By Jennifer Larson, contributor

Jan. 28, 2010 - When Massachusetts voters elected Scott Brown to fill the late Massachusetts Sen. Edward Kennedy’s Senate seat last week, it was big news. Not only would a Republican hold a seat that had been a Democratic stronghold for decades, but Brown’s election would remove the supermajority hold on the Senate that the Democrats had enjoyed since the 2008 election.
 
In other words, the Democrats could no longer count on getting their sweeping healthcare reform legislation passed. The House and Senate had already passed their own versions of the reform bill, and congressional Democrats believed—along with nearly everyone else—that all they had left to do was reconcile the two versions. But the Republican Party suddenly had enough votes to filibuster the legislation, effectively bringing the movement to a screeching halt.
 
Healthcare providers and other major players in the industry sat back, a little stunned by the sudden change. Some had supported the legislation, others had opposed it, but most had come around to believing that it was more or less a done deal.
 
Not anymore.
 
“Everyone is in a ‘wait-and-see’ posture,” said Julie Sochalski, Ph.D., RN, associate professor of nursing at the University of Pennsylvania School of Nursing, and a national expert on the healthcare workforce. It’s mostly a guessing game at this point, she noted. 

In President Obama’s State of the Union address on January 27, he urged Congress not walk away from reform, and asked them to “finish the job for the American people.”  He did not offer the solution for how to do that, but said he would listen if someone had a better approach for how to solve the nation’s healthcare problems than through the current legislation.
 
Many are now wondering if a much-scaled-back bill is now in the future—or if somehow, the effort to pass the existing sweeping healthcare reform bills will be revived. Two Democratic senators, Evan Bayh of Indiana and Blanche Lincoln of Arkansas, announced on Jan. 26 that they will oppose a strategy suggested by their party’s leadership to pass comprehensive healthcare reform legislation though the budget reconciliation process, lowering the threshold in the Senate from the 60 votes required to break a filibuster to the simple majority for passage and in order to get the bill sent to President Obama for his signature.

So for now, the situation remains unclear.
 
“It looks like, at this point, any bill that is passed is going to be very incremental,” said Rebecca Givan, assistant professor of collective bargaining at the ILR School at Cornell University, who has been monitoring the healthcare reform legislation.
 
She said she doubts that most healthcare providers would experience any significant changes while reform remains in limbo. But she wouldn’t be surprised if many of them are a little disappointed.
 
“I think they hoped the number of uninsured would be dramatically reduced, and a lot of them hoped the power of the insurance companies, and the drug and device companies, would also be reduced, and the capacity for doctors and nurses to use their professional judgment would be increased,” Givan said. “And it doesn’t seem like it’s going to happen.”
 
Even the health insurance companies are taking the ‘wait and see’ position for now, said Shirley Walker, the owner of a consulting firm that works with insurance companies and physicians’ practices in Arkansas.
 
“I think most people recognize that even if something got passed tomorrow, it would take years to get implemented,” she noted.
 
Jan Towers, Ph.D., NP-C, director of health policy for the American Academy of Nurse Practitioners (AANP), isn’t ready to give up just yet.
 
“It’s unfortunate that it appears to be unraveling,” she said. “But we don’t want to throw the baby out with the bathwater yet because there are some very important provisions in the legislation.”
 
Towers cited funding for medical homes, which includes nurse practitioner practices, as one such example and funding for advanced practice nursing education as another. Such resources would definitely help nurse practitioners and their patients, she said. Nurse practitioners want to be able to function at their full scope of practice, and anything that helps them do that is welcome. Additionally, they can help address the shortage of primary care providers. So the AANP is hopeful that Congress does not give up on healthcare reform.

“We are hoping they can put something together that is acceptable to both parties,” she added.
 
Like Towers, there are others who are already concerned about the potential loss of what they saw as vital investments in the healthcare industry for the future.

For example, if neither the House nor Senate version of the healthcare reform bill is passed, the future workforce could take a significant hit. The pending legislation contains numerous provisions that would have invested funds or other resources in bolstering the numbers of providers. The industry is already coping with a growing shortage of primary care providers, and most experts are predicting that the nursing shortage of the past decade will rebound soon, too.
 
“I believe the expected shortages will be worse without healthcare reform than with it,” said Edward Salsberg, director of the Center for Workforce Studies for the Association of American Medical Colleges. 
 
He continued, “While the bills would increase coverage and demand, they have many provisions to both increase supply and to improve efficiency and access. This includes such provisions as increased support for primary care practitioners, medical homes, nurse-managed clinics, etc. While it is possible that some of these programs and policies could be passed as separate initiatives, I think this is less likely without healthcare reform, and it would certainly be less comprehensive.”
 
Others just hope that, no matter what happens with the legislation, the healthcare community will try to make progress anyway.
 
Sochalski believes that clinicians should focus on building evidence-based models that can effectively reduce the cost and improve the quality of care—and make sure to have the right mixture of healthcare workers to achieve that goal.
 
“Health insurance reform won’t be affordable unless it’s accompanied with true and effective delivery system reform,” she said.

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