Taking it to the top

ANA and state associations promote health system reform
The importance of health system reform can seem like a distant memory when gas prices are going through the roof and homeowners are worried about keeping a roof over their heads.
Health system reform was a top issue when numerous candidates were vying for their parties’ top spot early on in the U.S. presidential race, but faded somewhat as other economic issues grabbed the spotlight. ANA and nurses nationwide, however, want to return it to a front-burner issue leading up to Election Day and beyond.
One way ANA leaders hope to accomplish that is to reinforce to nurses, policy makers, and the media the strategies outlined in the updated, comprehensive document, ANA’ s Health System Reform Agenda. ANA also is an active partner in several Washington-based coalitions that launched major grassroots and media campaigns to bring the need for health system reform to the public’s attention.
“ANA has always believed that access to quality, affordable care is a basic human right,” says ANA President Rebecca M. Patton, MSN, RN, CNOR. “But here in the United States—one of the richest countries in the world—it’s a right that’s being denied to hundreds of thousands of people, from the uninsured to the under-insured, to those unlucky enough to develop a costly chronic illness.”
“And who these days doesn’t know someone—a patient, a neighbor, or loved one—who’s been denied coverage for a preexisting condition or who faces serious debt from mounting medical bills? As nurses, it’s incumbent upon us to rally our colleagues, the policy makers, and the public to make the needed changes in our healthcare system so it’s both effective and compassionate.”
And that goes back to the economic issue.
“There is no way the economy is going to be fixed without addressing health care; the two are inextricably linked,” says Cynthia Haney, JD, senior policy fellow
in ANA’s Department of Nursing Practice and Policy. “When people are afraid of losing their jobs, they worry about losing their health insurance. Insurance costs—for employers and employees—continue to increase, which also affects other areas of spending. And, if your health is poor, you may not be able to keep or get a job.”
Adds Wisconsin Nurses Association (WNA) Executive Director Gina Dennik-Champion, MSN, RN, MSHA, “When you are looking at the economy and why people can’t afford this product or that service, isn’t it due to the high costs of health care?”
Getting national- or state-based comprehensive reform has been a tough nut to crack—with many policy makers leaning toward or implementing a patchwork of incremental changes. Longtime health system reform advocate and Colorado Nurses Association (CNA) member Sara Jarrett, EdD, RN, CNS, CNE, offers some reasons for the difficulty.
“Many polls have shown that a large portion of the public agrees with the idea of  universal coverage,” says Jarrett, a professor of nursing at Regis University and member of Colorado Nurses for Access to Health Care for All. “But there must be a strong educational campaign around universal coverage, because people still are afraid of what they may lose if this system is implemented, such as benefits and choice. And there’s been a lack of political will among policy makers and many organizations to make the changes that are needed.”
On the policy front, ANA—with the commitment of countless nurse members nationwide—has created a roadmap to reform that shows there is a way to lower costs and provide quality care, and it involves the nursing workforce.

On the agenda 
Health reform has been an ANA priority since at least 1989, when the Board of Directors appointed a task force to examine the issue. The panel’s work led to the groundbreaking 1991 document Nursing’s Agenda for Health Care Reform which, with the help of ANA’s Congress on Nursing Practice and Economics, was revised in 2005 to reflect changes in the environment. ANA updated key data and statistics this February, and included the most recent professional literature and studies to strengthen ANA’s argument for a better healthcare system.
ANA declares health care to be a basic human right, and the document highlights ANA’s positions that:
•      health policies must meet the Institute of Medicine’s six aims for quality care: care that is safe, effective, patient-centered, timely, efficient, and equitable. These policies also must be based on quality measures and outcomes research, which ANA contends will lead to cost savings.
•      the health system should focus more resources on preventive care, thereby reducing the current emphasis on a “sick care” model that relies on expensive, technology-driven, hospital-based acute services.
•      ANA supports those initiatives that will improve the quality of and access to health care in the United States for all and advocates for evidence-based approaches to advance these twin goals. Ultimately, though, ANA supports a single-payer mechanism as the most desirable way to finance a reformed system.
For any reformed heath system to work effectively, ANA contends that it’s crucial to have in place a well-educated and well-distributed nursing workforce. It is the inclusion of this fundamental cross-cutting workforce issue that distinguishes the ANA document from health reform proposals of other groups.
“No matter how wonderful your plan for a reformed system, it’s not going to work without thorough consideration of the essential element of the nursing workforce,” Haney says. “Nurses are the ones providing safe, quality care at the bedside. And RNs and APRNs need to be able to practice to the fullest extent of their scope in all settings and in all roles—from coordination of care to chronic disease management and education to primary care.”

In the states 
ANA’s state-based constituent member associations also continue to keep health system reform in the spotlight and have won some policy-making victories that will improve patient care.
Dennik-Champion says that WNA is part of a large coalition of health care and consumer organizations that backs the legislative proposal, “Healthy Wisconsin,” which is expected to be re-introduced during the upcoming session.
The proposal closely mirrors the principles in a WNA co-authored document, The Community of Nursing Agenda for Healthcare Reform, which supports “coverage for all” and emphasizes services aimed at prevention and health promotion, consumer health literacy, patient safety, and chronic care management. The document also speaks to the important role nurses have in a reformed system.
“In order for prevention and health promotion to happen, we need to launch a health literacy campaign so adults understand how these strategies can help them avoid or minimize illnesses,” Dennik-Champion says. “We are really asking people to do a whole paradigm shift by asking consumers to become knowledgeable and responsible for their health, which in the past has been the job of our health professionals who ‘know best.’”
Additionally, one of WNA’s districts recently hosted a legislative breakfast where nurses and policy makers came together to discuss health care reform and the economy. “We also are delighted to have five RNs who are running for state office and who support the nursing health care reform agenda,” Dennik-Champion says.
In Colorado, CNA members have been participating in a series of state-sponsored healthcare reform meetings to advance a universal care model. “Although single payer is our ideal model, we are also trying to work with other groups to ensure our voice is heard when considering incremental changes in health care,” says CNA Executive Director Fran Ricker, MSN, RN, CGRN. “We all can agree that the healthcare system is broken.”
One of CNA’s major victories this year centers on APRN practice. One new law ensures that all qualified APRNs who deliver primary care, mental health, and specialty services can be reimbursed by Medicaid. Another removes barriers for patients to directly select an APRN from their insurance network by requiring carriers to consider APRNs’ applications. Lastly, another new law will allow APRNs to sign certain documents, such as physicals and handicap parking placards that previously required physician signatures, and obtain services for patients, such as home oxygen and advance directives. “All these laws are important changes for patients because they increase access to care and prevent delays in care,” Ricker says.
CNA also backed a successful measure that requires insurance companies to get prior state review and approval before raising their rates; hosted an educational session on health reform for nurses; and gained five CNA-nominated RN appointments to a state panel aimed at commissioning a study on expanded and collaborative scopes of practice for APRNs, physician assistants, and dental hygienists. Additionally, the governor created a Task Force on Nurse Workforce and Patient Care to examine nursing-sensitive measures, nurse retention, and education issues.
“As the largest healthcare provider group, we need to have a much stronger voice if we want to shift from a totally economic-driven healthcare system to a service-driven healthcare system,” Jarrett says. “It’s part of our professional responsibility and part of our Code of Ethics.”
ANA’s Health System Reform Agenda is available online at www.nursingworld.org; click on “health care policy” and scroll down to “health system reform.”

Susan Trossman is the senior reporter in ANA’s Communications Department.

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