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ANA says Obama's budget would strengthen nursing

Wednesday April 10, 2013
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The American Nurses Association expressed its support for President Obama’s budget, released Wednesday, for including “vital investments that strengthen the nation’s healthcare system,” according to a news release.

The ANA commended the $251 million allocated to the Title VIII Nursing Workforce Development programs. The approximately $20 million increase over Obama’s previous budget proposals is designed to allow these programs to continue recruiting new nurses into the profession, promoting career advancement within nursing and allocating nurses to critical shortage areas.

“With the proposed increase to Title VIII funding, the Obama administration continues to recognize the invaluable contribution that nurses make in the delivery of care and the need to strengthen our primary care system,” ANA President Karen A. Daley, RN, PhD, FAAN, said in the news release. “This proposed budget takes the long view and reflects tough choices by the Obama administration, while still supporting programs that are needed to transform the healthcare system and improve health for all.”

From the ANA’s perspective, other worthwhile healthcare investments in the budget include:

• $80.1 billion in discretionary funding for the Department of Health and Human Services for investments in the implementation of the Affordable Care Act, medical research and other priorities;

• $803.5 million for insurance exchange operations, part of the ACA;

• $235 million in funding for new mental health programs, including $50 million to train master’s-level mental health specialists such as nurses, psychologists and counselors who work in schools. The funding is designed to expand the mental health workforce and help schools detect early warning signs in students that can threaten the safety of classmates, teachers and the surrounding community;

• $3.8 billion for community health centers that will provide key primary care services for underserved communities.

Obama’s budget proposals drew criticism from some healthcare groups.

The budget seeks to achieve deficit reduction through a combination of revenue increases and spending cuts. Among the proposed cuts is $400 billion in federal health spending, mostly on Medicare. The decrease would affect both providers and beneficiaries.

“The solution to what ails our nation’s fiscal health is not further cuts to providers that care for millions of America’s seniors, but creative solutions to modernize the Medicare program,” Rich Umbdenstock, CEO of the American Hospital Association, said in a news release.

The Affordable Care Act includes various provisions that reduce the rate of payment growth to Medicare providers. Hospital representatives stated they could accept these decreases, figuring the influx of newly insured patients would make up for the shortfall.

However, the automatic spending cuts that went into effect March 1 included additional reductions in Medicare provider payments of 2%. Obama’s budget would negate those cuts but would include other measures such as a $25.5 billion decrease in bad debt payments to providers and reductions in allocations for graduate medical education and payments to critical access hospitals (which serve rural areas).

Obama also proposed saving $79 billion by adjusting the reimbursement rate for post-acute care facilities.

"Our initial reaction is one of deep alarm about [the budget proposal’s] broad parameters and the inclusion of even more substantial Medicare cuts on top of $65.6 billion, 10-year reductions already slated for the U.S. [skilled nursing facility] sector," Alan G. Rosenbloom, president of the Alliance for Quality Nursing Home Care, said in a news release. "There is no doubt quality patient care would be threatened, workforce stability further destabilized, and the ongoing ability to sustain successful rehabilitative care outcomes jeopardized."

Among other healthcare-related items in the budget proposal:

• Physician practices would be able to count on stable reimbursement rates because Obama’s budget would freeze the rates at their current levels. Without such a measure, Medicare payment rates are scheduled to decline by 24.4% on Jan. 1.

The White House reportedly hopes for a long-term fix to the sustainable growth rate formula in conjunction with payment models that move physician reimbursement away from fee-for-service. The American Medical Association lauded the concept, with association President Jeremy Lazarus, MD, saying Obama’s proposals "align with many of the principles developed by the AMA and 110 other physician organizations on transitioning Medicare to include an array of accountable payment models."

• Although general Medicare benefits and the eligibility age would not be affected, higher-income seniors would have to pay a larger share of their premiums. Low-income seniors would benefit in the form of mandatory drug rebates.

• Reductions to Medicaid will be comparatively slim and mostly involve increasing cuts in disproportionate share payments to hospitals that serve significant numbers of low-income patients. Those cuts already were called for in the ACA. The budget actually would limit those cuts in 2014 in recognition of the likelihood that some states will opt out of expanded Medicaid coverage, then expand the cuts in 2016-17.

"The reality is that one in four hospitals operate in the red, so additional cuts will hamper their ability to provide access to the latest treatments and technologies, and could result in fewer caregivers and longer waits for care," Umbdenstock said.

Chances are slim that Obama’s budget will pass without changes. Republicans in the House of Representatives, seeking to implement more substantial cuts and changes to Medicare, will have their say. Some congressional Democrats are concerned about a proposal to reduce the rate of growth in Social Security payments.

The budget proposal is available at www.whitehouse.gov/omb/budget.


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