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President's Address: Step By Step - The Affordable Care Act
A message from ONA's Board President, Steve Rooney, RN

By now, everyone is aware that the Supreme Court upheld the constitutionality of the individual mandate of the Affordable Care Act (ACA). Pundits, politicians and organizations involved in health care, including the Oregon Nurses Association (ONA) and American Nurses Association (ANA), have written volumes about what the decision means.

ONA and ANA have been supporting health care reform for over 20 years. In 1991, ANA adopted Nursing’s Agenda for Health Care Reform with the cornerstone ideals of access to care, quality of care, cost effectiveness, and workforce issues. We believe that health care is a basic human right, as well as smart public policy. The ACA is projected to cover 30 million uninsured Americans and, while the ACA will not provide for universal health care, it is a huge step in that direction.

We are actively implementing portions of the ACA here in Oregon. Benefits of the law are already being realized and are changing lives, including no denials of coverage based on pre-existing conditions, adult children staying under their parent’s policy until age 26 and free access to preventive services like mammograms, colonoscopies, and others.

Oregon, with leadership from Governor John Kitzhaber, is setting up a system that will cover all of the Medicaid eligible citizens through Coordinated Care Organizations (CCO). These CCOs are to emphasize primary care, prevention, community-based care, and care coordination.

Nurses will play a vital role in this transformation from "sick care” to health care. Our holistic approach that considers the individual, the family and the community is exactly the emphasis required by the transformed health care system. Nurse Practitioners can become the primary care provider of choice. With all nurses working at their full capabilities, we can provide the highest quality, most cost effective care.

However, all is not roses. There is much work to be done. Rules and regulations are being written daily at the state and national levels. Your professional nursing organizations, ANA and ONA, are actively involved in the development of the new rules and monitoring and influencing how these "rules and regs” will be implemented. The change from "physician” to "provider” in a regulation can make a huge difference in the quality and cost of care.

There is a lot of money at stake. Governmental organizations (cities, counties, states), health care systems and administrators, insurers, nurses, physicians, and all other health care providers are at the table, along with citizen groups and individuals. They bring their agendas and those agendas may or may not align with ours. Some may even be envisioning a pot of gold in health care reform. There are, and will continue to be, disagreements on how best to achieve the goals of reform. Certainly there are disagreements on who will be the most cost effective providers. For example, many primary care clinics have become "nurse-free zones”, that is there are no nurses employed. Many community advocates are unaware of the difference between an RN and a medical assistant and the kind of care that they can give.

For RNs to ensure that we are included in the CCO primary care settings, nurses must become involved in the CCOs Clinical Advisory Panels or the Consumer Advocacy Panels. We must also do a better job in educating the public about the value of our skills. Without nurse participation in the formation of the reformed health care system, we find ourselves and our communities without the quality or cost effectiveness that we thought we were creating.

All in all, the Affordable Care Act is a start in the direction we as a nation must take. We cannot afford to be the only developed nation that does not provide basic health care to its citizens. We also cannot afford to be number one in per capita spending on health care while attaining the 37th best health outcomes. That is why ONA and ANA support health care transformation, and why we urge you to be involved.

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Oregon Nurses Association
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(503) 293-0011 or 800-634-3552 (Oregon Only)