Health Care Reform: An Update
In the March 5 Summit on Health Reform, President Obama kicked off the first serious effort to overhaul the nation's health care system in 15 years with a pledge to include Republicans and consider opposing views — and a vow to get it done this year.

Obama is not offering a specific plan, but rather is outlining general principles to guide the Democratic-controlled Congress as it writes the measure. The House and Senate will be left to do the heavy lifting. As written into the budget delivered to Congress in late February, the eight principles are:

  • Protect families' financial health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.
  • Make health coverage affordable. The plan must reduce high administrative costs, unnecessary tests and services, and waste and other inefficiencies that consume money with no added health benefits.
  • Aim for universality. The plan must put the United States on a clear path to cover all Americans.
  • Provide portability of coverage. People should not be locked into their jobs just to secure health coverage, and no American should be denied coverage because of pre-existing conditions.
  • Guarantee choice. The plan should provide Americans with a choice of health plans and physicians. They should have the option of keeping their employer-based health plans.
  • Invest in prevention and wellness. The plan must invest in public health measures proven to reduce cost drivers in our system — such as obesity, sedentary lifestyles, and smoking — as well as guarantee access to proven preventive treatments.
  • Improve patient safety and quality care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.
  • Maintain long-term fiscal sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

The Senate
On March 3, Senate Finance Committee chairman Max Baucus (D-MT) announced that he would push for a bipartisan, fully paid, health reform bill by midsummer, but acknowledged that the timeline, political cooperation, and overall cost make it "an ambitious goal." Baucus told reporters "It's clearly time to move. The administration is committed, the Congress is ready, and I'm really ready."

Despite his enthusiasm, Baucus acknowledged that attempts to change the misaligned payments, sketchy quality, and complex inefficiencies that are inherent in the current system would be challenging. This was borne out by some Republican members of Congress who the week before hammered parts of the Obama budget that contained a $634 billion health care reserve fund as well as several provisions meant to trim spending under Medicare and Medicaid. Chuck Grassley (R-IA), the senior Republican on the committee, has met with Baucus on a weekly basis in part to discuss the reform effort.

Baucus' goal is to produce a bill that both parties can support, moving "in tandem" with Senate Health, Education, Labor and Pensions Committee chair Edward Kennedy (D-Mass.), whose aides have met twice weekly with stakeholders to seek a consensus on the issue. Both committees, in an April 20 letter to President Obama, solidified their plans to move separate health care overhaul bills that will be combined on the Senate floor, likely after markups that are targeted for June.

The House
The three Democratic committee chairmen responsible for shepherding health care reform through the House are promising a bill by summer. Representatives Henry Waxman (CA), George Miller (CA), and Charlie Rangel (NY) made the pledge in a letter they sent President Barack Obama on March 11. Waxman chairs the Energy and Commerce Committee; Miller, the Education and Labor Committee; and Rangel, the Ways and Means Committee. The lawmakers said they would time their work to bring legislation to the House floor before Congress leaves town for its annual August recess.

Representative Joe Barton (R-TX), the top Republican on Energy and Commerce, said Republicans are prepared to work with Obama and congressional Democrats on health reform. Barton said Republicans want reform to be market based, and said he agrees with the eight principles for reform put forward by Obama in his fiscal year 2010 budget blueprint.

What's Ahead?
The five chairmen — Baucus, Kennedy, Miller, Rangel, and Waxman — agree that everyone must carry insurance and that employers should be required to help pay for it. They also agree that the government should offer a public health insurance plan as an alternative to private insurance. However, they have not yet tackled one of the biggest questions — how to pay for coverage of the uninsured, nor have they wrestled with the Republican objections to the idea of a new government-run insurance plan, competing directly with private insurers. Both of these items could delay or derail the process.

        Volume 6, Issue 1
            April 2009

Health Care Reform: An Update

ANSR Alliance Holds Congressional Briefing on Title VIII


HRSA Announcment: 2009 Faculty Loan Repayment Program

Online Health Workforce Information Center

NLN DataViewTM

Government Affairs Action Center
ANSR Alliance Holds Congressional Briefing on Title VIII
On March 25, 2009, the ANSR (Americans for Nursing Shortage Relief) Alliance, in conjunction with Congresswoman Lois Capps, held a "standing room only" briefing for Hill staffers entitled, The State of the Nursing Nation Part I - Health Reform, the Shortage & Title VIII. One of the four speakers had NLN ties; Jennifer Couvillon, PhD, RN, CNE, is an assistant professor of nursing at Louisiana State University Health Science Center School of Nursing. Couvillon discussed how Title VIII funding led her to establish a new master's in nursing education track focused on developing education skills in BSN-prepared nurses caring for underserved populations in the state of Louisiana.

The ANSR Alliance represents a diverse cross-section of health care and other related organizations, health care providers, and supporters of nursing issues that have united to address the national nursing shortage. Fifty national nursing organizations comprise ANSR. The NLN was one of the founding members of ANSR when it was established in 2001. A copy of the ANSR Consensus Document can be found at

Title VIII - Nursing Workforce Development Programs
(Amounts in Thousands)
Nursing Workforce
Development Programs

FY 2007

FY 2008

FY 2009





Advanced Education Nursing
(Section 811)




Comprehensive Geriatric Education
(Section 855)




Nurse Education, Practice and
Retention Grants
(Section 831)




Loan Repayment and Scholarships
(Section 846)




Nursing Faculty Loan Program
Section 846A)




Nursing Workforce Diversity
(Section 821)





Michigan Funds Nurse Educator Programs

In 2007, Michigan governor Jennifer Granholm (D) created the Michigan Nursing Corps (MNC), a program aimed at solving the nursing shortage by quickly producing more nurse educators so that schools can admit more nursing students. As part of this unique program, state legislators recently approved a continuation of funding for MNC and awarded grants of nearly $5 million to nine state public universities and two hospital partners by the Michigan Department of Energy, Labor and Economic Growth and the Michigan Department of Community Health (MDCH). The purpose of the grants is to provide educational stipends and tuition to graduate nursing education students. In return for this financial help, the new faculty members are required to teach in a Michigan nursing education program for five years.

The two largest recipients of the funding are Wayne State University ($1.8 million) and Michigan State University ($1.2 million). Other grantees include Eastern Michigan University ($634,000) and Northern Michigan University ($570,000).

Betty Beard, interim director of Eastern Michigan's School of Nursing, recalled that, in 2007, the state's nursing programs were unable to admit more than 4,000 qualified applicants because of a lack of faculty and clinical placements. Now, she said, "The EMU award will help to accelerate the plans of study for a master's degree for nursing students who will be very close to graduation, or will graduate, at the end of the 12-month grant program. These graduates will be ready to accept positions as nursing faculty in colleges and universities which, in turn, will expand the nursing workforce in Michigan."

Northern Michigan associate professor of nursing Julie Higbie called the grant a good investment. The funds will provide each student in the nursing education program with $5,700 for tuition and a $25,000 yearly stipend. NMU's nursing education program is online, and this year eight students went through the program. All the entrants are students with master's degrees in nursing who are seeking a nursing education certification, which will allow them to work as nursing educational faculty or clinical instructors. Higbie said the school expects to have 15 students enrolled next year, and that all 15 students will receive the tuition coverage and stipend.

With Michigan's nursing shortage expected to reach 18,000 by 2015, MDCH's chief nurse executive Jeanette Klemczak said it is important to begin addressing this shortage — not only of nurses — but also of nurse educators, because 50-75 percent of Michigan's nursing faculty is of retirement age. Affordability, Klemczak said, is a major problem with getting enough people through nursing education programs.

Texas Coalition Seeks Funding for Nursing Education

The Texas Nursing Workforce Shortage Coalition, a broad-based group of more than 100 organizations dedicated to addressing the state's nursing shortage, has asked the state legislature to allot an extra $60 million in special-item funding for nursing education. The coalition's members include health care organizations, education entities, and business groups. Its message is that if Texas does not increase its number of nurse graduates each year, the state will soon find itself in crisis.

According to coalition president and Texas Hospital Association (THA) CEO, Dan Stultz, "Demand for full-time registered nurses in Texas in 2008 exceeded supply by 22,000 and, without major increases in funding for nurse education, this gap will widen to 70,000 by 2020 as the state's rapidly growing population ages and as older nurses retire or reduce the hours they work." Moreover, the coalition adds, while Texas nursing schools have turned away thousands of qualified applicants because they lack sufficient faculty to teach additional students (e.g., last year alone, more than 8,000 qualified applicants were turned away), hospitals have been recruiting foreign nurses to fill vacancies.

If approved, the special-item funding would be split into two sections. Programs with a graduation rate that exceeds 70 percent would get $37 million, and those schools would receive $20,000 per new student, with each school increasing their RN enrollment by about 25 percent. Nursing programs with a graduation rate of less than 70 percent would receive only half of their funding up front, but enter into a memorandum of understanding with the Texas Higher Education Coordinating Board stipulating that after new enrollees complete their first year, the schools would receive an additional 25 percent of the funding. After students complete their second year, the schools would receive the final 25 percent.

The new funding would be a significant increase over the $15 million already allocated through the state's Professional Nursing Shortage Reduction Program. The funding through this program is given to schools after nursing programs increase their number of graduates. As Jennifer Banda, THA's senior director of governmental relations, points out, such retroactive funding makes it difficult for schools to use the money to hire new faculty. Coalition members say the $60 million would allow schools to hire enough faculty to nearly double the number of RN graduates by 2013.

McLennan Community College (MCC) offers an example of the benefits that would accrue from such funding. For MCC, the funding would go a long way toward meeting the school's goal of doubling its nursing program. The program currently graduates 120 nurses per year and the plan for increasing that number to 240 is going slowly. The high staff-to-student ratio causes the program to lose $555,000 annually. Because of that, MCC can afford to hire only one additional nursing instructor per year, meaning it can add only 10 students annually.

Representative Lois Kolkhorst (R-Brenham) introduced the proposal, HB 4471, which passed the Texas House on April 24. The House version of the budget still has to be reconciled with a Senate version, so funding for the grants could change.

Changes in Georgia Nursing Education Requirements before
Governor for Signing

The shortage of nurses in Georgia and across the nation pushed state lawmakers to pass new legislation meant to increase the number of nurses and protect patients. The bill, HB 475, requires the Georgia Board of Nursing to recognize Internet institutions of higher education as an acceptable form of education.

The nursing board and some local educators opposed the legislation stating that its passage would drop education standards. Those in favor of the measure acknowledged differences of opinion on the appropriate path to entry-level RN practice. They maintained, however, that when it comes to Georgia's shortage of RNs, there is no difference of opinion, which is why the need for the legislation was clear.

In defense of the measure, Senator Lee Hawkins (R-District 49), the sponsor of the corresponding Senate bill (SB 49), cited the nontraditional nursing program at the Excelsior College School of Nursing, which is accredited by the NLN Accrediting Commission. He noted that Excelsior has been designated as one of only 13 Centers of Excellence in Nursing Education by the NLN. Hawkins concluded his argument by pointing out that SB 49 represents a positive approach to the nursing shortage at no cost to taxpayers.

In opposition, Dee Keeton, president of the Georgia Board of Nursing, noted that the measure allows for the admission of LPNs, military service corpsmen, or paramedics into nursing programs. She added that, while such students may have had significant health care experience, they have never had an RN education course, but will be qualified to be licensed as RNs and stressed the differences between Excelsior's self-study module versus the many hours of supervised, hands-on, nursing clinical experience required by other board-sanctioned programs.

Both chambers passed the bill. It is now awaiting the governor's signature.

SHORTS . . .

HRSA Announcement: 2009 Faculty Loan Repayment Program

The Health Resources and Services Administration’s (HRSA) Bureau of Clinician Recruitment and Service is pleased to announce that it is seeking applicants for the 2009 Faculty Loan Repayment Program.

The Faculty Loan Repayment Program provides a financial incentive for degree-trained health professionals from disadvantaged backgrounds to pursue academic careers.

Individuals selected agree to serve on the faculty of an accredited health professions college or university for a minimum of two years.

In return, the federal government agrees to pay, for each year of faculty service, up to $20,000 of the outstanding principal and interest on the participant's educational loans.

To learn more about the Faculty Loan Repayment Program and for application information, please visit or contact the HRSA Call Center at 1-800-221-9393.

Online Health Workforce Information Center
Free access to the most recent resources on the nation's health workforce is now available in one online location ( Operated by the University of North Dakota's School of Medicine and Health Sciences and funded by the Health Resources and Services Administration, the Health Workforce Information Center offers the latest on: health workforce programs and funding sources; workforce data, research, and policy; educational opportunities and models; best practices; and related news and events, also available through email updates. In addition, information specialists are on hand with customized assistance to locate statistics, create databased maps, develop lists of possible funding sources, supply publications, and connect users to the right organizations or federal programs. Users can contact the specialists online or by phone or fax.

NLN DataViewTM

As part of its continuing efforts to make vital nursing and nurse faculty workforce data accessible to decision-makers in both the public and private arenas, the National League for Nursing has created the web-based NLN DataView at Through this new section of the website, featuring downloadable graphs and tables in four formats — PDFs, MS PowerpointTM slides, MS ExcelTM charts, and JPG images — the NLN's public policy research data covering the full spectrum of nursing programs, from LPN to doctorates, is accessible to all. The graphs illustrate essential data about applications, admissions, enrollment, retention, and graduation rates; and provide a comprehensive demographic profile of the current student population including ethnic-racial identity, gender, and age. Navigation is eased by generous use of thumbnail illustrations and a keyword search box on each page for quick and accurate data retrieval.

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