A Legislative Process Review of The National Clinical Care Commission Act H.R.309


A Legislative Process Review of The National Clinical Care Commission Act H.R.309

Jeanette Nicole Zoltowski

Drexel University



This paper explores the legislative process regarding bill passage into law at the federal level.  The ‘National Clinical Care Commission Act’ or H.R.309 is a bill which seeks to amend the Public Health Service Act in the coordination of care of the diabetic population, as well as other autoimmune, insulin deficiency or resistance diseases and the complications caused by these diseases (2017).  By evaluating current systems and implementing change where needed, H.R.309 would significantly reduce healthcare costs and improve the overall outcomes for these patients (2017). The structuring of H.R.309 invites input from an interdisciplinary team of healthcare providers, including nurses (2017).  With the expertise of those whom deal with this patient population on a daily basis H.R.309 has true potential to breach existing gaps in the current clinical system (2017).  By inviting nurses input in the implementation of H.R.309 this will open future doors for the nursing profession in health policy (2017).  By outlining the path for federal bill passage in an understandable way this paper encourages nurses to become involved in policy making.  

Keywords:  H.R.309, health care legislation, National clinical care commision act


A Legislative Process Review of the National Clinical Care Commission Act

As published in Diabetes Care, an American Diabetes Association (ADA) journal, diabetes accounts for one of every five dollars spent on health care in the United States (2013, p. 1033).  According to the Centers for Disease Control and Prevention’s (CDC) Diabetes Report Card 2014, diabetes related deaths ranked seventh in the United States for the year 2013 (2015).  The CDC states diabetes poorly controlled can cause kidney disease or failure, loss of eyesight, limb amputations, heart disease and stroke (2015).  The ADA reports an estimated $174 billion dollars spent in 2012 on health care for the diabetic population alone (2013, p. 1038).  In addition, the ADA estimates $69 billion dollars as a loss for the year 2012 due to permanent disability, time away from work as well as premature death caused from diabetes, which brings the total estimated cost to $245 billion (2013, p. 1038).  

Health Care Legislation

When faced with the staggering numbers both in American’s living with this disease as well as the dollars spent on treatment and complications from diabetes, policymakers have been moved to action.  The National Clinical Care Commission Act, H.R. 309 is a bill that proposes hyperfocus on finding and creating effective diabetes care through a number of methods over the next three years.  H.R.309 has passed the house of representatives and has been read twice in front of senate as of January 10, 2017.  H.R.309 is a critical bill for the nursing profession, specifically to the nurse’s role of patient advocate.  H.R.309 includes nurses and advanced practice nurses weighing in as experts, which opens the door for future nurse involvement in policy (2017).  The prevalence of diabetic complications related to poor education regarding the disease process, insufficient primary care as well as lack of pre-screening for this preventable disease is truly tragic and near and dear to the heart of nursing.  When confronted with these all too common realities in patient after patient in the Emergency Department, one’s longing for a more effective health care system for this particular population grows deeper.  The short time one has to educate, motivate, connect and support this patient is thinned further by the often organ saving and sometimes life saving interventions required to treat complications of diabetes.  H.R.309 intends to measure over a three year span the effectiveness of current systems, find existing gaps in care and create the most effective process possible (2017).  Through data collection, expert insight and measurable outcomes H.R.309 hopes to create the best coordination of care for people afflicted with these disease processes (2017).

Investigation of the Legislative Process

Understanding political processes regarding bill formation and passage can easily appear daunting to those outside the world of politics (Ridenour, 2016).  Also, many nurses may not realize the impact current health policies have on the nursing profession as well as the patient population they serve (Ridenour, 2016).  In the simplest terms, a federal bill becomes law by the joint agreement of the house of representatives and the senate and secondly by presidential approval of the bill (Ridenour, 2016).  Within both the house of representatives and the senate exist multiple committees that have expertise in specific areas of governmental processes (Ridenour, 2016).  Either a senator (a member of the senate) or a state representative (a member of the house of representatives) can introduce a bill as a primary sponsor and as Ridenour points out, the primary sponsor plays a crucial role in a bill’s chances for passage into law (p. 378, 2016).  Depending under which committee a bill subject matter falls, the bill is submitted to such committee and subsequently sub committees for consideration and either passed through to the full senate or house of representatives or deemed nonessential for further legislative action (Ridenour, 2016).  Ridenour references Kingdon’s policy stream model (p. 377, 2016) in regards to understanding formation of health care related bills;  a health care problem is identified, is in agreement with the general public opinion/political climate at the time of the bill’s introduction and ideally has a seemingly feasible solution.  

Opinion on Legislation’s Merit

Twenty nine million adults are currently living with diabetes in the U.S., one fourth of which are unaware (CDC, 2016).  According to the CDC’s 2016 report, At a Glance 2016, one in three adults have prediabetes and only ten percent of this population have been diagnosed. In conjunction with the estimated financial burden of diabetes and its complications, current clinical systems are in desperate need of intervention (ADA, 2013).  H.R.309 aims to find quality and effective models of clinical care systems that will improve health outcomes for diabetics, reverse prediabetes and reduce the incidence and severity of diabetes associated health complications (2017).  A worthy undertaking?  Unquestionably so.

The Finnish Diabetes Prevention Study results determined that lifestyle interventions are incredibly effective in reducing the onset of type 2 diabetes in at risk patients and dramatically reduces the incidence and progression of atherosclerosis versus metformin prescription (Uusitupa, M., Louheranta, A., Lindström, J., Valle, T., Sundvall, J., Eriksson, J. and Tuomilehto,J., 2000).  The program provided one on one interaction and coaching with case managers, several weeks of education and training on healthy eating, stress management and exercise individualized on a patient to patient basis (Uusitupa, et al, 2000).  At the two year mark, those with lifestyle modification as their intervention had maintained their weight loss from the initial study year (Uustipua, et al, p. 141, 2000).  Individualized and intensive plans of care are a necessity as well as continual support for several years for the results to be considered permanent and effective (Uusitupa, et al, p. 141, 2000).  

The New England Journal of Medicine also published a study in 2002 to measure the effectiveness of lifestyle interventions versus taking metformin (Knowler, W., Barrett-Connor, E., Fowler, S., Hamman, R., Lachin, J., Walker, E. and Nathan, D.).  Results showed a fifty-eight percent reduction in incidences of diabetes type 2 by lifestyle changes versus thirty-one percent with metformin (Knowler, et al, p. 398, 2000).  The evidence points to lifestyle modification in a supportive environment, highly individualized and catered to the individual as a viable solution to diabetes reduction in incidence, complications and prevention.  If H.R.309 is to be successful, it will utilize the proposed input from diabetes educators, case managers,  nutritionists, nurses, physician assistants, endocrinologists, advanced practice nurses, primary care facilities and hospital systems in conjunction with insurance companies and federally funded programs to create a framework for a sustainable lifestyle modification program that caters to the individual in every facet (2017).  

Evidence demonstrates that if individuals are taught in retainable ways and if systems were in place for community support of these individuals, rooftop gardens could become a cause for a cure instead of just pleasant greenery amidst the concrete jungle.  If people were given the tools to take ownership of their health, encouraged to become community educators themselves, to find meaning in their affliction and the strength to fight back we would see communities become healthier, prouder, empowered and motivated to take action towards a better life.  If we created systems where we came to them and met them at their place of need and asked what barriers to care exist and actually listened, this would transform the world and climate of health care.

Nurses could take a satisfied sigh of relief at one disease being slowly lifted from their shoulders.  The profession of nursing would be empowered to know that with nurses input, government support and proper study and implementation, disease cycles do not have to stay the same.  Instead of seeing the same patients every month coming into the emergency department with the same preventable high blood sugar one may see these same patients becoming empowered to advocate for themselves and others towards a better future.  If H.R.309 is made into law there is concrete hope for healthcare improvement for many other disease processes.  One can hope and pray that great strides are made and many key lessons are learned at the state, federal and local level as well as for hospitals, physicians and nurses.  Change can be made for a better future, a better tomorrow, a better America.



The National Clinical Care Commission Act proposes using already allotted government dollars to revise our current failing approach to treating and preventing diabetes (2017).  The skeptic may argue that lifestyle modification in the face of grim statistics is a futile undertaking, especially when considering the level of individualization to all aspects of the care continuum. Yes, the task at hand is daunting and casts dark shadows of doubt but the health of the United States deserves the high level of determination required to make a dent in diabetes.  As health care providers, may we never lose hope in progress.  Let us resonate with the spirit of Florence Nightingale and challenge status quo in health care.  Remember the strides that have been made in the treatment and prevention of Human Immunodeficiency Virus, the groundbreaking discoveries for curing cancer and the current viability of a twenty-three week old baby.   As fellow humans may we keep our hearts soft and our faith that strong that with undeterred resolution and a collaborative effort anything is possible.  



American Diabetes Association.  (2013).  Economic costs of diabetes in the U.S. in 2012.

Diabetes Care, 36, 1033-1046. doi: 10.2337/dc12-2625

Centers for Disease Control and Prevention (2016).  At A Glance 2016.  Atlanta, GA:

U.S. Department of Health and Human Services.  Retrieved from


Centers for Disease Control and Prevention. (2015).  Diabetes Report Card 2014.  Atlanta, GA:  

U.S. Department of Health and Human Services.  Retrieved from  


National Clinical Care Commission Act.  (2017).  H.R.309 To amend the Public Health Service  

          Act to foster more effective implementation and coordination of clinical care for people

          with a complex metabolic or autoimmune disease, a disease resulting from insulin

          deficiency or insulin resistance, or complications caused by such a disease, and for other


Ridenour, N.  (2016).  An overview of legislation and regulation.  In Mason, D.J., Gardner,   

   D.B., Outlaw, F.H, & O’Grady, E.T. (Eds.), Policy & Politics in Nursing and Health    

Care (7th ed.).  (pp. 377-388). St Louis, Missouri: Elsevier.

Uusitupa, M., Louheranta, A., Lindström, J., Valle, T., Sundvall, J., Eriksson, J. and Tuomilehto,  

  1. (2000). The Finnish diabetes prevention study, British Journal of Nutrition, 83(1),

137–142. doi: 10.1017/S0007114500001070.

Knowler, W., Barrett-Connor, E., Fowler, S., Hamman, R., Lachin, J., Walker, E. and Nathan, D.   

(2002).  Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  New England Journal of Medicine, 346(6), 393-403.   doi:10.1056/NEJMoa012512





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