Does Coverage = Care? --- Tine Hansen-Turton and Ann Ritter

By Tine Hansen-Turton, MGA, JD, Chief Executive Officer and Ann Ritter, JD, Director, Health Center Development & Policy, National Nursing Centers Consortium

The passage of the Affordable Care Act means that more than 30 million additional Americans will have health insurance by the year 2014. Can our primary care system handle the demand?

In Massachusetts, passage of a universal insurance plan in 2006 completely overwhelmed the Commonwealth’s existing supply of primary care physicians, and the effects are still being felt. In 2009, only 44% of internists in Massachusetts were accepting new patients. The average wait time for a new patient to get an appointment was 44 days.

Nurse practitioners can provide care that is similar in scope to a primary care physician in all 50 states.  Health care innovators have capitalized on nurse practitioners’ ability to provide high-quality care in independent settings such as convenient care clinics (also known as retail-based clinics) and nonprofit nurse-managed health clinics that serve vulnerable patients. Nurse practitioners in these settings have already served over 20 million people in the U.S., and they have the capacity to reach millions more.
 
How can nurse-led health clinics reach their full potential? A few common-sense policy reforms could go a long way towards increasing access to primary care for all Americans.
 
First, insurance companies should do a better job connecting their enrollees to nurse practitioners. We conducted a national survey of insurance companies last year and found that nearly half of all major insurers in the U.S. do not credential or reimburse nurse practitioners as primary care providers. 
 
This means that patients who want to see a nurse practitioner for primary care don’t have the flexibility to do so. It also means that many patients whose needs could be addressed in a cost-effective way by nurse practitioners have to wait weeks or months for an appointment with a physician.
 
Many of the insurers who refuse to recognize nurse practitioners as primary care providers are Medicare and Medicaid insurers. At the same time, nurse-led practices have been excluded from “medical home” projects designed to improve health care quality for seniors and other patients. Nurse practitioners are especially well-suited to provide affordable primary care to patients with chronic conditions. At a time when everyone is looking for better ways to control health care costs, we should make it easier for people with Medicare and Medicaid to choose a nurse practitioner as their primary care provider.