By Debra Wood, RN, contributor
With the votes in, America’s desire to tackle some of the tough issues facing the nation, such as health care reform, became clear. A new president, many new members of Congress and several new Senators face an abundance of challenges, but also the opportunity to repair a faltering health care system to improve access to care, workforce issues and more.
The new administration faces many health care challenges but also the opportunity to improve access to care, workforce issues, efficiency of medical practices and more.
“We’re excited because of the opportunity for change,” said Cynthia Haney, senior policy fellow for nursing practice and policy at the American Nurses Association (ANA), which had endorsed Barack Obama. “We’re thrilled Senator Obama was elected. He believes health care is a right as opposed to a privilege, and that is the ethical frame nurses have used to address all of the health reform issues throughout the many decades we have been working on this.”
Even though the incoming president plans to focus first on the economy, Haney said, “You cannot fix the economy without fixing health care.”
Health care represents 15 percent of the nation’s gross national product, she said, and it is the single largest sector for job growth.
“That being the case, health care needs to be among the top priorities of the new administration,” Haney said.
A variety of groups agree with the ANA. Haney reported support for change from insurers, pharmaceutical manufacturers, providers, hospitals, the business community and people feeling a lack of health security—not the typical entities pushing health reform as a top priority, but together they may create the momentum to push past difficult decisions.
“I think they realize this is an issue that will have to be sorted out,” Haney said. “The ability to plan and budget for the future and where the health economy is going relies on what approach the new Congress and administration will take to reform health care.”
Divided We Fail, a coalition comprised of the American Association of Retired Persons (AARP), the Business Roundtable, the National Federation of Independent Businesses and the Service Employees International Union, sent an open letter to President-elect Obama, published in USAToday and other media outlets, urging the incoming leader to address health care reform during the first 100 days of his presidency. The letter also offered to help him make access to qualify, affordable health care a reality.
The coalition believes that the nearly $1 million media blitz will keep the issue at the forefront.
“Now that this grueling two-year campaign is over, the hardest work still lies ahead,” said Nancy LeaMond, AARP executive vice president, in a written statement. “Our diverse coalition begins the march forward today, proving that Washington can overcome petty politics and find common ground on even the biggest issues.”
Senators and representatives are already working on proposals. Obama outlined his plan during the campaign. He proposed allowing Americans to continue their current coverage, creating a national health insurance exchange to help citizens and businesses purchase private health insurance, requiring large employers to contribute toward health coverage for their employees or pay into a public plan, providing tax credits to families who cannot afford coverage and to small businesses, expanding the State Children's Health Insurance Program (SCHIP) and Medicaid eligibility, and requiring children to have health coverage.
PricewaterhouseCoopers issued a report estimating that the Obama plan would eliminate two-thirds of the uninsured at an estimated cost of $75 billion per year, basing its analysis on results of a similar program established in Massachusetts.
“President-elect Obama has said that addressing health care reform will be a top priority in his administration, and my Congressional colleagues and I share that strong commitment,” said Rep. Lois Capps, RN (D-California). “We can and should begin by reversing some of the short-sighted policies of the Bush administration. Some of our earliest actions will likely be to allow federally-funded stem cell research and to expand and improve SCHIP.
“Furthermore, I think you can expect to see that decisions regarding federal health care policy will be dictated by science rather than ideology. We also need to provide access to quality, affordable health care to all Americans and improve the accuracy and efficiency of medical care by embracing the use of information technology.”
“Finally, one of the best ways to improve health care in America is to address our nation’s nursing shortage,” added Capps. “To that end, I’ll be working in the next Congress on reauthorizing the Nurse Reinvestment Act, legislation I passed into law in 2002 to increase the number of practicing and teaching nurses.”
Sen. Edward Kennedy (D-Massachusetts), chairman of the Health, Education, Labor and Pensions Committee, returned to the Capitol on November 17, after receiving treatment for a brain tumor, and said he will continue to lay the groundwork for early action by Congress on health reform.
“We’ve been making real progress in our discussions about a consensus approach, and I’m optimistic we’ll succeed,” Kennedy said in a written statement.
Sen. Max Baucus (D-Montana), chairman of the Finance Committee, has released his own health reform plan, addressing health care coverage, quality and cost. It would ensure that every individual can access affordable coverage by creating a nationwide insurance pool and allowing people age 55 to 64 years to obtain Medicare coverage, which differs from the Obama campaign plan.
Haney indicated she thinks there is a political will for change but also trepidation about mucking around in the complex health care arena and not being able to fix everything at once. She said reform will likely include increasing insurance coverage for the 46 million uninsured, improving access to care, enhancing quality, rewarding providers for good outcomes vs. the number of procedures, decreasing ethnic and regional disparities, and dealing with workforce issues to ensure the country has the capacity to care for everyone seeking services.
“There’s a web, and you cannot easily treat one strand at a time,” Haney explained.
Covering more people should benefit everyone with insurance. Haney reported that the average insured family’s annual premiums include $900 to $1,200 that go toward the care of patients without insurance. She called it a hidden taxation to pay for needed care.
“Obama’s plan says we know, as a country, we will have to pay for some of this, but let’s do it in an upfront way,” Haney said. “That step will be an amazing transformation of the system. It’s exciting to anticipate that.”
Haney said ANA feels a need to restructure the system, so it focuses on coordinating care, managing chronic conditions, preventing disease and educating people about health.
“For many years, these issues have not received attention, in part because the reimbursement system does not value and pay for these services,” Haney said. “That’s something we are delighted to hear more people talking about.”
Workforce development and deployment will be critical, she added. Haney believes that an improved nursing environment will be a natural consequence of changes in reimbursement and the refocus on primary care.
“We are seeking to have the best qualified, best-educated workforce in place to serve this country, and in order to do that, we will need to make changes in how the system has been viewing the role of the health care professional,” said Haney. She explained that the focus needs to change from treating sickness to maintaining health and promoting well-being.
“Nurses see the big picture, but they also see the patient as an individual who is a participant in a process of helping to maintain or optimize health,” Haney said.
Change will likely require nurses to speak up, let their representatives and senators know what is needed and how important reform is to the country.
“Nurses will be a big piece of this,” Haney said. “We’re excited. It cannot afford not to change. It’s not an option.”
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