Recognizing the Value of Nursing Under Universal Health Care Coverage

  

The debate over how the nation structures its health care delivery system has waged on for decades. At the heart of this debate has been how to ensure coverage and access to needed health care services for patients. Looking at a system where most get their health needs covered by Medicare, Medicaid, or commercial, employer-sponsored covered, many recognized that too many Americans continued to be left behind. On one side of the debate, we have seen a push towards a single-payer system—like what is in place in Canada and the United Kingdom. Others, pushing for more market-based solutions to expand coverage through private plans.

At ANA, we have long supported movement toward adopting a single-payer health care system as the most desirable option. That is a health care system that is structured where services provided are financed by one payer, typically the government. Since that position was formally adopted in 1999, ANA has altered its advocacy on ensuring all Americans have access to health care coverage and nursing care, rather than focusing on how the health care system is financed. This evolution is a result of a shift in conversations about health care reform and delivery system, which was fully realized with the passage of the Affordable Care Act (ACA)—which celebrates its 11th anniversary this year. This landmark legislation made several critical reforms to the nation’s health care delivery system that continue to influence health care policymaking today.

The ACA adopted some market-based solutions to expand access to coverage through the creation of federal and state-based marketplaces, while at the same time expanding eligibility for the Medicaid program to vulnerable adult patient populations. In addition to focusing on coverage, the ACA has helped to trigger a broader movement to value and quality in how health care services are provided and paid. We know that many of our nurses are integral in leading and ensuring the success of value-based models and other innovations that better the care for patients, recognized through underlying payment structures.

As ANA engages with Congress and policymakers, it is key that the association’s position better reflect the current conversations and priorities, as well as allowing flexibility that allows the association to weigh in on proposed legislation and regulations. This will only serve to allow our voice to be more effective on behalf of our members—making it clear that the existing support of a single-payer system must be updated. Rather, we must adopt a replacement policy that endorses universal health coverage that recognizes the value of nursing. As defined by the World Health organization, universal coverage is a system wherein everyone has access to the health care services they need.

Through promoting universal health coverage that recognizes the value of nursing, ANA has the opportunity to continue to amplify the vital role nurses play in changing and improving the nation’s health care delivery system. Nurses are key to the provision of high-quality care to patients—regardless of the patient’s health care coverage. What is critical in these debates is the recognition of the nurse role through equitable payment for the services they provide to patients. Additionally, as policymakers continue to drive innovation and reform into the delivery system, nurses must be allowed to practice at the top of their license to fully contribute to the success of any system changes.

While our complex health care delivery system is far from perfect, there are many opportunities to shape policies that impact coverage, care, and ultimately the nursing profession. Over 30 million of our fellow Americans remain uninsured, a number likely to continue to grow due the economic challenges we all face due to the COVID-19 pandemic. This will likely lead to actions that work to ensure greater access to health care coverage. We also know that innovation and delivery system reform will continue to be an area of focus for policymakers. The role of the nurse must be forefront in these conversations and—most importantly—in any resulting legislation or regulations. Adopting a position that recognizes that access to health care coverage is most important, regardless of the underlying financing, lets us focus on ensuring that the value of nursing is fully recognized in our health care delivery system.

Over the next few weeks, members should watch ANA’s communication platforms as we near this year’s Membership Assembly. Dialogue forums are back, and we look forward to a robust conversation about moving ANA from endorsing a single-payer system to one that supports universal access to health care that fully recognizes the value of nursing.

An Open Letter to the ANA Membership

  

Dear Member:

As you are probably aware by now, the ANA Board of Directors recently made the decision to uphold the 2019 Membership Assembly (MA) vote that rescinded the 1985 Presidential Endorsement Process and replaced it with a Presidential Engagement Policy. Whether to uphold the will of ANA’s highest governing body, which voted overwhelmingly to end the endorsement process, or endorse a presidential candidate in this year’s election, was one of the most important and toughest decisions this board has made.

We did not take this responsibility lightly. Each of us read every communication sent to us and as a group, we relitigated the debate that occurred at the 2019 Membership Assembly regarding the pros and cons of each option. I trust that you can appreciate the anguish that each board member experienced in making a decision. As an elected leader, could you ignore the will of the majority who, after debating this issue for two years, has already spoken through their vote at Membership Assembly, or send a message that ignores that result even if legally permitted to do so? I believe that you would agree that to undertake such a move sends a message that the ANA board ignores the ANA member governing body.

In making this decision, board members had the tough responsibility of detaching from their personal political views and experiences to act in the best interest of the association. ANA represents the interests of 4.2 million registered nurses with diverse political views. As a board, we could not ignore this fact given we are in the middle of one, if not the most, divisive election in history. The decision of the board, like that of the Membership Assembly, was evidence-based, and it underscored our belief in the critical thinking of each registered nurse.  

As a professional organization, ANA does not have a vote in national, state or local elections – but individually, you and I do. ANA’s Presidential Engagement Policy encourages each nurse to not only get out and vote – but to get other nurses and nurse advocates out to the polls as well. As ANA’s president, I know ANA benefits through its work with members of both parties to promote the profession before Congress and with the administration. As a Black man, who has spoken out against racism and the current political temperament fomenting hate and divisiveness, I pledge to personally get out the vote for the candidate that I believe will best represent my own values and priorities for a safe, equitable, just and compassionate country. 

I urge you to vote, engage and campaign for the candidates, from those running for president, down the ballot to members of Congress and state and local offices, who most align with your own political views – informed by your personal values and experiences and your professional responsibilities, guided by the Code of Ethics for Nurses.  This November and beyond, we must always fight for what is right for nurses, our patients and the public.

Sincerely yours,

Ernest J. Grant, PhD, RN, FAAN

President

American Nurses Association

ANA Advocacy – Transforming Nursing’s Voice on the National Stage

  

Last week, I represented the American Nurses Association (ANA) before the United States Senate Finance Committee to reiterate the urgent need to provide nurses a sufficient supply of personal protective equipment (PPE), safeguard the mental health and well-being of nurses, and address the racial health disparities exacerbated by COVID-19. Participating in a Senate hearing for the first time was an eye-opening experience. It was evident that senators unanimously respect and appreciate the significant sacrifices being made by nurses in response to COVID-19. What came to light during the hearing was that ANA’s bi-partisan approach to advocacy is working –as both sides of the aisle were interested in hearing our message and ensuring that the nation’s 4 million registered nurses are at the witness table as Congressional debate continues over access to PPE. More needs to be done to ensure nurses have access to PPE – therefore I urge each of you to help amplify our collective voice by taking ANA’s latest PPE survey and contacting your members of Congress today.

As ANA president, I am determined to ensure that ANA continues to be at the table to advance the voices of nurses and the patients they serve. This means the association representing the nation’s registered nurses needs to work with those who are elected regardless of political affiliation. Having good working relationships with the Administration and Congress allows for productive conversations even when we disagree. This approach has provided ANA’s leadership, including me, the opportunity to proactively discuss the threats our nurses face on the frontlines of the pandemic while voicing our opposition over the Administration’s defunding of the World Health Organization or the lack of action in authorizing the Defense Production Act. Despite these differences, ANA is recognized on Capitol Hill and within the Administration as the voice of nursing. This has allowed ANA additional opportunities to meet with influential decision makers.

In 2019, ANA’s highest governing body – its Membership Assembly – voted to move away from endorsing presidential candidates. In this presidential election cycle, ANA is focused on equipping nurses with information about the candidates to better engage in the 2020 elections. While ANA is not supporting a specific presidential candidate, I encourage every nurse and nurse advocate to actively participate in the political process, and vote on November 3. The decision not to endorse was based on recommendations of a bi-partisan task force made up of influential nursing leaders. ANA has developed NursesVote to help nurses activate, educate, support and vote for the political candidate of their choice. The ANA-PAC stands by its long history of endorsing pro-nursing Congressional candidates who typically have strong relationships with our Policy and Government Affairs staff and our Constituent/State Nurses Associations.

Since the beginning of the pandemic, ANA has met with the White House and has interacted with a number of federal agencies: the Department of Health and Human Services, the Department of Labor and the Federal Emergency Management Agency to raise concerns about a lack of PPE among other pressing issues. This is in addition to political advocacy efforts on Capitol Hill, which have already resulted in wins for nurses, outlined here in a June Capitol Beat blog. Nurses are at the table – and making a difference.

ANA’s advocacy focus is to ensure our ability to expand and promote nursing’s agenda and to fight for the profession and the patients they serve. We make our concerns known both publicly and in personal meetings with elected officials and their staff. ANA will not remain silent. We continue to lead the charge for nurses.