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A View From the Hill

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In addition to doing countless other things, American Academy of Nurse Practitioners Director of Health Policy Jan Towers, PhD, NP-C, CRNP, FAANP, works full-time on Capitol Hill. Towers, whose agenda for 2009 includes “all things related to health care reform,” shared some of her thoughts on the year ahead with Clinician Reviews.

What are some of the challenges of working with a new administration and a new Congress? What can be done to work around those obstacles?

The biggest challenge is that you have newcomers—and we have a lot of them—who often need to be educated about what NPs do, what our preparation is, and how we can have a positive impact in the health care arena. So it’s important for NPs, particularly if they have a new legislator coming to Congress, to try to meet with him or her and talk about what we do and what some of our issues are. [Editor’s note: While Towers speaks for NPs, her response certainly applies to PAs as well.]

What opportunities do you think the Obama administration might create for nonphysician providers?
President-Elect Obama is inviting input from and appointing people who have been known to be supportive of nonphysician providers, such as Mr. Daschle and Dr. Fox [Secretary of Health and Human Services (HHS) nominee Tom Daschle and Claude Earl Fox, MD, MPH, a member of the HHS agency review team for Obama’s transition team]. These are people who have some understanding of what nonphysician providers can do and how they can contribute to the health care scene, both in terms of high-quality care and in terms of cost-effectiveness. We feel that that should make it a little easier for us to have influence.

Based on your knowledge of the Obama-Biden health care proposal, how effective do you think the plan is in terms of addressing the nation’s health care problems?
I think everybody recognizes that you can’t just overturn the apple cart. You can’t do it any way, but with the precariousness of the economy right now, you just can’t do a major revamp in that kind of atmosphere. The changes that are being proposed are based on existing systems. That’s a different kind of challenge for us than if it was a total revamp.

What they have proposed are all things that have been discussed in the past and are logical in terms of trying to find ways to reach more people and make things more cost-effective. But in order to keep people healthy, there is an expenditure that has to be made. Nothing is going to come cheap.

On the other hand, when you say, “A $5 Band-Aid is not going to fix it,” that’s right. But what you want to do is try to make the cost go down to where it’s a logical cost. If you reduce the Band-Aid to a nickel, then you can use the other $4.95 to deal with other issues.

One of the things that’s being talked about more now than it has been in the past—it’s not necessarily coming from the Obama camp—is the fact that there are things we can do in terms of health care that don’t have anything to do with health care providers, hospitals, that sort of thing—such as parks, playgrounds, good nutrition, schools.

With the understanding that the wholesale health care reform we probably need will take time—longer than one year, possibly longer than a single term—what do you think the priorities need to be?
A lot has to do with the economy at this point in time. What’s being tossed around now is that there are going to be short-term things being dealt with initially. So we’re talking about SGR [sustainable growth rate], we’re talking about SCHIP [State Children’s Health Insurance Program], we’re talking about appropriations. We’re not talking about major reform in that first 100 days, which we were talking about many months ago. The priorities are the short-term things, and I think what they’ll try to do is adjust current programs to achieve those things.

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