Administration looks toward further cuts in health care spending

You'll be hearing a great deal about "enti- tlement programs" in this year's federal budget deliberations. White House budget proposals for 1982 were due in late January.

Last fall Richard S Schweiker, health and human services secretary, gave us a preview of what the new cuts might be. He made it clear the administration would go after what he termed the "automatic spending" of such pro- grams as Medicare and Medicaid. Under these entitlement programs, the government is re- quired to pay benefits to groups that meet cer- tain eligibility standards. Other examples are food stamps, Supplemental Security Income, and welfare.

Of the totalhealth and human services 1981 budget of $250 billion, about 96% was spent for entitlement programs. In 1980, Meaicare and Medicaid paid $60.6 billion in health bene- fits, of which $35.8 billion was for hospital care. The two programs accounted for more than one-quarter of the personal health care spend- ing of the entire nation. Small wonder entitle- ments are receiving so much attention.

Yet making cuts will not be easy, because these programs were established by law. In each case, Congress passed legislation man- dating that certain categories of citizens be covered. To trim spending, these basic laws must be changed. This will be difficult politi- cally.

For example, how would your parents feel if the government decided to charge higher premiums for Medicare coverage? How would

3 Legislation

your hospital be affected if Medicare and Medicaid reimbursement is reduced further when hospital costs have been rising faster than inflation? You can be sure that debate will be long and loud.

New Hampshire nurses were marshaling their forces in December behind a bill to rees- tablish their board of nursing. The law provid- ing for the board failed to pass a sunset review last summer, and its authority is due to expire March 31. The state legislature planned to consider two new bills at a special session Jan 5 and 6.

Lawmakers will not meet again in full ses- sion until 1983. If a bill was not approved in January, there would be no further opportunity to renew the board before then. The state would no longer have a system for licensing practitioners and approving schools of nurs- ing.

After last summer's review, nurses or- ganized a coalition. Composed of individual nurses, consumers, and nursing organiza- tions, the group has raised money and hired a lobbyist. They were responsible for introduc- tion of one of the bills. The other they opposed, explained Lois Murphy, RN, executive director of the New Hampshire Nurses Association.

"Everybody says we will have new authority for a board in January, but we are concerned about whether we could live with it," she said. The bill the coalition opposes would substitute a consumer for one of the professional board members and would give a hearing officer the authority to handle complaints except on ap- peal. The coalition's bill, in contrast, would add a consumer member to the board rather than removing a nurse member. Complaints would be handled by the professional staff and the

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board, as they are now. Nurses are also con- cerned about a council to advise the board about education proposed in the bill they op- pose. Murphy said the coalition fears this may be a preliminary move toward dividing the board into two parts, one assigned to regu- latory activities and the other, to education matters.

W A scientific measure of the need for nurses could be one outcome of work by the Gover- nor's Commission on Nursing Issues in Mary- land. After 11 hearings around the state, the panel's preliminary report was due in January. The commission was set up by law last year to investigate reports of a nursing shortage.

After hearings outlined basic concerns, the commission appointed four panels. They were to suggest recommendations on

articulation of diploma and associate de- gree programs with baccalaureate pro- grams the effect of Maryland's rate review pro- gram on nurses' salaries personnel policies governing state- employed nurses issues facing other nursing personnel such as licensed practical nurses and nursing assistants.

How severe is Maryland's shortage? To an- swer, you need to ask, What is a shortage? According to whom? Mary McCann Spicer, RN, the commission's executive director, noted there had been opinions of a shortage but no uniform measure. Reports varied from institution to institution and area to area. "Maybe we need to develop or adapt a tool for measurement," she said.

The commission has been afocus of a broad rangeof nursing issues. Commissioners heard from the grass roots, including nurses who work with prisoners and those who care for migrant workers. The group has also been a place to refer legislative proposals that dealt with bits and pieces of the nursing problem. With its broad perspective, the commission could fit these into more general recom- mendations, Spicer noted. She believes that Maryland is the only state to have had such a commission established by law.

record Nov 12 by Rep James M Shannon (D- Mass). He said, "The operating room nurse must possess not only medical knowledge and technical expertise, but also great resources of human compassion and understanding.. . . The personal attentions and reassuring, capa- ble manner of the operating room nurse do much to allay a patient's fears and make his hospital stay a less trying experience."

It appears nurses in Massachusetts have been doing a good job educating one of their national representatives.

W The American Nurses' Association (ANA) expressed both "our support and concerns" at a hearing last fall on the procompetition ap- proach to health insurance. Several con- gressmen have proposed a combination of tax reforms and economic incentives they believe would make health care more competitive and, it is hoped, more economical.

A strong supporter of comprehensive health services in past Congresses, ANA agreed there are "many barriers which prevent con- sumers from choosing nursing services and the services of professional providers other than physicians," according to a report in the American Nurse.

The organization also pointed out that any plan should cover preventive services as well as acute care and should be available to all Americans regardless of economic cir- cumstances. ANA observed that current pro- posals did not increase coverage for the poor and elderly. Further, the testimony called for covering nursing services as a benefit and recognizing RNs as health care providers. Claire Fagin, RN, FAAN, presented the state- ment before the House Ways and Means health subcommittee. She is dean of the Uni- versity of Pennsylvania School of Nursing and member of a national task force on competitive health insurance plans.

Patricia Patterson Assistant Editor

W A statement recognizing Operating Room Nurse Day was entered in the Congressional

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