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America’s Affordable Health Choices Act of 2009


The U.S. House of Representatives was busy before breaking for the August recess. The three committees with jurisdiction over H.R. 3200 (America’s Affordable Health Choices Act of 2009)—Energy and Commerce, Education and Labor, and Ways and Means—made significant headway by voting to move the bill out of their respective committees. It is expected that when Congress returns to Washington in September, discussions will take place in the House to incorporate pieces of the bill that each committee considered and amend them back into one comprehensive piece of legislation. The final bill would then come before the full House of Representatives for a vote.

To meet our nation’s healthcare needs, an integrated national healthcare workforce that looks beyond physicians must be put into action. Advanced practice registered nurses (APRNs), and in particular nurse practitioners (NPs) and nurse midwives, are proven providers of high-quality, cost-effective primary care that has been widely recognized by patients and the healthcare community and is supported by significant research and critical analysis. The ability of APRNs to practice within a holistic framework that views the individual, family, and community as an interconnected system is fundamental to the critical shift needed in health services delivery, with the goal of transforming the current “sick care” system into a true “health care” system. America’s Affordable Health Choices Act of 2009 clearly recognizes that the support, development, and deployment of this keystone profession are essential for any quality health reform plan to succeed.

H.R. 3200 focuses on community-based multidisciplinary teams to support primary care through the medical home model. This model demonstrates a commitment to high-quality, coordinated care by all health providers. It also represents a focus not just on treating illness but on emphasizing wellness and prevention. ANA is especially pleased that under H.R. 3200, NPs are recognized as primary care providers and authorized to lead medical homes. APRNs’ skill and education, which emphasize patient and family-centered, whole-person care, make them particularly well-suited providers to lead the medical home model. These provisions in H.R. 3200 would bolster the nursing profession and foster full integration, coordination, and collaboration at all levels among our nation’s healthcare workforce.

In addition to recognizing NPs as primary care pro­viders and leaders within the medical home model, H.R. 3200 also addresses a woman’s access to high-quality care and seeks to improve maternal and infant health. Certified nurse midwives (CNMs) provide essential primary care services to women of all ages. Multiple studies have documented the quality of services and positive outcomes associated with their care. Medi­care has covered CNM services since 1988, but reimbursement has been limited to 65% of the amount afforded to other obstetric and gynecologic service providers. H.R. 3200 addresses the Medicare reimbursement disparity for midwifery services by increasing reimbursement to 100% for midwifery services.

Besides provisions within H.R. 3200, the House Energy and Commerce Committee approved during their markup (by voice vote) inclusion of an amendment that would create an Independence Home Pilot Program to allow Medicare patients with multiple chronic conditions to receive primary care in their homes. The amendment aims to support an interdisciplinary model in which providers (both nurses and physicians) practice collaboratively and to the full extent of their education and licensure on the patient’s behalf. It recognizes the integral role nurses and NPs play in delivery of primary care and helps bring the focus of our healthcare system back where it belongs: to the patient and the community.

ANA will continue to be actively engaged on Capitol Hill, representing the interests of America’s 2.9 million RNs when Congress returns from recess. However, members of Congress need to hear from you, too. Without public support for reform, there is still a chance that this historic opportunity will slip away, and without your input, nursing’s voice could go unheard.

Join the fight for healthcare reform by becoming a member of ANA’s Health Care Reform Team. As a team member, you’ll get updates on progress from Capitol Hill, action alerts to members of Congress, and more!

Join our Health Care Reform Team by visiting and play a part in keeping nurses where they belong—at the center of healthcare reform.

Rachel M. Conant is Associate Director of ANA’s Department of Government Affairs.

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