Columbia Nursing Hosts Health Policy Panel on “Preparing for 2020 Elections”
Experts, Steeped in Decades of Clinical Work and Government Affairs, Offer Insights
On September 23, 2019, leaders with interdisciplinary backgrounds in medicine, nursing, public policy, and academia came to Columbia Nursing for a panel discussion about the implications of the upcoming 2020 elections—the primaries and general election—for the health of Americans. Sponsored by Columbia Nursing’s Center for Health Policy and Columbia Nursing’s Alumni Association, the panel, titled “Health Policy Issues: Preparing for the 2020 Elections,” was wide-ranging and informative. The panel was kicked off by Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy, who welcomed students, alumni, faculty, and staff.
The panelists included: David Blumenthal, MD, a former practicing primary-care physician and now the president of The Commonwealth Fund; Sheila Burke, RN, MPA, a Capitol Hill veteran and strategic adviser and chair, Government Relations & Public Policy group, at Baker Donelson; and Marian Grant, DNP, RN, a practicing palliative-care nurse practitioner, educator, and senior regulatory adviser for the Coalition to Transform Advanced Care. Columbia Nursing graduate Jasmine Travers ’16, PhD, RN, served as the moderator.
Health Care Options: Pros and Cons
Travers opened the panel by asking Blumenthal to provide guidance on the national debate on health care reform, that is, what the proposed health care system changes entailed, and the pros and cons of each. After making the point that no single election or a candidate’s platform can decide the fate of an entire health care system, Blumenthal then suggested that the implications of the election are without precedent and have many in the country transfixed on cost and coverage, as well as health care models. This is particularly salient given an aging population, whose needs have or will outstrip those of the younger demographic. Moreover, Blumenthal observed that we are at a “very important moment in the history of health,” adding that the public is engaged unlike at any other time. He described the proposals being offered to improve health care in America by categorizing them in three broad buckets.
Option One: “State-Oriented Programs”
According to Blumenthal, many adherents of the Republican Party see that moving to individual state-oriented programs would enable each state to determine levels of coverage, who to cover, and what to cover. Blumenthal and the other panelists were convinced that such a system would be regressive for the country, that is, creating more inequity, access-to-care problems, and needless complexity, while also disempowering patients further.
Option Two: “Medicare-for-All”
On the other hand, Blumenthal described how some Democrats envision “Medicare-for-All,” or single payer, as it is also known. A national insurance plan such as this would create efficiencies and decrease the fragmentation in our current system that is unmanageable in the long term. However, a single-payer model would sweep away private insurance, health care exchanges, and any vestiges of prior health care models. Blumenthal noted that the system’s tax burden would be higher but the care would be uniform.
Option Three: “Incrementalism”
Alternatively, other Democratic candidates are promoting an option of providing universal health care through changes to the existing system. Blumenthal dubbed these candidates “incrementalists.” They deem that the foundation of the health care system is both secure and familiar. In addition, they see that a battle to remove the current system, as would be the case for “Medicare-for-All,” may carry a politically prohibitive cost and be unpalatable to voters.
Ensuring Coverage & Access
Burke, who worked on Capitol Hill for almost 20 years, took the lead on answering the second question posed by Travers: Given payment and access-to-care challenges still present with the Affordable Care Act (ACA), as well as the proposed reforms, what should policymakers do to ensure people can gain, keep, and utilize coverage?
In response, Burke pointed out that while the number of uninsured initially fell with the ACA, it has recently risen. She further described how this was due to several causes. First, the absence of subsidies has left some individuals without the ability to secure coverage. A corollary issue is that where states have expanded access to Medicaid, this expansion has, in some cases, come with certain conditions. In Arkansas, for example, participation in Medicaid comes with a work requirement. The impetus behind imposing this condition—the first of its kind in the nation—resulted in thousands of people falling off of Medicaid rolls. Additional states, such as New Hampshire, have similar work mandates in place, which are being challenged in court, and other states have pending applications to add work requirements.
Blumenthal, who seconded Burke’s observations, stated that the ACA did not make insurance cheaper or provide for better coverage. Instead, it provided a means for those without employer-sponsored private insurance to buy into the insurance market. However, he noted that one primary gain of the ACA was educating the American public about health care and popularizing the notion that pre-existing conditions should not be grounds for denying coverage. In addition, Grant said that Kentucky’s expansion of Medicaid did translate into billions of dollars in economic development.
The Aging Population
In turning to Grant, who is well known in the field of palliative care, Travers asked about the health care challenges posed by the aging population. What factors did she see influencing health care policy planning for this population, many of whom have serious illnesses?
Grant said that “we will increasingly need to rely on ingenuity and technology to service this population, as well as have a robust social-services program, including transportation assistance, nutrition support, and home-modification services for increased mobility.” She also noted that this issue has been largely absent from the national debate and must be elevated.
“This population is also high-cost and high-need,” stated Blumenthal. He went on to add that although a small fraction of Americans falls within this demographic now, they account for 50 percent of health care costs. Addressing their needs is unavoidable in solving the upcoming health care crisis. According to Blumenthal, technology and a truly interprofessional health care work force will be essential to realizing “durable, sustainable, scalable solutions for people of this age demographic.”
The Nurses’ Role in Policy
Columbia Nursing has always championed nurses being at the vanguard of health care debates and policy. How then, Travers asked, should nurses see their role in policy to encourage and implement change?
All panelists concurred that nurses, as frontline care providers, were often the first to notice issues in patient care and delivery models that needed to be elevated legislatively—or spearheaded by nurses themselves. Burke said that at the “state level, battles remained unwaged,” and to solve shortages of care, “nurses needed to be able to practice at the full scope of their license.” She also exhorted nurses to become knowledgeable about policy and participate at every level of government. Blumenthal added that “nurses have undiscovered and unexploited authority”; they should tap into inner and outer resources to help move policy.
In the Q&A session that followed, policy came up again, with one attendee asking what the professional associations were doing to promote universal health care. Burke said that nursing associations have been supportive and outspoken proponents of universal health care, with members being vocal about its importance and message. She also noted that government appointments existed and that nurses join committees and advisory panels.
In a final question to the panelists, Suzanne Bakken, PhD, RN, FAAN, Alumni Professor of Nursing and Professor of Biomedical Informatics, wanted to know how technology and data science could improve efficiencies of our health care system. Blumenthal, who previously served as the national coordinator for Health Information Technology and authored seminal studies on the adoption and use of health information technology, said the answer is difficult, as data can be amorphous or in the form of metadata, and, as a result, untapped. It’s often kept in a cloud environment, and “its true potential cannot be realized without it being extracted, refined, and then distributed directly to patients” so that they can better manage their care.
Healing Our Health Care System
Learning how to improve care and participating in health care policy are responsibilities for nurses and was the overarching consensus of the panelists. A watershed moment in history, which this election may represent, as the panelists noted, brings into strong relief the priorities and problems with which we are confronted. In a country as far-flung, diverse, and spirited as America, addressing them can seem like making whole an unbridgeable divide in opinion. Yet, as Anna Maxwell, Columbia Nursing’s founder, stated: “Can a higher service be rendered mankind than is our power to give?” Nurses can render that power—in fact are that power, as the panelists concurred—not only in how they care at the bedside, but in being scientists, independent practitioners, and “having a seat at the table” in healing our health care system, for now and the future.