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Healthcare Reform Bill: What Nurses Need to Know

Tuesday March 30, 2010
Under a new law, healthcare coverage will be extended to 32 million people.
Under a new law, healthcare coverage will be extended to 32 million people.
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After more than a year of bitter debate, Congress last week wrapped up the final votes and amendments to the nation’s healthcare reform law, marking the most significant changes to the nation’s healthcare system since Medicare was created in 1965.

Under this new law, healthcare coverage will be extended to 32 million people, a goal to be achieved through new mandates for individuals and employers, subsidies for people who can’t afford coverage on their own, consumer-friendly rules clamped on insurers, tax breaks and marketplaces to shop for health plans.

The law’s most far-reaching changes don’t kick in until 2014, including a requirement that most Americans carry health insurance — whether through an employer, a government program or their own purchase — or pay a fine. That will require tax credits to help cover the cost of premiums. Medicaid also will be expanded to cover more low-income people.

Nursing organizations that had been working with the Obama administration as the legislation was being shaped were quick to applaud the overhaul.

“This was the final step needed in the long fight for meaningful healthcare reform,” ANA President Rebecca M. Patton, MSN, RN, CNOR, said in a statement. “This legislation greatly increases access to care for tens of millions of people and will strengthen and improve the healthcare system for generations to come.”

Here is a look at some of the provisions that will most directly affect nurses:

Reauthorization of Title VIII Nursing Workforce Development Programs
These programs, under the Public Health Service Act, are the primary source of federal funding for nursing education and help insure that there will be enough nurses in the future to care for the masses who will need healthcare. The major grant programs are:

• Advanced Education Nursing: Provides grants to nursing schools and academic health centers to enhance education and practice for nurses in master’s and post-master’s programs. These programs prepare nurse practitioners, clinical nurse specialists, nurse midwives, nurse anesthetists, nurse educators, nurse administrators, and public health nurses. The legislation also removes the 10% cap on grants for doctoral education.

• Workforce Diversity Grants: Provide grants to help people from disadvantaged backgrounds, including students from economically disadvantaged families as well as racial and ethnic minorities.

• Nurse Education, Practice and Retention Grants: Support schools and nurses at the associate and baccalaureate level. Grants go to schools of nursing, academic health centers, nursing centers, state and local governments and other entities.

• National Nurse Service Corps: The Nurse Education Loan Repayment Program repays 60 percent of nursing student loans in return for at least two years of practice in a facility that has a critical shortage of nurses. The Nursing Scholarship Program supports students enrolled in nursing school. Upon graduation, scholarship recipients are required to work full time for at least two years in a facility designated to have a critical shortage of nurses.

• Nursing student and nurse faculty loan programs: Establish loan programs within schools of nursing to support students pursuing master’s and doctoral degrees. Upon graduation, loan recipients are required to teach at a school of nursing in exchange for cancellation of up to 85 percent of their educational loans, plus interest, over four years.

Nurse-Managed Clinics
This provision will capitalize on the ability of nurse practitioners to provide high-quality primary and preventive care by defining “nurse-managed health clinic” in the Public Health Service Act and creating a new $50 million grant program to support innovative safety net providers. Nurse-managed health clinics serve as crucial health care access points in areas where primary care physicians are in short supply.

Kenneth P. Miller, RN, PhD, CFNP, FAAN, the chairman of the National Nursing Centers Consortium, said in a statement: “The inclusion of nurse-managed health clinics in health care reform shows that lawmakers understand that our healthcare issues cannot be solved by insurance alone, and that nurse practitioners are the future of primary care in the United States.”

Demonstration Provision for Graduate Nurse Education
This provision will allow Graduate Medical Education monies to be directed to Advanced Practiced Registered Nursing programs to support clinical education. In a letter to congressional leaders, the American Association of Colleges of Nursing said that the measure was “uniquely structured to address the need for expanded clinical education, which has been a barrier to APRN enrollments.”

Funding for National Health Service Corps
Raising the level from $75 million to $300 million will enable the National Health Service Corps to double its field strength by Sept. 30, 2010, HRSA says. Through scholarship and loan repayment programs, the Corps helps Health Professional Shortage Areas in the U.S. get the medical, dental and mental health providers they need to meet their tremendous need for healthcare.

National Healthcare Workforce Commission
An independent group of 15 members will be chosen to assess needs of the healthcare workforce, evaluate programs and make recommendations to Congress and the Administration. Nurses will be among those considered for the positions.

Nurse-Family Home Visit Partnerships
The maternal, infant and early childhood home visitation provision adds $1.5 billion over five years that can help programs such as Nurse-Family Partnership, in which specially trained registered nurses deliver home visits to first-time, low-income mothers for a period of 2 1/2 years, coaching them on healthy pregnancies and helping them cope with the realities of caring for small children.

Studies have found that the program yields lasting improvements in a variety of maternal, child health, and social indicators.

School-Based Health Centers
The legislation authorizes a federal SBHC grant program and an emergency appropriation that would provide $200 million for SBHCs over four years. These centers provide comprehensive preventive and primary healthcare services to students on a school campus, particularly the uninsured and underserved. They are staffed by a team that includes nurse practitioners.

So now the question has turned from “Will we have healthcare reform?” to “How can we make it happen in the most expedient, effective way?” Nurses will play a big role in making reform happen.

“Even though the legislation has now passed, we know that our work isn’t done,” the ANA’s Patton said in a statement. “ANA will work to inform its members and the public about what health care reform will mean for them. We will fight to ensure that these important new reforms continue to be informed by nursing’s unique and vital perspective, and that they are well-implemented and effective.”

Marcia Frellick is a freelance writer. To comment, e-mail editorNTL@gannetthg.com.