The Dermatology Nurses' Association
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What is Sequestration…

What is Sequestration and what does in mean for Nursing Practice?

Its day five of the sequester and you may be asking yourself "What does this mean for nursing?" Below is some explanation of the reductions set in motion as a result of sequestration along with a collection of articles and information on sequestration that you might find interesting as we navigate in this new world order. The next deadline is on March 27 when the continuing resolution expires.

What is Sequestration?

The automatic budget cuts set in motion by sequestration yesterday are complex and difficult to understand. How this will eventually affect the nation, health care and nursing in particular remains to be seen.
Sequestration, sometimes called the sequester, is a process that automatically cuts the federal budget across most departments and agencies. Congress included the threat of sequestration in the Budget Control Act of 2011.
The simplest view can be found in this table from the Office of Management and Budget (OMB), though even they admit that the final impact is subject to change and interpretation of the law.

Preliminary OMB Estimates of FY2013 Uniform Percent Reductions Under
BCA-Triggered Sequester Scheduled for January 2, 2013

Category of Funding Defense Nondefense
Nonexempt Discretionary 9.4% 8.2%
Nonexempt Mandatory (other than Medicare and selected health programs) 10.0% 7.6%
Medicare and mandatory components of selected health programs NA 2.0%

Source: OMB Report Pursuant to the Sequestration Transparency Act of 2012 (P.L. 112-155), September 2012.

In an attempt to lessen the impact of budget cuts on those least able to afford it, there are limits to the cuts to the most vulnerable populations. Some programs are exempt from these cuts, like:

  • Social Security benefits (old-age, survivors, and disability) and Tier 1 Railroad Retirement benefits.
  • All programs administered by the VA and special benefits for certain World War II veterans.
  • Medicaid

Some have limits to the amount that they can be cut, like the 2% limit on:

  • Community and migrant health centers
  • Medicare

Here is a quote from the Congressional Research Service from the 28 page document “Prepared for Members and Committees of Congress”

“There have been some concerns that although Medicare benefits are not to be reduced under sequestration, reductions in provider payments, in addition to reductions already mandated under ACA, could discourage some providers from accepting Medicare patients.”
For the full report see http://www.fas.org/sgp/crs/misc/R42050.pdf

From the ANA:

“Although the sequester was meant to spur action to address fiscal issues in a thoughtful way, we are now facing a situation where cuts in Medicare funding will result in the elimination of hundreds of thousands of health care jobs.”
The full statement is here: http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/2013-PR/ANA-Calls-on-Lawmakers-to-End-Painful-Cuts.pdf

Below are some selected quotes from news articles that talk about the Sequester:

“For weeks, President Obama has barnstormed the country, warning of the dire consequences of the cuts to military readiness, educators, air travel and first responders even as the White House acknowledges that some of the disruptions will take weeks to emerge. The reverse side has gone unmentioned: Some of the most liberal members of Congress see the cuts as a rare opportunity to whittle down Pentagon spending. The poor are already shielded from the worst of the cuts, and the process could take pressure off the Democratic Party, at least in the short run, to tamper with Social Security and Medicare. At the same time, the president gets some relief from the constant drumbeat of budget news to focus on his top policy priorities: immigration and gun control. And Republicans, while denouncing the level of military cuts and the ham-handedness of the budget scythe, finally see the government shrinking in real dollars.” - The New York Times

The full article is here http://smtp01.kaiserhealthnews.org/t/35664/537253/40794/0/

“Major medical groups, including the American Medical Assn., the American Hospital Assn. and the American Nurses Assn., have warned that the Medicare cuts will lead to lost jobs. The reimbursement cuts may be particularly difficult for providers with fewer privately insured patients.” - LA Times

“NIH Director Francis Collins told reporters this week that his agency was looking at losing $1.6 billion by the end of the year” -LA Times (http://smtp01.kaiserhealthnews.org/t/35664/537253/40796/0/)

“Centers for Disease Control and Prevention, which stands to lose more than $300 million”-Washington Post (http://smtp01.kaiserhealthnews.org/t/35664/537253/40798/0/)

There is no arguing that much is about to change. How this will impact each of us individually and as dermatology nurses is not known. We encourage you to do some reading because it will affect all of us in some way. It seems likely that we will have to “do more with less” and that is not new in nursing.