HEALTH CARE FUNDING

As anyone in health care delivery knows, funding drives good care. Therefore, legislation affecting Medicare and Medicaid is always pertinent to nurses. President Bush’s tax cut, enacted earlier this year, was said to greatly diminish any budgetary reforms that would have boosted Medicare and managed care coverage.

That tenuous discussion about Medicare changed dramatically and permanently with the events of Sept. 11. Debate earlier in the year was inching toward some mild reforms for Medicare proposed by President Bush. One of the most visible reform issues was prescription benefits for seniors. Although some see a resurrection of the issue, most believe that it cannot survive the competition from bioterrorism appropriations bills.

The battered economic climate helped contribute to Medicare spending increases of 10 percent for fiscal year 2001-the largest increase since 1995. Even without the damage of terrorist attacks, the increases have been attributed to health care inflation and the growing number of beneficiaries. Medicare beneficiaries will likely bear a portion of increased costs with increases in premiums, deductibles and co-payments. (Medicare is expected to spend $41.7 billion on physician services in 2002, a $500 million increase.)

Another legislative casualty of Sept. 11 is broader coverage for the uninsured. Wakefield believes any progress in securing coverage for the uninsured will be stalled for a while, which will exacerbate the problem.

“Much of health care funding for the uninsured is supported by state government or state-federal partnerships. For a lot of states, we now have a markedly weakened financial situation with revenues rising, unemployment rising and the economy slowing. [But] by law, states are required to operate with a balanced budget. Thus, they will need to find cuts,” Wakefield said.

“There is a big outflow of money when people are out of work and not paying taxes. This, in turn, increases the state’s welfare rolls. States are feeling a tremendous pinch all over,” she said.

“Consequently, they will be belt-tightening, which will include health programs.”

Wakefield points to a rough economy as increasing the burden on state budgets as well as reducing the number of employers who offer health insurance. “Employers are getting double-digit increases to cover their employees. They will want to shift those costs to their employees,” Wakefield said.

Small businesses, especially, cannot afford 10 percent increases, she added, so employers will drop coverage. Increased costs and a weakened economy are likely through the end of 2002.

As 2001 winds down, Wakefield offers a summary of where the next legislative calendar is headed:

“It’s important for nurses to stay engaged in the discussion and debates,” she said. “When the cost of care goes up, access goes down and quality of care suffers. Nurses need to offer their perspective on what can be done and how to address those issues. Nurses, after all, are there to protect the public’s access to care. This is the time to provide accurate information to policy-makers and the public when these hard choices [about care and delivery] are made,” she said.

“It’s important for nurses to contribute to the national and state dialogue. How [else are] they going to make sure the voice of nurses is heard for the benefit of the public’s health?”