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  1. Kuznar, Wayne


Experts suggest how nursing can assume leadership.


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In a bulletin issued in December 2011, the U.S. Department of Health and Human Services declared that states would be given the flexibility to define the benefits and services included in the health insurance plan selected by the state, as long as items and services in at least 10 categories of care are covered in the essential benefits package, as required by the Patient Protection and Affordable Care Act (ACA) of 2010.

Table 1 - Click to enlarge in new windowTable 1. Ten Categories of Care in the Essential Benefits Package of the ACA

Each of these areas is ripe for nursing leadership.


Nurses can bring a patient-oriented perspective to discussions of such benefits packages, a perspective that emphasizes holistic care of the population being served, believes Erin Murphy, an RN and the assistant majority leader in the Minnesota House of Representatives. She encourages nurses to get to know their state legislators and present themselves as health care content experts. "Introduce yourself to that person as a constituent who has expertise in health care," she said.


Nurses should be at the table when essential health benefits discussions are taking place "because not only are we educated in a wellness model, but we participate in it on a daily basis," said Betsy Snook, executive director of the Pennsylvania State Nurses Association. She hopes nurses try to get involved in certain state level committees or departments, such as health information exchange committees, health workforce boards, departments of health and welfare, and chronic care committees.


"It's important that nurses who want to influence this discussion understand what the benefit sets in the public programs in their states already look like," said Murphy, which can often be determined from a state's department of health Web site. With that knowledge, "nurses should be prepared to argue the reasons that a comprehensive and holistic benefit set needs to be available to those purchasing coverage through an exchange and for those getting coverage through extended Medicaid."


Nurses can't be patient advocates unless they're also nursing advocates, said legislative consultant and nurse Edie Brous, an AJN contributing editor, and to be advocates for nursing "you do have to know what's happening in the larger political arena and you do have to take a stand on it."


Becoming a part of your state nurses association and knowing its stance, and the stance of the American Nurses Association (ANA), on political issues is imperative. "The ANA is our voice on the Hill, whether you agree with them or not," she said.


The ANA does have a health system reform agenda and plans to assist its state nurses associations in promoting greater patient access to advanced practice nurses, said Cheryl Peterson, director in the department of nursing practice and policy at the ANA.


"Credentialing of APRNs in the private insurance market is poor," she said. "We don't want that to be immortalized in models that would continue to limit access to APRNs in these state insurance exchanges."


The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health and the expanded access to health care under the ACA together act as the "perfect storm" to argue for an enhanced role for nursing in redesigning health care to include more preventive care and deliver essential benefits, Brous believes.-Wayne Kuznar