Nurses win battle for reimbursement in West Virginia

Independent relmbursement for nurses is gaining ground. West Virginia has joined Washington as the second state with a law requiring insurance companies to reimburse registered nurses in private practice. Any reg- istered nurse is eligible-not just advanced practitioners or specialists.

“We decided it was time to treat all regis- tered nurses as professionals,“ said Louise Browning, executive director and lobbyist for the West Virginia Nurses’ Association. Nurses faced an uphill battle, with opposition from the medical society, dental association, Health In- surance Association of America, and Blue Cross/Blue Shield.

In the end, the “vote wasn’t even close,” Browning said. Only four senators voted no, and the state house passed the bill by voice vote. Intensive lobbying was needed, how- ever, to persuade the governor to sign the bill.

Success was due to staying on top of action in the legislature. “I was there every day,” Browning commented. Other nurses came to help as needed.

“We tried to educate the legislators about nursing,” Browning added. “We wanted them to understand that they could have confidence in nurses to know their limitations.”

The law takes effect in January 1984. The Washington State law passed in two

parts, in 1973 and 1981, The earlier law cov- ered commercial insurance companies, and the later law covered health care contractors, such as Blue Cross/Blue Shield. The law man-

dates reimbursement to any registered nurse in private practice providing services that would be paid if they were provided by a physi- cian.

In effect, these usually are nurses who have national certification, said Kathie Moritis, pro- gram specialist for the Washington State Nurses Association. She estimates about 60 RNs are receiving independent reimburse- ment.

How is it working? Generally well with some difficulties, Moritis commented. Commercial companies are complying, except for some based outside the state. They contend they do not have to follow state law if they do not have their headquarters there.

Health contractors are presenting more roadblocks, “because they are physician- owned,” Moritis said. In some cases, they re- fuse to give RNs provider numbers, so the nurses are forced to collect from the patient, who then applies for reimbursement.

Nine other states have laws allowing inde- pendent reimbursement for specialty nursing services. Nurse midwives may receive direct reimbursement in Alaska, Maryland, New Jer- sey, New Mexico, New York, and Pennsyl- vania. Maryland, Mississippi, and Oregon provide reimbursement for nurse practitioners. In California, psychiatric nurse specialists are directly reimbursed.

Nurse midwives are eligible for reimburse- ment under some federal programs, including Medicaid, the federal employees’ health plan, and the health plan for military dependents.

The hlgh cost of health care really hits home if you’re unemployed. Some 10.7 million Americans lost their health insurance when they were laid off. This spring, congressmen

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and the President were trying to figure out what to do about the problem.

“Health insurance becomes an expensive luxury for the unemployed as they cope with survival,” Maribeth Badura, RN, a pediatric clinical nurse specialist from Chicago told a congressional committee in May. She testified for the American Nurses’ Association (ANA).

She told some sad stories. An unemployed clerk was found near death in a diabetic coma because she had not been able to scrape to- gether enough money to buy insulin. A new- born was dying in an intensive care unit be- cause a family was not able to afford the follow-up visits that would have detected a strangulated bowel early.

“The family’s guilt is tremendous. They felt that maybe they had waited too long before bringing him to the hospital,” she said. “Yet they had an outstanding hospital bill of about $2,500 for his delivery to pay.”

The unemployed find individual health in- surance much more expensive than employ- er-paid group plans. A family would have to pay about $1,600 ayear fora low-benefit major medical nongroup plan. A comprehensive fam- ily nongroup plan may cost $3,000 annually. For a couple in their 50s, a low-benefit plan may run $4,000 a year. Moreover, public health departments are cutting back services as federal, state, and local funds dry up.

Under congressional pressure, the Reagan administration reluctantly presented a plan in late April. The plan primarily emphasizes ex- panded use of existing private insurance. Budget Director David Stockman said the White House would oppose any proposal that does not specify how to raise new money to pay for it.

Stockman has recommended that the gov- ernment obtain the money by lowering the amount of tax-free employer-paid health in- surance an employee could receive. A current bill puts the limit at $175 per family. Stockman would lower this to $160.

The administration also proposes: 0

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requiring employer-paid plans to let laid- off employees keep coverage at their own expense requiring individual plans to allow a work- ing spouse to add a laid-off spouse quickly giving states greater flexibility in the use

of block grants to provide coverage for the unemployed.

In Congress, Democrats wanted to bring the unemployed under Medicare temporarily and create long-term state health insurance pools for them. A Republican plan to provide tempo- rary federal money to the states was not sup- ported by the White House. Final action was expected by mid-summer.

The Insurance industry has dug in to fight a federal bill (HR 100) that would prevent discrimination in insurance and annuities. Legislation is supported by women’s groups, consumer organizations, and labor unions, in- cluding ANA.

Originally, insurance companies had said they would compromise in equalizing pre- miums and benefits as long as the legislation was not retroactive. In mid-May, they changed their position to total opposition.

Under the bill, insurance policies could not treat individuals differently on the basis of sex, race, color, religion, or national origin. For example, insurance companies would not be allowed to pay women lower retirement bene- fits than men when they have made equal con- tributions. On the other hand, men could not be charged more for life insurance and auto in- surance, as they are now.

ANA has been fighting sex discrimination in pensions since 1973. They have sued in nine states, seeking equity in pension benefits for nurses on university faculties. Although they contribute amounts equal to men, women fa0 ulty receive lower pension checks, because women have a longer life expectancy. Al- though the federal Equal Employment Oppor- tunity Commission has ruled in favor of using equalized actuarial tables, ANA has run into an impasse in having these pension tables im- plemented.

The insurance industry contends the bill will benefit no one. At a news conference announc- ing opposition, Bankers Life Chairman Robert N Houser said that differentiating between the sexes is a legitimate and proven aspect of risk classification. He maintained the practice works to the advantage of consumers.

Patricia Patterson Associate editor

AORN Journal, July 1983, Vol38, No 1