| Washington Watch | Vital Signs | Issues Update |
By Stephanie Reed
Stephanie Reed is an associate director in the ANA’s Department of Federal Government Relations.
One year ago, the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry—upon which three state nurses’ association members served—reached consensus on a “Consumer Bill of Rights and Responsibilities” for health care consumers. This landmark document presented standards of health care that could help establish a stronger trust among consumers, health care professionals, health care institutions, and health plans.
Six months later, in March 1998, the Advisory Commission published its full report, delineating the issues that must be addressed for improvement in the quality of the nation’s health care, including wide variation in health care services, underuse of some services and overuse of others, and an unacceptable level of errors.
Now, a full year after the initial report, both public and private initiatives have begun addressing the goals set out by the commission.
Most public attention has focused on federal legislation that would codify the commission’s Consumer Bill of Rights and Responsibilities. Earlier this year, Democratic leaders in Congress introduced the Patients’ Bill of Rights Act of 1998 (S 1890/HR 3605). This comprehensive bill, which included all aspects of the Consumer Bill of Rights and Responsibilities, was endorsed by a wide range of organizations representing consumers and health care providers. In addition to the ANA, organizations working for enactment of the bill included the American Medical Association, the Consumers Union, the National Partnership for Women and Families, the AFL-CIO, and the American Psychological Association.
Despite widespread public support for comprehensive managed care reform, business and insurance interests mounted strong opposition to federal intervention. As a result, in July, the House of Representatives passed a much weaker bill—introduced by Speaker Newt Gingrich (R-GA)—by a small margin, with 10 Republicans breaking party ranks to support the comprehensive Patients’ Bill of Rights.
“The proposals offered by Republican leaders are not credible alternatives,” stated ANA President Beverly L. Malone, PhD, RN, FAAN, in an August 10 statement to the press. Malone, along with Mary Wakefield, PhD, RN, FAAN, and Marta Prado, RN, represented nursing on the President’s Advisory Commission. “For the nurses at the bedside, the need for patient protection and patient advocacy is played out every day, and the ANA will be steadfast in its support for genuine, comprehensive reform,” said Malone.
In the Senate, supporters of the comprehensive bill, S 1890, continued to push for full debate and votes on the legislation, but efforts stalled. As the congressional session drew to a close in October, it became clear that legislative efforts would have to be shelved until a new Congress convenes in January 1999. Health care reform is expected to be a priority in the new Congress given the number of candidates who emphasized the topic in their campaigns for this month’s elections. For example, health care was a key issue in the North Carolina Senate and the Montana House races. The ANA will continue efforts with the new Congress to bring about genuine quality-of-care protections.
“It is important that we not lose sight of the first principle for the Consumer Bill of Rights and Responsibilities adopted by the President’s Commission on Consumer Protection and Quality in the Health Industry: All consumers are created equal,” Malone stated in August. “The commission was clear that its work must apply to all consumers, regardless of the type of plan they have. And yet the Senate Republican leaders’ bill leaves out millions of Americans. This omission is unacceptable.”
Malone also has been involved in an initiative in the private sector aimed at implementing another major proposal of the President’s Advisory Commission. In September, she attended the second meeting of the 23-member planning committee that was established in June to develop the Forum for Health Care Quality Measurement and Reporting.
The forum is to be a private, nonprofit entity created to develop a comprehensive quality measurement and reporting strategy that addresses priorities for quality measurement for all stakeholders consistent with the national aims for quality improvement in health care. These aims would be established by a quality council, whose formation is awaiting congressional action. The forum’s membership would be a broad-based group of participants including consumer and patient representatives; private group purchasers; public group purchasers; quality oversight organizations; health care professionals; state health and insurance commissioners; health plans; institutional health care providers; labor unions; experts in quality assurance, improvement and measurement; and professional associations.
“The nursing profession is particularly concerned about the availability of consistent, reliable information for educating individual consumers, purchasers of health plans, health providers, and other stakeholders in the health care system, so that they will be able to make informed health care decisions,” Malone stated in a letter to Vice President Al Gore.
The planning committee is defining the mission, discussing issues of governance, and addressing the financing and implementation procedures for the forum, which is expected to begin work in early 1999.