Feds deny requests to extend regulation comment period

The U S Department of Health and Human Services (HHS) in August denied requests to extend the Aug 19 deadline for commenting on the proposed Medicare/Medicaid regulations. The document includes a rule that would per- mit operating room technicians and licensed practical (vocational) nurses to circulate during surgery. AORN has opposed the change for over five years and submitted an extensive statement.

The Health Care Financing Administration (HFCA) of HHS had completed tabulating its national hospital survey on the circulating role in mid-August. (See related article in this issue of the AORN Journal for the results.) HCFA said the purpose of the survey was to get a picture of current practice.

rn Passage of a new Nurse Training Act (NTA) was uncertain as Congress moved toward a pre-election recess. Committees in both houses had approved legislation for the health professions. But the Senate panel wanted to continue the current funding program for another year and put the new legislation in place in 1982. Current health professions leg- islation expires this year.

At issue is a three-year authorization that sets the upper limits for funding health profes- sions education programs. Then each year appropriations committees vote on the amount to fund within those limits.

The House committee approved an om- nibus bill for 1981 through 1983, authorizing

Legislation &m %

$101 million for the first year. The Senate rec- ommended $84.3 million for 1982, the first year of its bill. For funds to continue, Congress will need to decide either to pass a new pro- gram or continue the old one. With legislation jammed up at the end of the session, a continu- ing resolution seemed more likely.

Support for nursing education funds does not break cleanly along partisan lines. Presi- dent Carter has opposed continued funding for most of the Nurse Training Act programs, whereas rival Sen Edward Kennedy (D-Mass) advocates continued funding for nursing.

Ronald Reagan's top health advisor, Sen Richard Schweiker (R-Pa) sponsored a mod- erate bill with continued funding for nursing education. But another Reagan health expert, Rep David Stockman (R-Mich), wants to cut health professions funding. With these split views, it is difficult to predict how Reagan would approach nursing education funds if elected.

In August, Regan announced that his chief advisor on health policy would be William Walsh, director of Project HOPE.

rn Congress was due to recess Oct 4, in effect winding up the 1979-1980 legislative session. Lawmakers were eager to get out and cam- paign for the general election Nov 4. All of the U S House of Representatives face reelection, along with one-third of the Senate. Represen- tatives serve two-year terms, and senators serve six-year terms.

The new 1981 -1 982 legislative session be- gins in January. All bills not passed into law before this year's adjournment die. They must be reintroduced in the new session to be con- sidered further.

592 AORN Journal, October 1980, Vol32, No 4

The Nurses Coalition for Action in Politics (N-CAP) announced its initial endorsements for Congressional candidates in the Sep- tember American Nurse. You can find out who has been endorsed in your state by contacting your state nurses association. N-CAP, the political arm of the American Nurses Associa- tion, was not planning to endorse a Presidental candidate.

rn Is there a right to health care? How much are we willing to pay to extend that right to everyone? What kind of programs best serve the poor and the aged? What is the role of private enterprise? Answering these questions may help you decide between voting for Carter or Reagan.

Republicans want to limit government’s in- volvement in health care, whereas the Demo- crats would gradually expand it.

“Republicans unequivocally oppose social- ized medicine, in whatever guise it is pre- sented by the Democratic Party,“ their plat- form states. “We reject the creation of a na- tional health service and all proposals for com- pulsory national health insurance.”

They applaud the voluntary effort by medi- cine and the hospital industry to control costs, adding that “more needs to be done.”

“What ails American medicine is govern- ment meddling and the straitjacket of federal programs,” the GOP states. “The prescription for good health care is deregulation and em- phasis upon consumer rights and patient choice.”

Tax incentives and a reform of federal pro- grams are their proposals for protecting Americans from catastrophic medical ex- penses. They support home health care, pre- ventive care, and physical fitness with few specifics. Accusing Democrats of neglecting the “financial stability” of Medicare and Medicaid, the Republicans promise “a careful, detailed reevaluation.” The platform does not mention nursing education funds nor other health professions issues,

Democrats rejected Sen Edward Kennedy’s comprehensive national health insurance plan in the convention platform floor fight. Instead, they selected Carter’s more gradual approach, which has made little progress in the current Congress. The Carter plan would first cover catastrophic illness, the poor, the aged, and

mothers and infants. “We want to implement fully a comprehen-

sive national health-care program, phased in very carefully so that Congress will buy it after all these years of failure to act,” Carter said in an interview with the New York Times Magazine (July 27).

Democrats have been trapped this year on a merry-go-round of health insurance proposals. There is much they want to achieve-better coverage forthe poor, the elderly, and mothers and children, protection from catastrophic ill- ness, and reform of the cumbersome Medicare and Medicaid systems. But they differ on how fast and how far to go. Stymied by the economy and the budget crisis, they have been unable to come up with a compromise.

Sen Russell Long (D-La) has struggled for coverage of catastrophic illness, while the Car- ter Administration has tried to tack on low- income benefits and Sen Edward Kennedy has held out for comprehensive coverage. Carter had succeeded in getting his Child Health Assurance Program (CHAP) through House and Senate committees, but it was stalled by antiabortion riders and attempts to fit it in to a broader national health insurance bill. CHAP would expand Medicaid eligibility for pregnant women and infants.

Meanwhile, some members of Congress have been flirting with the “competition” ap- proach, which would reform the health care system through such economic measures as tax policy and health maintenance organiza- tions. These approaches are aimed mainly at the employed and have not addressed how to cover the indigent. Strong Presidential leader- ship could make a difference, but Congress must also coalesce around an approach to health policy before much progress is possi- ble.

Patricia Patterson Associate editor

AORN Journal, October 1980, Vol32 , No 4 593