Following is the Reality Check column that will appear in the September 2009 AANA NewsBulletin. It is being emailed to the AANA membership in advance of publication at the request of President Jim Walker, CRNA, DNP, to address member concerns about the AANA's position on HR 3200.

Reality Check
AANA and Health Reform: Setting the Record Straight

The "Reality Check" column was created in 2002 to address misinformation about CRNAs that has appeared in a public forum, state the facts, and empower CRNAs to accurately inform their patients, healthcare colleagues, employers and payers should the need arise. The column has been used selectively, but never for the purpose of addressing AANA member misperceptions about actions taken by the Association. Until now.

AANA members may use this column as necessary: Post to state association websites, reprint in state association newsletters, use as background or support materials for a meeting, etc. 

If you have questions, comments, or suggestions for future columns, please contact Christopher Bettin, AANA Senior Director of Communications, at cbettin@aana.com . 

Misperceptions
Few issues are as incendiary as health reform.

On July 29, 2009, the AANA sent a letter to Nancy Pelosi, Speaker of the U.S. House of Representatives (http://www.aana.com/letter_pelosi.aspx), stating that the AANA is pleased "to extend our support for the America's Affordable Health Choices Act (HR 3200)." Despite the fact that the letter clearly explained the AANA's meaning and intent, it nonetheless ignited a firestorm of member protest to the AANA Board of Directors and headquarters office. Emails and phone calls from passionate, concerned members repeated the same message: "How dare the AANA support this legislation! HR 3200 jeopardizes CRNAs' livelihood by reducing hard-earned compensation and will create a system of socialized medicine disastrous to timely, quality patient care!" "Hasn't the federal government proven through the failings of the Medicare/Medicaid and Social Security programs that it can't effectively manage a national healthcare system?" "It's not the healthcare system that needs fixing, it's the insurance industry and the legal system!"

The comments, concerns, and complaints have been varied, pointed, and informative. To everyone who has written or called-whether to vent or to show support-the AANA thanks you for caring and being involved.

Before addressing any misperceptions about the health reform letter, it is important to make clear that the AANA is a bipartisan organization. It always has been a bipartisan organization. Despite a track record in D.C. and the states that clearly supports this ideology, many members who have written or called to voice their concerns about the letter accused the AANA of favoring the Democratic administration. But the letter was not written because of which party is in the White House or currently controls Congress. It was written because the AANA wants-in fact, needs-to have a seat at the table during important discussions on the future of healthcare in this country. Further, the AANA has never endorsed a particular party's candidate for president of the United States, and didn't start doing so with the current administration. Last summer/fall, the AANA had a significant presence at both national conventions, with a goal of building political relationships for the benefit of CRNAs and student nurse anesthetists across the country. Finally, the CRNA PAC donates as equally as possible to congressional candidates from both parties, supporting those politicians who support the profession of nurse anesthesia. This is the first and foremost consideration, among many, in determining whether to support a candidate.

So why did the AANA send a letter of "support" for HR 3200, and what is meant by "support"?

The reason for sending the letter is simple: Precisely because the AANA has concerns about health reform, it has signed on to work with the Obama Administration to hopefully get health reform right-for patients as well as for healthcare providers. The AANA has always believed it is far more productive and beneficial to have a place at the discussion table and a say in the matter than to stand on the sidelines, cup our hands to our mouth, and shout about how unhappy we are with the way things are going. It has been our experience that legislators and regulators pay small attention to the sideline shouters-but they take notice of organizations and individuals who want to affect change through discussion, debate, analysis, and research conducted in a positive, proactive manner. If there's a choice between taking an active role in shaping legislation that could affect CRNA practice and quality patient care, or standing by and allowing others to make decisions that could have a significant impact on the nurse anesthesia profession, isn't it better to roll up our shirt sleeves and get down to work?  The notion that it's more dangerous to be involved than to stand on the sidelines is foreign to the AANA.

What, then, is meant by "support." Upon a careful reading of the letter, which states many of the AANA's concerns with HR 3200, it becomes clear that the AANA supports the concept of health reform and intends to be a meaningful contributor to the discussions ahead as the bill is shaped and reshaped by congressional lawmakers. AANA members can rest assured that throughout the process, the AANA will never shirk its responsibilities to protect CRNA practice rights and reimbursement as well as patient access to safe, affordable care. Additionally, the AANA understands and will remain vigilant about the need to reform the insurance industry and legal system, and the fact that a national health system, unless carefully constructed and implemented, is at risk of failure. The Association's long record of success on behalf of its members in matters debated on Capitol Hill and in state houses across the country should speak for itself.

Have a Seat at the Table
It's uncertain whether there was a direct correlation between the letter to Speaker Pelosi and what happened next, but during the AANA's recently concluded Annual Meeting, FY2009 President Jackie Rowles, CRNA, MBA, MA, FAAPM, received a call from Mary Wakefield, PhD, RN, head of the Health Resources and Service Administration for the Obama Administration, asking the AANA to be one of several nursing organizations to work with the White House on health reform, including the American Nurses Association, the Oncology Nursing Society, and the American Academy of Nursing. The first meeting, a 6 a.m. (PST) conference call involving representatives from the various nursing groups and White House staffers, was held on August 13. A follow-up call was conducted between AANA and White House staff on August 19. The nature of the calls was to establish a direction for nursing and the administration to work together on this important initiative.

When President Rowles announced this development during the Annual Banquet in San Diego on August 12, more than 1,200 CRNAs and student nurse anesthetists rose to their feet cheering and applauding. The AANA had gained a seat at the discussion table.

Anesthesiologists being Anesthesiologists
Over the last several weeks the AANA has been receiving regular reports from CRNAs who work with anesthesiologists that their physician colleagues are trying to stir things up by telling them the AANA has "sold them down the river" by "endorsing" HR 3200 (note: the word "endorse" is never used in the letter to Speaker Pelosi). Unfortunately, some CRNAs have bought into these lies and contacted the AANA with angry admonishments and threats of not renewing their membership. This is unfortunate, because if one thing has proven to be true over the years, it's that when it comes to politics and business between the AANA and ASA, CRNAs would be wise to take what anesthesiologists say with a very big grain of salt.

If you are a CRNA who has had heard similar nonsense from your anesthesiologist colleagues, here are two pieces of advice: 1) Make a copy of this column and hand it to them. 2) Ask them what they think about the July 31 letter from American Medical Association President J. James Rohack, MD, to ASA President Roger Moore, MD, in which the AMA takes the ASA to task for its attacks on the AMA's position on health reform. Writes President Rohack: "We are particularly troubled by the orchestrated effort within anesthesiology to unfairly criticize the AMA, especially given the frequent staff-level communications between our two organizations." He adds later in his letter that "It is a shame that a long history of support and close collaboration has been overshadowed by differing strategic views and critical judgments." It's nice to see that the anesthesiologists have more than just CRNAs upset with them for a change.

Closing Comments
In closing, a paragraph in the letter from Dr. Rohack to Dr. Moore neatly sums up the AMA's views on HR 3200: "There are many actors involved with crafting health system reform legislation, and the AMA never expected any single bill emerging in the early stages of the process to include only provisions that we fully support. Our intent behind signaling early support [emphasis added] for the House proposal was to reinforce medicine's importance to the legislative process and to be sure that the profession's viewpoint would be valued and taken into account as these bills continue to be refined. We intend to be fully engaged and consulted when the details of the final bill are negotiated, so that we are in a strong position to advocate strongly against inclusion of objectionable provisions like a Medicare-based public plan."

The AANA couldn't have expressed it better.

Comments Welcomed
The AANA wants to know what you think about HR 3200 and the concept of health reform in general. What are your concerns? What would you like to see in a final bill? Please share your thoughts via email by sending them to pr@aana.com. Please type "Health Reform" on the subject line. This information will be compiled into a database to help guide the AANA's activities as the legislation works its way through Congress.