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Friday, April 19th 2002

The Honorable Edward M. Kennedy
Senate H.E.L.P. Committee
428 Dirksen Senate Building
Washington, DC 20510
The Honorable W.J. Tauzin
House Energy & Commerce Committee
2125 Rayburn House Building
Washington, DC 20515
The Honorable Judd Gregg
Ranking Member
Senate H.E.L.P. Committee
393 Russell Senate Building
Washington, DC 20510
The Honorable John D. Dingell
Ranking Member
House Energy & Commerce Committee
2328 Rayburn Building
Washington, DC 20515

Dear Members of Congress:

The nation is experiencing a nursing shortage of crisis proportions across the country. We want to express our gratitude for your leadership in addressing this vexing public health problem through your authorship of the House and Senate-passed versions of legislation to provide incentives for students to choose a nursing career, the Nurse Reinvestment Act.

However, both versions of the Nurse Reinvestment Act are severely flawed. Specifically, the bills bar nurses from working in for-profit hospitals to pay back their nursing loans to the government.

The nursing shortage is pervasive across all regions of the country and for all hospitals regardless of their ownership status. It is singularly unfair to limit nurses’ eligibility for financial assistance based on the ownership status of the hospitals where they choose to work. It is imperative that nurses have the freedom to work in the facility of their choosing.

Further, since the nursing shortage hurts all hospitals -- non-profit and for-profit alike -- and virtually all hospitals participate in Medicare, it is critical that all hospitals that provide care to Medicare patients receive the government’s help in addressing their nursing shortage. Hospitals that participate in Medicare also provide critically needed access to Medicaid and other patients seeking urgent health care in their emergency departments. To require patients and newly trained nurses to subsidize the training for nurses who work in certain sites and not in others is flawed, inconsistent, and unfair.

When the Public Health Service Act (PHSA) was originally enacted, health care delivery in the United States was very different – there were few for-profit health care facilities. Today, the forprofit sector represents nearly 20 percent of all hospitals, and, in some regions, they are 100 percent of the market – as in rural America where they are often the Sole Community Provider or Critical Access Hospital.

The unfortunate reality is that the nursing shortage is as widespread in this country as it is severe. It affects all hospitals, regardless of location and ownership status. We appreciate your efforts to address the national nursing shortage, and commend your leadership in seeking innovative solutions. However, we remain seriously concerned with both the House and Senate versions of the Nurse Reinvestment Act. Therefore, despite the importance of this legislation, we will be compelled to oppose the measures unless Congress removes the nursing employment restrictions on for-profit hospitals.

We are happy to work with you to resolve this issue and address the nursing shortage faced by all hospitals and their patients throughout the country.


Rick Pollack
Executive Vice President
American Hospital Association

Charles N. “Chip” Kahn III
Federation of American Hospitals


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