Since the beginning of the pandemic, several states have passed "safe staffing" laws aimed at balancing patient-nurse ratios in hospitals. In Pennsylvania, health care advocates are calling on lawmakers to vote on legislation still stalled in committee.

Senate Bill 240, also known as the Patient Safety Act, would establish limits to the number of patients one nurse is responsible for during a shift.

Maureen May, president of the Pennsylvania Association of Staff Nurses and Allied Professionals, said it is about ensuring positive outcomes for patients.

"I want to be in a hospital bed in which I know that there are enough nurses to care for me and my family members," May asserted. "I want to be a nurse that works in a hospital and walks away from the bedside at the end of the day and know that I did everything I could to make sure my patients received the best care possible."

Many health care system administrators oppose safe-staffing legislation, saying it is costly to their bottom line. Senate Bill 240 and its companion House Bill 106, which has more than 100 co-sponsors, have been referred to each chamber's health committees and await a vote.

Sen. Maria Collett, D-Montgomery County, said the pandemic exposed the cracks in the health care system and the need for legislation such as the Patient Safety Act. She stressed it has been disappointing to see the legislation stalled by a few lawmakers, given the bipartisan support for the bill.

"If you're someone that's not going to stand with nurses, that's not going to stand with patients, then put your name on the record," Collett urged. "Vote no on this bill because the people in our communities deserve to know where we stand when it comes to protecting patient outcomes and protecting the hardworking nursing staff."

A 2017 study found patients were much more likely to survive when nurses followed a hospital-mandated patient-nurse ratio. Lower patient-to-nurse staffing ratios also have been associated with significantly lower rates of cardiac arrest, hospital-acquired pneumonia, respiratory failure and patient falls.

Health industry mergers are a major driver of high health care costs, and now, California lawmakers are considering a bill to regulate more of these mergers.

Assembly Bill 2080 gets a hearing in the Senate Health Committee Wednesday. It would give the state Attorney General the power to place conditions on, or even block, mergers of for-profit hospitals and other major health care entities.

The California Hospital Association opposes the bill, arguing it would give the Attorney General too much power and stifle many types of care arrangements.

Anthony Wright, executive director of the nonprofit advocacy group Health Access California, countered more protection is needed for consumers.

"This bill goes to the heart of why health care costs are so inflated," Wright argued. "And it makes sure that there is public oversight, so that access is preserved and costs are not inflated as the health industry consolidates."

The Attorney General already has the oversight power to review nonprofit hospital mergers, and in 2019, secured a $575 million settlement from Sutter Health over charges they drove up prices. Sutter, the largest health care provider in northern California, agreed to end what the state considered anticompetitive policies. The bill would ban anticompetitive contracting industrywide.

Wright pointed to a 2018 University of California-Berkeley study, which found hospital mergers have resulted in much higher prices.

"Sometimes there can be a loss of access if the acquiring entity decides to shut down certain services," Wright explained. "Sometimes the merged entity now has more market power, in order to charge higher prices."

The bill also includes an appeals process if a merger is denied. The measure has already passed in the State Assembly. If it passes in the Senate Health Committee, the next stop would be the Judiciary Committee.

State agencies gathered in Austin last week for hurricane exercises. They emphasize that all Texans need to prepare before the next disaster.

Harris County Public Information Officer Brian Murray said the Atlantic hurricane season began on June 1 and will continue through the end of November. He said most residents in vulnerable areas have heard what they need to do to be ready.

"Having a disaster kit - food, water, medications, supplies for your pets for seven to 10 days so you can be independent," said Murray. "Having a plan - do you need to worry about having to evacuate for a storm surge or are you able to ride-out where you are? And then, being able to stay informed."

Staying informed may mean an extra battery pack for your phone, and telephone numbers for important contacts. Last week's exercises by 30 state agencies covered preparation, response, recovery and mitigation.

Juanita Jiménez-Soto, associate state director of communications with AARP Texas, said being prepared can mean peace of mind, especially for older Texans and their families.

"If you're rushing at the last minute, you forget things," said Jiménez-Soto. "Sometimes you forget things that are vital to your health - vital to your financial future. So, being prepared means that you've basically put a sense of relief in your life."

Murray said he's surprised by the number of folks in Harris County who tell him they don't expect a hurricane.

"Everyone always thinks, 'It can't happen to me,'" said Murray. "Well, sorry, we have more federally-declared disasters than any county in the United States. If you believe that it can't happen to you - it doesn't matter where you are - I'm going to tell you that you're wrong."

Jiménez-Soto said the organization has created hurricane checklists and an instructional video in both English and Spanish - at AARP.org/Houston. She said everyone needs to know about the checklist, especially older family members.

"And if you have someone who is 50-plus," said Jiménez-Soto, "you've got medications - you've got doctor's appointments - maybe there's a nutritional need that they have."

Without federal intervention, a new report warns, rural hospitals across the United States, including many in Nebraska, could be forced to reduce services or even close their doors after pandemic relief funds expire.

Nemaha County Hospital chief executive Marty Fattig said ending across-the-board federal spending cuts, known as sequestration, would be a good start. Since lawmakers haven't used cuts to bring down the national debt as promised, Fattig said, he believes hospitals should receive full reimbursement from Medicare.

"So, it looks to me like the only people that are paying for this thing are those of us that take care of Medicare patients," he said. "And we get 2% off of what we would normally get paid. That's kind of a big deal."

Researchers at the Bipartisan Policy Center found that 30 rural hospitals in Nebraska suffered financial losses for patient services over a three-year average. More than 20 hospitals had negative earning margins. Current and long-term financial liabilities exceed current assets for 18 Nebraska hospitals. Nationally, the report says 441 rural hospitals face multiple financial risk factors.

In addition to putting a pause on sequestration, the report recommends making higher Medicare payments permanent, and maintaining flexibility in telehealth until at least two years after the federal public health emergency ends.

Report co-author Julia Harris, the think tank's senior policy analyst, said 116 hospitals closed between 2010 and 2019, but that pace slowed as COVID peaked.

"So, the CARES Act and the American Rescue Plan really did a lot to stave off more hospitals from closing," she said, "but that aid masked the fact that the underlying finances of rural hospitals continue to deteriorate, especially with new pressures brought on from the pandemic."

Fattig said lawmakers also should push back against efforts by drug companies to make it harder to get discounted medicines through a program known as '340-B.' He said those savings help pay for patient services that aren't financially viable otherwise.

"Right now 'Big Pharma,' the big pharmaceutical companies, are throwing all kinds of roadblocks down," he said, "so that they will not pay for the 340B program like they should."