Oregon lawmakers have concluded the legislative session with a measure aimed at alleviating the state's nursing shortage.

In it's final week, the Legislature passed House Bill 4003, a measure that will allow nursing students to gain a license so they can work with limited duties and gain experience in hospitals.

Idaho and Washington already have similar nurse intern licenses.

Jana Bitton, executive director of the Oregon Center for Nursing, said there was a shortage of nurses before the pandemic, but COVID-19 has made the problems worse.

"A lot of people that I've talked to, within the nursing community and outside of the nursing community," said Bitton, "all have horror stories of themselves or a family member or a friend who's become ill, with COVID or with something else, and having to go to the emergency room and sitting through extraordinarily long waits to be able to see a provider."

Bitton said the shortage is greater in certain work settings and rural parts of the state.

Some critics have balked at the idea of student nurses providing care. The Oregon Nursing Association says the bill is a great first step, but more is needed to alleviate the shortage.

Bitton said the newly created license will also help ensure that future nurses can support themselves.

"That licensure is really going to help nursing students," said Bitton, "who need to get a place where they can practice their skills while they're in school, give them an opportunity to make money and support their education. But it will also help workplaces enhance their workforce."

The bill also expands a wellness program to registered nurses so they access free therapy sessions. Bitton said the pandemic and other events like wildfires have taken a mental toll on nurses.

During National Health Center Week, health-care advocates are highlighting the work Community Health Centers are doing to improve access to care throughout the state.

More than 600,000 Missourians turn to Community Health Services for primary care and preventive services - as well as dental, mental-health and substance-abuse services.

Steve Douglas - director of marketing and public relations with ACCESS Family Medical and Dental Clinics in Neosho - said their focus is underserved populations, including people without health insurance or gaps in coverage.

"We're able to get them a lot of care they can't get any other place," said Douglas. "And if we can take care of a debilitating health issue, or a toothache, whatever it may be, they can get back into the workforce and provide for their family and keep them off of other government assistance programs."

Nearly 75% of Missourians served by CHCs have incomes at or below 100% of the federal poverty level. About one-in-four lack health insurance, and nearly half have Medicaid.

Douglas said state and federal funding are critical to their work, especially in rural communities where medical care is more scarce. He pointed to programs such as the National Health Service Corps, which helps connect medical professionals to jobs in underserved areas.

"We need incentives to get the very best providers that we can possibly have," said Douglas. "The people that are in our region deserve the same quality of health care they might see in Los Angeles. So support grants that help us to recruit and train great talent are just vital."

During National Health Center Week, the Missouri Primary Care Association and Community Health Centers are celebrating a $150 million investment in the 2023 state budget that will help expand services.

Health advocates are hailing the new Inflation Reduction Act, saying it would be the biggest health-care reform since the Affordable Care Act.

The House of Representatives is expected to vote tomorrow on the bill, which already has passed the Senate. Anthony Wright, executive director of the Health Access California, said it includes many proposals activists have pursued for years.

"It would allow the government to negotiate down prices for the most expensive drugs," said Wright. "It would cap Medicare costs for medications, and it would require rebates if prices rose greater than the rate of inflation. That would help millions of Californians."

The bill also would extend subsidies from the American Rescue Plan that help people afford health care. Without the extension, Wright said he predicts the average Covered California enrollee would see an 82% increase in premiums - a jump of about $1,000 per year.

Bianca Blomquist - California policy director and Northern California outreach director for Small Business Majority - said more than half of people enrolled in ACA-subsidized health plans work for or own a small business, or are self-employed.

"The provisions in this package are crucial for the equitable recovery of small businesses in California," said Blomquist. "And we urge Congress to advance a vote on this legislation quickly."

The American Rescue Plan capped CoveredCA premiums at 8.5% of income. That is set to expire at the end of the year unless the Inflation Reduction Act becomes law.

Backers of a bill now in the U.S. Senate contended it will address rising health care costs and could provide Americans with some relief.

Part of the Inflation Reduction Act would allow Medicare to negotiate directly on prescription drug prices in 2023, and cap out-of-pocket drug costs for Medicare patients at $2,000 a year. It comes a month after Gov. Ned Lamont expanded the state's Covered Connecticut program to adults without children.

Jim Manley, board member of Consumers for Quality Care, noted rising out-of-pocket costs are a chief concern.

"The issue comes down to caps on copays, rising deductibles and prescription drug copays," Manley explained. "Caps on copays are largely absent from the current health care bill that the Senate is going to take up this week. And so, that's been driving out-of-pocket costs higher and higher for more and more Americans."

In the group's new survey, 45% of Americans said their out-of-pocket costs are far too high, and more than 70% feel health care costs are increasing "much more than other things they need." The Urban Institute said one in 10 people in Connecticut, and 13% of Americans overall, have past-due medical debt.

Manley feels while the issue is important, it will not be a dominant factor in the November midterm elections. However, he believes a change is needed. In the survey, 60% of people said they skipped or delayed medical treatment because it is so expensive.

"Health insurers have shifted costs onto patients through higher deductibles and out-of-pocket costs," Manley pointed out. "That's proven to be a real problem for the American consumer. It is leading them to either skip the care and/or go into medical debt. Medical debt is increasingly rampant throughout this country."

For now, the Affordable Care Act outlines out-of-pocket caps, but Manley believes they should be updated. His group also is backing a cap on the price of insulin, which according to a 2020 study is much higher in the U.S. than in most countries.