Remarks to Public Health Nurses at the Minnesota Department of Health

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U.S. Department of Health & Human Services
Health Resources and Services Administration
HRSA Press Office: (301) 443-3376


by HRSA Administrator Mary K. Wakefield

March 6, 2013

I’m delighted to have the chance to talk with you about the Affordable Care Act, the health reform law signed by President Obama in 2010, and how we can work together to make the most of this new era in health care for all Americans, with a focus on children and youth with special health care needs. 

I’ll also address the interests and opportunities of nurses in this new reform environment.  I understand that most of you watching today are public health nurses.  Congratulations to you on your choice of profession -- I’m a nurse, too!  So to all my colleagues in Minnesota, hello and welcome to this webcast.

Let me begin by telling you a bit about HRSA, the $8 billion organization that I’m in charge of.

The part of HRSA I imagine you’re all most familiar with is our Maternal and Child Health State Block Grant Program – better known as Title V.  States use Title V funds to provide a foundation for ensuring the health of more than 44 million women, infants, and children, including children with special health care needs.  And we administer the Newborn Hearing Screening program that, I’m told, many of you work on.

HRSA also runs the Community Health Center Program, which funds primary and preventive care for more than 20 million low-income patients at 8,500 clinical sites.  The Affordable Care Act invested $11 billion over five years to expand their reach across the nation.  You may be familiar with them through your own work.  We fund 10 health centers alone just in Minneapolis.

HRSA also administers the Ryan White HIV/AIDS Program, which provides top-quality care and life-sustaining medications to more than half a million low-income and uninsured people living with HIV/AIDS.

Our National Health Service Corps places primary care and other clinical care providers in medically underserved areas in exchange for student loan repayments.  Currently we have close to 10,000 NHSC clinicians caring for low-income people across America; that number has more than doubled following substantial hikes in funding through the ACA.

HRSA also is responsible for a broad range of health professions education programs, the nation's organ and tissue transplantation system; rural health policy; and poison control centers, to name just a few of the rest of our duties.

That’s a quick summary of our major programs at HRSA.  Right now, in addition to that work, we’re heavily involved in implementing the Affordable Care Act.  We are on the home stretch of implementation; parts are still being rolled out.  But already the new law has made a big difference in the lives of millions of women and children in America. 

One of the best things about the ACA is that it prevents insurers from denying health insurance coverage to anyone, including children with special needs – no denying coverage because of pre-existing conditions.  What a difference this makes!

Among children and youth with special health care needs, almost all of them have health care coverage, but it’s often not broad enough to meet their many and complex needs.  Those problems will be greatly reduced under the ACA, since the law prohibits insurance plans from placing a lifetime dollar limit on most benefits.

Other parts of the law that benefit a wide range of Americans are very significant to children with special needs and their families.

For example, the ACA allows youths to remain on their parents’ health plans until they are 26 years old.  Youths and young adults with special needs are more likely to transition successfully into the adult system of care if they have continuous health insurance coverage.

Additionally, the expansion of Medicaid under the ACA will provide stability in coverage and promote continuity of care, for parents and for their children. 

The ACA also promotes the adoption of the patient-centered medical or health home, a health care delivery model that improves care coordination across a broad spectrum of services.  And that’s especially important to children, youths, and adults with chronic conditions and special health care needs.

Given that these children often require multiple services from many parts of the health care and community system, it’s imperative that effective care coordination be available when needed, especially coordination between sub-specialty services and primary care. 

The ACA emphasizes coordination to improve care quality, and so do we at HRSA.  Title V has long been a national leader in promoting care coordination.  In fact, one of the Title V national performance measures that all states report on tracks the percentage of children to age 18 with special health care needs who receive coordinated, ongoing, and comprehensive care within a medical home.

Our health centers have joined Title V in efforts to re-engineer the delivery of primary care through an initiative that encourages our grantees to gain recognition as patient-centered medical homes recognized by the National Committee for Quality Assurance.

I also should tell you about a new organization HRSA funded recently near you at the University of Minnesota that has the potential to push our knowledge of the value of coordinated care to new levels.

It’s called the Center for Interprofessional Education and Collaborative Practice, and HRSA launched it with a $4 million, five-year grant late last year.  The promise of the Center’s ability to do important work is reflected by the fact that four respected national foundations pledged an additional $8 million to the project, bringing total funding for the Center to $12 million over five years.

The grant to Minnesota will help students and health professionals across the country learn how interprofessional team-based care can improve patient safety and reduce duplicative tests and procedures.  We feel confident that the Center’s work will help transform today’s fragmented health care delivery system to one which values coordinated care that engages patients, families and communities.  And all of you can follow its progress close up – and perhaps inform it as well.

Since there are nurses in the audience, let me say a few words about the ACA and nurses.  The law’s encouragement of care coordination is good for patients, and it’s good for nurses, too, since coordinating care is a role that nurses do well.

The Affordable Care Act also capitalizes on nurses’ skills by emphasizing the need to keep people healthy, prevent illness and manage chronic conditions. 

Nurses see every day many of health problems that could be prevented, or at least mitigated, through earlier investments in disease prevention activities like screenings, health and wellness promotion, and patient education.  And that – for the first time in our country – is where the Affordable Care Act takes us.  And when people talk prevention, they’re talking about nurses’ knowledge and skills.

And in terms of jobs, the significant ACA investments I mentioned earlier in HRSA’s Health Center program and the National Health Service Corps mean jobs and new opportunities for thousands of nurses, from RNs to nurse practitioners to certified midwives. 

In addition, greater support in the ACA for School-Based Health Centers gives children – and very importantly, disadvantaged children – immediate access to care before major health problems take root.  Nurses, of course, are the main providers of school-based care.

The Affordable Care Act also funded the Maternal, Infant, and Early Childhood Home Visitation Program to improve maternal and child health.  Under this program – which HRSA administers and Minnesota participates in – nurses, social workers and others visit pregnant women and young children in high-risk communities.  There they provide early counseling and intervention services based on models that are known to improve health outcomes.  HRSA administers the program, but it’s run at the state level.

Nursing’s centrality to the ACA is certainly clear when you look at the additional investments made in funding for nurse education programs that HRSA administers.  Do you know that we have committed nearly $1.1 billion over the last four years to educate new nurses, prepare them for today’s challenges, and place them where they’re needed most?

On a broader scale, the ACA brings opportunities to think about Title V and other MCH programs in a new context.  Our challenge is to align the values and traditions of Title V with the ACA as we pass through this transition leading to the law’s full implementation.  Right now we have a great opportunity to re-envision Title V and the systems it supports as implementation continues.

Over the past 20 years, State Title V programs have played a critical role in expanding initiatives  like Medicaid and the Children’s Health Insurance that benefit children with special health care needs.  Now we need your leadership again. 

State Title V programs will play a very important role in informing the implementation of both the new health insurance marketplaces – more on that in a minute – and ACA-related Medicaid expansion.

State Title V officials also can help families understand changes to the health care system and ensure that all Americans, especially children with special needs, receive high-quality care in this reform era.

We must ensure that the populations you care about and have responsibility for fully participate in the ACA provisions for which they are eligible.  The expertise of State Health Departments like yours in Minnesota in building systems of care, integrating services, and monitoring population health is extremely important to the robust implementation of the law. 

There’s one more way you can help the people you serve benefit from the ACA.  Right now, we need your help in a big way to help get the word out about the creation of the state-based Health Insurance Marketplace later this year.  The Marketplace is designed to help people find health insurance that fits their budget – and their needs.  Enrollment begins in October.

The best place to learn about the Marketplace and other coming benefits is a specific website,  Through, you can learn how people can get health insurance and accurate information on different plans.

Consumers will be able to get comprehensive information about insurance benefits and quality, side-by-side with facts about price, in order to help them make the best coverage decision.

They’ll also be able to learn if they qualify for a free or low-cost health insurance plan, or a new kind of tax credit that lowers their monthly premiums.  And, as I mentioned earlier, because the law outlaws discrimination against pre-existing conditions, nobody will be turned away because of her health status.

So I encourage you to go to often to learn more about upcoming changes.  And please link it, email it, put it in newsletters, and recommend it as an information source to your patients, friends, and family members and through civic and professional organizations. 

Getting ready to cover America begins now, and it all begins with you and health professionals like you across the country.

I thank you so much for inviting me to speak to you today.

Date Last Reviewed:  March 2016