His death was a tragedy, compounded by the fact that it could have been prevented, according to Illinois Nurses Association (INA) president Mary Maryland, PhD, RN, APRN,BC. Nurses found prescriptions in his pocket for asthma medications he had received during an earlier visit to the same ED. Without insurance, he couldn’t afford to fill them.

Like other nurses, Maryland has many stories about the uninsured, who number about 1.7 million in Illinois and 41.2 million in the United States. And at a Chicago town hall meeting March 10, the first day of Cover the Uninsured Week, she shared the story of the young man who frequented the ED for his care, as well as strategies she believes will ease this growing health care crisis.

The first Cover the Uninsured Week, which ran through March 16, consisted of a series of simultaneous events around the country aimed at building awareness among policymakers, the media, and the public on the issue of the uninsured. Some 875 events, which included town hall meetings, health fairs, and interfaith breakfasts, took place in more than 40 states.

This massive effort was sponsored by the Robert Wood Johnson Foundation (RWJF), the California Endowment, and the W. K. Kellogg Foundation, along with other national organizations, including the ANA. More than 20 of the ANA’s constituent member associations also cosponsored or participated in events within their states to ensure nurses’ voices were heard on this issue.

The background

The weeklong project was only part of a larger, ongoing campaign to raise public consciousness about the uninsured. For example, in January 2000 the RWJF and its national partners held a conference to present proposals they believed would im­prove Americans’ access to health care. At that meeting, former ANA president Mary Foley, MS, RN, discussed the ANA’s vision for a national insurance program in which everyone in the United States would be covered under an expanded, restructured Medicare.

Ongoing projects launched in February 2002 include national advertising and a web site (www.covertheuninsuredweek.org) featuring information about grassroots and national activities focusing on the uninsured, as well as numerous fact sheets that focus on the problem.

The fact sheets detail several disturbing facts:

• Eight of 10 uninsured Americans come from working families who either have no health coverage through their employer or cannot afford insurance when it’s offered.

• Nearly 25% of the uninsured are children, and those most likely to lack health care coverage are between 18 and 24 years old.

• Others most likely to be uninsured are Hispanics, low-wage earners, and people without high school diplomas.

• When examining coverage over a three-year period, three out of 10 people lacked health insurance for at least a month.

Around the nation

Several days before Cover the Uninsured Week began, the RWJF brought together leaders of its partner organizations at an event in Washington, DC, designed to spark media interest in upcoming activities. (Judging by media coverage throughout the week, the initiative was a success.)

“Every day, nurses see the human face of the uninsured,” said ANA president Barbara Blakeney, MS, APRN,BC, ANP, at the kick-off event. “We hope to raise our voices in the message that 41 million uninsured people in this wealthy nation is not acceptable. We want to focus attention on the need to get these people covered.”

Echoing her remarks was Karen Ballard, MA, RN, New York State Nurses Association (NYSNA) director of practice and governmental affairs. NYSNA cosponsored several of the events held throughout New York City, and more than 100 nurses participated.

“We're facing a societal issue here,” Ballard said. “People either have to be so absolutely poor that they qualify for government programs to provide them with access to adequate health care, or they have to be so rich that they don’t have to worry about affording health care.”

In addition to sponsoring a town meeting March 10 in which Senator Hillary Clinton (D-NY) was the keynote speaker, NYSNA had a prominent role in coordinating a March 15 business and labor conference, as well as educational sessions held at local health care facilities and colleges of nursing.

At the labor conference, NYSNA’s Economic and General Welfare program director Lorraine Seidel, RN, stressed the importance of health care coverage aimed at preventive care. She said that even employers in health care are resisting coverage for preventive services. And many are unwilling to provide retirees with health benefits—even though many of their employees have practiced within hospitals, nursing homes, or home care agencies for 40 years.

Advocating access and affordability of health care is also important to the Minnesota Nurses Association (MNA) and is part of its mission statement.

“MNA has a long and rich history of working on health care reform,” said MNA executive director Erin Murphy, RN. So it was natural that MNA staff and nurse members would be involved in planning Cover the Uninsured Week activities within Minnesota, a state where about 4%, or 230,000 people, lack health insurance.

“One of the best things about the week is that it brought a broad spectrum of people, such as the state chamber of commerce, consumer groups, and health care organizations, to the same table,” Murphy said. “Everyone agreed that this is an issue that needs attention. The challenge, however, is to create a plan for health care coverage when there is a huge budget deficit and no state plan to raise revenues.”

“Nurse leaders have been instrumental in identifying the uninsured as an issue that must be addressed in our state,” said KSNA member and event coordinator Kay Hale, RN. “They also have been very involved in providing services to those who cannot afford health care services in clinics and organizing other health professionals to meet their needs.”

KSNA, for example, called on 28 schools of nursing to hold campus programs on the uninsured. At one of the schools, Emporia State University, the Newman (KS) Association of Nursing Students and KSNA District 11 collaborated on several activities, including a blood pressure clinic at a local county health department. The coalition also sent 10,000 invitations to low-income Kansans, asking them to attend open houses at 15 participating community-based clinics to learn about available resources.

The coalition also developed a public service announcement and purchased airtime at several radio stations to inform the public about the plight of the uninsured. Kansas governor Kathleen Sebelius supported the radio campaign by recording the public service announcement.

Montana Nurses Association (MNA) executive director Sami Butler, RN, worked with RWJF staff to coordinate events in Helena that included a panel discussion in which a mother of four discussed the need for universal coverage. She lost her health insurance and was then diagnosed with breast cancer.

Butler also used the events to raise some of nurses’ concerns with policymakers and business and community leaders. For example, she asked an insurance CEO why his firm does not allow advanced practice RNs who work as primary care providers to provide cost-effective quality care throughout its entire network. She also inquired about what’s being done to assure health care access for retirees not yet eligible for Medicare and why health care is the most expensive for those who can least afford it—those without health insurance.

“Provocative issues raised at the town hall meeting were the fact that health care in our country is treated as a commodity and the lack of political will and moral courage needed to address the crashing health care system,” Butler said.

MNA members also participated in a heath fair at a local shopping mall. The event was so successful that nurses ran out of vaccines to immunize children.

Back at the Chicago town hall meeting, Maryland called on her ED experience and presented some solutions to ensuring that Americans receive needed health care.

Maryland believes EDs should have “fast-track” areas where nurse practitioners can provide primary care to the many uninsured people who come to the EDs for nonemergency care.

“Many people come to the ED because they don’t know where else to go or they’ve delayed care and allowed minor respiratory symptoms to become pneumonia,” she said.

Maryland also called on health care leaders and policymakers to “find the will” to implement universal health care.

As part of the national effort, Tennessee Nurses Association president-elect Maureen Nalle, PhD, RN, was one of several members of the ANA’s Congress on Nursing Practice and Eco­nomics who agreed to participate in the making of video news releases that were distributed nationwide. She addressed issues in her state, and the great costs associated with the uninsured seeking routine care in the ED.

Interviewed nurses agree that the weeklong initiative was a good first step. They now want to work on the next step—ensuring all Americans have the health care they deserve.

Susan Trossman is the senior reporter for the American Nurse at the ANA.

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