May 31, 2011 - A ballooning budget deficit and the 2010 elections overshadowed every decision the Legislature made during the 2011 Regular and Special Sessions. Adding to cuts made since 2009, the state budget grew from 4.6 billion in December to 5.1 billion in March. To put this in perspective, eliminating all of the state’s four year and community and technical colleges would only save about 3 billion dollars.
The legislature preserved priority health services, but not without severe cuts
For all essential government services in health and education, WSNA not only advocated to maintain these services, but also for new revenue or revenue sources to make up for the budget gap.
Public Health Funding
- Local public health funding administered by the Department of Health sustained a 6.5% cut by the Governor. The legislature cut an additional $10 million to flexible funds.
- Maternity Support Services provides healthcare to women at highest risk for poor pregnancy outcomes like low birth weight and prematurity. To avoid complete elimination by March 1st as proposed the Governor’s budget, WSNA advocated to maintain funding by organizing public health nurses Karson Bennett, Bobbi Merriman-McClain, and Darla Mosse to testify in support of MSS. WSNA also worked with key legislators to develop ways to effectively spend reduced MSS dollars. In the end, MSS was not eliminated, but sustained a cut of 30% or by $26 million.
The Basic Health Plan is the only option for low income adults without access to employer provided health insurance nor can afford private insurance. Proposed for elimination by the Governor, WSNA’s support of House Bills 1544 and 1312, and continued state funding assured some BHP enrollees coverage under a federal waiver until 2014 when implementation of the health insurance exchange will provide more options. Unfortunately, the final budget cuts BHP by $202.5 million and shrinks BHP to 34,000 enrollees by 2013. 150,000 people on the waiting list no longer have access to this program.
Apple Health for Kids provides health insurance and preventative coverage for low income children. When the Governor and Legislature both proposed cuts that would impact the most vulnerable among enrolled children, WSNA supported House Bill 2003 which implemented new changes such as making sure additional premiums are placed on children who could most afford it. As a result, cuts to the program were reduced to $1.6 million.
Other priority health programs that escaped elimination but not drastic cuts include Disability Lifeline, the only source of medical care for individuals who’s disability prevents them from working is cut by $116 million and interpreter services for Medicaid patients. Interpreter services, a requirement of federal law, was cut by $16 million with a new delivery system.
Nursing Education
- Next to healthcare, higher education saw the most reductions. Cuts to institutions of higher education totaled $535 million.
- Students will experience higher tuition and scarce financial aid. All higher education institutions will raise tuition at least an additional 11-16%. Health professions scholarships will not be available in 2011-2013 ($7.6 million in savings to the state); state need grants for low income students are maintained by shifting funds from other financial aid sources, and the state committed to matching private contributions to the Opportunity Scholarship Program for low to middle-income students pursuing a baccalaureate degree in high demand fields, such as nursing.
- WSNA worked to maintain the ability of community colleges to increase funding for nursing faculty from funds gained as a result of salary and benefits saved from faculty turn-over.
Highlights of Policy Bills that WSNA Advocated for Passage
SHB 1304 (Jinkins) Concerning the administration of drugs by healthcare assistants Legislation passed in 2009 intended to allow only HCA categories C and E to administer certain over the counter drugs and diagnostic agents. A technical error gave all HCAs this ability and SHB 1304 corrects this error.
SB 5005 (Keiser) Concerning exemptions from immunization WA state has the highest immunization exemption rates in the nation, endangering everyone in our communities from vaccine preventable disease. This legislation requires parents to consult with a health care provider, including nurse practitioners, about the risks and benefits of immunization when considering exempting their child from vaccination requirements.
SB 5594 (Kohl-Welles) Regulating the handling of hazardous drugs This legislation requires the Department of Labor and Industries and Department of Health to establish regulations for the handling of antineoplastics and other hazardous drugs by health care personnel. Such drugs are linked to higher rates of illness and disease among nurses exposed to them on the job.
HB 5394 (Keiser) Primary care health homes and chronic care management outlines incentives to promote health homes in programs paid for with state funds such as Medicaid and the Basic Health Plan. ARNPs are defined as primary care providers and RNs as part of the health home team.
SB 5445 (Keiser) Establishing a Health Benefit Exchange An operational exchange will be established in WA State by 2014 as required by the federal health reform law.
SB 1058 (Keiser) Including wound care management in occupational therapy establishes educational and training requirements, as well as provider oversight for safe patient care.
HB 1493 (Pedersen) Providing transparency to the health professions disciplinary process revises the Uniform Disciplinary Act. Disciplining authorities, such as the Nursing Care Quality Assurance Commission must promptly respond to inquiries regarding the status of a complaint against a provider and provide a copy of the status of the complaint to both those making the inquiry and providers.
HB 1290 (Green) Concerning mandatory overtime for certain health care employees allows employees of the Depart of Corrections to finally catch up with private sector and be protected from mandatory overtime.
HB 1220 (Rolfes) Regulating Insurance Rates requires public information about how insurance companies will spend dollars from raised premiums, such as how much will go to healthcare versus administration.
SB 5307 (Kilmer) Concerning evaluating military training and experience towards licensing requirements in medical professions establishes for certain health professions the ability to apply military experience towards health professions training. This bill does not apply to Registered Nurses.
SB 5636 University Center of North Puget Sound Managed by WSU, North Puget Sound will provide baccalaureate and graduate degrees, including nursing degrees, for North King, Snohomish, Island, and Skagit counties.
SB 5073 (Kohl-Welles) Concerning the Medical Use of Cannabis establishes a regulatory system for producing, processing, and dispensing cannabis intended for medical use, establishes protections from criminal liability and arrest from qualifying patients, designated providers, health care professionals, licensed producers, licensed processors, and licensed dispensers; and establishes a voluntary registry in which qualifying patients and designated providers may enroll and receive protection from arrest and prosecution. Governor Gregoire vetoed several sections, citing risk of federal prosecution of state employees. Therefore, the Departments of Health and Department of Agriculture will not be licensing commercial businesses that produce, process, or dispense cannabis. Furthermore, DOH will not be licensing dispensaries.
Other bills of note
HB 2069 (Cody) Concerning Hospital Payments In the 2010 session, the Legislature passed HB 2956, a bill imposing assessments (or tax) on most hospitals known as the Hospital Safety Net Assessment, to increase the amount of federal match received. Proceeds are deposited in the Hospital Safety Net Assessment Fund, to be used for increases in hospital payments. Inpatient and outpatient payment rates were restored to June 30, 2009 levels, some hospitals received a 13 percent increase in rates for non-psychiatric inpatient services and a 36.83 percent increase in rates for outpatient services, and $49 million per biennium from the Fund to pay hospitals instead of general fund state dollars.
HB 2069 decreases the inpatient rate increase is decreased from 13% to 3.96% and the outpatient rate increase is decreased from 36.83% to $27.25%. It also permits $200 million to be expended from the Fund in lieu of State General Fund payments to hospitals during 2011-13. The bill has passed the legislature and is awaiting the Governor’s signature.
SB 5960 (Keiser) Concerning Medicaid Fraud would add to current state Medicaid fraud law and
establishes the Medicaid Fraud False Claims Act (Act) which would allow the Attorney General to bring civil actions for certain violations of fraud and false claims provisions and establishes civil penalties between $5,000 and $10,000 and awards of treble damages for violations. It also establishes a right for private citizens to receive 15 to 25 percent of the proceeds from any successful action or settlement achieved by the Attorney General under the Act based upon information provided by the private citizen (qui tam). Medicaid theft is established as a class B felony with a fine up to $50,000.
SB 5960 passed the Senate and the House Ways & Means Committee but died on the House floor calendar.
