Ensuring Access to Albuterol in Schools: From Policy to Implementation. An Official ATS/AANMA/ALA/NASN Policy Statement.

Rationale: For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access.Objectives: To provide policy recommendations and outline steps for passing and implementing stock albuterol laws.Methods: We assembled a diverse stakeholder group and reviewed guidelines, literature, statutes, regulations, and implementation documents related to school-based medication access. Stakeholders were divided into two groups-legislation and implementation-on the basis of expertise. Each group met virtually to review documents and draft recommendations. Recommendations were compiled and revised in iterative remote meetings with all stakeholders.Main Results: We offer several recommendations for crafting state legislation and facilitating program implementation. 1) Create a coalition of stakeholders to champion legislation and implement stock albuterol programs. The coalition should include school administrators, school nurses and health personnel, parents, or caregivers of children with asthma, pediatric primary care and subspecialty providers (e.g., pulmonologists/allergists), pharmacists, health department staff, and local/regional/national advocacy organizations. 2) Legislative components critical for effective implementation of stock albuterol programs include specifying that medication can be administered in good faith to any child in respiratory distress, establishing training requirements for school staff, providing immunity from civil liability for staff and prescribers, ensuring pharmacy laws allow prescriptions to be dispensed to schools, and suggesting inhalers with valved holding chambers/spacers for administration. 3) Select an experienced and committed legislator to sponsor legislation and guide revisions as needed during passage and implementation. This person should be from the majority party and serve on the legislature's health or education committee. 4) Develop plans to disseminate legislation and regulations/policies to affected groups, including school administrators, school nurses, pharmacists, emergency responders, and primary/subspecialty clinicians. Periodically evaluate implementation effectiveness and need for adjustments.Conclusions: Stock albuterol in schools is a safe, practical, and potentially life-saving option for children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal quick-relief medication. Legislation is imperative for aiding in the adoption and implementation of school stock albuterol policies, and key policy inclusions can lay the groundwork for success. Future work should focus on passing legislation in all states, implementing policy in schools, and evaluating the impact of such programs on academic and health outcomes.

Update on the Affordable Care Act. King v. Burwell and Obergefell v. Hodge.

Patients with respiratory diseases, critical illness, or sleep disorders who lack health insurance endure disparities in access to care and worse health outcomes. These disparities were partly addressed in the United States in 2010 by passage of the Affordable Care Act. Low- and moderate-income individuals and families with incomes between 138 and 400% of the federal poverty level are eligible for insurance premium subsidies when purchasing policies on the health insurance marketplace exchanges. Since the act was passed, nearly 16.5 million Americans have gained health insurance. In 2015, the act survived what may be the last significant judicial challenge to the law: King v. Burwell. The plaintiffs challenged whether people who purchased health insurance in states that use the federal insurance marketplace HealthCare.gov , rather than a state-run marketplace, were eligible to receive insurance premium subsidies. At the time of the ruling, 34 states used the federal exchange, and as a result, nearly 7.5 million people could have lost their health insurance if the court had ruled in favor of the plaintiffs. However, in King v. Burwell, the Court ruled six to three in support of the legality of subsidies regardless of type of marketplace states use, thereby ensuring continued health insurance coverage for patients in states using the federal marketplace exchange. In 2015, the Supreme Court also heard a landmark case, Obergefell v. Hodge, in which the Court upheld the right for two people of the same sex to marry, thereby opening crucial access to both state and federal benefits and protections for same-sex couples.

Engaging patients in public policy advocacy.

Health professionals can and should be game-changing influencers of U.S. health policies. The American Thoracic Society (ATS) is enabling its members to advocate on important issues through such initiatives as the Breathing Better Alliance network and the annual ATS Hill Day. Patients are also organizing to make their voices heard by participating in the member organizations of the ATS Public Advisory Roundtable and by accompanying ATS members and staff on visits to legislators and government regulators. If we join together, we can amplify our messages and promote better health policies. Doing so will require us to embrace a partnership steeped in trust and hope.