The Nurse Managed Health Clinic Investment Act, Research Paper Example

Introduction

The 2009 bill introduced in the US Congress has enough perspectives to be adopted and pursued in the near future because of the dramatic situation with the public healthcare observed in the modern period of time. The USA has favored the individual-based insurance schemes for a long time, making the system complex and unintelligible; as a result, the schemes served as exclusion criteria for those who could not afford insurance and were not eligible for federal insurance. The crisis in the US economy led to massive insurance losses, enlarging the groups of uninsured citizens. Thus, the public health system designed to respond to the needs of vulnerable population groups, suffered a shock in the past decade; the overload in patients led to closures of nurse-managed health centers (NMHCs), and continued to worsen the state of public health, limiting the citizens’ access to healthcare. The grant program initiated by the S 1104/HR 2754 Bill  and presented in 2009 to the House Committee on Energy and Commerce is called to support public health care and to provide additional opportunities for the uninsured (Bill Summary and Status, 2010).

The reason for such optimism resulting from renewed attention to MNHCs’ funding is that the latter are not subject to higher levels of reimbursement offered to other providers of health services. The present amendment may alter the status of MNHCs and will afford their functioning equally with other providers, enjoying all rights and financial obligations others do. The financial outcome of the grant program is surely positively assessed nationwide:

“Supporting this legislation will give these clinics a stable source of grant funding and prevent future closings. The additional funding will permit established NMHCs to continue serving the uninsured and will support the creation of new sites and the expansion of services” (NNCC, n.d., p. 2).Taking into consideration the negative conditions in which the NHMCs have to exist and under which limited resource availability they have to act to provide the primary care for uninsured and underinsured citizens of the USA, there are many more proponents of the bill than there are opponents.

Environments in Which the Adoption of the Bill Takes Place

Historical. There is much being said about the health care system of the USA, and no good conclusions about its effectiveness have been recently reached. Every government coming to power in the US puts the healthcare reform to the forefront of the governmental and public attention, though no significant improvement and simplification of the system is still observed. The US healthcare system has grown into a slow, complex and ineffective organism that lacks coordination and appears too branched and developed that it loses sense and becomes unintelligible for both policy-makers and ordinary citizens. The ongoing complications leave more and more US citizens aside, without the basic access to healthcare, and the situation has been aggravated by the recent economic crisis that left millions of people without a job, hence without insurance as well.

Socio-cultural. The USA has always been the state attracting millions of both legal and illegal immigrants, so the healthcare system has to take into consideration the high level of patient diversity. There are families with various levels of income in the US, and not all of low-income households are able to qualify for a federally funded program because of strict compliance criteria and complexity of the whole system of health insurance provision. Therefore, the result is the dramatic increase of uninsured or underinsured citizens in the US.

The economic crisis of 2008-2009 has added much problem to the system of health insurance provision in the USA. The majority of children used to be eligible for the healthcare services under the insurance of their parents; once millions of people lost their jobs at the outbreak of the crisis, the number of uninsured citizens not doubled but tripled because of loss of the insurance by both parents and their dependants. As a result, the national public health system started to experience the unbelievable overload by uninsured patients seeking care, and the main pressure was conducted on the NMHCs.

Ethical. The ethical principle of utilitarianism dictates making decisions to make every stakeholder participating in the situation happy; the S 1104/HR 2754 Bill is able to achieve the purpose by means of both returning NMHCs as the point of destination of desperate low-income or uninsured citizens, and to increase the protection of public health institutions against the overload of uninsured patients. The regulations pertaining to reimbursement put the NMHCs in line with other safety-net providers, ensuring the higher levels of reimbursement required, thus easing the burden of financial losses through public healthcare provision. Surely, the uninsured patients will lose their opportunity to be treated for free, but they will have easier and cheaper access to public health even without insurance. Preservation of the balance between leaving NMHCs still affordable for vulnerable categories of patients, and allowing the institutions to function without bankruptcy and excessive strain on resources is required to make the legislative act succeed in its implementation.

Economic. NMHCs are known to have limited access to the federal and state funding resources despite the fact that they perform numerous duties and have many indispensible benefits for patients.  Many of NMHCs have been established through grants of the Division of Nursing of the Health Resources and Services Administration to promote, protect, and optimize health of the community alongside with illness prevention efforts. However, as soon as the need for primary care was realized, many NMHCs have expanded their mission and have started to provide healthcare services for the uninsured population. However, the funding provided by the Division of Nursing of the Health Resources and Services Administration cannot be sustainable for the coverage of costs associated with all medical services uninsured patients require. For the reason of lack of funding, about 50% of NMHCs organized since 1993 had to close (Text of H.R. 2754, 2009).

Political. Nurse-managed health clinics (NMHCs) that are in the center of attention in the process of adopting the S 1104/HR 2754 Bill provide primary health care for uninsured and underinsured patients, which often goes beyond their responsibilities and capabilities offered by the resources available. The critical situation is aggravated by no regulations obliging uninsured patients to reimburse the healthcare costs of NMHCs, thus causing the crisis in the public health care and leading to closing some NMHCs (Text of H.R. 2754, 2009).

History of the Bill

Since the closure of the majority of NMHCs, the US government has recognized the dramatic impact it had on the provision of health services for the vulnerable groups of population such as uninsured and underinsured citizens. The Senate Report 109-103 included the request to the Congress to entrust the Bureau of Primary Health Care (BPHC) to establish a grant program that would help solve the problem with NMHC funding and maintenance (Text of H.R. 2754, 2009). The predecessor of the currently discussed bill is the Nurse-Managed Health Clinic Investment Act of 2007 (S.2112) that actually claimed the same grant funding for NMHCs (NNCC, n.d.). However, only with the outbreak of the 2008 economic crisis and the dramatic tempos of employer-based insurance losses, the government recognized the urgent necessity to enact the funding scheme to support public healthcare.

Stakeholders Supporting and Opposing the Bill

Among the Congressmen who actively support the S 1104/HR 2754 Nurse Managed Health Clinic Investment Act of 2009 one should distinguish Lois Capps and Pete Stark. Both of them have announced their full support of the bill and conduct varied activities on promoting it and ensuring its support by the community and governmental bodies. Thus, for example, Stark as a representative of the 13^th district of California, propagates the adoption of the S 1104/HR 2754 Bill because he estimates that its adoption will allow California to provide better health insurance coverage for 467,000 residents, to 17,000 uninsured residents, will allow funding for 27 community health centers that carry the burden of uninsured and underinsured patients, and will reduce the non-compensated health care expenditures by $14 million annually (Committee on Energy and Commerce, 2010). Capps, in her turn, supports the legislation actively as the way to reduce health disparities and to protect the most vulnerable categories of the US population in terms of healthcare provision (Capps Celebrates Energy And Commerce Passage Of Comprehensive Health Insurance Reform Bill, 2009).

The National League for Nurses (NLN) has voiced a strong support for the S 1104/HR 2754 Bill due to the additional resources and opportunities it is likely to offer to NHMCs and uninsured patients. The cosponsors supporting the claims for support voiced by NLN are Ted Kaufman from the Delaware, Daniel Akaka and Daniel Inouye from the Hawaii, and Lamar Alexander from Tennessee (NLN, 2010). Emergency Nurses Association has also joined the claim for the adoption of the S 1104/HR 2754 Bill because of the ability to allocate some sources for the provision of adequate help and funding for the emergency units as well (ENA, 2010). In addition, the National Nursing Centers Consortium has also voiced a strong claim for the bill with the proper explanations of its propriety and potential benefit for the healthcare system, patients and other stakeholders (NNCC, n.d.).

Currently there are no opponents of the S 1104/HR 2754 Nurse Managed Health Clinic Investment Act of 2009 because of the common understanding of the set of benefits it is likely to introduce in the public health care system of the US.

Evaluation of the Bill

The realm of problems associated with uninsured and underinsured citizens, non-citizens and other groups of population who do not have insurance plans for diverse reasons, is one of the most burning problems in the modern US political and social life. Hence, the S 1104/HR 2754 Bill has a potential to help solve a part of the healthcare problems and become a serious step to the reformed, renewed system of medical care. Therefore, the opponents of the bill may be found only among those who want to allocate the annual $50 million to other areas of economy. The bill is assessed as a highly significant one for the needs of the society:

“This legislation is extremely important because it will strengthen the nation’s healthcare safety-net and ensure that thousands of medically underserved patients have access to much needed primary care services” (NNCC, n.d., p. 1).

Recommendations for the Improvement of the Policy

It seems that the policy of NMHC assistance surely has sense under the modern conditions of crisis in the healthcare due to the vast categories of people who lost their insurance because of job losses. However, such policies may bring the US healthcare system to the dead end: once public health is financed to provide the needs of uninsured patients, it may appear that in several years patients will realize the support and will not strive for the insurance. Hence, additional attention has to be paid to finding the ways to make insurance more accessible for citizens, or to design a nation-wide premium insurance program for the uninsured and low-income households to fit their needs for healthcare.

References

Bill Summary & Status (2010). 111th Congress (2009 – 2010). Retrieved October 22, 2010, from http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR02754:@@@L& summ2=m&

Capps Celebrates Energy And Commerce Passage Of Comprehensive Health Insurance Reform Bill (2009). Medical News Today. Retrieved October 22, 2010, from http://www.medicalnewstoday.com/articles/159625.php

Committee on Energy and Commerce (2010). The Benefits of Health Care Reform In the 13th Congressional District of California. The House of Representatives. Retrieved October 22, 2010, from http://www.stark.house.gov/images/stories/ 111/legislation/healthreform/ca13hcr.pdf

Emergency Nurses Association (2010). Government and Advocacy. Retrieved October 22, 2010, from http://capwiz.com/ena/issues/bills/?bill=13659321

National League for Nursing (NLN) (2010). Government Affairs. Retrieved October 22, 2010, from http://nln.capwiz.com/nln/issues/bills/?bill=13909776&cs_party =all&cs_status=C&cs_state=ALL

NNCC (2007). The Nurse-Managed Health Clinic Investment Act of 2007 (S.2112) . Retrieved October 22, 2010, from http://www.nncc.us/policy/NMHCAct.pdf

NNCC (2009). Help Strengthen the Nation’s Healthcare Safety-Net by Cosponsoring The Nurse-Managed Health Clinic Investment Act (S. 1104/ H.R. 2754). Retrieved October 22, 2010, from http://www.nncc.us/docs/nmhcactfacts heet.pdf

Text of H.R. 2754: Nurse-Managed Health Clinic Investment Act of 2009 (2009). Congress Legislation. Retrieved October 22, 2010, from http://www.govtr ack.us/congress/billtext.xpd?bill=h111-2754