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Legislation Grid and Testimony/Advocacy Statement – Amendment of the Public Health Service Act

Legislation Grid and Testimony/Advocacy Statement – Amendment of the Public Health Service Act

In addition to caring for patients, nurses play a crucial role in advocating policies, regulations, and laws that have an impact on relevant healthcare concerns. Consistently, nurses also need to understand the legislative process in order to be effective in their advocacy role. The purpose of this article analysis is to examine an essential bill in health using a legislation grid with a focus on H.R.3645 and provide a testimony/advocacy statement on the Bill.

Health-related Bill Name To amend the Public Health Service Act to establish emergency grants to safeguard essential healthcare workers and for other purposes.
Bill Number H.R.3645
Description The H.R.3645 was introduced to the House on May 24, 2023. It is sponsored by Rep. Lee, Summer L. [D-PA-12]. The Bill was referred to House Energy and Commerce and the House Energy and Commerce Subcommittee on Health. It already has 37 cosponsors. It is yet to be passed in the House and in the Senate.
Federal or State? Federal
Legislative Intent The Bill’s legislative intent is to make amendments to the Public Health Service Act with the aim of establishing emergency grants to safeguard essential healthcare workers and for other purposes. It also defines emergency and disaster for the purpose of providing emergency grants. It further identifies essential healthcare workers eligible for the grant in emergencies and disasters as healthcare workers whose services cannot be delivered remotely. These essential health workers are identified as all healthcare providers who provide direct care services, medical technologists, public health workers, and those who offer environmental services, including janitorial services and custodial services within healthcare settings, and any other professionals whose services may be needed in healthcare settings during public health emergencies. The proposed bills also define how the funds from the emergency grants will be used and the maximum compensations to be provided for each essential health worker.
Proponents/ Opponents Proponents: 37

  1. Rep. Lee, Barbara [D-CA-12]
  2. Rep. Khanna, Ro [D-CA-17]
  3. Rep. Blunt Rochester, Lisa [D-DE-At Large]
  4. Rep. Bowman, Jamaal [D-NY-16]
  5. Rep. Brown, Shontel M. [D-OH-11]
  6. Rep. Boyle, Brendan F. [D-PA-2]
  7. Rep. Bush, Cori [D-MO-1]
  8. Rep. Carson, Andre [D-IN-7]
  9. Rep. Carter, Troy [D-LA-2]
  10. Rep. Casar, Greg [D-TX-35]
  11. Rep. Crockett, Jasmine [D-TX-30]
  12. Rep. Clyburn, James E. [D-SC-6]
  13. Rep. Deluzio, Christopher R. [D-PA-17]
  14. Rep. Foushee, Valerie P. [D-NC-4]
  15. Rep. Frost, Maxwell [D-FL-10]
  16. Rep. Garcia, Robert [D-CA-42]
  17. Rep. Jackson, Jonathan L. [D-IL-1]
  18. Rep. Jackson Lee, Sheila [D-TX-18]
  19. Rep. Johnson, Henry C. “Hank,” Jr. [D-GA-4]
  20. Rep. McClellan, Jennifer L. [D-VA-4]
  21. Rep. Mfume, Kweisi [D-MD-7]
  22. Rep. Moore, Gwen [D-WI-4]
  23. Rep. Ocasio-Cortez, Alexandria [D-NY-14]
  24. Rep. Omar, Ilhan [D-MN-5]
  25. Rep. Pressley, Ayanna [D-MA-7]
  26. Rep. Ramirez, Delia C. [D-IL-3]
  27. Rep. Sewell, Terri A. [D-AL-7]
  28. Rep. Strickland, Marilyn [D-WA-10]
  29. Rep. Tlaib, Rashida [D-MI-12]
  30. Rep. Watson Coleman, Bonnie [D-NJ-12]
  31. Rep. Williams, Nikema [D-GA-5]*
  32. Del. Norton, Eleanor Holmes [D-DC-At Large]
  33. Rep. Jayapal, Pramila [D-WA-7]
  34. Rep. Clarke, Yvette D. [D-NY-9]
  35. Rep. Balint, Becca [D-VT-At Large]
  36. Rep. Tokuda, Jill N. [D-HI-2]
  37. Rep. Cherfilus-McCormick, Sheila [D-FL-20]
Opponents: None (As of now)
Target Population Essential healthcare workers
Status of the Bill (Is it in hearings or committees?)  

Referred to the committees

General Notes/Comments


This Bill is promising and has the potential to solve some of the concerns and challenges faced by essential healthcare workers during public health emergencies, including transport and maintenance costs. Voting for it guarantees a satisfied essential and frontline workforce that will enable the U.S. to effectively manage its public health even during emergencies.

 Part 2: Legislation Testimony/Advocacy Statement

I strongly support H.R.3645, Which amends the Public Health Service Act to establish emergency grants to safeguard essential healthcare workers and other purposes. From a personal perspective, the Bill presents a great opportunity to contribute to the current discussion on supporting and protecting essential healthcare workers during public health emergencies. It also greatly appreciates and seeks to address the challenges these essential healthcare workers face while delivering direct and other supporting services during these emergencies. As learned from the experiences of the COVID-19 pandemic, frontline workers are at a greater risk of exposure (Ashinyo et al., 2020), and most suffer from psychological issues (Rodríguez-Rey et al., 2020). I further support the Bill as it provides legal backing to support essential healthcare workers with funding and compensation for their services during public health emergencies.

The social determinants of income, age, education, and gender significantly impact the legislative process of H.R.3645 in many ways. For instance, the level of income will influence how much funding and resources the various groups of essential health workers have to engage in advocacy. Other determinants, such as education and age, will determine how well the workers understand the legislative process and get involved in advocating for the Bill. Evidently, insufficient knowledge of health policy-making is associated with the nurses’ lack of participation in policy-making (Hajizadeh et al., 2021). Additionally, age, income, level of education, and gender have an influence on how people get compensated. Although most gender-related pay gaps in healthcare are mostly attributed to the fact that male care providers work longer hours compared to female providers (Ganguli et al., 2020), evidence shows that gender discrimination exists in enterprises and contributes to discriminative compensation practices (Bilan et al., 2020). These social factors will influence how H.R.3645 will be developed as it will seek to acknowledge this reality of pay and compensation gaps and challenges faced by low-income essential and frontline workers such as in transport. Thus, the Bill will help achieve a notable level of equity in compensating essential and frontline workers for their services.

Some members of the House may oppose the Bill on the grounds of extra need for funding. However, I would respond to such opponents by highlighting the long-term benefits of granting subsidies to protect important healthcare employees. This will include providing evidence on the influence of compensations on motivating healthcare workers, keeping them at their work, and ensuring continuity of healthcare services delivery even during public health disasters.


The H.R.3645, To amend the Public Health Service Act to establish emergency grants to safeguard essential healthcare workers and for other purposes, introduced to the House on May 24, 2023, is an essential bill aimed at improving support for essential healthcare workers. The Bill recognizes all workers who, whether directly or indirectly, are physically involved in providing or supporting the provision of healthcare services during public health crises as essential healthcare workers and the challenges they face. It is important that members of the House support this Bill as it will improve the U.S. disaster preparedness and efficiency in dealing with public health emergencies.


Ashinyo, M. E., Dubik, S. D., Duti, V., Amegah, K. E., Ashinyo, A., Larsen-Reindorf, R., Kaba Akoriyea, S., & Kuma-Aboagye, P. (2020). Healthcare Workers Exposure Risk Assessment: A Survey among Frontline Workers in Designated COVID-19 Treatment Centers in Ghana. Journal of Primary Care and Community Health, 11.

Bilan, Y., Mishchuk, H., Samoliuk, N., & Mishchuk, V. (2020). Gender discrimination and its links with compensations and benefits practices in enterprises. Entrepreneurial Business and Economics Review, 8(3), 189–204.

Ganguli, I., Sheridan, B., Gray, J., Chernew, M., Rosenthal, M. B., & Neprash, H. (2020). Physician Work Hours and the Gender Pay Gap — Evidence from Primary Care. New England Journal of Medicine, 383(14), 1349–1357.

Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC Nursing, 20(1), 1–9.

Rodríguez-Rey, R., Garrido-Hernansaiz, H., & Bueno-Guerra, N. (2020). Working in the times of COVID-19. The psychological impact of the pandemic on frontline workers in Spain. International Journal of Environmental Research and Public Health, 17(21).


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As a nurse, how often have you thought to yourself, If I had anything to do about it, things would work a little differently? Increasingly, nurses are beginning to realize that they do, in fact, have a role and a voice.

Amendment of the Public Health Service Act

Amendment of the Public Health Service Act

Many nurses encounter daily experiences that motivate them to take on an advocacy role in hopes of impacting policies, laws, or regulations that impact healthcare issues of interest. Of course, doing so means entering the less familiar world of policy and politics. While many nurses do not initially feel prepared to operate in this space effectively, the reward is the opportunity to shape and influence future health policy.

To Prepare:

  • Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.

The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)

Be sure to add a title page, an introduction, a purpose statement, and a conclusion. This is an APA paper.

Part 1: Legislation Grid

Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:

  • Determine the legislative intent of the bill you have reviewed.
  • Identify the proponents/opponents of the bill.
  • Identify the target populations addressed by the bill.
  • Where is the bill currently being processed? Is it in hearings or committees?

Part 2: Legislation Testimony/Advocacy Statement

Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:

  • Advocate a position for the bill you selected and write testimony in support of your position.
  • Explain how the social determinants of income, age, education, or gender affect this legislation.
  • Describe how you would address the opponent to your position. Be specific and provide examples.
  • At least 2 outside resources and 2-3 course-specific resources are used.

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