View On Washington: Staffing Gets Congress's Attention--Even Now. (Frontlines).

Congress's priority of funding a response to the September 11 terrorist attacks placed many healthcare proposals in jeopardy. Yet the long-term care industry could take hope in the fact that legislators in both houses bestirred themselves to work on the industry's big issue of 2001--staffing.

On October 4, Republican Congress-woman Sue Kelly placed a copy of the Nursing Employment and Education Development Act in the hopper of the clerk of the House of Representatives. The so-called NEED Act was designated H.R. 3020 and assigned to be reviewed by a House subcommittee.

Literally hundreds of pieces of legislation follow the same process, but Kelly's introduction of the NEED Act had special significance. The NEED Act had been introduced in the Senate six months earlier as an alternative to the Nurse Reinvestment Act, a bill authored by Democrats. When Kelly introduced the NEED Act in the House, it was a signal that moderate Republicans had convinced their party's House leadership that Congress actually has to spend some money on the nursing staff crisis.

Kelly was a logical choice to send that signal. A midranking Republican from New York's Hudson Valley, Kelly has adopted the nursing crisis as one of her most visible concerns. She has spoken forcefully to national groups about the risk of having most nursing professionals retire just when members of the postwar baby-boom generation are beginning to develop the chronic conditions associated with aging.

The reason for competition between the NEED Act and the Democrats' Nurse Reinvestment Act is difficult to explain--unless you look at the budget numbers (Table). The NEED Act, as sponsored in the Senate by Republican Tim Hutchinson of Arkansas, authorizes approximately $85 million next year and $100 million in 2003 for a variety of grants and scholarships. Further, it would create a $5 million national public awareness campaign to encourage young people to consider nursing as a profession and allocate an additional $30 million among four other recruitment and training programs targeted to specific populations. The NEED Act offers $20 million in grants to nursing homes and other healthcare providers to provide education and training to individuals employed in long-term care, and $20 million in scholarships for would-be nursing school faculty to complete their advanced degrees. It also establishes a National Commission on the Nursing Crisis, which would meet at least four times over two years to discuss long-te rm growth of the nursing workforce.

The Nurse Reinvestment Act, sponsored by Democratic Senator John Kerry of Massachusetts, has a price tag of just under $120 million per year for three years. It includes most provisions of the NEED Act but is less restrictive in funding nurse recruitment programs. In effect, it gives the Department of Health and Human Services more latitude in deciding who will receive grants to educate young people about educational opportunities in nursing.

The crucial difference between the NEED Act and the Nurse Reinvestment Act is in funding for a new National Nursing Service Corps Scholarship program. Both pieces of legislation create scholarships that offer nursing school tuition in exchange for a commitment to be employed for at least two years in a SNF or other facility that is suffering a critical shortage of nurses. Both private- and public-sector nursing homes would be eligible to employ graduates of the scholarship program.

Roughly half of the federal spending proposed in the Nurse Reinvestment Act would be devoted to funding the National Nursing Service Corps Scholarship program. Budgeted at $50 million per year for three years, the scholarship program would fund the education of approximately 1,000 new nurses. In contrast, the NEED Act funds the scholarship program at $10 million for its first year and $15 million each for a second and third year. Although the NEED Act is slightly more generous to the individual recipients of the scholarships, it would support the education of no more than 200 to 300 additional nurses.

The authors of the NEED Act deliberately chose a relatively small Nursing Service Corps. A spokesperson for Senator Thad Cochran (R-Miss.), a cosponsor of the NEED Act, explained that most Republicans want to avoid a scholarship entitlement that might balloon in size. The Nursing Service Corps in the NEED Act is conceived as a means for a few talented, economically disadvantaged students to enter the nursing profession. The Nurse Reinvestment Act, in contrast, features the Nursing Service Corps as the key federal response to the nursing shortage.

In the Senate, the Nurse Reinvestment Act had 38 sponsors by October 1, including six Republicans. The NEED Act had 21 Senate cosponsors on October 2, including five Democrats. Nearly a dozen senators cosponsored both pieces of legislation, forming a bipartisan bloc of moderates who were willing to support either of the competing bills.

In the House there was much less bipartisanship. Until Kelly introduced the NEED Act in October, the only serious piece of nursing crisis legislation under consideration was the House version of Kerry's Nurse Reinvestment Act. Introduced in April, the bill rapidly won support from more than 175 Democratic members of Congress but only a handful of Republicans (including Kelly). In September, however, several influential Republican members of Congress signed on as sponsors of the legislation. They included former Delaware governor Michael Castle, outspoken veteran Ray LaHood of Peoria and physician/legislator Dave Weldon of Florida, the Republican leadership's "star" on healthcare issues. Faced with the prospect of their party members joining as House sponsors of a bill supported by virtually the entire Democratic bloc, the conservative leadership of the House reluctantly agreed to allow the competing NEED Act to be introduced in their chamber.

On October 9, however, Senate Majority Leader Tom Daschle (D-S. Dak.) signed on as a cosponsor of the NEED Act. The following day, he was joined by James Jeffords, the Vermont senator whose defection from the Republican party gave the Democrats control of the Senate. The message of their action was clear: The NEED Act can serve as the basis for an acceptable compromise that can be passed during the 107th Congress.

Table

Comparing Legislative Solutions to the Nursing Workforce Crisis:
The NEED Act (S. 721) and the Nurse Reinvestment Act (S. 706).


Legislative Features               NEED Act (S. 721)

  I. Nursing Service Corps         $10 million in the first year,
     Scholarships                  $15 million in the second
                                   and third years
 II. Scholarships for nursing      $20 million in the first year,
     school faculty members        $30 million in the second
III. Grants to SNFs and other      $20 million per
     facilities for continuing     year for two years
     education and
     residencies/internships
 IV. Education campaign to         $35 million divided among 5
     encourage entry into nursing  specific programs
     profession
  V. National Commission on        $500,000 for meetings over
     the Nursing Crisis            two years

                                   Nurse Reinvestment Act
Legislative Features                       (S. 706)

  I. Nursing Service Corps         $50 million per year for three
     Scholarships                  years

 II. Scholarships for nursing      $46 million per year for three
     school faculty members        years (II and III combined)
III. Grants to SNFs and other
     facilities for continuing
     education and
     residencies/internships
 IV. Education campaign to         $20 million
     encourage entry into nursing
     profession
  V. National Commission on        Not included as a provision
     the Nursing Crisis