Ready to Rumble
As the presidential election heads for the home stretch, RNs throw their support to candidates who share
their views on nursing and health care issues
By Heather World
September 20, 2004
In an election year darkened by war and terrorism, health care ranks high among voter concerns. Dawn Morrell, RN, BSN, CCRN, spends three hours a day ringing doorbells and listening to constituents in her bid for a second term as a Democratic legislator in Washington state.
“This year, no matter who you’re at the door with, they’re worried about health care,” Morrell says.
The importance of a topic that has long concerned nurses has not gone unnoticed, says Marla Weston, RN, MS, executive director of the Arizona Nurses Association.
“Nurses recognize health care is a big issue in this election year, and there is some excitement about that,” Weston says.
Nurses want to know how candidates propose to address the nursing shortage, be it funds for nursing education or changes in workplace conditions like overtime restrictions and staffing ratios.
Yet, like the general population, they are also concerned about access to adequate, affordable health care — particularly for their patients, family, and friends.
As patient advocates, nurses see how the lack of a coherent system affects their clients every day, says Erin Murphy, BSN, chair of American Nurses Association Political Action Committee Presidential Task Force and the executive director of the Minnesota Nurses Association.
“Nurses are hungry to solve this problem,” Murphy says. “We’re privileged with that knowledge and obligated as advocates to talk about it.”
Pundits and politicians characterize this year’s election as polarized.
The two main candidates for president in 2004 have some overlapping ideas — both advocate advancing medical records technology, for example — but they offer different solutions to most health care issues.
Health coverage
Democratic nominee Sen. John Kerry of Massachusetts proposes expanding federal aid to cover health insurance and expanding government regulation of the workplace.
President George W. Bush offers tax credits to expand health insurance and has shied away from government workplace regulation.
The Republican Party’s approach has attracted followers like Mary Griffith, RN, MN, chair of the legislative committee for the Arizona Nurses Association.
“The more government there is, the less empowerment and accountability there is,” she says.
The first step in Bush’s approach was found in the Prescription Drug and Medicare Improvement Act of 2003, which created health care savings accounts.
The two-part approach is meant to stimulate market competition to control prices. Subscribers buy a catastrophic health insurance plan with low monthly premiums, but for routine medical expenses, they have no insurance. Instead, they pay for doctor’s visits and medication with their own money invested in a tax-free health care savings account.
“When it’s your money you’re spending, you have the tendency to demand better service,” Bush said, explaining the rationale behind the program in a Jan. 28 speech on health care.
Critics say the health care savings accounts are of little value to Americans who, as a whole, have become notoriously bad at saving money.
The latest Census Bureau statistics available online show that more than one-third of Americans do not have savings or interest-earning accounts. According to the Department of Commerce, Americans saved about 2% of their disposable incomes last year, compared with 8% in the early 1990s.
Others charge the plan ignores the high cost of medications for some people, a criticism that also extends to the rest of the Medicare act, which is more widely known for its changes to senior benefits. Medicare should not be pitted against private plans, opponents say. Kerry voted against the act twice in procedural votes.
Other aspects of the act will give seniors prescription drug coverage, expand preventive care benefits, and will give seniors the option of buying into the federal health plan.
An August survey by the Henry J. Kaiser Family Foundation/Harvard School of Public Health found that nearly half (47%) of seniors and people with disabilities on Medicare say they have an unfavorable impression of the new Medicare law.
More than half (53%) say the new discount cards “aren’t worth the trouble” and are “too confusing to use.”
Most people on Medicare (62%), according to the survey, haven’t decided if they will enroll in the new drug plan in 2006, and eight in 10 (79%) favor changing the law to allow prescription drug sales from Canada, a position that Kerry supports.
Myrna Allen, RN, MSN, associate executive director of ANA\ California and a Republican, says the details may not be perfect, but she credits the Bush administration with a willingness to tackle the problem.
In keeping with his approach, Bush’s proposals for health care involve tax credits to buy into the insurance market. The nonpartisan Kaiser Family Foundation says the main components of Bush’s proposals will insure an additional 1.3 million people and cost about $70 billion over 10 years.
As part of a five-year plan, the president also proposes to open or expand 1,200 community health centers to serve an additional 6.1 million people, according to his campaign.
Kerry proposes a more comprehensive health care coverage plan aimed at insuring an additional 26.7 million people.
The plan’s cost — the Kaiser Family Foundation estimates about $653 billion over 10 years — would be paid for by rolling back Bush tax cuts for those making more than $200,000 a year.
A Kerry administration would pick up the full cost of insuring children on Medicaid in exchange for states expanding their Medicaid coverage of families. He has proposed reimbursing employers and insurers for three-quarters of catastrophic health care costs above $50,000, but only if the savings are passed on to employees.
To help small businesses, Kerry proposes refundable tax credits for up to 50% of the cost of coverage; a “premium rebate” pool for certain high-cost health cases would help reduce costs for everyone, his campaign says.
He would provide assistance to those whose health insurance premium costs exceed 6% of income, and open up the federal health insurance plan to everyone.
Medical malpractice
The two candidates also differ on medical malpractice, as well as caps on noneconomic awards in medical malpractice lawsuits.
The Bush administration claims that capping noneconomic compensation at $250,000 will lower soaring malpractice premiums. In 2001, the administration supported a House-led Patients’ Bill of Rights that capped such awards and limited malpractice suits.
That same year, Kerry supported a competing Senate-led Patients’ Bill of Rights that did not cap awards. The two bills died when both houses of Congress could not settle their differences.
Kerry proposes to control malpractice premiums by punishing lawyers who file frivolous malpractice suits and having specialists review the merit of cases before they are allowed to go forward. He also favors “whistleblower” protections for health care workers who report errors or problems, which he has supported in past legislation.
Kerry has sponsored and supported a number of health care bills, as well. Most notably, he co-authored the recent Nurse Reinvestment Act, a combination of scholarships, loans, and grants designed to create more nursing faculty, send nurses to underserved areas, and support career-enhancing education for nurses.
Rep. Lois Capps, RN, a Democrat from California, sponsored the legislation in the House. A nurse for more than 40 years, Capps said Kerry recognizes the important role nurses play in the country’s health care system.
“On issues such as increasing access to health care, truly modernizing Medicare, and protecting the overtime pay of nurses and health care providers, John Kerry will demonstrate the same leadership as president he displayed as a senator while working to pass the Nurse Reinvestment Act,” she says.
The Bush administration has proposed spending almost $147 million in 2005 on the act, an overall increase of $5 million from last year; the ANA believes $205 million is needed to adequately support the effort.
Kerry cosponsored the Safe Nursing and Patient Care Act of 2003, which seeks to limit mandatory overtime for nurses, helped pass needlestick safety legislation, and has voiced support for nurse-determined rules about safe staffing levels.
Kerry supported legislation in 1997 that expanded reimbursement opportunities for advanced practice RNs by eliminating geographical and practice site restrictions, and he voiced support for any ANA-sponsored legislation that would allow APRNs to practice more fully.
Megan Hauck, deputy policy director for the Bush-Cheney 2004 re-election campaign, said the president has not taken a position on mandatory overtime or staffing ratio legislation, but that his policies support nurses.
Ultimately, Hauck said, the Bush administration has shown a commitment to helping the nation’s nurses through its policies and funding of the Nurse Reinvestment Act.
“We’re trying to invest as much federal money as we can to give nurses incentives to go into the profession and stay in the profession,” she says.
The American Nurses Association, which endorses a candidate for president based on an examination of voting records, future proposals, interviews, accessibility, and the results of a nonscientific poll of members, chose Kerry as the top pick for president back in February before he was even the clear Democratic nominee.
“Senator Kerry was the leader because of his position on our issues, the virtual vote, and his performance on the campaign trail,” Murphy says.
Early ANA support for Kerry may bode well for the organization should he be elected, says Mary Foley, RN, MS, vice chair of the ANA-PAC. “Being an early friend is a good thing,” she says.
Nurses are gaining more political clout with both parties as their donations to the ANA’s political action committee flow to candidates, says Greer Glazer, RN, PhD, CNP, FAAN, the committee’s chair.
She attended the Democratic National Convention, where she connected with delegates, politicians, and lobbyists over issues concerning nurses.
Glazer talked to attendees from a nurse’s viewpoint about the profession and health care, and she looked into collaboration opportunities for the ANA. She was told that people think of nurses as the linchpin of the health care system and that the profession doesn’t get the credit or place at the table it deserves.
“We had great access because of everybody’s generosity,” she says. “This is how we can make a difference.”