Medicaid cuts a major issue in House-Senate
budget conference

The Senate in March voted 52-48 to remove a proposed $14 million cut to Medicaid from its fiscal year 2006 budget resolution and instead to create a commission that will study Medicaid.

The Senate originally called for the Finance Committee to find $15 billion in savings from programs under its jurisdiction, most of which—about $14 billion—was expected to come from Medicaid.

Such a deep Medicaid cut would increase pressure on the already stressed healthcare system. The loss of Medicaid funding means healthcare providers would face lower Medicaid reimbursements at the state level, which could have devastating consequences for hospitals and nursing homes across the country, including an increase in uncompensated care; sicker patients who delay care because of costs; and less job security for healthcare professionals.

The quality of care that patients receive and the working conditions for healthcare providers erode when hospitals are reimbursed below the cost of providing care.

The amendment, co-sponsored by Sens. Jeff Bingaman (D-N.M.) and Gordon Smith (R-Ore.), restores the $15 billion and creates a bipartisan commission to study Medi-caid and to provide recommendations to improve the program.

The vote "was important because it showed rare bipartisan cooperation," says AFT president Edward J. McElroy. "Instead of stripping federal Medicaid funds, the Senate’s action provides a fairer process to control runaway healthcare costs at the state level."

Meanwhile, the House voted 218-214 to pass a 2006 budget resolution that would cut $20 billion from Medicaid over five years. The cut is in line with President Bush’s fiscal year 2006 budget proposal, which contains a $60 billion cut to Medicaid over the next 10 years.

The competing versions of the budget resolution will now go to House-Senate negotiators. Reconciling the House and Senate budgets could be difficult because of the approved Medicaid amendment. However, AFT members still have time to contact their representatives in Congress and ask them to keep Medicaid cuts out of the joint budget resolution.

Bill would establish staffing standards in hospitals nationwide

Federal legislation to improve patient care while helping to ease the national nursing shortage has been introduced in the House. The Nurse Staffing for Patient Safety and Quality Care Act of 2005, introduced March 10 by Rep. Janice Schakowsky (D-Ill.), would set minimum nurse staffing ratios in hospitals that would give direct care nurses more manageable patient loads.

This would improve retention of nurses who have been leaving direct patient care because of increased workloads created by inadequate staffing, says the AFT. "Numerous studies show that the quality of patient care is directly connected to nurse staffing levels," says AFT president Edward J. McElroy. "By requiring safe staffing ratios in hospitals, the federal government will help improve the delivery of high-quality healthcare in our nation."

This legislation also could reduce the number of medical errors, says McElroy, "which not only cause unnecessary deaths but add billions of dollars to our nation’s runaway healthcare costs."

The measure calls on hospitals to establish minimum direct care registered nurse-to-patient ratios in designated units, such as pediatrics or the emergency room. Hospitals would be required to develop and implement a staffing plan, with the input of their direct care nurses, no later than two years after the bill is enacted into law. Hospitals that failed to comply with the staffing standards could face monetary penalties or a loss of funding.

The legislation currently has 15 House co-sponsors.

Bid to block staff ratios in Calif. denied

A state appellate court in April rejected a request from the California Hospital Administration and Gov. Arnold Schwarzenegger to block a lower court decision that maintains new hospital nurse staffing ratios.

In March, a Sacramento Superior Court judge declared that an emergency regulation issued by the governor in November 2004 to block stricter nurse-to-patient ratios was not valid and that the nurse staffing-ratio law, which went into effect on Jan. 1, 2004, must be upheld.

The decision by Judge Judy Holzer Hersher forced California hospitals to immediately restore safe staffing in emergency rooms, and implement ratios of no more than one RN for every five patients in general medical units as the hospitals were supposed to do in January 2005.

PEF launches broad-scale attack on privatization

One million dollars: That is how much the New York State Public Employees Federation (PEF) is investing in quality public services and its members who work for state government.

In February, PEF, the largest AFT Public Employees local, launched "Go Public: Invest in Public Employees, The Returns Are Better for New York Taxpayers." The $1 million campaign against privatization of public services will be implemented over 20 months.

Phase one, already under way, includes print advertisements to educate the public and policymakers and a Web site (www.stopprivatization.org) that provides access to case studies, privatization failures in New York and analyses debunking the affordability and efficiency myths that the private sector is a better provider of public services.

PEF hopes its investment will produce excellent returns—accountability within state government, including the legislative and executive branches, for quality public services.

"We have been telling state policymakers for years that the loss of accountability, when they take public services out of the hands of state employees and hand them off to others, costs New Yorkers far too much both in tax dollars and lost quality," says PEF president Roger Benson. "We are telling the state to save money and improve the quality of its public services by putting them back in the hands of state employees and by setting rigorous rules and standards for the awarding of any future contracts to the private sector."

Among the rules and standards PEF is lobbying the Legislature to establish are full disclosure by state agencies of the number of contract employees they use and mandatory cost-benefit analyses before contracting out.

Oregon bill seeks to protect nurses from workplace violence

Oregon lawmakers Sen. Rick Metsger (D) and Rep. Andy Olsen (R) are co-sponsoring legislation that would increase protection from workplace violence for all of the state’s nurses and home healthcare workers.

The Nurse Violence Protection Act creates a statewide, mandatory reporting system that would help nurses, hospitals and home healthcare workers keep track of violent patients and the places where violence occurs.

The legislation would ensure that nurses who report violent acts would be legally protected from employer reprisals. The bill also would allow the Oregon Health Division to place sanctions on any healthcare facility that did not adequately protect its nursing staff from workplace violence.

In addition, the measure would allow home health nurses to refuse to visit homes alone if they fear for their safety, and would require employers to provide cell phones to use in emergencies.

"This legislation helps give nurses and home healthcare workers the information they need in order to make the best decisions to keep themselves safe," says state Sen. Metsger. "Nurses are often in a very vulnerable position. It is their job to protect us, so it is our job to protect them."