POLITICS BEHIND HOME HEALTH CARE CHANGES IN THE
BALANCED BUDGET ACT: A POLICY ANALYSIS
FOR COMMUNITY HEALTH NURSES WORKING IN HOME HEALTH CARE
The elderly is the fastest growing population in the United States; indeed, it is estimated that by 2010, people aged 65 years and older will comprise almost 14 percent of the American population (FedStats, 1998). Although most people aged 65 years and older need relatively little medical care, many do have health problems. In this regard, Papalia and Olds (1995) report that about 10 percent of older Americans (most of whom are 85 or older) are ill, disabled and isolated and very much in need of home health care. As the American population continues to gray, the number of older persons needing home health care is going to continue to increase, and so are health care costs (Papalia & Olds, 1995).
However, some very real policy and operation changes were introduced into the home health care industry as a result of the passage of the Balanced Budget Act of 1997 (BBA). These changes included but were not limited to: IPS for home health, per-visit cost limits; an aggregate per-beneficiary annual limit and home health prospective payments based on the site of services. The issue examined in the policy analysis presented here involved an examination of the sources behind the home health care changes mandated by the Balanced Budget Act of 1997 in order to determine whether each source operated to hinder or facilitate the goals of community health nurses as they relate to providing home health care services. This was considered to be a significant issue because the major services provided by the home health care industry are either directly provided by nurses or are managed by nurses.
The sources identified as major contributors to the BBA were: politicians of all political parties; home health care agency administrators, geriatric health care providers, insurance companies, and s...