Nurses and the Undoing of the ACA
Many in the nursing community supported the Affordable Care Act (ACA) when it was first introduced. This is understandable, given our firsthand experience of patients who didn’t seek care until they were gravely ill because they lacked health insurance. We know how disease management can change outcomes for those with chronic illness and how preventive care can make the difference between having a treatable cancer or a metastasis.
In the years since, as both supporters and detractors continued to argue over the law and its need to be improved (or scrapped, depending on your viewpoint), over 20 million people gained health insurance and access to care.
Now as Congress moves to repeal and replace the ACA with a yet-to-be-determined plan, many are concerned that major gains will be lost and once again it will be the poor and vulnerable who will suffer. (I touched on some of the concerns in my March editorial.)
To get a little more insight, I spoke with two very policy-smart nurses about what might happen and what they feel should happen.
What ANA president Pam Cipriano said:
I asked ANA president Pam Cipriano what she thought was the most critical aspect of the gains from the ACA that need to be preserved. Her answer:
“We must preserve access to affordable care—and that includes essential benefits like reproductive and mental health care services, coverage of preexisting conditions, keeping children on parent coverage up to age 26, and providing coverage through Medicaid to those living in poverty or with chronic illness or disabilities.”
Cipriano was pessimistic about the renewed call for “Medicare for all,” saying that “it would require a major change of heart by Congress,” which she doesn’t see happening. The ANA sent its priorities in a letter to the new U.S. president.
Cipriano thinks it’s time for the health care community to galvanize and pressure Congress on the local and state levels. She urges nurses to get to these representatives and tell the stories of what changes will mean for families and patients, “make the results of their decisions real.” She also noted:
“We’re in a whiplash situation, with changes occurring so rapidly that we can get caught up reacting to many things. We need to keep to our basic principles and stay focused on the main point—a system that allows for affordable care for all Americans.”
What the the AARP’s Susan Reinhard said:
I also spoke with Susan Reinhard, senior vice president and director of AARP’s Public Policy Institute, who also voiced concern that changes to Medicare and Medicaid will cause “considerable instability in health care.” Though President Trump promised in his campaign that he would not “mess with Medicare,” some Republicans want to do exactly that, and the AARP is gearing up to fight this. She also worries that changes to Medicaid, which covers not only nursing home care but many home- and community-based services that allow older adults to stay in their homes, will create more burdens for family caregivers.
Opposing the ‘age tax.’ The AARP is lobbying especially hard against what it calls the “age tax,” which would let insurance companies institute age ratings to levy higher premiums on older adults—up to five times more than for younger people. Currently, companies can charge only three times higher.
Reinhard says nurses need to “speak up in calm and thoughtful conversations and raise concerns about care and what patients need.” Like Cipriano, she reminds nurses to draw on their experience to support advocacy:
“There’s a lot of power in patient stories, and nurses speak with authenticity on what policy changes will mean to those who depend on Medicare and Medicaid.”
She urges nurses to seek out Congressional staffers, who are often young and lack life experiences dealing with illness and disability and death, and “change their orientation from data and numbers to the personal consequences.”
We can do this.