AORN JOURNAL APRIL 1988, VOL. 47, NO 4

Legislation

After passing the 1988 budget, Congress focuses on nursing shortage, AIDS, Vietnam Women’s Memorial

he 1988 budget reconciliation act was of T special interest because AORN was able to attach a bill to it-the RN first assistant bill- when it was discussed in the House. The bill was subsequently deleted during debate in the conference committee. Hundreds of bills were still attached to the budget reconciliation bill when President Reagan signed it. These are described in a 1,194-page Conference Report published by the House of Representatives. The 2-inch thick publication is equivalent in size to two pre- Congress Journals.

These bills run the gamut from a $94.8 million appropriation to the Census Bureau for “collecting, compiling, analyzing, preparing, and publishing statistics” to an additional $2.8 million appropri- ation to the Department of Defense to finish construction of a parking facility at Arlington National Cemetery. The overall cost of the parking facility will be approximately $13 million.

Several pieces of health care legislation were included in the bill. Legislation supported by the American Nurses’ Association and AORN were reported in the March “Legislation column” of the Journal. These were the Medicare Community Nursing and Ambulatory Care Act (community nursing organizations), Advanced Nursing Services in Nursing Homes Act (certification and recertification in nursing homes), and those bills dealing with nursing home reform and Medicare reimbursement for nurse midwives. Other health care related bills of interest to OR nurses follow:

Overpriced procedures. A 2%, across-the- board cut will be made in payments to physicians for procedures that have been determined by

Medicare to be overvalued, such as coronary artery bypass surgery, hip replacement surgery, and cataract surgery.

Medicare payments. Changes in Medicare payments that affect clinical laboratory costs and durable medical equipment costs include reducing clinical laboratory payments and freezing reimbursement of durable medical equipment.

Physician payments. Participating physicians will receive a 3.6% increase for Medicare primary care services and a 1% increase for nonprimary care services; nonparticipating physicians will receive 3.1% increase for primary care services and a 0.5% increase for nonprimary care services.

Other health-related items in the Conference Report are as follows:

an appropriation of $23.4 million for the National Center for Nursing Research; an appropriation of $19.5 million to Research, Development, Testing, and Evaluation (Title IV) for advanced medical development. Of that $2.1 million is earmarked for the National Bone Marrow Donor Registry; and an appropriation of $30 million to the Agency for International Development for its program on prevention and control of acquired immune deficiency syndrome (AIDS); half goes to the World Health Organization for its AIDS program.

Second-Session Issues

ecause the first session of the 100th Congress B took most of November and December to

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Congressional Schedule The following is a schedule of both the House and Senate for the remainder of 1988. This

will help you know where to contact your representative or senator-either in his or her Washington, DC, office or his or her home state office.

April 1-8 May 2-6 May 30-June 3 June 30-July 5 July 18-22 July 18-21

Aug 15-Sept 6 Aug 15-18

Oct 8

Senate Easter recess Not in session Memorial Day recess Independence Day recess Not in session Democratic National Convention Not in session Republication National Convention Adjournment (target date)

April 1-8 May 28-31 July 1-5 July 15-25 July 18-21

Aug 12-Sept 6 Aug 15-18

Sept 12-1 5 Sept 21 Oct 5

House Easter recess Memorial Day recess Independence Day recess Not in session Democratic National Convention Not in session Republican National Convention Rosh Hashanah recess Yom Kippur re- Adjournment (target date)

discuss the budget reconciliation bill, several major pieces of the legislation were held over to be discussed during the second session. (See “Congressional Schedule.”) These include legislation on AIDS testing and education, mandatory employee health insurance, and long- term care.

AIDS issues. A proposal that is expected to be controversial would authorize up to $400 million a year in federal grants to health care facilities to provide voluntary, anonymous counseling and confidential testing for AIDS, except as prohibited by state law. It would also ban discrimination against people with AIDS in housing, employment, government services, and public accommodations. The bill was introduced by Rep Henry A. Waxman (D-Calif) in the House (HR 3071) and by Sen Edward Kennedy (D- Mass) in the Senate (S 1575).

Another AIDS bill (S 1220), sponsored by Senator Kennedy, would provide a comprehensive program of AIDS education. This includes requiring the Centers for Disease Control, Atlanta, to develop a program to teach public safety workers (eg, firemen, policemen, and paramedics) how to protect themselves from individuals who are human immunodeficiency virus (HIV)

positive. Each state would receive funds for education, prevention, and treatment, and the federal government would be in charge of research of AIDS.

Mandatory health insurance. This proposal (S 1265), sponsored by Senator Kennedy, would require employers to provide minimum health insurance benefits to workers. Regardless of the size of the company, employers would be required to offer insurance covering inpatient and outpatient hospital care, physician services, diagnostic and screening tests, and prenatal and well-baby care. All employees would be protected against catastrophic health care costs that exceed $3,000 a year. Employers would be required to pay 80% of the cost of the insurance program; employees would pay the remaining 20%. For low-income employees, the employer would be expected to pay the full cost.

Long-term cure. A proposal (HR 3436), introduced by Rep Claude Pepper (D-Ha), would provide comprehensive home care benefits to chronically ill children, the disabled, and the elderly. It would also provide Medicare coverage of all drug costs above $250 a year. Because it has a $23.7 billion fiscal estimate, it is expected to be controversial.

A O R N J O U R N A L APRIL 1988, VOL. 47, NO 4

Nursing Shortage Bills

everal nursing shortage bills were introduced S in the first session of Congress. The Senate passed one last fall, and three other bills are still pending action in committees.

Nursing Shortage Reduction Bill (S 1402). Introduced by Senator Kennedy, this bill would authorize $5 million for demonstration projects to study the role of the clinical nurse and to test innovative wage structures and benefits. Ways to increase nurse recruitment in home health care and nursing home settings would also be studied. The measure would also create as many as five regional nurse-recruitment centers.

The Senate passed this bill. Nursing Shortage Reduction Bill (HR

3340). Introduced by Rep Ron Wyden (D-Ore), this bill would authorize up to $8 million for demonstration projects that encourage professional nurse training (eg, nurse-recruitment centers, local educational outreach programs, and job- placement programs).

This bill is pending in the House Energy and Commerce Committee.

Nursing Manpower Shortage Bill (S 1 765). Introduced by Sen George J. Mitchell (D-Me), this bill would allow hospitals that provide graduate-level clinical training for nurses to be reimbursed by Medicare. It would also establish ways to test the cost-effectiveness of delivering community-nursing care and ambulatory care on a prepaid, capitated basis to Medicare beneficiaries.

The bill is pending in the Senate Finance Committee.

Medicare Nursing Practice and Patient Care Improvement Bill (S 1833). Introduced by Sen Dave Durenberger (R-Minn), this bill would authorize $30 million for demonstration projects that focus on case management, career ladders, and improved working conditions for nurses.

The bill is pending in the Senate Finance Committee.

According to Kathy Michels, RN, JD, senior staff specialist for American Nurses’ Association, it is unlikely that any of these four bills will be

passed as is. Initial discussions after Congress reconvened for the second session focused on incorporating parts of S 1402 and HR 3340 into the reauthorization of the Nurse Education Act, she said. Committee members have no plans to act on S 1765 or S 1833 or incorporate them into the Nurse Education Act, she added.

A hearing on the Nurse Education Act has been tentatively scheduled in April in the health subcommittee for the House Energy and Com- merce Committee. A hearing has not been scheduled yet for the bill in the Senate Labor and Human Resources Committee.

Commission on Nursing. In addition to legislation that addresses the nursing shortage, a Commission on Nursing has been created at the US Department of Health and Human Services (HHS) that will develop recommendations for improved recruiting and retention of registered nurses in health care facilities. The commission will also address reports of nurse shortages and identify the practices of health care facilities that successfully recruit and retain full nursing staffs.

The 19-person commission is chaired by Carolyne K. Davis, RN, PhD, former adminis- trator of HHS Health Care Financing Adminis- tration and current health care advisor for Ernst and Whinney, Cleveland. An interim report is expected in May and a final report is expected by the end of 1988.

The commission was developed at the request of the American Nurses’ Association, the National League for Nursing, the American Organization of Nurse Executives, and the American Associ- ation of Colleges of Nurses. At a 1987 Interna- tional Nursing Research Conference in Washing- ton, DC, the groups also requested federal support for (1) a national nurse-recruitment program, (2) scholarships and stipends for undergraduate nurses, (3) and clinical work-study programs in schools of nursing, hospitals, and other health care institutions.

Vietnam Women ’s Memorial

he Vietnam Women’s Memorial, which was T created to honor women who served in the Vietnam War, is creating controversy. A request

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to make the statue part of the Vietnam Veteran’s Memorial in Washington, DC, was rejected last fall. The Secretary of the Interior, the National Capital Planning Commission, and the US Commission on Fine Arts reviewed the request made by the Vietnam Women’s Memorial Project. To be placed in the Vietnam Veteran’s Memorial, the statue needed the support of all three agencies; however, the Fine Arts Commission rejected it.

Because of that rejection, legislation has been introduced in Congress that support its inclusion in the Vietnam Veteran’s Memorial. The House bill (HR 3628) was introduced by Rep Sam Gejdenson (D-Conn), and Senate bill (S 2042) is a combination of legislation introduced both by Sen David Durenberger (R-Minn) and Sen

Alan Cranston (D-Calif). The legislation would direct the Department

of Interior Secretary Donald Hodel to work with the Vietnam Women’s Memorial Project. The original draft of the bills eliminated the role of the Fine Arts Commission, but an amendment has been added that would include the commission in the approval process.

To support the statue being part of the Vietnam Veteran’s Memorial, nurses are encouraged to write their congressional representative or the Vietnam Women’s Memorial Project, 5 1 1 1 1 th Ave S, PO Box 45, Minneapolis, MN 55415.

SUSAN SCHLEPP ASSISTANT EDITOR

New Vaccines Studied in United States If licensed, a new chicken pox vaccine will be the first live herpes virus vaccine used in the Uni- ted States. The vaccine for the varicella virus would protect an estimated 3.5 million children who get chicken pox every year. It could be licensed for use on healthy children and adults within two years, according to an article in the Dec 4 issue of American Medical News.

The vaccine was difficult to produce and took longer to develop than any other current vaccine, the article reports. Researchers are not concerned that an injection of the live varicella virus will cause other infections.

In the meantime, due to serious adverse reac- tions to the currently used diptheria-pertussis- tetanus (DPT) vaccine, researchers in the United States and abroad are testing acellular pertussis vaccines that could replace it. A study performed in Great Britian reveals that a permanent neuro- logical disorder is associated with one of every 340,000 doses of the current DPT vaccine. It also shows that whooping cough produces 10 times the rate of brain damage as the vaccine.

The acellular vaccine is also less associated with fever and local reactions.

Cholesterol Levels, Cyclosporin Use Related An inverse relationship between the use of cy- closporine and low total serum cholesterol has lead researchers to conclude that cyclosporine therapy for immunosuppression in liver trans- plantations may cause a syndrome of encepha- lopathy, seizures, and white-matter changes.

According to a study reported in the Oct 1 issue of The New England Journal of Medicine, a retrospective analysis of 54 liver transplantations performed in 48 patients revealed that 13 patients had symptoms of severe central nervous system (CNS) toxicity, characterized by confu- sion, cortical blindness, quadriplegia, seizures, and coma. Computerized tomography and mag- netic resonance studies disclosed a severe, diffuse disorder of the white matter. The study indicated that the 13 patients had a lower total serum cho- lesterol level than patients who did not expe- rience CNS toxicity. All side effects and radiographic findings were reversed with the discontinuation or reduction in the dose of cyclosporine.

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