U.S. Rep. Jim Nussle (R-Iowa) champions rural healthcare provider issues-but not just because the six-term congressman hails from a rural district.
"It's personal," Nussle says.
In early 1989, a year before he first ran for Congress, Nussle's infant daughter was rushed to the local 35-bed Regional Medical Center of Northeast Iowa and Delaware County in Manchester, Iowa, suffering from heart failure.
"They saved her life. I just know that," Nussle says.
During her stay at the hospital, Sarah's condition worsened. She was transferred to the University of Iowa Hospitals and Clinics, Iowa City, where surgeons performed open-heart surgery.
"It gives you an appreciation of the network of healthcare, that it is not just a one-stop shop," Nussle says. In Iowa and rural areas in particular, children and senior citizens rely on that network to be bolstered by the Medicare program, Nussle says. "It's all pretty interlaced and pretty dependent on each other for survival."
Healthcare issues affect all segments of the population, but when legislators face them-as a patient, family member or a member of the profession-they see the human side of the industry, far beyond the statistics, dollars and policy. The experience often prompts lawmakers to throw their clout behind legislation.
Today Sarah is a healthy preteen. But the role of the rural hospital in saving her life has had a strong influence on Nussle. "If that facility wasn't there, who knows what would have happened. That is true not only for Sarah but for hundreds of people, thousands of people in Iowa and across this country who depend on these rural facilities."
Nussle advocated rural provider issues as chairman of the Congressional Rural Health Care Coalition from 1997 to 2001. Now, as chairman of the House Budget Committee and a member of the House Ways and Means Committee, Nussle continues to advocate for rural health providers. Last month, he successfully added a provision that would increase Medicare base payments for rural hospitals to those of equally large urban hospitals by 2004 to the Medicare prescription drug package passed by the House in June.
"It's always in the back of my mind," Nussle says.
It happens time and time again in Congress, says Alan Morgan, vice president of government affairs and policy for the National Rural Health Association. The Kansas City, Mo.-based group has found a natural pairing with Nussle. "When they have a personal experience dealing with the healthcare system or a certain sector of it, they have a better understanding of what is needed to make sure you have a good system ... of healthcare."
Observers also say those firsthand encounters with the healthcare system often educate lawmakers the most. "Then the power of policy fades and the power of personal experience locks their focus," says Richard Wade, spokesman for the American Hospital Association.
When hospitals wanted lawmakers to roll back the effects of the Balanced Budget Act of 1997, the AHA found personal connections between lawmakers and its members. Perhaps the hospital had cared for the lawmaker or a family member, or a family friend worked at the facility.
"All of a sudden, the impact of policy is real in human terms," Wade says.
Senators on their side
Often lawmakers are so affected by a health issue that they act on their own, and provider groups help lay the groundwork.
Such is the case of the Mental Health Parity Act, a 1997 law that required health insurance policies to cover mental health treatment. Its authors, Sens. Pete Domenici (R-N.M.) and Paul Wellstone (D-Minn.), both have family members who suffer from a mental illness. The senators want Congress to pass legislation that would require insurers to cover treatment of mental illnesses to the same extent that they cover physical treatments. Last year, the bill passed the Senate as an amendment to an appropriations bill but was blocked by the House. Momentum is building, however. In June, the Senate bill had 66 co-sponsors, and a companion House bill has 237 co-sponsors.
"It makes our jobs a lot easier," says Michael Strazzella, American Psychiatric Association deputy director of congressional relations. "You can have someone sit down on a peer level to discuss the effects in society."
Wellstone does not often publicly speak about his brother, who suffers from depression. But it has had a profound impact on the senator. "Our family's firsthand struggle with the problems of lack of coverage for mental illness treatment has played a major part in shaping my legislative efforts in Congress," he wrote in an op-ed article in the St. Paul Pioneer Press on Jan. 27.
Domenici would not discuss his personal situation, but says it led him to meetings sponsored by the National Alliance for the Mentally Ill. "I just got to where I knew what was going on in the lives of hundreds and hundreds of families who have young people whose parents do not have the capacity," he says. "They are not covered, and it has just totally destroyed their lives."
The five-term senator persuaded President Bush to propose mental health parity legislation by the end of the year-influence the mental health associations could not muster on their own, Strazzella says.
Lawmakers with that kind of power are key, says William Dombi, vice president of law for the National Association for Home Care. Although many members of Congress tell him they have had family experiences with home care, those who sit on committees with jurisdiction are the ones who can make changes.
It helps if they are in the majority party. But when someone like Rep. Karen Thurman (D-Fla.) has a compelling story, it doesn't matter that she is a member of the minority party. "She will have the opportunity to speak on those issues with those who have the power to move this forward," Dombi says. "It means a very positive impact for home care."
Thurman lived through the expense and mounds of paperwork of home healthcare firsthand after her 74-year-old mother, Donna Loveland, had surgery to remove jaw cancer in 2000.
Thurman was no stranger to home care. She represents an elderly population and has family members who have experienced short-term home health visits. But managing multiple needs on a daily business was a new experience and one she carried out while making decisions as a member of the Ways and Means health subcommittee.
"When you are looking at legislation, certainly anything you have an experience with makes you a better advocate for an issue because you have a real-life experience no different than anybody else that comes into this office," says Thurman, who fought for home health dollars in this year's Medicare package.
Loveland had lived with Thurman for 14 years, following her from Tallahassee to the nation's capital. Through home healthcare, she continued to live with Thurman until her death in January 2001. "I figured that with my funds and her funds, if I could keep her home that is what we were going to do," Thurman says.
At first, Medicare paid for the highly skilled needs, including bandage changes, tube feeding and speech therapy. Then Thurman had to switch to private services.
At $26 per hour, home healthcare was costly, especially for a family with two children in college. "If my mother had stayed alive for another two or three months, frankly, I don't know what we would have done," she says.
Thurman has tried to make sure others won't have the same experience. For the past year, she and Rep. Nancy Johnson (R-Conn.), chairwoman of the Ways and Means health subcommittee, have pushed for a bill that would provide a tax deduction for anyone who buys a long-term-care insurance policy. The bill also would provide caregivers an annual $3,000 tax credit.
Colleagues listen to Thurman because they saw her managing home care for her mother while working on the Hill. "You tend to put a face on an issue that is real out there in districts across the country," Thurman says.
Drawing from experience
Members of Congress who have had personal experience with healthcare issues have strong track records of crafting legislation to improve the system. It has been a mission for Sen. Max Cleland (D-Ga.) going back to his days as a state senator and as the Veterans Administration administrator from 1977 to 1981. The first-term senator has been a strong supporter of patient rights, long-term and home care, and nursing issues.
Much of Cleland's inspiration comes from his own encounters with healthcare providers. An Army captain in the Vietnam War, he lost both legs and an arm after a grenade exploded in 1968. He spent 18 months in VA hospitals.
"Every day that I was in those hospitals, I wanted to go home and function as close to a normal human being as I could," Cleland says. "I was very frustrated with my care because I wanted to get up and get out and get going."
Cleland recently introduced legislation that would lift a ban on nurse practitioners and physician assistants from practicing in a home-care setting so more patients can live at home and receive treatments instead of traveling to an institution or receiving care as an inpatient.
"Sometimes governmental regulations actually impede the progress of people rather than facilitate them," Cleland says.
Doctors-and nurses-in the House
Personally experiencing an illness or injury isn't the only way to see the nation's healthcare profession firsthand. Along with the scores of traditional lawyers, Congress counts among its members nine physicians and three nurses.
"Every day that I am here, I draw upon my skills as a nurse," says Rep. Lois Capps (D-Calif.), who is still an active member of the American Nurses Association. She often talks with Rep. Carolyn McCarthy (D-N.Y.), also a nurse, who, like Capps, has pushed for nurse-specific legislation, and Rep. Eddie Bernice Johnson (D-Texas), a former nurse who has lobbied for health-related issues, largely in the Black Caucus.
"We all have our niche to play, but we all talk to each other," Capps says.
"I wish we had a hundred more," says Erin McKeon, associate director of government affairs for the ANA. "They introduce better legislation because they know. They understand the impact and the problems."
McKeon credits Capps with pushing the Nurse Reinvestment Act, which would address the current nurse shortage. On the Hill, Capps has a reputation for buttonholing colleagues on nurse issues. It reminds her of the time she spent time as a school nurse persuading local organizations to contribute eyeglasses and other items for students.
"I have done that all my life," Capps says. "It is no different here."
That realization led Capps to run for Congress in 1997 to fill her husband's seat after he died of a heart attack. She cited her experience as a nurse when she persuaded colleagues to name her to the coveted House Energy and Commerce health subcommittee. There she has fought for more Medicare funding for providers.
"It gives me a fresh perspective that is valued just because people understand where I have been," she says.
Her caregiving experience has helped her take a broad perspective on provider issues, not just the nursing industry. "We are in a healthcare crisis. We need to be focused on the issues from a variety of perspectives," Capps says.
McCarthy agrees. "In thinking as a nurse, you have to think holistically and in a whole circle," she says.
McCarthy was a practicing nurse for more than 30 years until Dec. 7, 1993, the night her husband was killed and her son was seriously injured by a gunman on a Long Island commuter train. Months later, McCarthy ran for office to fight for gun control. But her interest in the healthcare profession continues.
She routinely meets with hospital administrators and nurses to talk about current conditions. Sometimes the conversations yield tidbits of information that lead to a bill. When a hospital administrator made an offhand remark that HMOs were slow to pay providers, McCarthy last year acted by introducing prompt-pay legislation, a bill that has been referred to several House subcommittees.
She also has tackled familiar issues such as mandatory overtime for nurses. Earlier this year, McCarthy, along with Rep. Mary Bono (R-Calif.), introduced legislation that would award grants of up to $500,000 for hospitals that attain "magnet" status from the American Nurses Credentialing Center's Commission on Accreditation. Magnet hospitals are more collaborative and patient-centered, and typically retain nurses twice as long as other hospitals, McCarthy says.
Most important, McCarthy is aware of the many different aspects of nursing today and is working to make sure laws have language that includes all of them. "I've got 434 patients here in Congress. It's my job to educate them as much as possible," she says.
The medical profession can be a campaign issue, too. In his race against Sen. Thomas Harkin (D-Iowa), a lawyer, Rep. Greg Ganske, M.D. (R-Iowa), is using his experience as a plastic and reconstructive surgeon as a platform. "Lawyers are trained to argue. Physicians are trained to solve problems," Ganske says.
The four-term congressman has pressed for medical malpractice reform and increased Medicare payments for physicians. "They are at the point where (doctors) cannot take any more patients into their practice and still meet expenses and make some type of living," says Ganske, a member of the Energy and Commerce health subcommittee.
The problems he faces as a member of Congress may differ from the operating room, but they are no less satisfying to solve. "It takes a lot longer to get things done here," Ganske says. "But when you get something done, then it is affecting a pretty large number of people."