12 October 2011

Talking with Nurses about the Affordable Care Act

About This Document

This document is designed to help you reach out to nurses with information about the Affordable Care Act. If your goal is to educate nurses, this information could help you develop a more effective toolkit. Our hope is that it will help you understand nurses’ thoughts on the law, and to open the conversation with language that addresses their concerns and meets their need for specific kinds of information. The language below has been tested with nurses and found to be effective; feel free to use and adapt it in your educational materials. No attribution is necessary.

 About Our Research

While the Affordable Care Act (ACA) directly impacts nurses personally and professionally, many of them don’t know much about it, or how to take the best advantage of it for themselves, their families, and their patients. It is important to educate nurses about the law for at least two reasons. First, we know that patients turn to nurses for information and opinions about the law, as do other members of the public, elected officials, and the media. Second, the Affordable Care Act is the law of the land, and will require participation from all members of the health care system in order to ensure that it is implemented fully and correctly. In order to reach out to them effectively, those talking to nurses need to connect with them on the aspects of the law that help address the longstanding issues that they care about.

To find out what those issues are, and to answer similar questions about primary care and specialist physicians, the American Academy of Family Physicians and Herndon Alliance gathered a number of leaders in the doctor and nurse communities[1] together to design and conduct research specifically with doctors and nurses. From November 2010 – February 2011 Lake Research Partners carried out this research, which included 12 phone triads (small focus groups)[2] and an online survey among a total of 628 health care professionals, including nurses[3], primary care physicians, and specialist physicians.[4]

Our research revealed that by connecting with nurses about how the law will affect them on a personal level as well as a professional level, and by meeting their general need for more information about the basics of the law, we can be much more effective in educating them about the ACA.

Findings

Many nurses approach the ACA from the perspective as consumers first, then as health care professionals. Like consumers, nurses express that they don’t know much about the law, and the concerns that come to mind first often relate to their own families and their personal insurance.

Nurses express uncertainty about the ACA and how it will be implemented. What they do know is often limited to insurance reforms, such as ending pre-existing conditions exclusions. Many also note that the law places greater emphasis on preventive care.

Nurses are concerned about some of the trends they see in their profession. They are worried about overwhelming patient loads, increasing amounts of paperwork, and growing control over patient decisions by insurance companies. Some nurses are concerned that expanded access could result in overloading the system and a shortage of nurses and doctors.

We can improve nurses’ knowledge of the ACA by helping them understand its basic components for consumers and families, as well as for nurses. If we use language that clearly explains how the law works for nurses and their families, they are much more likely to note that the law can reduce insurance companies’ control over patient care decisions. They are also more likely to note that the law can have a positive impact on the number of tasks and responsibilities nurses have, and on income and reimbursement for nurses.

Nurses appreciate that the law encourages prevention. Nurses value preventive care and see the lack of prevention, wellness, and adequate follow-up care to be a real weakness of the health care system. If we emphasize how the law encourages prevention, we can be more effective in educating nurses.

Nurses want to learn more about the ACA. They express a desire for clear, concise, unbiased information in a variety of different formats (online and in print). They also trust and prefer to hear information about the law from fellow nurses (although research indicated that doctors can also be good messengers), and delivered through the American Nurses Association (most preferred) or their specialty organizations.

Example Language to Connect with Nurses

Note: The language below was developed for the research, and is not attributable to real nurses and doctors in the field. For your communications, seek out nurses in your community who can speak to these issues.

Provide concrete examples of things the ACA does for nurses as consumers, and for nurses as professionals. Keep in mind that many nurses are still unfamiliar with the law’s basic provisions: “I’m Margaret Powell, a registered nurse. When I first heard about health care reform, I had a lot of the same concerns that many people have. How will it affect the quality of patient care? How will it affect my own family’s health coverage? I have learned that the new health care law will end numerous insurance company abuses like denying coverage to those with pre-existing conditions or lifetime caps on coverage, so I can count on less uncompensated and delayed care for my patients. It will place a strong emphasis on prevention and wellness programs to help keep people healthy and reduce chronic disease costs. Unreasonable insurance rate hikes will no longer be tolerated, and our families’ coverage can’t be dropped. These are some of the important reasons why the American Nurses Association supports the health care reform law, and I agree with them.”

Talk about how the law curtails insurance company power, and gives autonomy back to nurses and doctors: “I’m Doctor Walker, and I have a private internal medicine practice. The insurance companies have controlled the health care system for decades, but the health care reform law curtails their power and gives greater control to doctors. They will be much less able to deny payment for what I think is best for my patients. They will no longer be able to deny coverage for patients with pre-existing conditions, or impose lifetime caps that rescind coverage when people get sick, and adult children under 26 can stay on their parents’ plan. I have more authority over patient care now, whereas in the past insurance companies often used payment denials and pre-authorizations to limit my treatment decisions.”

Address concerns about nursing shortages: “I’m Judi Lopez, and I am a registered nurse.  We already have an alarming shortage of nurses in this country.  When health care reform became law, I was concerned that adding millions of newly insured patients would make shortages worse.  But then I learned the law includes new incentives for nursing students, like loan forgiveness programs, grants to nursing schools to promote nursing career advancement, and loan repayment for students who decide to serve as nursing faculty. The law also includes incentives for nurses to enter primary care, including a 10% Medicare reimbursement bonus payment for primary care services for the next five years. We still have a nursing shortage, but this law is taking concrete steps to fix it.”

Remind nurses why we needed reform in the first place: “I’m Jane Dean, and I’ve been a nurse practitioner for over twenty years. Let’s face it: our health care system needed big changes. It’s not right that millions of Americans just couldn’t get insurance, including some of my patients who paid their premiums for years, only to be denied coverage when they needed it most. Over the course of my career I have been asked to do more with less – more paperwork and bureaucracy for less quality time with patients and less money. This new health care law isn’t perfect, but it does good things and is a major step to correct this unsustainable course.”

Inform nurses about changes to the health care delivery system that will address their concerns in the medium and long term, such as how the law:

• Encourages the use of electronic medical records
• Simplifies insurance company paperwork
• Encourages nurses, physicians, and other healthcare professionals to work together in teams
• Facilitates the use of evidence-based health care

General Tips

• Peers are the best messengers to educate nurses. Use nurse messengers or a nurse’s voice as much as possible in your communications. If you are looking for nurses who can speak in the first-person voice using the most effective language, consider asking the leadership of your nurse organization or chapter to be that voice.
• Nurses want to hear more information about the law from the American Nurses Association, and from their national, state, and local specialty groups when applicable.
• Nurses are open to receiving information about the law in a variety of ways (online, via e-mail, and in print).
• Nurses are also getting information on the law from the mainstream media. If we consistently use the most effective language, over time the media will begin to echo this language.

Questions? Contact Herndon Alliance /  206.397.4144 /  herndonalliance.org

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[1] Other members of the research steering committee included American Academy of Nurse Practitioners, American Academy of Pediatrics, American College of Cardiology, American College of Physicians, American Federation of State, County, and Municipal Employees (AFSCME), American Nurses Association, American Osteopathic Association, Doctors for America, National Physicians Alliance, New America Foundation, and Service Employees International Union (SEIU).