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Beyond the White House: Electing More Than a President

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Health care is always one of the top issues on the national agenda, and as the United States prepares to elect its first new president in eight years, all eyes are on the presumptive Democratic and Republican nominees, Sen Barack Obama (D, Illinois) and Sen John McCain (R, Arizona).

Yet, “presidential elections seem a little remote, I think, in terms of actual impact on one’s life,” says Nicole Gara, Vice President of Government and Professional Affairs for the American Academy of Physician Assistants (AAPA). “I think it’s hard for local members of Congress to get attention, and it’s even harder for people running for state office. But those are probably the places that you should start.”

That’s why leaders from both AAPA and the American Academy of Nurse Practitioners (AANP) are encouraging all members of their respective professions to do their duty as American citizens and health care professionals. The message is simple: VOTE!

Focus on Financing
Neither the AANP nor the AAPA endorses presidential candidates. However, leaders from both organizations are keeping an eye on the campaigns. So how much attention are the presumptive nominees paying to nonphysician clinicians?

AAPA President Cynthia B. Lord, MHS, PA-C, may speak for most Americans (or at least the cynical ones) when she says, with a laugh, “If you really look at McCain and Obama—the two big candidates—at their health care policy, first of all, they change every day depending on who they’re speaking to, I think.” Getting serious, she adds, “But they’re basically focused on financing; everything is about financing.”

Her assessment is echoed by Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health Policy for the AANP. “One of the things I find is that they talk a lot about how to pay the insurance and [give] a lot of attention to doctors and hospitals,” she says. “But there doesn’t seem—yet—to be a good awareness on the part of either candidate of the role that other health care professionals play in the health care system.”

“Are we on the radar? I don’t see any evidence of that,” adds Gara. “They’re really concerned with the financing aspects. They’re not drilling down to workforce issues very much.” (See sidebar.)

Getting those issues adequately addressed may be more difficult than usual in light of the current state of the nation. Polls have indicated that health care has dropped from the No. 2 to the No. 3 spot, behind the war and the economy, in terms of issues considered most important by voters. “It gets harder when the economy gets tough,” Towers says. “People have to be able to eat, work, hang onto their houses.”

“The war and the price of gas and everything else could easily consume everybody’s attention,” adds Gara. “But the [health care] system is probably failing badly, and really, procrastination isn’t going to help.”

The “Other” 468
Every four years, an increasingly large chunk of the national attention is focused on the US presidential elections. “I think you can’t help it, it’s like a four-year primary,” Gara says with a laugh. “The election season gets longer and longer, and for pretty much everybody who turns on the TV, that’s what they’re going to see in the news.”

But this election year, one-third of the seats in the US Senate and the entire House of Representatives are up for grabs—that’s a combined total of 468 legislators. Clinicians “need to be looking not just at what the president is going to be thinking but also what the representatives from their state or district are thinking,” Towers observes.

Health care providers received a reminder of the importance of supporting and working with members of Congress during the recent Medicare reimbursement bill brouhaha. To forestall a 10.6% payment reduction for physicians (scheduled to take effect on July 1), Congress instead voted to reduce reimbursement to private insurance companies that serve Medicare recipients. When President Bush exercised his right to veto the bill, members of both the House of Representatives and the Senate voted by an overwhelming majority (383 to 41 in the House and 70 to 26 in the Senate) to override his veto. (The measure is considered a stopgap, and Congress will have to revisit the issue in 18 months; Towers says, “It depends a lot on how the elections go, as to just what direction that might take.”)

Cindy Lord knows firsthand what effect that reimbursement cut could have had. She works in a primary care practice in eastern Connecticut (“we are in the underserved part of Connecticut—as much as it can be underserved”). “If that 10.6% reduction had gone through, our practice—it’s a family practice, but after many years, it gets very elderly; almost all of my patients are 80- and 90-year-old farmers who are still doing well, but elderly—wouldn’t be able to accept any new Medicare patients,” she says. “We would have had to close our practice to those people. It was stressing the two docs I work with.”