Like all political propositions, healthcare reform has left nurses wondering what's in it for them. Why should they support a bill? What could it do to their roles?

The American Nurses Association examined the Affordable Health Care for America Act, introduced in late October by the U.S. House of Representatives, finding there's a lot in it pertaining to nurses. For instance, the bill would create programs aimed at building the workforce and reimbursing more for services provided by nurse practitioners.

To give just an overview, the bill would:

• pour a lot of money into educating nurses  —  an additional $638 million over the next 5 years for various nursing programs to be appropriated from the Public Health Investment Fund. Currently the fund is worth $171 million.
• increase loan repayment benefits for students and faculty.
• increase Medicare payment rate by 5 percent for primary care services of primary care practitioners  —  including nurse practitioners. Eligible practitioners practicing in health professions shortage areas receive an additional 5 percent.
• establish a demonstration program to reduce the student-to-school nurse ratio in public elementary and secondary schools.
• authorize nurse practitioners to lead various new models of coordinated care, including the "medical home" and Independence at Home pilot program.
• create transparency in nursing homes by detailing its staffing ratios, patient census and staff turnover rates on Centers for Medicare & Medicaid's Nursing Home Compare Web site. The bill would also include whistleblower protection for employees who complain in good faith about the quality of care or services at a skilled nursing facility.

There's a lot more in the bill aimed at strengthening the role of nurses. After you read ANA's full synopsis of the bill here, let your Representative know what you think and share your opinions with other nurses.

To clear up any confusion, the president provided some details of the bills drafted by Congress. He said nothing changes for people who receive health insurance through their employers, those on Medicare, Medicaid, and those who receive care through the VA health system — except, reform will provide "more security and more stability."

For instance, he said, insurance companies will not be able to deny care based on a preexisting condition. It will be against the law for insurance companies to drop people when they get sick or water down the care they receive. There will be no caps on what care people can get in a year or a lifetime.

"We'll place a limit on what you'll be charged out of pocket. ... No one should get broke" because they're ill, Obama said. 

Clash of the Chamber

The chances of the president getting bipartisan support for healthcare reform didn't seem too great last night.

Most notably, jeers came when he confronted some of the myths about the bills. A panel of bureaucrats will not decide when senior citizens will die. Federal money will not be used to fund abortions.

And, when the president said reform would not provide insurance coverage to people who are in the country illegally, loud boos came from the Republican side of the chamber. In an already infamous scene, Rep. Joe Wilson of South Carolina yelled "you lie!"

Obama noted the healthcare legislation won't include medical malpractice reform, a cause the Republicans strongly support. Obama explained he doesn't think tort reform is "a silver bullet." Instead, patient safety and allowing physicians to practice should be priorities.

Following the Money

Talking about the costs of healthcare reform, the president said the plan will cost $900 billion over 10 years, and he will not sign legislation that will "add one dime to our deficit, now or in the future."

Healthcare reform will be paid for with money that is already being spent in the system, but being spent badly, the president said.

"There will be a provision [in the legislation] that we'll have to cut spending if the savings we promised aren't coming," he added.

Also, President Obama reiterated his support for "the public option," a government-backed health insurance plan that will compete with private insurance plans. Money to fund the public option will rely on premiums it collects, he stressed.

Honoring Kennedy

In one of the most memorable points of his speech, Obama honored the late Sen. Edward M. Kennedy. Obama said he received a letter Kennedy wrote that he requested the president receive upon his death. In it, the Massachusetts senator said healthcare reform was his "great unfinished business."

To create a healthcare system that provides treatment and care to people, despite how much money they have, is more in line with the "character of our country," Kennedy wrote.

"His passion was more than ideology," Obama said, talking about Kennedy's two children who battle cancer. "[Kennedy's] large heartedness is not partisan. It too is part of the American character."

Even dissenters of the president's plans for healthcare reform can't deny Obama is a fantastic speaker. Last night, he spoke passionately about driving down healthcare costs and expanding coverage to all Americans.

Did his plea to Congress and the American people work? Will the Senate and House pass reform bills this year? Time will tell.

The White House hasn't previewed his talking points, but he'll likely reiterate the need for Congress to pass a reform bill that provides coverage to all Americans, helps lower the cost of healthcare, improve quality of care, while not adding to the federal deficit.

CBS News political director Steve Chaggaris said the session will allow the president to gain control of the debate, which through late July has taken on a hostile tone in town-hall debates around the country.

I expect the president to also take the opportunity during the session, which will be televised Wednesday night, to further honor Sen. Edward M. Kennedy, who passed away Aug. 25.

Will reminding the legislators of Kennedy's career-long fight to reform healthcare ignite the fire to get a bill passed this fall? What do you think — will Congress be more inclined to pass healthcare reform this year to honor Sen. Kennedy?

Serving the people of Massachusetts in the U.S. Senate for 46 years, Sen. Kennedy led legislation on civil rights, education, immigration, among other issues. In 2002, he voted against giving President Bush authority to invade Iraq, an act he referred to as his proudest Senate vote.

It was healthcare, though, that Kennedy referred to as "the cause of my life." Long fighting for universal and affordable healthcare in the U.S., Kennedy would often ask his Senate peers who opposed healthcare reform, "Do we really care about our fellow citizens?"

The committee Kennedy led before his illness forced Sen. Christopher Dodd (D-CT) to take over — the Health Education, Labor and Pensions committee — passed healthcare reform legislation July 15.

Whether Obama will have the opportunity to sign such legislation into law this year remains up in the air. But I can't think of a better tribute to a man who served this country for nearly half a century.

My colleague Stacey Miller, who directs ADVANCE's Healthcare Reform Center, succinctly discussed in her Aug. 12 post, "Separating Healthcare Reform Facts From Fiction," the importance of healthcare consumers' ability to sort out credible information from erroneous chatter related to potential changes being proposed and discussed.

However, there are many consumers who are confused about the volume of information communicated by all forms of media. Certainly, I can understand why they might feel anxious about what is going to happen to them related to their own healthcare needs and their families'. It is understandable why people at town hall meetings are acting out these feelings, although I think some have gone a bit overboard with their displays.

Nurses can play a major role in helping the public understand the nuances of what's on the table in Washington and how the issues of healthcare reform would affect all citizens of our country. Certainly, nurses aren't health policy experts, but the common denominator we share is we are nurse scientists and can think critically.

Because I believe nurses are self-directed to seek out information on important issues that involve the profession, practice and healthcare in general, I was a bit out of sorts when I saw the results of an online poll ADVANCE published in the Aug. 3-10 editions of the magazine.

The poll asked: "Do you support healthcare reform?" The final results: 44 percent said no; 31 percent said yes and 24 percent said they didn't know enough about the president's plans. Of course, I question how much of an effort the last set of responders took to learn about the critical issues.  

I'm not going to tell you everything I read makes sense to me or I understand the issues completely, but the more I read and listen to press conferences and experts, I learn more and can begin to put pieces of the issues together.

Let me give you just one example of the value of keeping up on just one proposal that has just about been discarded because of misinformation.

Two weeks ago, I participated in a webinar titled "Health Reform: What's In It for You?" sponsored by the U.S. Department of Health and Human Services. Besides Secretary Kathleen Sebelius, there were a number of health policy experts who reviewed the need for healthcare reform now, citing many of the facts I already knew. However, at the end of the 1-hour session, the plan for end-of life consultation was introduced. This certainly sounded like a viable option.

As a nurse and a relative of several family members who didn't want extensive treatment performed when their quality of life had diminished, I thought this was a good idea - to pay for consultation with the healthcare team. Most all of us know how difficult this is to set up, so if paying for it to happen was the incentive, why not?

Later I learned that in a person's last year of life the average medical costs are $25,000. I also learned about a program in Wisconsin, where paying for end-of life consultation had decreased the cost to $18,000 - a savings of $7,000 per person. In no way did this come across as healthcare rationing to me. How then, I asked myself, from this factual information, based on experiences I had observed, did this option become known as a "death panel?" Certainly I could understand why healthcare consumers would react to this idea, if it were presented this way.

If healthcare reform is going to happen, we need logic to prevail, and hopefully this is where nurses' voices, the most trusted of all healthcare professionals, can override political partisanship.

If you’ve turned on television news in the past week, chances are good you’ve seen footage of town-hall meetings turn sour. Members of Congress are using their August break to return to their districts to further explain to their constituents what healthcare reform is all about. But, as evident in Tampa, FL, fights are breaking out, voices are being raised and commonsense is going out the door. 

Watching the footage two things are clear: people are scared and they’re misinformed. 

Elizabeth Lee Vliet, MD, a women’s health specialist, wrote in an op-ed piece about the meetings, “Citizens attending town halls and voicing their well-founded fears about government-run healthcare should be listened to attentively, not demonized and dismissed.”

She’s right. Well, partially. People should speak up and have open communication with their elected leaders. But the fact she says “government-run healthcare,” fuels that fear she refers to. 

In the healthcare reform legislation Congress has drafted, there is an expansion of Medicare (a government-run health plan) insurance and a new public option to compete with private insurance. There will be no government take over of the entire healthcare system, as Vliet alludes to.

Furthermore, she wrote “The current healthcare proposals set up a fundamental decision we all face: do we remain free and have the power to control our healthcare decisions or do we let government take over these decisions that affect our very right to live?”

She might as well have cited Sarah Palin’s Facebook posting where the former governor of Alaska said under healthcare reform, people would be subjected to Obama’s “Death Panel,” where bureaucrats decide “level of productivity in society.”

Again, not true. In the legislation, Medicare, for the first time, will pay for doctors’ appointments for patients who opt to discuss living wills and other end-of-life issues with their physicians. AARP supports the measure. 

The lies and myths surrounding healthcare reform are out of control, especially when Palin and Vliet use such scare tactics.  

The New York Times on Aug. 10 did a simple-to-follow piece breaking down fact from fiction in the legislation, and St. Petersburg Times’ PolitiFact.org constantly examines claims politicians and members of the media make on various issues to expose what is actually true.  

These are just two of the reputable sources people can turn to for the facts on healthcare reform. Citizens should also, as Vliet suggests, become engaged and attend those town-hall meetings. (Health Care for America Now is listing town-hall meetings across the country. Enter your ZIP code to find an event near you.) Just, please, when you go, leave the boxing gloves at home.  

Launch Google, Bing or your favorite search engine. Do a news search for “healthcare reform.” Open each article on the first page of results and ask your computer to find the words “personal responsibility.”

Lost in the debate over healthcare reform is a serious discussion about my role and yours, and I cannot think of anything more important to talk about.

As politicians and stakeholder groups volley proposals and counterpoints, where is the parallel campaign to encourage healthy eating habits, regular exercise, adequate sleep, work-life balance and stress management?

Where is the role model, a non-commercial, non-political Joe the Plumber of sorts, who can step up and say, “Look at me, America! This is what I do everyday to stay healthy, and it works!”

What if politicians prefaced statements on healthcare reform with an honest description of their daily diets and how eating said foods may affect their health, for better or worse?

Following a breakfast of passion fruit, heart-healthy cereal, an 8-ounce cup of coffee and an equal amount of water, Senate Finance Committee Chairman Max Baucus today announced the bipartisan working group has a draft healthcare reform bill.

“Sleeping 6-8 hours each night and starting each day with a well-balanced meal helps me to maintain a healthy weight and state-of-mind,” Baucus said, adding that 3 days a week he walks two miles in the morning and at night. “Just look at me! I feel great. Getting back to politics for a moment, I am pleased to report that this bill would actually reduce the federal deficit in the 10^th year by several billion dollars.”

Would anyone listen? Would anyone care?

To our nurses:

How do you encourage patients to take responsibility for their health? Do you see results?

Do you feel it is your responsibility, as a frontline healthcare provider, to lead by example?

Please comment below and let us know.

When it comes to when a healthcare reform bill could go to the full House and Senate for a vote, on one hand, you have President Obama during his primetime press conference July 22 saying he wants it before the lawmakers leave for the August recess. If not, the issue will lose inertia, he said.

On the other hand, Senate Majority Leader Harry Reid (D-NV) says that won't happen because the Senate Finance Committee wants the bill to have support from Democrats and Republications. When the committee passed its bill, only Democrats supported it.

But healthcare reform shouldn't be about Democrats vs. Republicans, said Howard Dean, MD, former governor of Vermont. He spoke July 22 on a conference call organized by various groups representing nurses and physicians, including the American Nurses Association and National Physicians Alliance.

"This is not a fight between Democrats or Republicans," he said. "This is the fight between insurance companies and the American people."

While nurse and physician groups are speaking up for healthcare reform, a majority of Americans say they too want healthcare reform, according to a July 14 Gallop poll.  

Yet, the public seems pretty quiet. Is the general population just apathetic? Are people just weary of any action Congress takes, not sure how it will get paid for? Is it because they're happy with their health insurance as is? Is it because they think the system is already so broken, nothing will help repair it?  

When you look at healthcare reform in the manner which Dean frames it - the fight against insurance companies and the American people - that seems like a battle more people would want to fight.     

Later this summer, a similar scene will play out in Washington. Two Senate committees, three House committees, as well as a group of former senators, are currently designing individual plans to reform healthcare in the U.S. The Senate Health, Education, Labor and Pensions committee released the first draft of its 600-plus-page Affordable Health Choices Act in June.

The other committees too are focused on expanding coverage, improving care and cutting costs. Their drafts are still in the works.

Yet, by the end of the summer, members of each house of Congress are expected to nail down their reform plans and ways to pay for them into one plan and send the bill to President Obama in the fall for approval.

Of course, like those highway projects, the road to healthcare reform isn't expected to be smooth sailing, and could come to a sudden halt or derail completely.

As the healthcare reform debate heats up, ADVANCE for Nurses will follow the goings-on inside the Capital Beltway, get opinions from nursing associations and explain how the reform will affect ordinary taxpayers.