Eye on Washington

The 104th U.S. Congress: Outcomes and Alarms

The 104th Congress has left town for the year. What, if anything, happened? Certainly not what we heard all the rhetoric about throughout the year. The promise to topple the federal regulatory fortress had only a few bricks shaken loose. The Commerce Department is still in place. The Department of Energy continues and even got a small budget increase. The Environmental Protection Agency turned criticism of its operations and priorities into budget increases and a great deal of public support. OSHA, the Occupational Safety and Health Administration, which we were prepared to hold a wake for, is still running-also with a budget boost. The November 5th election loomed high in the waning days before the October 4th closure of Congress as the anti- regulatory focus and fervor for cuts seemed to vanish. The federal agency budgets for fiscal 1997, which were signed into law by President Clinton September 30th, to be effective October 1,1996 (no sense in completing bud- get too early!), were described in the Washington Post to be "like pennies from heaven" (Skryzycki, 1996). Congress did pull the plug on the Bureau of Mines helium program created in 1925 and the FDA's Tea Tasting Board.

The $600 billion catch-all federal spending bill bun- dled six appropriations bills, including those of the Departments of Health and Human Services, Labor, Defense, Commerce, Justice, State, Treasury, and the Postal Service. Included in this bill were sweeping measures to combat illegal immigration and a package of banking law changes that strengthens the thrift deposit insurance fund. The DHHS appropriation includes about $356 billion for domestic programs and benefits with increases for programs such as disease prevention, substance abuse control, and domestic vio- lence initiatives.

Nursing and health care fared with more positive than negative results. Nursing programs funded by the Nurse Education Act at $65 million is a $7 million increase over FY 1996. The National Institute for Nursing Research (NINR) received a $4 million increase and is budgeted at $59.7 million. OSHA and NIOSH (the National Institute for Occupational Safety and Health)

received $22 million and $13 million increases, respec- tively, within their $325 million total appropriation. We are always vigdant about these two agencies because of nursing workplace health and safety concerns. Finally, the AIDS Education and Training Centers (AETECs), with intensive advocacy efforts by nursing and other provider pups, did not vanish as proposed but actually got a $4 million increase over FY 1996. The American Nurses Association's premiere government relations staff commended the Congress and the Administration for recognizing the contributions of professional nursing to the health and welfare of our citizens (ANA, 1996).

In a surprising first for federal health intervention, on September 26th President Clinton signed into law P.L. 104-204, the first step in mental health parity. The bill requires that group health insurance plans cover mental illness at the same annual and lifetime limit as physical ill- ness. While it applies only to insurance plans that include mental health coverage and does not apply to companies with 50 or fewer employees, the bill's spon- sors, Senators Domenici (R-NM) and Wellstone (D-MN), nonetheless called this a historic first step toward equal treatment for people suffering from mental illness. I am sure nurses everywhere agree with that assessment. We finally see a crack in the door of stigma and discrimina- tion. Hooray for all of us! Be assured that next year nurses will once again mount the advocacy trail for equal coverage, especially for mental and physical care such as that which was dropped in the House-Senate negotiations of P.L. 104- 191, the Kassebaum-Kennedy Reform Bill.

What I have not shared with you is how children and families fared in this 104th Congress. This is not a pretty picture and all the details are not in yet. For starters, the General Accounting Office released a report early in the summer that indicated a steady decrease, since 1987, in the percentage of children with private health insurance coverage. A Government Accounting Office report titled "Health Insurance for Children: Private Insurance Coverage Continues to Deteriorate," found that 14.2% of children had no health insurance coverage in 1994 and 2.9 million Medicaid-eligible children were not enrolled.

JCAF" Volume 10, Number 1, January-MarCh, 1997 47

Eye on Washington

This number represents 30% of all uninsured children from birth to 5 vears old from famhes below the poverty level. In effect, 30% of eligible children below the poverty line have no health coverage in the most formative years of life (Health, 1996).

In the next issue of ths journal I wdl ask you to walk with me in a closer examination of welfare reform and its direct effect on the cluldren, adolescents, and f d e s you come in contact with each day. As you know, these are not nameless, faceless numbers to be thrown around by politicians in an attempt to pass a reform bill. Banners and rallies such as the “Stand for Children” march, the “Who Speaks for Children?” rally, the Children’s Crusade, and Save the Cluldren Fund all call for someone to fdl the leadership vacuum. There is a great void as to where this nation stands in its resolve to do what is neces- sary for our children to reach adulthood with healthy bodies, minds, spirits, and emotions. We are lanpshing in attempts to have vitality, productivity, and optimism instilled in our future generations. In a June 1996 Time magazine poll (Gleick, 19961, 73% of Americans ”favored spending more tax dollars on programs to help duldren” (p. 31 ). Nutrition, immunizations, day-care, teen preg- nancy prevention, and pre- school education were given highest priority by up to 67% of respondents. The diffi- culty for many concerned people is to find a way to ”help poor and needy children without subsidizing their par- ents’’ (p. 31). Hence, we have a welfare reform law signed by the President. Attention nurses, tlus is happening on our watch! How can we engage broad-based politics around family issues in an effective way? Many of us

travel across the country as well as within federal, state and local circles, and we are alarmed by the greatly diminished enthusiasm for experimental models and community-based efforts to reform our current system. In a democracy, experts purport that values dominate policy and the only time you get a change in policy is when there is a correspondmg change in values. Is that what we are experiencing? A change in values related to children and healthy futures? This should serve as a wake-up call for advocates for children.

References

Gipitiil Updntt7. American Nurses Association. (1996). Washington, DC.

Gleick, E. (1996, June 10). The children’s cmsade. Time, 247, p. 31.

Health insurance tor children: Private coverage continues to deteriorate (GAO/HEHS-96-129). (1996). Washington, DC: Government Accounting Office.

Skrzycki, C. (1996, October 18). Rock blunts scissors, and agencies with- stand clutters. The Washington Post, pp. F1-2.

Vanderbilt, M., & Shelin, A. (1996, August 30). Legislative update: Welfare reform enacted. Capital Updnte. 14(6), 2-3.

v. 16, p. 1.

Sarah Stanley, MS, RN, CS Senior Policy Analyst

Deparhnnit of Practice, Economics, and Policy American Nurses Association

N e s t issue: Public LOW 104-193, The “Personal Respomibility and Work Opportunity Reconciliation Act of 1996“ (i.e. the zuelfare reform act)

These CE offerings from the previous issues are still available: Title Contact hours cost JCAPN Issue Reducing Violence in a Child Psychiatric Hospital Through 1.5 $9.00 Apr-Jun ’96 Planned Organizational Change

Retardation, and Related Disabilities: Ethics and Efficacy Parents‘ Perceptions of Their Child’s Emotional Illness and Psychiatric Treatment Needs

Behavioral Treatment of Children With Autism, Mental 1 .0 $9.00 Jul-Sep ’96

1 .o $9.00 Oct-Dec ’96

Call Buchanan & Associates: 800/929-1233

48 JCAPN Volume 10, Number 1, January-March, 1997