Nurse.com submitted questions to the campaigns of President Obama and Gov. Romney regarding their positions on issues about nursing and healthcare. Following are the answers as submitted by the campaigns. The responses are unedited with the exception of small changes for grammar or clarity.
President Barack Obama
How will President Obama continue to address nursing workforce issues, such as safe staffing in hospitals and the need to provide enough nurses and other healthcare workers to accommodate rising demand?
From day one, my administration has made strengthening the healthcare workforce a priority. The Recovery Act made an initial investment, and the Affordable Care Act followed through. We have provided loans to master’s and doctoral nursing students who plan to become nurse faculty after completing their education. The healthcare law created the Graduate Nurse Education Demonstration to support the training of advanced practice registered nurses. And the administration dedicated half of the first-year funding — $250 million — from the Prevention and Public Health Fund to workforce improvements.
While nurses are needed throughout the country, we must also specifically work to improve the availability of qualified nurses in rural communities. We’ve worked to increase funding for nurses, doctors and other healthcare workers in rural areas through loan and scholarship programs, allowing more nurses to receive accredited training and go to work in rural health clinics and other facilities facing a critical shortage of qualified personnel. The National Health Service Corps has nearly tripled in size since 2008.
Analysts predict healthcare spending in both public and private sectors to increase between 10% and 20% after the implementation of the ACA, with Medicare and Medicaid spending increasing from $1.1 trillion to $1.8 trillion by the end of the decade. How will the country pay for this increase and still keep these programs going?
The healthcare law reduces the deficit by more than $100 billion in the first 10 years, and more than $1 trillion after that.
But healthcare costs aren’t just a problem for taxpayers; they also put a burden on families across the country. Before the healthcare law was passed, insurance premiums were skyrocketing, and the shared cost of caring for the uninsured added $1,000 to the typical insured family’s premium. As promised, healthcare reform has begun to address our nation’s healthcare costs. Now insurance companies must publicly justify excessive rate hikes and provide rebates if they don’t spend at least 80% of premiums on care instead of overhead, marketing and profits.
In 2019, when the law is fully implemented, economists believe health insurance premiums will be about $2,000 less because of the law. The Department of Health and Human Services estimates that the Affordable Care Act will save a typical middle-class family that doesn’t get insurance at work about 60% on premium costs starting in 2014 — including [from] both the tax credit and the savings from more efficient markets in the [state health insurance] exchange.
Overall, the healthcare law strengthens Medicare and Medicaid by reducing waste, increasing accountability, promoting efficiency and improving the quality of care — without shifting the cost of care to our seniors or people with disabilities. We oppose any plan that would simply shift costs to seniors and the vulnerable by undermining Medicare and Medicaid.
There has been some criticism that new federal regulations intended to contain costs are interfering with how providers practice medicine. For instance, some hospitals received lower reimbursements because of high readmission rates, even though they had acceptable mortality rates. Are there ways to prevent this from happening and to keep from inadvertently penalizing providers who are doing what they believe is best for their patients?
We are committed to improving our healthcare delivery system so that we keep people healthier while providing better care at lower costs. Providing financial incentives to promote the right care in the right setting is part of this effort. Too many patients are readmitted for preventable conditions, which hurts these patients and adds costs to the system. We will work with doctors, nurses and hospitals as partners in this effort and all efforts to ensure that patients always receive the best care.
What will happen if more providers decide not to accept Medicare patients because of lowered reimbursements? How will the ACA prevent hospitals from cutting staff as a result of low reimbursements, as happened during the managed care movement?
The Affordable Care Act is making Medicare stronger by getting rid of waste, fraud and needless subsidies to insurance companies. The improvements in the healthcare law are focused on strengthening Medicare’s financing the right way — by making the program more efficient, not by cutting benefits for seniors. We will continue to make sure that seniors can access the care they need, to seek a permanent fix of Medicare’s flawed physician payment system and to ensure that our hospitals are strong and staffed to serve the needs of an aging society.
Will President Obama provide some way to standardize or expand scope-of-practice for nurse practitioners, as recommended in an Institute of Medicine report, including allowing nurse practitioners to be reimbursed as Medicaid and Medicare providers in all states?
My administration has been focused from the start in expanding the primary-care workforce, and advanced practice nurses are a critical part of that workforce.
For example, we are cutting regulations that prevent hospitals from using nurse practitioners and physician assistants in lieu of physicians. These reforms will save hospitals and patients money while improving the quality of care. We’ve also provided funding to support nurse-managed health clinics, which will improve access to primary care and enhance nursing practice by increasing the number of clinical teaching sites for primary care and community health nursing students.
What sort of importance does President Obama place on receiving leadership and counsel from nurses on matters of healthcare policy?
Two exceptional nurses — Mary Wakefield, RN, PhD, FAAN, and Marilyn Tavenner, RN, BSN, MHA — have served in leadership positions at HHS in my first term. Mary serves as the administrator of the Health Resources and Services Administration, leading our efforts to strengthen the nursing and primary care workforce. I have nominated Marilyn to lead the Centers for Medicare & Medicaid Services, where she has been the acting administrator for the past year. Marilyn’s experience as a nurse has helped her guide Medicare, Medicaid and the new Center for Consumer Information and Insurance Oversight, which is the lead agency on implementing the Affordable Care Act. Mary and Marilyn, along with countless other nurses, do tremendous work implementing the Affordable Care Act and leading their departments.
What does President Obama see as the greatest challenge for nurses and other healthcare workers in the next five years? How important will nurses’ contributions be as the act is implemented?
There are few things as important to families as healthcare. For too long, people have been paying more and getting less. For those with insurance, too many were dropped or denied because of a pre-existing condition or because the insurance company found something wrong on the application. It was a system that worked well for big insurance companies, but not so well for average Americans.
For this reason, I signed a healthcare law that puts the American people on a path toward that comprehensive solution. The law builds on what works, and fixes what’s broken. People who like their coverage can keep it, but now patients and their nurses and doctors — not insurance companies — are in control. The law also helps doctors and nurses to coordinate the care they provide, so people don’t have to get the same tests twice.
The Affordable Care Act is a major step forward, but I know that the law is not perfect; no law ever is. I will always remain willing to work with the medical and nursing communities to improve it in the years to come.
Former Massachusetts Gov. Mitt Romney
How will Gov. Romney address healthcare workforce issues, such as safe staffing in hospitals and the need to provide enough nurses and other healthcare workers for the future?
Our healthcare system faces a growing number of challenges. Among the most serious is the added strain being imposed on medical professionals as they are asked to shoulder an ever increasing caseload. This is nowhere more evident than in the nursing field.
What does Gov. Romney see as the greatest challenge facing nurses and other healthcare providers in the next five years?
Unfortunately, President Obama’s healthcare law makes the situation worse. The law raids $716 billion from the Medicare program to help pay for trillions in new government spending. Worse, the dramatic cuts in Medicare payments to medical institutions and the failure to fix a broken reimbursement formula continue to drive America’s best and brightest out of the healthcare profession.
As part of his health plan, Gov. Romney has said he will work to repeal the Affordable Care Act. Will there be any aspects of the ACA he will keep, such as keeping children on their parents’ insurance until they are 26 or requiring no copay for certain preventive services?
Nurses and doctors — those who actually provide medical care — should be empowered to treat their patients without interference from federal bureaucrats. That is why Gov. Romney has put forward reforms that focus on greater patient choice and control, lower costs and better access for every American.
If he succeeds in his efforts to get the ACA repealed, how will Gov. Romney’s plan ensure prevention and expanded access to coverage, including affordable coverage for people with pre-existing conditions?
Gov. Romney’s approach ensures those with pre-existing conditions will still have access to the care they need, states have the resources and flexibility they need to craft programs that address the needs of any residents who remain uninsured, and Medicare is protected for today’s seniors and strengthened for future generations.
Will Gov. Romney provide some way to standardize or expand scope-of-practice for nurse practitioners, including allowing nurse practitioners to be reimbursed as Medicaid and Medicare providers in all states? What role does he see advanced practice nurses playing with regard to a predicted primary-care physician shortage?
(Did not answer.)
How much input is Gov. Romney seeking from nurses on healthcare issues, and will nurses have strong voices in his administration, the way Marilyn Tavenner and Mary Wakefield do in the Obama administration?
(Did not answer.)
What does Gov. Romney see as the most important elements in reforming healthcare — increasing access to care, delivering cost-effective care, improving quality of care or something else?
Gov. Romney is fundamentally opposed to the Washington-knows-best approach that President Obama has pursued. Instead, he believes we must pursue a system that puts providers and patients first. Nurses and doctors — those who actually provide medical care — should be empowered to treat their patients without interference from federal bureaucrats.
For much more coverage, visit www.Nurse.com/Election2012.
President Barack Obama
How will President Obama continue to address nursing workforce issues, such as safe staffing in hospitals and the need to provide enough nurses and other healthcare workers to accommodate rising demand?
From day one, my administration has made strengthening the healthcare workforce a priority. The Recovery Act made an initial investment, and the Affordable Care Act followed through. We have provided loans to master’s and doctoral nursing students who plan to become nurse faculty after completing their education. The healthcare law created the Graduate Nurse Education Demonstration to support the training of advanced practice registered nurses. And the administration dedicated half of the first-year funding — $250 million — from the Prevention and Public Health Fund to workforce improvements.
While nurses are needed throughout the country, we must also specifically work to improve the availability of qualified nurses in rural communities. We’ve worked to increase funding for nurses, doctors and other healthcare workers in rural areas through loan and scholarship programs, allowing more nurses to receive accredited training and go to work in rural health clinics and other facilities facing a critical shortage of qualified personnel. The National Health Service Corps has nearly tripled in size since 2008.
Analysts predict healthcare spending in both public and private sectors to increase between 10% and 20% after the implementation of the ACA, with Medicare and Medicaid spending increasing from $1.1 trillion to $1.8 trillion by the end of the decade. How will the country pay for this increase and still keep these programs going?
The healthcare law reduces the deficit by more than $100 billion in the first 10 years, and more than $1 trillion after that.
But healthcare costs aren’t just a problem for taxpayers; they also put a burden on families across the country. Before the healthcare law was passed, insurance premiums were skyrocketing, and the shared cost of caring for the uninsured added $1,000 to the typical insured family’s premium. As promised, healthcare reform has begun to address our nation’s healthcare costs. Now insurance companies must publicly justify excessive rate hikes and provide rebates if they don’t spend at least 80% of premiums on care instead of overhead, marketing and profits.
In 2019, when the law is fully implemented, economists believe health insurance premiums will be about $2,000 less because of the law. The Department of Health and Human Services estimates that the Affordable Care Act will save a typical middle-class family that doesn’t get insurance at work about 60% on premium costs starting in 2014 — including [from] both the tax credit and the savings from more efficient markets in the [state health insurance] exchange.
Overall, the healthcare law strengthens Medicare and Medicaid by reducing waste, increasing accountability, promoting efficiency and improving the quality of care — without shifting the cost of care to our seniors or people with disabilities. We oppose any plan that would simply shift costs to seniors and the vulnerable by undermining Medicare and Medicaid.
There has been some criticism that new federal regulations intended to contain costs are interfering with how providers practice medicine. For instance, some hospitals received lower reimbursements because of high readmission rates, even though they had acceptable mortality rates. Are there ways to prevent this from happening and to keep from inadvertently penalizing providers who are doing what they believe is best for their patients?
We are committed to improving our healthcare delivery system so that we keep people healthier while providing better care at lower costs. Providing financial incentives to promote the right care in the right setting is part of this effort. Too many patients are readmitted for preventable conditions, which hurts these patients and adds costs to the system. We will work with doctors, nurses and hospitals as partners in this effort and all efforts to ensure that patients always receive the best care.
What will happen if more providers decide not to accept Medicare patients because of lowered reimbursements? How will the ACA prevent hospitals from cutting staff as a result of low reimbursements, as happened during the managed care movement?
The Affordable Care Act is making Medicare stronger by getting rid of waste, fraud and needless subsidies to insurance companies. The improvements in the healthcare law are focused on strengthening Medicare’s financing the right way — by making the program more efficient, not by cutting benefits for seniors. We will continue to make sure that seniors can access the care they need, to seek a permanent fix of Medicare’s flawed physician payment system and to ensure that our hospitals are strong and staffed to serve the needs of an aging society.
Will President Obama provide some way to standardize or expand scope-of-practice for nurse practitioners, as recommended in an Institute of Medicine report, including allowing nurse practitioners to be reimbursed as Medicaid and Medicare providers in all states?
My administration has been focused from the start in expanding the primary-care workforce, and advanced practice nurses are a critical part of that workforce.
For example, we are cutting regulations that prevent hospitals from using nurse practitioners and physician assistants in lieu of physicians. These reforms will save hospitals and patients money while improving the quality of care. We’ve also provided funding to support nurse-managed health clinics, which will improve access to primary care and enhance nursing practice by increasing the number of clinical teaching sites for primary care and community health nursing students.
What sort of importance does President Obama place on receiving leadership and counsel from nurses on matters of healthcare policy?
Two exceptional nurses — Mary Wakefield, RN, PhD, FAAN, and Marilyn Tavenner, RN, BSN, MHA — have served in leadership positions at HHS in my first term. Mary serves as the administrator of the Health Resources and Services Administration, leading our efforts to strengthen the nursing and primary care workforce. I have nominated Marilyn to lead the Centers for Medicare & Medicaid Services, where she has been the acting administrator for the past year. Marilyn’s experience as a nurse has helped her guide Medicare, Medicaid and the new Center for Consumer Information and Insurance Oversight, which is the lead agency on implementing the Affordable Care Act. Mary and Marilyn, along with countless other nurses, do tremendous work implementing the Affordable Care Act and leading their departments.
What does President Obama see as the greatest challenge for nurses and other healthcare workers in the next five years? How important will nurses’ contributions be as the act is implemented?
There are few things as important to families as healthcare. For too long, people have been paying more and getting less. For those with insurance, too many were dropped or denied because of a pre-existing condition or because the insurance company found something wrong on the application. It was a system that worked well for big insurance companies, but not so well for average Americans.
For this reason, I signed a healthcare law that puts the American people on a path toward that comprehensive solution. The law builds on what works, and fixes what’s broken. People who like their coverage can keep it, but now patients and their nurses and doctors — not insurance companies — are in control. The law also helps doctors and nurses to coordinate the care they provide, so people don’t have to get the same tests twice.
The Affordable Care Act is a major step forward, but I know that the law is not perfect; no law ever is. I will always remain willing to work with the medical and nursing communities to improve it in the years to come.
Former Massachusetts Gov. Mitt Romney
How will Gov. Romney address healthcare workforce issues, such as safe staffing in hospitals and the need to provide enough nurses and other healthcare workers for the future?
Our healthcare system faces a growing number of challenges. Among the most serious is the added strain being imposed on medical professionals as they are asked to shoulder an ever increasing caseload. This is nowhere more evident than in the nursing field.
What does Gov. Romney see as the greatest challenge facing nurses and other healthcare providers in the next five years?
Unfortunately, President Obama’s healthcare law makes the situation worse. The law raids $716 billion from the Medicare program to help pay for trillions in new government spending. Worse, the dramatic cuts in Medicare payments to medical institutions and the failure to fix a broken reimbursement formula continue to drive America’s best and brightest out of the healthcare profession.
As part of his health plan, Gov. Romney has said he will work to repeal the Affordable Care Act. Will there be any aspects of the ACA he will keep, such as keeping children on their parents’ insurance until they are 26 or requiring no copay for certain preventive services?
Nurses and doctors — those who actually provide medical care — should be empowered to treat their patients without interference from federal bureaucrats. That is why Gov. Romney has put forward reforms that focus on greater patient choice and control, lower costs and better access for every American.
If he succeeds in his efforts to get the ACA repealed, how will Gov. Romney’s plan ensure prevention and expanded access to coverage, including affordable coverage for people with pre-existing conditions?
Gov. Romney’s approach ensures those with pre-existing conditions will still have access to the care they need, states have the resources and flexibility they need to craft programs that address the needs of any residents who remain uninsured, and Medicare is protected for today’s seniors and strengthened for future generations.
Will Gov. Romney provide some way to standardize or expand scope-of-practice for nurse practitioners, including allowing nurse practitioners to be reimbursed as Medicaid and Medicare providers in all states? What role does he see advanced practice nurses playing with regard to a predicted primary-care physician shortage?
(Did not answer.)
How much input is Gov. Romney seeking from nurses on healthcare issues, and will nurses have strong voices in his administration, the way Marilyn Tavenner and Mary Wakefield do in the Obama administration?
(Did not answer.)
What does Gov. Romney see as the most important elements in reforming healthcare — increasing access to care, delivering cost-effective care, improving quality of care or something else?
Gov. Romney is fundamentally opposed to the Washington-knows-best approach that President Obama has pursued. Instead, he believes we must pursue a system that puts providers and patients first. Nurses and doctors — those who actually provide medical care — should be empowered to treat their patients without interference from federal bureaucrats.
For much more coverage, visit www.Nurse.com/Election2012.
Cathryn Domrose is a staff writer. Write to editor@Nurse.com or post a comment below.
