While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Nurse leaders across the nation greeted the U.S. Supreme Court's decision upholding the constitutionality of the Patient Protection and Affordable Care Act (ACA) with responses focused on its impact on patients and the nursing profession.
In Washington, D.C., American Nurses Association (ANA) President Karen A. Daley, PhD, MPH, RN, FAAN, highlighted the law's provisions designed to extend insurance coverage to tens of millions of Americans, and its "mandate" that all Americans have insurance, many with the aid of federal subsidies. “This decision means that millions of people will have access to the basic health care and preventive services that they’ve lacked," she said. "Instead of getting sicker and developing serious and costly complications because they can’t afford to manage their health conditions, people will get the care they need to recognize problems earlier or avoid them altogether." The ANA is a partner in the Robert Wood Johnson Foundation’s (RWJF’s) new Academic Progression in Nursing program.
Some nursing leaders related the decision to uphold the law to personal experiences. "I had a young lady who was a patient in a newborn IC [intensive care] where I worked," Minnesota Nurses Association First Vice President Bernadine Engledorf, RN, told a local television station. "She's had lifelong issues with her health…. After she graduated from college, she discovered she [couldn't] get insurance. This bill will allow her to be covered under her parents' insurance until she's age 26. At that time, the entire ACA will be in place and she will be covered because [refusing coverage on the basis of] preexisting conditions will no longer be allowed."
Susan B. Hassmiller, PhD, RN, FAAN, RWJF senior adviser for nursing and director of the Future of Nursing: Campaign for Action blogged about how the ACA's provisions intended to better transitional care might have improved her father's quality of life in his final year, in a post on the RWJF Human Capital Blog. Hassmiller wrote, in part, “One of the best parts about the Affordable Care Act is that it will make transitional care possible for more patients. The transitional care program is one of many provisions in the law that will provide an unprecedented opportunity for nurses to take on greater roles as members of health care teams—they’ll be better able to provide preventive health care services, care coordination and chronic disease management to patients.”
A number of nurse leaders applauded the law's likely impact on the practice of nursing.
“Nurses are valuable members of the interdisciplinary health team and stand ready to transform the current bloated, uncoordinated, inefficient health care delivery system," said Deborah Hackman, CAE, chief executive officer of the Georgia Nurses Association. "[We are] also pleased the law provides for the growth and dissemination of long-standing, nurse-pioneered programs, such as nurse-managed health centers and the establishment of innovative models of team-based, patient-centered care delivery.”
Some nurse leaders noted that the decision is both an opportunity and a challenge for the profession. “The promise and potential of health reform will rely on nurses,” said Matthew D. McHugh PhD, JD, MPH, RN, CRNP, assistant professor at the University of Pennsylvania School of Nursing in Philadelphia and an RWJF Nurse Faculty Scholar. “To meet the demands of a reformed health care system and increased numbers of insured Americans with increasingly complex health care needs, the nursing workforce must increasingly be educated at a higher level.”
“Registered nurses are well-positioned to lead in providing essential prevention and wellness services and care coordination for individuals and families,” the ANA’s Daley said. “The law enhances opportunities for nurse practitioners and nurse midwives to provide primary care. This will increase accessibility for the growing number of people needing basic health services.”
Nancy Ridenour, PhD, APRN, BC, FAAN, dean of the University of New Mexico College of Nursing and an alumna of the RWJF Health Policy Fellows andExecutive Nurse Fellows programs, observed that "Nursing is critical for the successful implementation." Writing on the RWJF Human Capital Blog, she said that "Transforming our health system from disease-based rescue care to primary care and disease prevention requires dramatic change in how we approach our practice. Focusing on the health of our nation necessitates public health approaches to all levels of care."
Jane Kapustin, PhD, CRNP, FAANP, professor and an assistant dean at the University of Maryland School of Nursing in Baltimore, told NurseZone: “For nurses and nurse practitioners on the front lines of health care, I want to see health care outcomes improved and health care disparities eliminated as a result. It will make our jobs more tolerable, because we won’t have to fight to get services. [People] will have access."
Although the decision settles questions about the law's constitutionality, it did little to bridge the political divide over health care reform, even among nurses serving as members of Congress. On the day of the decisions, some responded by acknowledging the Court's authority to decide the law’s constitutionality, but promising to continue to fight its law's implementation and to push for repeal.
Rep. Renee Ellmers, RN, R-N.C., focused on reform's cost. "Today the Supreme Court verified that Obamacare is a tax—one that increases the financial burdens on every American by $500 billion and will go down in history as the most significant expansion of government power over the lives of its citizens. This law has and continues to be bad policy for all Americans and future generations. I respect our judicial system and the legislative process by which our nation is governed but am deeply concerned in what this means for the future of our country. Today's decision by the Supreme Court sends a direct message to Congress and policy makers that we have to get back to work to repeal this law and replace it with effective, efficient reforms."
Rep. Diane Black, RN, R-Tenn., said that she "vehemently disagree[d] with the Supreme Court's ruling on the President's health care law," calling it a "flawed" decision because of its implications for federal power. "But one thing this decision does not change," she said, "is the need for Congress to repeal Obamacare—immediately…. As a nurse for over 40 years, I am convinced that Obamacare is the wrong medicine for our health-care system. It is driving up health-care costs and stifling innovation—all the while it is killing jobs and accelerating our debt crisis. This is an assault on the American Dream and our nation’s founding principles. Anything short of full repeal is unacceptable."
Rep. Ann Marie Buerkle, RN, R-N.Y., took a similar line in delivering the Republican response to President Obama's weekly radio address after the Supreme Court ruled. "The health care law, which carries an astronomical price tag and a mess of regulations, taxes and fees, fosters a climate of uncertainty and instability throughout our economy," she said. "The President may think this matter is settled, but for the hardworking taxpayers and small business owners in my district, anxiety over his health care law is only growing more and more palpable. This health care law just flies in the face of what America is supposed to be, and repealing it would revitalize our economy and the values upon which our country was founded.
Democratic members of Congress, on the other hand, disagreed, usually stressing specific provisions in the law that would help ensure access to care. Rep. Karen Bass, RN, D-Calif., said she was "pleased that the Supreme Court held firmly to their principles and did not politicize this important decision. Now, the Affordable Care Act can do what the American people need it to do, including providing millions of Americans access to cancer-screenings like mammograms and colonoscopies, ensuring coverage for millions who have preexisting conditions and youth who remain on their parent’s coverage; and finally give seniors a stronger Medicare program."
Rep. Lois Capps, RN, D-Calif., founder and co-chair of the House Nursing Caucus, applauded the decision, saying that it "ensures we can build on the progress already underway to fix our broken health care system." Noting that the law had already made it possible for 10,000 young adults in her district to get insurance, and ensured that 40,000 female constituents would have access to "preventive services like cancer screenings without burdensome co-pays," she extolled the provisions of the law soon to take effect. "There are many more improvements to come," she said, "and this ruling ensures that will now happen, including a basic benefits plan that, among other things, guarantees all women access to contraceptives without burdensome co-pays or co-insurance, will be implemented. Health insurance companies will soon no longer be able to deny coverage to any American who has a pre-existing condition, and low and moderate income families will receive tax credits to help them afford quality insurance. Moreover, insurance companies will finally be required to spend individuals’ premium dollars on medical care, not bonuses for CEOs."
Rep. Eddie Bernice Johnson, RN, D-Texas, also spoke in terms of the law's impact back home. "The Affordable Care Act is already benefiting Texans," she said. "In the Act’s first year alone, Texans saved more than $1.3 million in health care costs, an average of $639.36 per beneficiary. In my district, 18,000 children and 80,000 adults now have health insurance that covers preventive services without paying any co-pays, coinsurance or deductibles. By 2014, 181,000 residents who now lack health care coverage will have access to affordable coverage for the first time, and everyone in the 30th district will be protected from discrimination by insurers based on a preexisting health condition. Texas has the highest number of uninsured in the entire Nation. With full implementation of the Affordable Care Act, Texas will hopefully no longer lead the nation in uninsured individuals."
Read reactions to the ACA ruling from Robert Wood Johnson Foundation President and CEO Risa Lavizzo-Mourey, MD, MBA; and from RWJF Scholars and Fellows on the RWJF Human Capital Blog.
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