Remarks to the Phoenix chapter of the National Association of Hispanic Nurses

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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

August 22, 2014

I am really pleased to be able to speak to you today, first as a nurse colleague and as the highest ranking nurse in the Obama Administration, and secondly to thank all of you for all the great work you have done to get the word out about the ACA and in particular for getting individuals and families enrolled in health insurance coverage during the first open enrollment period.  Before I say more about this law and about nurses, let me say just a word about the Agency I lead -- for those of you who may not be aware of it.

The Health Resources and Services Administration is an operating division of HHS. With over a $9 billion budget, the programs that HRSA funds go to:

  • Improving access to quality health care and services,
  • Strengthening the health workforce,
  • Building healthy communities, and
  • Improving health equity. 

We focus on these goals through a portfolio of over 80 different programs that are largely designed to either deliver health care services or to train the next generation of health care providers.  Given the transformation under way in health care today, I think of our programs as vehicles to drive change, to address challenges head on, and to maximize the effectiveness of these programs on behalf of the populations we serve. 

Our work at HRSA plays out in very tangible ways – for example, by making sure needy Americans have access to life-saving HIV/AIDS drugs; by launching new efforts to procure more transplantable organs and sign up more organ donors; by supporting research on rural health issues and maternal and child health; and by working to improve the supply and distribution of primary care providers, including nurses.

And since President Obama signed the Affordable Care Act in 2010, HRSA has been responsible not just for the many impactful programs in our traditional portfolio, but for implementing ACA provisions to make health insurance coverage more broadly available.  As each of you know, access to health insurance means access to health care, and that link gives individuals and families a clearer shot at getting or staying healthy.

As part of that responsibility, like many of you, I spent much of the first open enrollment period engaging key stakeholders about the importance of helping to get the word out about -- the website that is the repository of information on insurance coverage -- and more -- and a website that I hope each of you has personally explored.

I first learned about the outreach and enrollment work of the Phoenix chapter through a fellow nurse.  She knew that, as part of my commitment to helping get the word out about the Marketplace, I was connecting with national nursing organizations across the country to talk about best practices for educating and enrolling as many people as possible in coverage.

She said I needed to watch a news story that ran on NBC, which starred your Chapter President, Dr. Adriana Perez.  Needless to say, I was mightily impressed with the great work that nurses were doing in Arizona to get people insured.

So, I reached out to Dr. Perez and asked her to join me, and then-Secretary Kathleen Sebelius, on a teleconference with thousands of nurses across the country to discuss the Affordable Care Act and

And, as it turned out, Dr. Perez was in Washington, D.C., on the date the call was to occur, so she participated in the call right with us -- in person.

On that call, she explained to nurses from across the country how your ‘boots on the ground’ operation in Arizona worked -- where you would go in the community to raise awareness about the Marketplace.  What she couldn’t say then was that your efforts would result in over 2,000 people learning about health insurance coverage through

Thank you so much for that work and commitment to helping to improve the health of your friends and neighbors.

Your contribution was part of the now more than 8 million Americans who have signed up for insurance through the ACA Marketplaces.  Another 3 million young adults under age 26 enrolled in coverage under their parents’ plans, thanks to the provision in the law making that possible.  And 7 million additional individuals have enrolled in health insurance coverage through Medicaid or the Children’s Health Insurance Program since open enrollment began.

And, you should be proud to live in a state with a robust Medicaid program.  By expanding Medicaid in Arizona -- as allowed by the ACA -- 51,000 more AZ residents will be insured in 2016.  This expanded coverage is, of course, a direct benefit to residents of Arizona -- for many of them it’s likely life changing. 

But in addition to that, the added federal resources flowing in the state will support your Medicaid expansion will also contribute to the economic health of Arizona’s health care systems in which many of you work.  This is because health care systems historically have had to bear the burden of providing care that would go uncompensated.  And that has been a key financial strain on hospitals and clinics.

And now we’re starting to see evidence that the expansion of health insurance coverage sparked by the ACA is having exactly its intended impact.  A new study in the New England Journal of Medicine found that 10.3 million adults gained health insurance coverage following the first enrollment period that began last fall.  As a result, the uninsured rate for Americans ages 18 to 64 fell from 21 percent in September 2013 to 16.3 percent in April 2014. As a nurse, I’ve watched the percent of uninsured in this country climb steadily over the years -- seemingly unabated—until the enactment of the Affordable Care Act.  Watching that trend-line bend is a huge accomplishment!

This article and other recent surveys all point in the same direction -- they confirm that the health insurance Exchanges are fulfilling the ACA's goal of reducing the number of uninsured Americans.

Unfortunately though, as you know, is there’s still a lot of misunderstanding about the ACA’s benefits among the general public -- so let me lay out a few key facts.

Thanks to the ACA, people cannot be denied coverage because they have a pre-existing condition like obesity or diabetes, both of which tend to affect minority populations more so than the general public.  That provision is an important provision for the Hispanic community.

The ACA stops insurance companies from limiting yearly or lifetime coverage expenses for essential health benefits, and it bans a practice of some insurance companies that charged women more for insurance coverage than men. 

The law also breaks the link between losing your job and losing your health insurance coverage.  All of that and more means that going forward, both people who have had insurance coverage -- and people who have gone without insurance but are now able to get it -- both groups will have a better opportunity to get the health care that they need, when they need it.

Expanding health insurance coverage may be what the ACA is best known for, but another of the law’s very important benefits is its expansion of disease prevention services to everyone who has health insurance -- with no out-of-pocket costs to patients.

A study released last month found that the Affordable Care Act has made about 76 million Americans who have private health insurance newly eligible to receive expanded coverage for one or more recommended preventive health care services, such as a mammogram or flu shot -- without cost-sharing on the part of the patient.

Included in those 76 million Americans with expanded access to preventive health services are almost 19 million (18.6M) children.  For example, these children can now receive immunizations, vision screenings, and hearing screenings for newborns with no out-of-pocket costs to their parents.

And almost 30 million women (29.7M) now can receive coverage for preventive services like screenings for cervical cancer with no out-of-pocket costs, thanks to the ACA.

As an aside, many years before I came to Washington to work in health policy I worked in a hospital, in the intensive care unit.  I can tell you that many of the people I cared for there -- critically ill people with advanced diseases -- could have avoided that fate if they had been able to access the type of health screenings that the ACA provides at no out-of-pocket cost to patients.  Because those screenings would have caught some of the problems that I saw much earlier and helped put the patient on a course of treatment to improve -- or even resolve – their health situation.  And in addition to some of the avoidable compromises in health there’s also a huge difference in cost between regular visits to primary care providers to maintain one’s health and the enormous expense in money -- as a result of ICU care.  That’s why preventive health care is so important -- decreased disease burden and decreased health care costs, and that’s why expanding access to it is a central focus of the ACA.

To be sure, the work of getting people into coverage is critical, and the second open enrollment period begins November 15, less than three months away. 

But it is equally important that individuals who are newly insured are aware of the full range of benefits covered by their insurance. 

To help with this, in May our HHS colleagues at the Centers for Medicare and Medicaid Services announced a new initiative called “From Coverage to Care.”  Through it, there are now tools – in Spanish and English -- to help nurses and other providers communicate to patients at places of worship, health fairs, and community groups, in college classrooms, and patient waiting rooms.  “From Coverage to Care” has materials you can use to talk with patients, students, and others, such as:

  • How to find the right health care provider;
  • When and where to seek health services; and
  • Why prevention and partnering with a steady source of care is important for good health.

“From Coverage to Care” can be found at the website:; it’s a great addition to the next phase of ACA outreach.   

And why is it especially important for nurses specifically to be engaged in this?  Because research indicates that when it comes to information about the ACA, people place the greatest level of trust in what they hear from nurses and from doctors.  As you probably experienced during the first open enrollment period, the nursing profession’s voice in this – one by one and collectively – matters greatly.

It isn’t enough, however, to just give individuals and families the opportunity to have health insurance coverage.  We also must ensure that we have a health care system – including an adequate number of providers who are well distributed – to care for patients.  So, with an eye toward all of that, the Affordable Care Act included many other provisions to build out our health care infrastructure.  Much of that responsibility for those provisions was given to HRSA. I’ll say a word about 3 of them.

The law invested $11 billion over five years in HRSA-supported community health centers, which, through a network of 9,200 sites, from mobile vans to new multi-story clinics, deliver primary care services to some of the most vulnerable populations. 

Largely as a result of the ACA, health centers now deliver primary and preventive care to 21.7 million patients (2013), up from 17 million when President Obama first took office.

In Arizona alone, the number of health center sites has grown from 115 sites serving 356,000 patients in 2008 to 137 sites serving more than 438,000 patients in 2013.  That’s a growth rate in patients served of 23 percent in just five years!

This massive and much-needed boost to the primary care infrastructure provides a comprehensive range of services, including oral health, behavioral health, and vision care, in addition to traditional primary health care. 

And nurses are certainly central to this health center expansion.  Health centers have used ACA funds to add some 4,500 nursing positions across the nation since 2009.  Right now, nearly 18,000 nurses work at health centers nationally.  And this year we expect to stand up around 150 more health center sites across the country to provide additional access points for primary care.  That will create even more job opportunities for nurses.

In terms of the second ACA provision I want to mention, as some of you probably know, many of these health centers employ advanced practice nurses and other primary care providers from HRSA’s National Health Service Corps.  By joining the NHSC, advanced practice nurses and other clinicians – physicians, dentists, psychologists and more -- commit to practice in underserved areas in exchange for student scholarships and educational loan repayments.  This program is critical to getting primary care providers to the places where our country needs them the most.

Largely as a result of ACA investments, the ranks of the NHSC have more than doubled over five years, from about 3,600 clinicians in 2008 to nearly 8,900 primary care providers in 2013.  Of that number, nearly 1,600 are advanced practice nurses – that’s more than three times as many nurse practitioners, certified nurse midwives, and psychiatric nurses as there were in the NHSC just five years ago.

And the increase in NHSC Nurse Practitioners and Certified Nurse Midwives in Arizona in recent years has been nothing short of astonishing.  In 2008, there were five NHSC-supported NPs and CNMs in the state; today, largely because of the ACA -- just five years later -- there are 71!  In fact, this program has been especially important to supporting health care providers from minority backgrounds -- helping them to afford to go to school and to ultimately work in communities where they most want to serve.

The third program supported by the ACA is actually a new federal program that focuses on home visiting.

The Home Visiting Program puts more health care resources into at-risk communities.  Under this program, nurses and others work with pregnant women, fathers, and young children in their homes, providing early counseling and evidence-based intervention services to improve health outcomes.  Now, more than 500 nurses work in this program – and the program is in all states now across the country.

Throughout my work, I have met with some of these nurses and the families they serve, and I can tell you that it is a lifeline for these typically young and fragile families, providing an array of information and referrals, from nutritional education to early learning strategies.  And most important, home visiting has well documented impacts on lowering domestic abuse and increasing parenting skills, increasing economic self-sufficiency and children’s readiness to learn.  The program resets circumstances for infants and children and their moms in remarkable and, frankly, essential ways.

And, by the way, at HRSA we’re not focused only on the supply and distribution of primary care providers – we’re also working hard on competencies that nurses and others will need to practice effectively in the redesigned health care system.  We know we need redesigned curricula to train health care providers in new team-based models of care – such as Patient Centered Medical Homes, Accountable Care Organizations and other models.  Tracking workforce training with emerging health care delivery models is absolutely essential.

So, to bring a more precise focus to interprofessional education and team-based care, HRSA supports initiatives designed to help transform the prevalent siloed healthcare delivery system into an integrated health system of coordinated, collaborative, team-based practice that reaches both patients and populations and can become a new national norm.

Looking forward, thanks to these and other investments made possible through the ACA, HRSA is funding training and education initiatives capable of developing a nursing workforce that can care for patients and lead teams of providers across different settings.

Let me conclude my remarks by summing up where we are right now with the Affordable Care Act – and by asking members of the Phoenix chapter of the National Association of Hispanic Nurses to continue your great efforts in support of HRSA’s mission of making health insurance coverage available to all Americans.

First, you can help right now.  As you know, for those who meet the eligibility criteria, Medicaid accepts enrollment all year long.   In addition, people also can sign up for health care coverage any time during the year when a life circumstance changes their connection to health insurance, say through getting married -- or divorced -- having a baby, changing jobs, or graduating from college.

Second, the re-opening of the Marketplace – on November 15 – will be here before we know it, so then everyone without health insurance will be eligible to apply for coverage through  

Few groups are as skilled at reaching people where they live and work as all of you are, and I know you need little encouragement to keep that effort going.  But I ask you to keep up your incredible commitment, and go even further than you did last year to get your neighbors, friends and family members signed up. 

And third, remember that you can be a continuing source of information and advice for those who need help using their new insurance by going to the “From Coverage to Care” website at and making use of the resources there.  Another good source of important facts about the Marketplace and the importance of prevention can be found at the main HHS website at

Right now, it’s about getting people signed up, making sure they stay enrolled, and helping them use their benefits wisely -- and nurses have key roles to play in all of those areas.

To members of the Phoenix chapter of the NAHN, I thank you for everything you’ve done – and for everything that I know you’ll do in the coming weeks and months -- on behalf of the health of people in your communities and your state.

Thank you and thanks so much for the opportunity to be part of your meeting. 

Date Last Reviewed:  March 2016