E.D.'s Notes, The

Alabama Nurse,  Mar-May 2005  by Decker, Joseph F II

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One of our most important news items this quarter is the availability of ASNA state-only membership. In mid-January 2005 we received our contract from ANA approving that option for a threeyear term through the end of 2007. This new arrangement will allow Alabama nurses to individually join ASNA or ANA, or both. These membership options are available at the time you would normally renew your membership or upon initial application. Of course, the standard joint ANA/ ASNA membership remains available and we certainly view that as the preferred choice. Our partnership with ANA remains strong, and we very much value ANA's continued outstanding advocacy for nurses and health issues on the national scene. The new/revised membership applications are printed in this edition of The Alabama Nurse, along with an explanation of the benefits and dues schedules. In addition, we are also able to announce an individual affiliate application for LPNs and other health care vvorkers here in Alabama. Inquiries should be directed to our offices in Montgomery, where details and applications are now available, or visit our website www.alabamanurses.org

As the Alabama legislature convenes in February, Janet Donoghue (President), Don Eddins (Attorney) and I will pursue several bills with our lobbying efforts. First, of course, we will re-introduce our bill from last year's session that would classify the assault of nurses and other health workers in the workplace as a felony. This bill is similar to legislation covering teachers in the classroom setting. At present, we hope to have Dr. Barbara Boyd, (D) from Anniston introduce it in the House, and Sen. Ted Little (D) from Auburn in the Senate. Don has also drafted a bill relating security improvements and tax incentives to potential scholarship funds for nursing students. We are not as sanguine about this effort, but wanted to at least introduce the idea on the Hill. Again, please communicate with us about any additional ideas you have regarding legislation you think should be introduced or issues you think should be raised.

Another critical area of this year's legislative session concerns the 2006 budget. If I can beg your indulgence, please let me discuss the Alabama Medicaid problem and ask for your support. As you may be aware, Alabama's Medicaid budget for 2006 is some $129 Million short at this writing. It had a shortfall of $60 Million in 2005 that was plugged by the legislature last year, but no permanent fix was agreed upon. The state General Fund budget provides dollars for this program, and it is under severe pressure again this year. One bit of recent good news: an article in the 3 February Montgomery Advertiser indicated that an additional $25 Million for both 2005 and 2006 will be made available to the state by the federal government under the auspices of the Centers for Medicare and Medicaid Services (CMS). The additional funding is applicable to rural nursing home settings. This could reduce the 2006 shortfall by up to $50 Million in 2006, down to $79 Million, still a very significant number. At a recent ACAE seminar I attended here in Montgomery, all four speakers from the Alabama legislature (Sen. Lowell Barron, Sen. Roger Bedford, Rep. Seth Hammett and Rep. John Knight) emphasized the need for additional state revenues in 2006 to fill the gap in Medicaid funding and other areas. Rep. Ron Johnson from Sylacauga has offered the possibility of an additional tax of 5 cents per bottle/can on soft drinks as one technique to support the Medicaid shortfall. Rep. John Rogers from Birmingham has floated the idea of a one-time $300 Million draw from the Education Trust Fund to solve the problem. It's likely that Dr. Paul Hubbert of AEA and a number of legislators would oppose that idea, though. Gov. Riley's 2006 budget submission contains no new taxes, so developments in the budget fight will be very interesting to follow. Medicaid is a major player in Alabama's health delivery system; last year the Medicaid Agency paid $3.7 Billion for health care services covering 700,000 Alabamians. There are really two primary issues in this continuing difficult situation.

First, the Medicaid program provides a health safety net for Alabama's poor, its elderly and its children. About 20% of our population qualifies for Medicaid; the Agency paid for almost lh. of baby deliveries in Alabama last year, and 74% of nursing home residents are covered. In addition, Medicaid covers 37% of Alabama's children and 21% of our elderly. Some 47% of Medicaid funds go to people who are on Medicare. In short, a great many of our citizens depend directly on Medicaid to receive the health eare they need.

Second, the financial impact of Medicaid programs in Alabama is of major economic consequence. For every state dollar input, the federal government applies almost three dollars in matching funds, a very favorable rate. Of the $3.7 Billion spent last year, every county in the state realized a significant monetary impact. For example, Medicaid payments to the five most populous counties were: Jefferson, $474 Million; Montgomery, $302 Million; Mobile, $275 Million: Tuscaloosa, $137 Million; and Madison, $118 Million. In all, 37 counties received at least $20 Million. These sums clearly indicate that every county would be adversely affected if Medicaid were not funded adequately. Thus, not only would the health of many of our citizens be negatively impacted, but also from a business perspective, literally thousands of jobs and hundreds of businesses would immediately be at risk. Many of these jobs are nursing positions: LPNs, RNs and Advanced Practice Nurses. We are already aware of some APNs who have either lost jobs or are underemployed as a result of recent difficulties in Medicaid funding. And this rationale does notf even consider the turnover effect of those same dollars in every community. In short, we really must find a way to fund Medicaid. Therefore, I urge all of our nurses to be aware and to get involved politically with your legislators to push for a successful solution.