraining safety net outlays as opposed to increasing them. Nonetheless, the possibility of success of protective legislation at the state level is high in proactive states such as California and New York (Rani & Yeatts, 2026). Legislative arenas below the federal level possess the political resolve and financial resources needed to construct protections at a local level from federal retrenchment. Advanced practice nurse leaders need to anchor their advocacy efforts on tangible measures of improvement in health care such as reduction in hospitalization costs.

Next Steps

· Create Automatic Tracking System: Monitor the legislative website of the state legislature and Congress.gov regularly to get updates on the amendments and public hearings concerning both the HEAL Act and the state safety net budget (Dawes & Williams, 2020).

· Collect Local Financial Information: Collaborate with the local Federally Qualified Health Centers (FQHCs) to gather quantitative information related to the insurance coverage and soaring cost of emergency department visits, as an economic argument for the legislation.

· Utilize State Nursing Coalitions: Work with state nursing organizations to develop position papers and testimony for the budget hearing (Goupil de Bouillé et al., 2025). 

· Proactively Share Results: Present this agenda at regional or national nursing conventions as part of building up advocacy resources and mentoring future nurse policy entrepreneurs.