AJN/January 1998/vol.98, no.1 |
| Washington Watch | Issues Update | Vital Signs |
by Stephanie Reed, RN
The coinciding of the American Nurses Association's Public Policy Conference in early November with the end of the 105th Congress's first session offered a unique opportunity for nurses to celebrate the legislative victories of the nursing profession this year. More than 300 registered nurses gathered at the conference, held just blocks from Capitol Hill. The location afforded many the chance to meet with key legislators. Conference speakers and sessions focused on many of the issues that were addressed in Congress during 1997 and unfinished business that will be on the agenda in 1998.
The most far-reaching achievement this year for the nursing profession was inclusion of language in the budget reconciliation legislation expanding direct Medicare reimbursement to all nurse practitioners and clinical nurse specialists--regardless of practice or geographical setting. This victory followed seven years of ANA lobbying. The legislation also extended the authorization of the Community Nursing Organization demonstration project for two years (see AJN Washington Watch, October 1997).
"From now on, nurse practitioners and clinical nurse specialists at long last can get direct reimbursement for their services--no matter where they practice," noted Senate Minority Leader Tom Daschle (D-SD) when he spoke at the Public Policy Conference. Daschle, who sponsored 1989 legislation to provide direct Medicare reimbursement for NPs and CNSs serving rural areas, has been a strong supporter of expanding the reimbursement to all areas.
Also testament to nursing's clout on Capitol Hill is the funding secured for the Nurse Education Act, which supports graduate-level nursing programs and funds nurse-managed clinics affiliated with university schools of nursing. In February 1997, the Clinton Administration had proposed cutting this funding by almost 90%. Nurses across the nation flooded members of Congress with calls to keep adequate funding in place, and Congress responded by funding the program for fiscal year 1998 at $65.6 million, an increase over the previous year's funding of $65.3 million.
Other funding decisions in the first session included increased allocations for the Occupational Health and Safety Administration and the National Institute for Occupational Safety and Health. As latex allergies, bloodborne pathogens, and ergonomic injuries pose growing threats to nurses, the ANA has worked closely with legislators to ensure that these agencies have adequate resources to address these and other occupational health and safety problems.
Besides scoring these legislative triumphs, the ANA made solid progress in 1997 on a number of issues crucial to the nursing profession. The ANA's Patient Safety Act, HR 1165, was introduced in March 1997 by Representative Maurice Hinchey (D-NY) and had gained 40 cosponsors by the time Congress adjourned in November. This legislation would require hospitals and other health care institutions to make public information on staff numbers, staff mix, and outcomes, provide "whistle-blower" protection to nurses who advocate for patient safety, and require review of proposed hospital mergers and acquisitions for community impact.
Another ANA priority of requiring Medicaid programs in all states to reimburse advanced practice registered nurses was addressed in legislation introduced in both the House and the Senate. The bills, HR 1354, introduced by Representative John Olver (D-MA), and S 1326, by Senator Daschle, will take center stage in the ANA's efforts at the federal level to provide better access to nursing care and to lower practice barriers too often encountered by NPs and CNSs.
"We need to change the policy that says Medicaid will only reimburse for some nurse specialties," Daschle said at the Public Policy Conference. "Medicaid should provide direct reimbursement for all nurse practitioners--regardless of specialty--and to clinical nurse specialists as well."
The ANA also worked with legislators on two bills introduced just before Congress's adjournment that address the safety of both health care workers and patients. The first, the Health Workers Protection Act of 1997 (HR 2754), introduced by Representative Fortney (Pete) Stark (D-CA), requires the use of safer needle devices within hospitals and hospital-owned facilities.
The second (HR 2854) amends the Newborns' and Mothers' Health Protection Act, which requires health plans to cover minimum hospital stays unless the provider and the mother choose an earlier discharge and which was signed into law in 1996. Introduced by Representative Steven LaTourette (R-OH), the new legislation would provide for a follow-up home or other outpatient visit for a mother and her newborn child if they are discharged from a hospital less than 48 hours after the infant's birth, or 96 hours in the case of a cesarean birth.
The ANA also succeeded in stalling legislation threatening nurses' workplace rights. While the Family Friendly Workplace Act (HR 1/S 4) passed in the House, it was stopped in the Senate, where it fell nine votes short of the 60 needed to bring it to the floor for action. The bill would amend the Fair Labor Standards Act to allow private sector employers to compensate their employees for overtime with time off instead of overtime pay as required under current law. In addition, it would replace the 40-hour work week with 80 hours over a two-week period in which employees could work 50 hours one week and 30 the next with no extra pay. The ANA believes that such a measure unwisely undermines the 40-hour work standard and fails to provide adequate employee control or federal enforcement mechanisms to protect against coercion and discrimination.
During the Public Policy Conference, Daschle lauded the ANA for its role in several important legislative successes, both in the past year and in 1996. "The reason we were able to move ahead on children's health, on health care portability, and on banning 'drive-through' deliveries is that the ANA and other major health care organizations... refused to take 'no' for an answer," he said. "I'm here to tell you as personally and sincerely and convincingly as I can--you made a difference."
Besides continuing its ongoing efforts on legislation introduced in 1997, the ANA will push for enactment of legislation putting into effect the "Consumer's Bill of Rights and Responsibilities," which was presented by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry on November 20. President Clinton is expected to recommend enactment during his State of the Union address January 27, the same day Congress reconvenes.
The commission, whose 34 members include ANA President Beverly L. Malone, PhD, RN, FAAN, Florida Nurses Association member Marta Prado, RN, and the Maryland Nurses Association's Mary Wakefield, PhD, RN, FAAN, has recommended seven important safeguards for health care consumers (see "President Embraces Quality Commission's Consumer 'Bill of Rights'", The American Nurse, November-December 1997). Even though there is substantial bipartisan support for many of these reforms, Republican leaders and some business and insurance interests are vehemently opposed to any federal legislation of this kind.
In its push to enlist more cosponsors for the Patient Safety Act in the coming year, the ANA also will work to have the bill's components on staffing and outcomes information and whistle-blower protections included in the comprehensive legislation embodying the advisory commission's work. Both of those concepts are in the Consumer Bill of Rights and Responsibilities.
Also promising to receive considerable Congressional attention during the second session is the effort to enact comprehensive federal legislation to reduce Americans' use of tobacco. With the impetus of the proposed settlement among several state attorneys general, other anti-tobacco litigants, and tobacco companies, along with President Clinton's subsequent announcement of provisions that he would insist upon in a settlement, there is expected to be a push to resolve this matter. Among the issues to be addressed is the role of the Food and Drug Administration in regulating the industry. Committed to reducing tobacco use among Americans, particularly children and teenagers, the ANA will continue spearheading nursing's efforts to solve the problem.
Stephanie Reed is associate director of ANA's Department of Federal Government Relations.