Health System Transformation


For decades, the American Nurses Association (ANA) has advocated for health care reforms that would guarantee access to high-quality health care for all. With the passage of the Patient Protection and Affordable Care Act (ACA), millions more Americans have greater protection against losing or being denied health insurance coverage and better access to primary care and preventive services. ANA recognizes the debate over health system transformation is constant and remains committed to educating the nursing public about how the changing system impacts patients and the nursing profession.

ANA continues to deliver nursing’s message, provide resources, develop solutions, and offer grassroots advocacy opportunities to ensure the successful implementation of health system transformation while continuing to represent the interests of the nation’s nurses and patients. 

ANA also recognizes that the COVID-19 pandemic has begun a paradigm shift in health care delivery and coverage. COVID-19 has dramatically increased the breadth and use of telehealth services, shed light on the continued lack of access to affordable health care services, particularly among minority populations and communities of color, and emphasized the importance of personal protective equipment and behavioral health services, while underscoring the central role that registered nurses (RNs) and advanced practice registered nurses (APRNs) play in the nation’s health system. ANA will continue to be a leading voice in the conversations around these and other issues as they evolve.

We believe that any attempt to transform the American health care system must follow four major principles.

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, and treatment for substance use disorders.
Prohibition of the denial of coverage due to a pre-existing condition.
Inclusion of children on parents’ health insurance coverage until the age of 26.
Expansion of Medicaid as a safety net for economically disadvantaged people and the most vulnerable, including the chronically ill, elderly, and poor.

Optimize primary, community-based and preventive care 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 constrain RNs and APRNs from contributing fully to patient care in all communities.
Care coordination that reduces costs and improves outcomes with consistent payment models that is sustaining for all qualified health care professionals delivering such services, including nurses.

Encourage mechanisms to stimulate cost-effective use of health care services while minimizing burdens on those who do not have the means to share in costs. This includes:

A partnership between the government and private sector to address health care affordability.
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 obtain insurance coverage.
Programs to incentivize improved equity in health care access, disease burden, and cost outcomes.

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

An adequate supply of RNs who have the education, placement, and practice authority to meet the needs of all patient populations. 
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.

Stay tuned for updates as ANA works with the Administration and the 117th Congress on this highly visible topic.