By Debra Wood, RN, contributor
November 9, 2012 - After listening to months of rancor, United States voters have spoken, re-electing Pres. Barack Obama, a clear win for health care reform and the opportunities the Affordable Care Act offers nurses.
“The nursing [community] should be excited, partially because of President Obama getting re-elected and also about the number of female candidates elected,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, the Lucy Jo Atkinson Scholar in perioperative nursing at the Frances Payne Bolton School of Nursing at Case Western Reserve University in Cleveland, Ohio, and past-president of the American Nurses Association (ANA).
Twenty women will serve in the U.S. Senate. Patton explained that women often focus more attention on health care. In addition to the president, many American Nurses Association PAC-endorsed candidates won their seats, including incoming senators Angus King (I-ME), Tammy Baldwin (D-WI), and Martin Heinrich (D-NM); and seven U.S. representatives.
ANA looks forward to working with these lawmakers to affect positive change for nurses, patients, and the broader community, said Rose Gonzalez, PhD, MPS, RN, director of government affairs at the American Nurses Association.
One of the biggest effects for nurses is that health care reform is going to go forward, said Janet D. Allan, PhD, RN, FAAN, dean of the University of Maryland School of Nursing in Baltimore. “It’s time for us, as the richest country in the world, to have health care for as many of our citizens as possible.”
Katie Horton, RN, MPH, JD, said implementation of the Affordable Care Act will do a lot of good things for people and create opportunities for nurses.
Katie Horton, RN, MPH, JD, a research professor at the George Washington University School of Public Health and Health Services in Washington, D.C., added, “The election results will allow full implementation of the health reform law and will do a lot of good things for people who need help. But we still have the split government and all of the challenges that come with that.”
Republicans continue to hold a majority of seats in the House of Representatives and Democrats control the Senate, making for some interesting dynamics.
“It remains to be seen how well folks will talk with each other, negotiate and compromise,” Horton said. “Some of the health reform provisions need additional funding.”
Julius Hobson, senior policy adviser at the law firm Polsinelli and Shugart in Washington, D.C., expects the Republican House might try to block certain pieces of the act or tinker with the plan on the edges.
Several portions of the ACA were authorized but money not appropriated, such as a health care workforce advisory commission, which Congress will need to address before they can be implemented.
“It’s a big challenge for nursing to craft their message in a persuasive way, in difficult fiscal times, to compete with other priorities,” Horton said.
Allan hopes to see more bipartisanship. But not everyone is as optimistic.
Hobson said that after 18 months of negative campaigning, elected officials might not be ready to cooperate.
Creating nursing opportunities
The ACA will increase health care access to approximately 30 million currently uninsured Americans. It also aims to improve quality, reduce the need for acute-care services to save money, and improve health and wellness.
The Obama administration has successfully changed the focus from the treatment of disease to health promotion and prevention, Patton said.
“That’s going to have a significant impact on the nation long-term, first on the quality of our lives and second on the long-term impact it will have on cost,” Patton added.
Kathleen Potempa, PhD, RN, FAAN, said nurses must be able to deliver care to the full capacity of their education, training and national certifications in order to support the needs of the public.
As the act is implemented, it offers the chance for nurses to coordinate complex care so patients can avoid hospitalizations and educate people about prevention and health promotion. In addition, the country will need more home care nurses who can reach out and support patient transitions after discharge, said Kathleen Potempa, PhD, RN, FAAN, dean of the University of Michigan School of Nursing in Ann Arbor.
Horton agreed, saying, “The law has a number of provisions that offer nurses great opportunities--the accountable care organizations, the Medicaid health homes and some of the delivery reform that we know will now move forward.”
“Public health is another area where nurses can make a difference,” Allan added.
The government has built in quality incentives.
Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, said the main signal the election sent to the health care system is that the momentum from fee-for-service to value-based purchasing and quality and safety will continue.
Caring for the additional Americans seeking care will create a new demand in the formal health system for many more primary care providers, and there is no single profession, including physicians or nurse practitioners, that can wholly meet this demand, said Potempa.
“All providers, MD and NP alike, must be able to deliver care to the full capacity of their education, training and national certifications in order to support the needs of the public,” Potempa added. In some states, such as Michigan, that will mean legislation that recognizes the scope and skills of nurse practitioners be passed and signed into law.
“Nurses, whether RN or APRN (NP) are highly trained professionals ready to meet the existing and new demands as health care coverage expands and more people enter the formal health-care system,” Potempa said.
Nichols projected the country will need a “ton of nurses. You will see serious re-evaluation of scope-of-practice rules and norms of care that will use key members at the top of their training, and that will be positive for nurses.”
Patton reported a huge emphasis on workforce readiness, including increasing the diversity of the nursing workforce, preparing more nursing faculty and ensuring the country has enough nurses, physicians and allied health providers to care for the expected influx of insured patients.
“The Obama administration is moving ahead and finding funding for nursing education, and with ‘Obamacare,’ there’s an expansion of the role nurses will play,” Patton said. “It’s reason for us to celebrate.”
Maryland has already begun work on its insurance exchanges, Allan said.
Nicholas anticipates other states that have been holding back will begin looking at this like an analytical problem and less a political or rhetorical issue, as other states start receiving federal dollars while they sit on the sidelines.
“In the long run, history suggests math trumps philosophy, but it takes a few years,” Nicholas said. For instance, some states did not offer Medicaid for years after it was passed.
But first, before the country sees more health care reformed implemented, when the lame duck Congress returns, they will be asked to deal with sequestration with its 2 percent Medicare cut, the sustainable growth rate and the end of the Bush tax cuts at the same time that everyone is trying to reduce the deficit.
“Medicare will be on the table for major reform, and we will all have to watch that carefully,” Horton said.
Hobson said Republicans are worried about sequestration and defense, while Democrats are focused on sequestration’s effect on domestic programs. He expects Congress may postpone any decisions for a few months.
“There is still a chance they won’t agree to anything,” Hobson said. “If sequestration happens on January 2nd, the world is not going to fall apart on January 3rd. It’s going to be a long, slow slide downward. And it’s up to Congress to stop that.”
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