The President's Budget, Health Care, and Nursing

Published: February 4, 2015

On Monday, the President released his Fiscal Year 2016 budget, setting the stage for negotiations with the new 114th U.S. Congress on health care and other pressing issues facing the nation. Fiscal Year 2016 will begin on October 1, 2015.

The 2016 budget expands upon the key priorities outlined in the President’s January State of the Union address, which focused primarily on middle class economics, affordability of higher education, job creation, and national security.  Much of the news and discussion surrounding the budget release speaks to the opportunity for Republicans and Democrats to compromise in several areas, including health care, corporate taxes, infrastructure improvement, and military spending.

Even though much of the initial reaction to the President’s budget is focused on the deficit, taxes, spending and immigration, the portion of the budget allocated to the U.S. Department of Health and Human Services (HHS) is 27.3 percent.  For context, the budget apportions 14.7 percent to the Department of Defense, and the Department of the Treasury is allotted 14.5 percent.

The $83.8 billion in discretionary funding for HHS is provided, in part, to continue the work happening under the Affordable Care Act (ACA), as well as for provider education, public health, assisting vulnerable populations, and medical research.  The money under the ACA umbrella is slated to operate and improve the health insurance marketplaces and for the health insurance subsidies provided for in the ACA.

In addition to the continued implementation of the payment reform initiatives in the ACA and the focus on consumer enrollment in the health insurance marketplaces, of specific interest to nursing are the FY 2016 allocations that would impact the nursing workforce, critical health care research, and primary care practice.

The budget proposes level funding with FY 2015 for the Nursing Workforce Development programs under Title VIII of the Public Health Service Act.  For over 50 years, the Title VIII programs have been supporting the pipeline of registered nurses, advanced practice registered nurses, and nursing faculty.  As nursing schools face increasing pressure to maximize enrollment, some in the nursing community are concerned with the budget’s lack of an increase in Title VIII funding.

“As we consider the health needs of our country, it is essential that the nursing workforce is prepared to provide high-quality care to the nation’s aging and vulnerable populations,” says the American Association for Colleges of Nursing (AACN) President Eileen T. Breslin. “For decades, these federal nursing workforce and research programs have supported efforts to improve access and health outcomes while reducing cost. The proposed level funding for Title VIII will not sustain the growth necessary to educate the next generation of nurses. At the same time, AACN appreciates the recognition that funding for nursing science is critical to improving national and global health.”

The President’s budget does include a 2.53 percent increase over FY 2015 for the National Institute of Nursing Research (NINR) within the National Institutes of Health.  Another bright spot is the President’s proposal to expand the beneficiary assignment in the Accountable Care Organizations (ACOs) Medicare Shared Savings Program to include nurse practitioners and clinical nurse specialists, which “could result in a greater number of Medicare fee-for-service beneficiaries being assigned to ACOs that rely on non-physician practitioners for a majority of primary care services, such as those in rural or underserved areas” according to the HHS Budget in Brief.

As the negotiations, posturing, and compromises in Washington, D.C., take form this year, it is imperative for nursing to stay organized and carry the patient safety message.  Even though this year’s State of the Union address and FY 2016 budget are less focused on health care than in prior years, many important health policy discussions will still take place.  The current patch on the Sustainable Growth Rate (SGR) mechanism to determine Medicare reimbursement rates expires at the end of March, and will require extensive negotiations in Congress to find a fix.

There are five nurses in this 114th U.S. Congress.  One may even be your representative.  These legislators are advocates for the nursing profession and are able to speak with expertise and credibility on the clinical realities underlying health care policy.  However, they need your help to ensure the nursing voice is heard. AORN and the American Nurses Association track and monitor legislation of interest to the nursing profession and issue action alerts to RN members as needed.  As members of Congress begin tackling the competing issues of today, we must work together to ensure that health care policy and patient safety do not take a backseat or fall short of needed attention.

Related Resource

Find more information on the President’s FY 2016 Budget.