The healthcare reform debate continues and nurses are bombarded daily with new information, along with contradictions, as to what is included in the reform. It is critical nurses have information regarding the current bills regarding healthcare reform along with knowledge regarding the need for insurance reform.

In addition, misconceptions (i.e., the use of death panels, the insuring of illegal persons, the loss of nursing jobs) continue to be published. This article will attempt to provide clarity regarding healthcare reform, including bills and areas of concern for nurses.

Specific Bills Regarding Healthcare Reform
Nurses experience confusion when attempting to sort through bills regarding healthcare reform. There are multiple bills being considered, and it is confusing when listening to the media as to what "bill" is being discussed.

In the House, the original draft of a healthcare reform bill was considered by three committees: the Energy and Commerce, Ways and Means, and Education and Labor committees. These House committees developed one bill, America's Affordable Health Choices Act of 2009 (HB 3200). Once developed, additional compromise occurred and this bill should be sent to the House for full debate soon.

The Senate assigned the original legislation to two committees, the Committee on Health, Education, Labor & Pensions (HELP) and the Finance Committee. The HELP committee produced The Affordable Health Choices Act (SB 1679) and the Finance Committee just passed the America's Healthy Future Act. However, the two aforementioned Senate committees have not reconciled their differences into one bill that can be considered for full Senate debate.

Nurses need to remember that, even after debate occurs in both the Senate and House, conference committees would be appointed to negotiate consensus, with the conference bill returned for a final vote in both the House and Senate, and signing by President Obama.

The 'Public Health Plan'
Nurses will frequently hear reference to the "Public Health Plan Option" when healthcare reform is discussed. The public plan alludes to an option for the public to purchase insurance via a government run program. "Co-op" health plans also are being considered as an alternative to private insurance.

The American Nurses Association strongly supports the inclusion of a public health insurance plan to ensure patient choice is a reality. Noted in an ANA statement, "The inclusion of a public plan option will help make healthcare more affordable for patients, generate needed competition in the insurance market, and guarantee the availability of quality, affordable coverage for individuals and families no matter what happens."

While the ANA supports this concept, a public health plan raises significant concern expressed by Congress and the public. Many individuals associate the term with socialism and breaking Medicare. Sources cite the problem with the "public plan" is there isn't a consistent definition as to what a public plan is. It will depend on the wording reached in a final bill what a public plan option means. Meanwhile, nurses would benefit by staying well-read regarding the possible options.

Insurance Reform
Along with the need for healthcare reform, most people agree there is a need for insurance reform. Reducing the number of uninsured in the U.S. is the primary focus for insurance reform with the goal of equity in access to insurance while ensuring affordability.

Insurance reform measures being considered include:

• prohibiting denial based on pre-existing conditions;
• prohibiting dropping or decreasing insurance coverage for individuals who become seriously ill;
• ending gender discrimination for coverage;
• ending annual or lifetime caps;
• extending coverage for young adults; and
• guaranteeing insurance renewal as long as the policy holder pays their premium in full.

Providing for preventive care services covered under insurance is another suggested reform nurses are strongly encouraging. Insurance reform may reduce the number of uninsured, but reform measures continue to be challenged with how to ensure affordability. It is for that very reason additional support is given to the possibility of a "public plan."

Nursing Workforce
The nursing profession remains vigilant in supporting the nursing workforce while expanding healthcare services. Several items are considered in HB 3200 that address the nursing shortage. Primarily this would be accomplished by strengthening Title VIII: Nursing Workforce Development Programs.

Both the House and Senate bills update advanced education nursing grants, which would support students willing to practice in underserved areas, as well as increase diversity among advanced education nurses. Both bills also update the Nurse Education Loan Repayment and Scholarship program, expanding the program to include loan repayment for serving 2 years as a nursing faculty member. These two programs would recruit new nurses into the profession, promote career advancement and improve patient care delivery by directing nurses into the areas with the greatest need. Furthermore, the Public Health Investment Fund will provide a more stable baseline of funding for Title VIII.

Advanced Practice Nursing
Recognition of advanced practice nurses as primary care providers also remains an important part of healthcare reform. The proposed HB 3200 uses the term "community-based multidisciplinary teams" in relation to primary care. It also recognizes advanced practice nurses as primary care providers and authorizes them to lead medical homes. Current medical home statutory language differs from state to state.  HB 3200 recognizes nurse-managed health centers as a sensible, cost-effective way to provide primary healthcare.

Stay Informed
Part of the challenge of the healthcare reform debate is to separate fact from fiction. The ANA has devoted a section of their Web site to providing current, timely information on the issue for nurses. View the online information available through the Health Care Reform Resources section to keep updated on the latest information.

Nurses care for patients on a daily basis who have been affected by the inequities in our current healthcare system. Nursing is an important voice to carry the message to the lawmakers as to what reforms need to occur. Contact your legislator today and let them know your thoughts.

Sarah Tidwell is an assistant professor at Emporia State University, Emporia, KS, and the legislative chair for the Kansas State Nurses Association.