GA Committee Update 3/03 Nursing Shortage Issues H.R.501, Referred March 3 to a House Committee on Education and the Workforce subcommittee, would forgive up to $17,000 in nursing student loans for registered nurses who work full-time in a health care setting. Write your representative to support this bill. March 6, 2003 The Honorable Thomas Tancredo U.S. House of Representatives 1130 Longworth House Office Building Washington, DC 20515 |
Dear Rep. Tancredo: The American Hospital Association (AHA) commends your efforts to address the nursing workforce shortage in your bill, the Nurse Loan Forgiveness Act of 2003, H.R. 501, and is pleased to support your legislation. We believe your bill is an important component in the overall strategy of addressing the national nursing shortage. The AHA represents nearly 5,000 hospitals, health systems, networks and other health care provider members. Hospitals and health care facilities across America are experiencing a critical shortage of nurses. A recent AHA survey of the workforce shows that there are currently up to 126,000 registered nurses (RNs) needed by hospitals today. The need for nurses will be further compounded by the potential health care demands of the looming 78 million aging baby boomers who will also begin to retire in 2010. The U.S. Department of Health and Human Services projects that by 2020, our nation will need 3 million nurses, 1 million more than the projected supply. The current nursing shortage is creating an environment with the potential to jeopardize hospitals ability to provide timely access to non-emergency as well as emergency services. An inadequate number and mix of personnel has caused some facilities to close beds, put emergency rooms on stand-by status, delay elective surgeries, and pare down hospital services. Hospitals have enlisted many innovative strategies and creative approaches to address the nursing shortage, but this is a complex problem that cannot be solved by hospitals alone. The role of the federal government is critical in the support and funding of an adequate nursing workforce. Your bill, the Nurse Loan Forgiveness Act of 2003, will help alleviate the nursing shortage by encouraging young people to enter and continue in the nursing profession. It will help ensure an adequate supply of nurses to meet the future needs of our nation. Helping to alleviate the critical shortage of nurses is a priority for health care providers. We applaud your effort and pledge to work with you to address this very important issue. Sincerely, Rick Pollack Executive Vice President |
Uninsured Issues
High Rates of Uninsured Residents Can Affect Community Care Access (3-07-03) |
A large number of uninsured residents in a community can affect access to care for the entire community, according to an Institute of Medicine report released yesterday, theAP/Detroit News reports (Schmid,AP/Detroit News, 3/7). The report, "A Shared Destiny: Effects of Underinsurance on Individuals, Families, and Communities," found that communities with high rates of uninsured residents are more likely to reduce hospital services, to take resources from disease prevention and surveillance programs and to reallocate tax revenue to cover the cost of uncompensated care (Institute of Medicine release, 3/6). The report also found that large numbers of uninsured residents in a community can lead to overcrowded emergency rooms and trauma care centers, which may prompt the facilities to close (AP/Detroit News, 3/7). In addition, physicians in communities with a high rate of uninsured residents may limit their availability to patients. "For example, some specialists in Phoenix have ended affiliations with certain hospitals, or refused to offer on-call services, in part to avoid treating uninsured patients for whom they do not expect to be reimbursed," the report said (Fox, Reuters/Detroit Free Press, 3/7). The report also found that the presence of uninsured residents in a community can have a more "direct effect" on the health of others in the community. According to the report, for example, 20% of individuals with HIV do not have health insurance, and many remain unaware of their conditions because they do not receive regular care, which makes them more likely to transmit HIV to others (Institute of Medicine release, 3/6). |
Analysis |
Dr. Arthur Kellermann, professor and chair of the Emory University School of Medicine and co-chair of the IOM committee that prepared the report, said, "It is mistaken and dangerous to assume that the prevalence of uninsurance in the United States harms only those who are not insured" (AP/Detroit News, 3/7). The IOM released the report one day after the release of a study prepared by Families USA for the Robert Wood Johnson Foundation that found an estimated 75 million U.S. residents younger than 65 lacked health insurance for at least part of 2001 or 2002 (California Healthline, 3/5). An abstract of the IOM report is available online. Note: You must have Adobe Acrobat Reader to view the abstract. Study highlights diversity of uninsured population March 11, 2003 Of the roughly 41 million Americans who lacked health insurance for all of 2001, nearly 18 million had moderate-to-high incomes, according to a report released March 11 highlighting the diversity of the nation's uninsured population. More than 14 million Americans were eligible for public insurance programs such as Medicaid and the Children's Health Insurance Program, but were not enrolled, indicates the study by the National Institute for Health Care Management Foundation. Another 9 million uninsured were low-income Americans who were not eligible for public programs. For this group, affordability was the biggest hurdle, the study notes. The research, funded by the Robert Wood Johnson Foundation, found successful initiatives to get coverage for the uninsured were characterized by aggressive marketing to the target population, affordable coverage choices and flexible product design. To underscore the plight of the uninsured, thousands of health care leaders, students and organizations such as AHA are participating March 10-16 in Covering the Uninsured Week, for which RWJF is a major sponsor. The report, "The Uninsured: A Study of Health Plan Initiatives and the Lessons Learned," is online at http://www.nihcm.org. |
Medicare, Medicaid Legislation 'Best Bets' for Passing Congress This Year, Thompson Says03/10/2003 |
At a breakfast meeting for reporters hosted by theChristian Science Monitoron Friday, HHS Secretary Tommy Thompson said the bills concerning Medicare, Medicaid, medical liability insurance and coverage for the uninsured are among the "best bets" for passing Congress this year, the Washington Times reports. Thompson also said that Americans "are not very healthy" and that disease prevention is "imperative," theTimes reports. He said, "We need to reduce smoking, eat properly and exercise more," advocating the administration's $25 million "healthiest cities" competition, which would reward localities that have the largest reductions in rates of diabetes, asthma and obesity. Thompson said another administration goal is to make the health care system "paperless," adding that "grocery stores are more technologically advanced than hospitals" (Pierce,Washington Times, 3/10). Cover the Uninsured Week Kicks Off 03/06/03 |
Medicare Reform Issues
Zerhouni Discusses Medicare Reform |
NIH Director Dr. Elias Zerhouni Friday answered questions about President Bush's Medicare reform framework from 75 senior citizens at the Detroit-based Joseph Walker Senior Center, the Detroit News reports (Hall,Detroit News, 3/9). Under Bush's proposed framework, beneficiaries who remain in traditional Medicare would receive drug discount cards, with savings of 10% to 25% on prescriptions, and low-income beneficiaries in the traditional program would receive $600 per year to offset their drug costs. In 2006, all beneficiaries in traditional Medicare would receive catastrophic drug coverage, which would take effect after beneficiaries spent $5,500 to $7,000 on medications in a year. Under a second option, seniors could join a new private system called "Enhanced Medicare," which would begin in 2006 and give beneficiaries a more generous drug benefit, full coverage for preventive care and lower out-of-pocket costs for hospital stays. The "Enhanced Medicare" option would allow private health plans to offer different drug benefits, with different premiums, copayments and deductibles, so long as the plans meet "a basic federal standard," which is not yet set. The third option, called "Medicare Advantage," would be similar to Medicare+Choice, which offers beneficiaries a choice of private plans with and without drug coverage but no guaranteed drug benefit. Bush aides said that implementing the proposals under the administration's new Medicare framework would cost $400 billion over 10 years; the president's fiscal year 2004 budget proposal calls for a $6 billion "downpayment" on the plan (California Healthline, 3/5). Zerhouni is part of a "traveling road show" of administration officials who are gathering feedback from seniors and promoting the Medicare framework, theNews reports. "I'm a physician, and I can tell you disease has no politics and it doesn't wait for Congress to move," Zerhouni said, adding, "Our elected officials need to fight out these details however they want to fight it out and pass a plan this session" (Detroit News, 3/9). |
Nursing Education Issues
| AB 1543 just introduced is requiring standardization for admissions and perquisites. To review report, go to www.ucop.edu/cprc and on the left side, click publications. |
Local Issues
Budget Reductions in Orange County Health Care Programs Could Serve as 'Preview' for Actions in Other Counties |
03/10/2003 |
The Los Angeles Times yesterday examined budget reductions for health care and other services in Orange County that could serve as "a preview of what other California counties face." Counties statewide are facing budget "squeezes," with increased demand for services and lower revenue, according to Jean Hurst, a legislative analyst for the California State Association of Counties. Los Angeles County Chief Administrative Officer David Janssen said that officials in the county are preparing for "some pretty serious local-revenue problems as well ... more than Orange County" (Mehta,Los Angeles Times, 3/9). The Orange County Board of Supervisors last week approved $106.4 million in spending cuts for fiscal year 2003-2004. The board agreed to stop paying for discretionary programs and said budget concerns would keep it from compensating health and social services programs that lost funding from the state or other sources. The board's budget plan would save $14.8 million by reducing or eliminating funds for substance abuse programs for drug offenders, psychiatric treatment beds for adults with severe mental illnesses and medical beds at Theo Lacy Branch jail. In addition, the county Health Care Agency would lose $8.4 million in funds for clinics, children's and mental health services and other programs (California Health Line, 3/5). "These cuts will affect individuals of all ages. The cuts will be deep. And in many important areas, we will not be able to provide services for all those in need," Pat Markley, spokesperson for the county Health Care Agency, said. Orange County's cuts do not take into account the state's projected $35 billion budget shortfall, which local officials say could cost the county "tens of millions of dollars more," theTimesreports. Orange County Chief Financial Officer Gary Burton said, "There is a chance, if the state is not careful, they could bankrupt the count[ies]. And [we] would be one of the first ones that would fall" (Los Angeles Times, 3/9). |
Smallpox Issues
| American Nurses Association Says HHS Proposal On Smallpox Falls Short |
| Plan fails to address health and safety issues |
Washington, DC -- After months of silence from the administration regarding its concerns about the smallpox vaccination program, the American Nurses Association (ANA) welcomed a legislative proposal released by the Dept. of Health & Human Services (HHS) yesterday regarding compensation for health care workers who suffer side effects after volunteering for the smallpox vaccination, but said the proposal falls far short of addressing many concerns about the program. "The HHS proposal demonstrates that the administration recognizes a problem exists; however, it falls short of addressing the range of issues that ANA is concerned about," said Barbara A. Blakeney, MS, APRN,BC, ANP. "This compensation plan is solely focused on worst-case scenarios and does nothing to address the more common scenarios where individuals experience side effects that would cause them to lose less than five days of work," she said. "Furthermore, the plan fails to address the other issues we have raised regarding both patients' and nurses' health and safety." ANA is particularly concerned about the risks of nurse-to-patient transmission of the vaccinia virus. Recent reports of cases of secondary transmission underscore the need for clear safety guidelines. "It's easy to understand why nurses who work with high-risk groups, such as cancer and AIDS patients, are reluctant to receive the vaccine," Blakeney said. "Given the lack of information on the risk of a smallpox outbreak and the well-documented risks associated with the vaccine, many nurses are making the professional judgment not to be vaccinated," she added. The proposed HHS plan focuses solely on compensation and is modeled after the Public Safety Officers Benefit program, a benefits package currently available to police officers and firefighters. Under the HHS plan, individuals who die or suffer permanent disability from the vaccination would be eligible for $262,100 in benefits. Individuals with temporary or partial disability would receive two-thirds of lost wages, but only after losing five days of work, and benefits would be capped at $50,000. To date, the federal Centers for Disease Control and Prevention (CDC) reports only 12,690 health care workers have been vaccinated since the program began on Jan. 24, despite the administration's plan to vaccinate 500,000 volunteers. Registered nurses are included in the first phase of the plan, as well as the second phase of 10 million first responders who are scheduled to receive this vaccination. In letters to HHS Secretary Thompson on Nov. 7 and to President Bush on Jan. 16, ANA identified the following issues that must be addressed before the program moves forward: • the potential transmission of the vaccinia virus to patients and family members; • the right to coverage of medical costs associated with receiving the vaccine; • the utilization of safer bifurcated needles; • the critical need to establish an adequate prescreening and education program; • maintaining sufficient staffing during the voluntary, pre-event vaccination program; • compensation for lost time at work due to adverse effects of the vaccination program; and • protection from job discrimination or retaliation for refusing to be vaccinated. "Many of the critical safety issues questions are not addressed in the HHS plan," Blakeney said. ANA praised a bill introduced by members of the U.S. House of Representatives in February, calling it a more comprehensive approach to addressing the shortcomings of the vaccination program. The bill, the Smallpox Vaccine and Compensation and Safety Act (H.R. 865), introduced by Rep. Henry Waxman (D-CA) with original co-sponsors Reps. Sherrod Brown (D-OH), Lois Capps (D-CA) and Edward Markey (D-MA), would offer education, medical screening and surveillance to health care workers who volunteer for the smallpox vaccine. In addition, the legislation would provide medical care and a no-fault compensation fund for anyone harmed by the vaccine, including patients. Assistance would be administered through state grants. "We heartily applaud Congressman Waxman and his colleagues in the U.S. House of Representatives for their courage and initiative in addressing the tough safety and liability questions associated with smallpox vaccination," said ANA President Blakeney. |