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Health System Transformation

The American Nurses Association (ANA) believes that every person has the right to the highest quality of healthcare. For decades, ANA has utilized the experience and expertise of its members to fight for meaningful health care reform.

Advocating in reaction to political policy

At the highest levels, ANA advocates for policymakers to recognize the true value of nursing, and the unique perspective that nurses have to offer. The voices of nurses are instrumental in advancing public health. The passage of the Patient Protection and Affordable Care Act (PPACA, often referred to as the ACA) in 2010 created essential health benefits, increasing protection for millions of people against losing or being denied insurance. ANA has outlined cornerstones of effective reform.

What’s at Stake Without the Affordable Care Act?

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There have been many attempts to repeal the ACA but the strongest began at the end of 2016. In determining whether to support these proposals, ANA analyzed the proposed reforms against its four principles for health care reform. As the nation’s largest group of healthcare professionals, ANA was instrumental three times in 2017 in stopping the passage of legislation that would undermine the current health care delivery system, impacting nurses and their patients.

ANA's Principles for Health System Transformation

In December 2016, ANA delivered a letter to then President-elect Trump outlining ANA's Principles for Health System Transformation.
The system must:

Ensure universal access to a standard package of essential health care services for all citizens and residents.

This includes:

  • An essential benefits package that provides access to comprehensive services, including mental health services.
  • Prohibition of the denial of coverage because of a pre-existing condition.
  • Inclusion of children on parent's health insurance coverage until age 26.
  • Expansion of Medicaid as a safety net for the most vulnerable, including the chronically ill, elderly, and poor.

Optimize primary, community-based, and preventive services while supporting the cost-effective use of innovative, technology-driven, acute, hospital-based services.

This includes:

  • Primary health care that is focused on developing an engaged partnership with the patient.
  • Primary health care that includes preventive, curative, and rehabilitative services delivered in a coordinated manner by members of the health care team.
  • Removing barriers and restrictions that prevent Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) from contributing fully to patient care in all communities.
  • Care coordination services that reduce costs and improve outcomes with consistent payment for all qualified health professionals delivering such services, including nurses.

Encourage mechanisms to stimulate economical use of health care services while supporting those who do not have the means to share in costs.

This includes:

  • A partnership between the government and private sector to bear health care costs.
  • Payment systems that reward quality and the appropriate, effective use of resources.
  • Beneficiaries paying for a portion of their care to provide an incentive for the efficient use of services while ensuring that deductibles and co-payments are not a barrier to receiving care.
  • Elimination of lifetime caps or annual limits on coverage.
  • Federal subsidies based on an income-based sliding scale to assist individuals to purchase insurance coverage.

Ensure a sufficient supply of a skilled workforce dedicated to providing high quality health care services.

This includes:

  • An adequate supply of well-educated, well-distributed, and well-utilized registered nurses.
  • Increased funding, whether grant or loan repayment based, for programs and services focused on increasing the primary care workforce.
  • Funding to elevate support for increasing nursing faculty and workforce diversity.

ANA also spoke out against the proposed American Health Care Act (AHCA) in May 2017, arguing that the reforms would endanger the health of Americans, eliminate the Prevention and Public Health fund, and fundamentally jeopardize the quality of healthcare delivery.

Reform for an aging population

In addition to shifts in political policy, the aging population may necessitate dramatic health care reform. These changing demographics present the need for more complex and longer-term care. To provide the best possible experience for patients, innovative approaches should be considered; whether through utilizing new technologies or by extending the nursing scope of practice to reflect the true extent of nursing expertise.

Promoting ongoing conversations

Like in the case of our aging population, ANA recognizes that the debate over healthcare is ongoing, and we remain committed to educating the public about how nursing impacts our lives and the profession.

ANA continues to deliver the role of the nurse and the profession in a manner that is informative, rich in resources, and solution oriented. We encourage nurses to take action, and advocate for themselves and their patients to all receive the highest quality care.

To keep abreast of ANA’s efforts, join the Capitol Beat blog and for additional details about ANA’s federal legislative agenda and /or to get involved, sign up at

View All ANA Health System Reform Resources

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