News from Capitol Hill
Aging Committee Hears Impact of Reagan's Budget
On April 6, the House Aging Committee held a hearing to consider the impact of the proposed Reagan budget on older adults, at which Director of the Office of Management and Budget David Stockman defended the President's 1982 budget. Stockman repeated the common theme that the elderly would fare better than most groups after the budget's cuts. Proposals in the budget package that would affect the elderly include:
Social Security. The Administration Budget recommends: The elimination of the minimum benefit ($122) received by 3.1 million persons; elimination of the lump sum death benefit ($255) for beneficiaries without survivors; elimination of postsecondary student benefits for future students and reduction of existing students' benefits by 25% each year beginning in 1982; stricter requirements for disability benefits.
Medicaid. The Administration proposes a "cap" on Federal contributions at $17.2 billion in 1982 rather than continuing a Federal match of state expenditures for health care for the needy. Currently five million low income older persons participate in the Medicaid program.
Medicare. The Administration proposes repeal of the expanded home health benefits approved by Congress last year. Also, nursing homes would be inspected less frequently, nursing care reimbursement would be cut, and reimbursement would not be provided for the pneumococcal vaccine.
Food Stamps. The Administration proposes to reduce the food stamp program by $ 1.8billion by changing the eligibility levels. Eligibility also would be determined on the basis of retrospective, rather than prospective, income.
Title XX. The current Title XX program would be replaced by a new Social Services program providing block grants to states. One million older persons presently are receiving services through Title XX.
CETA. If approved, the $4.7 billion cut in CETA funding will mean that 26,000 older workers will lose their positions. Equally affected are the services provided by CETA workers to as many as 270,000 older adults.
Housing, energy assistance, legal services, and Supplementary Security Income are programs for older adults that also will be hit hard by the budget cuts.
The Senate Aging Committee has reviewed the proposed 1982 budget and its impact on older adults. A summary, "The Proposed Fiscal 1982 Budget: What It Means For Older Americans" is available from: The Senate Aging Committee, Room G233, Dirksen Senate Office Building, Washington, D.C. 20510.
Economic Recovery Program Reviewed
In March, Department of Health and Human Services (DHHS), Secretary Richard Schweiker appeared before several committees responsible for reviewing the Administration's proposed budget cuts. The Secretary read a statement to the Senate Finance Committee summarizing the Department's portion of the Administration's Economic Recovery Program, including changes in the areas of Social Security; Welfare; Medicare/Medicaid; and the four proposed Block Grants (Health Services, Preventive, Social Services, and Energy and Emergency Assistance).
Appearing before the House Budget Committee, Secretary Schweiker responded to concerns about the block grant proposals. Two health block grant programs are expected to draw opposition from various interest groups, certain that their present categorical grant programs will be lumped with others and the funding of the programs will be left to the discretion of state policymakers.
The basic health services block grant will include Community Health Centers, sudden infant death syndrome funds, emergency medical services, mental health services, drug abuse programs, alcoholism treatment services, and maternal and child health grants.
The prevention block grant will include hypertension efforts, family planning, genetic diseases, immunization programs, fluoridation, health education, and health incentive grants.
The plan is to fund the block grants at 75% of the current fiscal 1981 level, with minimal increases for fiscal year 1982 and subsequent years to reflect inflation.
House Budget Committee Chairman James R. Jones (D, OK), who has been the most vocal adversary of the Administration's budget, expressed the following concerns:
1. Many proposed program reductions could be counterproductive
2. No preparation or planning has taken place to prepare states to administer the block grants
3. There is a lack of clarity as to who will designate the "truly needy
4. The effects of placing a "cap" on Medicaid at a time when most states are already experiencing funding problems.
House Health Subcommittee Takes Closer Look at Medicaid Cap
The Reagan Administration 's proposed Medicaid cap drew the close attention of the House Commerce Subcommittee on Health and panelists before the subcommittee. The president's proposal has served as a challenge to his critics to come up with something better. Nursing home providers, in particular, become the vehicles by which Medicaid cost savings could be achieved. The only group to propose an alternative to the Administration's 5% cap on Federal expenditures is the National Governor's Association (NGA). The governors' program proposes long-term care block grants and a 7% cap only for nursing home services. Speaking for the NGA, James B. Hunt, Governor of North Carolina, emphasized that no single issue. is more important than the Medicaid cap. Subcommittee Chairman Henry Waxman (D, CA) expressed deep concern for the consequences of the proposed cap.
Health Program Amendments of 1981 (H.R. 2562)
In March Rep. Henry Waxman (D, CA), Chairman of the House Energy and Commerce Committee's Health and Environment Subcommittee, introduced legislation to extend and amend several categorical health programs. The categorical nature of the extensions, of course, is contrary to the Administration's proposed block grant approach to health program funding.
H.R. 2562 wouldextendauthority for Community Health Centers for two additional years. The Migrant Health Program authorization also would be extended for two years. Health Services Administration's (HSA) Primary Care Research and Demonstration program would be extended for one year (FY 1982) at $3 million.
Community Home Health Services Act of 1981 (S. 234)
Sen. Orrin Hatch (R, UT) opened the Senate Labor and Human Resources Subcommittee hearing on S. 234 by declaring the Community Health Services Act of 1981 his "principal legislative priority." He emphasized that one of the main purposes of the proposal is to encourage home health care as an alternative to nursing home institutionalization. The five other committee members participating in the hearing (all Republicans) vigorously supported the general thrust of S. 234, although reservations were expressed about fraud and abuse in the home health care field and the potentially high numbers of persons eligible for home health care.
Heinz and Chiles Oppose Taxation of Social Security Benefits (S. Res. 87)
Senate Aging Committee Chairman John Heinz (R, PA), and Ranking Minority Member Lawton Chiles (D, FL), introduced resolution S. Res. 87, opposing taxation of social security benefits. The resolution was proposed in response to the recommendation of former President Carter's Commission on Pension Policy to begin taxing social security benefits. In introducing the legislation, Heinz said: "We know that the total retirement income for many older people is not adequate, and many of those who would be affected are already struggling to keep up with the cost of basic necessities."
Hearings on Older Americans Act Reauthorization
Several committees held hearings in Marchand April on reauthorizing the Older Americans Act, which expires this year. David Rust, Executive Director of the 1981 White House Conference on Aging, represented the Administration at a hearing of the Subcommittee on Aging of the Senate Human Resources Committee. Rust said the Administration soon would submit a request for a three-year extension to Congress. The Administration's proposal would merge the three separate social and nutrition services authorities under Title III of the act. State and area agencies also would have greater flexibility in spending by the Administration's proposal to repeal the 50% spending requirement for access, in-home, and legal services under Part B of Title III. It would also grant greater flexibility for stateroperated ombudsman programs serving older residents of long-term care facilities.
Health Professions Educational Assistance and Nurse
Training Amendments of 1981 (H.R.2004, S. 799)
Senator Orrin Hatch (R, UT), Chairman of The Senate Labor and Human Resources Committee, introduced S. 799 in late March. In his opening remarks, Chairman Hatch stated that his bill represents a thorough reexamination of titles VII and VIII of the Public Health Service Act and builds upon work done by the committee during the last two years. The main features of the bill include the following: continuation of the Health Education Assistance Loan program; continuation of the'Health Profession student loan and the nursing student loan programs, using revolving funds with no new funds; and continuation of special project grants and advanced training for nurses. For the House side, Rep. Henry Waxman (D, CA) has introduced and conducted hearings on his proposal, H.R. 2004 (See "Policies & Politics" in previous issues of this journal.)
Conference of Nurses Prepares Report on White House Conference on Aging
In March, the American Nurses' Association co-sponsored a nursing conference on the 1981 White House Conference on Aging with the Cleveland Clinic Foundation and Upjohn Health Care Services. Also participating in the conference was the office of the Chief Nurse of the Public Health Service and staff of the White House Conference on Aging. For the first lime in the history of White House Conferences, the nursing profession has a document identifying nursing's position on health care of older adults. The following recommendations are included in the document that was prepared for delegates to the conference:
1. Government and the private sector should provide reimbursement for health education, health promotion and disease prevention, and should allow the consumer to choose services and providers.
2. The government and private sector should work together to provide financial support for educational opportunities to prepare nurses in the care of the older adult.
3. The government and private sector should pursue policies that would encourage the development and implementation of care provided by nurses based on creative concepts of wellness.
4. The government and private sector should give priority to and provide support for nursing research that would address the major health issues of older adults.
Carolyn Davis Named to HCFA Post
Carolyn Davis, R. N., Ph.D. has been appointed to the position of Administrator of the Health Care Financing Administration, the Department of Health and Human Services Agency that manages the $280 billion Medicare and Medicaid Programs. Dr. Davis, formerly Associate Vice President of Academic Affairs and Dean of the School of Nursing at the University of Michigan, has had an outstanding career in nursing and education. Her strong political activity and leadership have been rewarded by this appointment.
Bush To Head Regulation Task Force
A task force headed by Vice President George Bush will study nursing home survey and certification rules as well as the conditions of participation for Medicare and Medicaid facilities. A number of major regulations will be reviewed by the task force to decide whether the regulations are essential and cost effective. Elimination of unnecessary federal regulations is a major desire and campaign promise that President Reagan seeks to fulfill.