This week, I interviewed Nancy Ridenour, the dean of UNM’s College of Nursing. She worked on Capitol Hill, and she had a hand in crafting portions of the health care reform bill.
All of her excellent interview didn’t make it into the paper. Here, the health policy expert talks about her international work, her experience as a staffer on the House Ways and Means Committee and the road ahead for health reform.
Besides policies directly affecting the health care system, what is crucial to the health of a nation?
One of the things I’ve learned from my international work is the most important criterion for whether or not a community is healthy is the literacy rate of women. Now, you think, is that health care? Well, when I worked in India for example, one of the major things we did in the nursing school was teach women to read, because that was going to have more impact on their health than anything else we could have done.
The health behaviors are incredibly important, and those are also tied with: Do you have the ability to have a healthy lifestyle? How much of it is individually driven in terms of what choices we make? And how much of it is environmentally based in terms of what choices we have access to?
The economic conditions are incredibly important. Whether or not people have access to jobs and education are all incredibly important to the health of a community.
During your time on Capitol Hill between 2007 and 2008, how did you contribute to the health care bill?
Working on committee staff gives you the opportunity to be involved in writing language for bills.
Ways and Means works on Medicare, so that was the angle that I was focused on—ways in which Medicare needed to be in health reform. I had some hand in some of the Health Information Technology bills that came out in the stimulus funds, which were really part of health reform. But that was done before the health reform package. [Editor’s note: See the article for details about Ridenour’s focus during her time as a congressional staffer.]
Talk about some of the political and legislative forces that contributed to the final version of the bill.
Any time we’ve tried health reform in the United States, it’s followed similar patterns. People on one side say, We need universal and single-payer. Then you have graduations in between, all the way to, We want no government involvement at all. I think that is, in some ways, a fiber of our country.
So some of it’s political, and so some of it’s how some people view, What’s the role of government? ...
There were several adjustments that were made along the way to get things moving that I probably would not have done. But part of what happens in negotiating is, one, you negotiate with staffers on your own committee. But there are staffers on the other committees of jurisdiction, minority and majority—so there’s complicated negotiation.
One thing that surprised me, for example: I was working with Energy and Commerce very closely, because they are one of the committees of jurisdiction in the House, and we had to have a common ground before we took things forward. I got to know [Rep. John] Dingell’s staff very well, and we worked all the time. So when [Rep. Henry] Waxman became chairman and Dingell was no longer chair, overnight there was a whole new staff. So even though we were both on the same page, and we both want the same thing, it’s totally new people.
For the Ways and Means committee, we really started over with Energy and Commerce. That’s something I hadn’t realized externally, that those relationships change depending on the chair of the committee. And that was good for me to learn, and now that I see it, I understand how it works. But that was a lot of extra work.
What has to happen now that the bill’s passed to bring it into reality?
Now Heath and Human Services (HHS) and the Heath Resources and Services Administration are just slammed. They now have to write regulations. Several of the pieces have very tight timelines. And the regulation process is very complicated. The assigned agency, usually HHS, has responsibility for putting out draft regulations that then have to be published in the federal registry. They have a certain amount of days, and then they have to have a public comment period. Then they have to republish based on the comments.
It’s a very organized and important step, but it’s also very labor intensive and time consuming. And it’s also up to us in the public and particularly nurses that we make sure we’re involved in how the regulations get written and certainly making public comments and responding to the federal register, because that does make a difference. How the regulation gets written can make or break a program.