Congress left town for the year last week without completing a delayed 2004 omnibus appropriations bill but did manage to pass a one-year extension of legislation that mandates equal health benefits for mental health patients.
Two months after fiscal 2004 began, the House belatedly passed a $328 billion spending bill that would finance some federal government programs for the year, including HHS. The Senate, although it began floor debate on the measure early last week, departed before voting, leaving what could be a politically charged vote to wait until senators return late next month.
In the final tally, the $142.7 million targeted for nursing programs in the House-passed appropriations bill was a bit like a meal at an upscale restaurant-not completely filling but enough to tide things over for now.
For nursing programs, the bill represents a moderate response to requests for additional funding to head off the nation's nursing shortage-up roughly $30 million from last year's allocation but slightly less than what the industry had requested for fiscal 2004. Last year, Congress allocated about $113 million for nursing programs. This year the industry had set its goal at $175 million.
The omnibus bill being considered now is a consolidation of seven of 13 annual spending bills that pay to keep the federal government running. Because Congress could not complete work on those seven bills before Thanksgiving, they were rolled into one package. The bill does not affect the six spending bills that already had been passed by Congress affecting funding for agencies including the departments of Defense, Energy and Interior.
While appreciative of the increase over the previous year, industry representatives also said that the funding would do little in the long run to solve the nursing shortage.
"I'm pleased we got $30 million (more)," said Debbie Campbell, director of government affairs at the American Association of Colleges of Nursing. "We have to be realistic. It's a real tough budget year," and nursing is not a priority, she said.
In addition to funding for nursing programs, the omnibus bill would set aside $518 million for hospitals for homeland security preparations and $39.8 million for rural healthcare outreach programs. Community health centers would receive $1.6 billion while the National Institutes of Health would get about $28 billion.
Of the overall $328 billion in discretionary spending in the omnibus bill, HHS would receive $62.1 billion. Including funding for mandatory programs such as Medicare and Medicaid, the bill totals $820 billion and HHS' share rises to $360.4 billion, up from $316 billion for fiscal 2003. Funding for mandatory programs is set administratively by the separate agencies, while funding for discretionary programs is determined by Congress. The Senate is not expected to vote on the bill until after Congress returns Jan. 20, 2004.
If recent history is any indication, the process may extend beyond that. Congress didn't approve the 2003 appropriations bill until mid-February, more than four months after the fiscal year began. Sen. Ted Stevens (R-Alaska) has expressed concern about dragging out the process because it may hurt veterans' access to healthcare. New doctors and nurses cannot be hired and new clinics cannot be opened until the fiscal 2004 budget is resolved, Stevens said.
The appropriations bill also would scrap opposition to changes in overtime rules that the Bush administration has proposed. Earlier this year, the administration proposed changing the criteria dictating which workers are eligible for overtime. The Senate had initially rejected the administration's plan in earlier versions of the spending bill, but backed off under pressure from the administration in the version being considered last week. If the changes go through, many nurses would be ineligible for overtime pay, the American Nurses Association has said.
"For a lot of nurses the difference between being paid overtime and not is the difference between a good week and making ends meet," said Chris Donnellan, associate director of government affairs at the ANA.
Also last week, the House gave its nod to separate legislation that would extend for one year the Mental Health Parity Act of 1996, which required insurers to maintain the same lifetime and annual benefits for mental health patients that individuals being treated medically or surgically receive.
The 1996 law, however, contains major loopholes that need to be filled with more sweeping legislation that addresses mental health parity, according to some lobbyists for the industry. For example, some employers have found ways to skirt the law by placing limits on outpatient office visits and the number of days inpatient care is covered.
"I don't think one can really close one leak in the dike and avoid the problem of flooding," said Ralph Ibson, vice president of government affairs at the National Mental Health Association.
A White House spokesman said that President Bush is likely to sign the bill but declined to specify when.
Looking into next year, Ibson's group said it would work to close remaining loopholes. Sens. Pete Domenici (R-N.M.) and Edward Kennedy (D-Mass.), proponents of closing the gaps in coverage and making mental health parity permanent, have indicated that Sen. Judd Gregg (R-N.H.), chairman of the Senate Health, Education, Labor and Pensions Committee, would make such legislation a top priority early next year.
Parity was one of the top concerns of Sen. Paul Wellstone (D-Minn.), who died in a plane crash in October 2002, and mental health advocates hope to pass more comprehensive legislation to honor his memory.
-with Jeff Tieman