Nurses and the Affordable Care Act
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Nurses and the Affordable Care Act

October 22, 2019


Dr. Wakefield:
Thank you very much, Operator. I want to welcome all
of you and thank you for joining the call today. I’m Doctor Mary Wakefield
and I’m the administrator of the House Resources and
Services Administration. That’s a division of the U.S.
division of Health and Human Services and I’m also a nurse. And I am very, very excited
to be joined today by the First Lady of the United
States, Michelle Obama. And to be speaking with all of
you about the very important role that nurses can and are
playing in the implementation of the Affordable Care Act,
which President Obama signed into law just over six months ago. As the First Lady knows, across
America, nurses are on the front lines of our nation’s
health care system, each hour of each day. Nurses know how much our nation
needed real health reform. And now that the Affordable Care
Act is the law of the land, we know what a huge difference its
provisions will make to millions of Americans across the country. But this is still a very new
law, and we know that your patients have questions about
what this law means for them. And that’s why we so appreciate
your interest and willingness to spend some time with us this
afternoon to hear about what we think will be vitally important
information for both you and for your patients. So on today’s call, first
you’ll hear from our First Lady, Michelle Obama, who will
highlight what this law means for you and for your patients. And then you’ll hear from
me again about a few other components of the Affordable
Care Act relevant to nurses. And then I’m going to turn it
over to Jillian Roth, another nurse, who will speak about
the importance of prevention. A strategy that
is just integral. It’s an integral part
of this new legislation. Finally, we’ll have just a few
minutes to take your questions before wrapping up. So now I’m honored to turn over
the call to our nation’s First Lady, Michelle Obama. The First Lady:
Thank you, thanks so
much, Dr. Wakefield. Thank you for that introduction
but more importantly thank you for your hard work in fighting
for health care reform for so many years. She’s truly been a wonderful
advocate and a partner to this White House. I also want to thank all the
nurses who are joining me here today at the White House. And of course I want to thank
all of you joining us on the call across the country today. We have a wonderful
representation of the profession on this call. But we’re on this call today to
talk about what health insurance reform means for you
and for your patients, specifically the new provisions
that just went into effect. But I do want to start by
saying that I was looking forward to this call
for a couple of reasons, not just because we’re talking
about important reforms, but because Barack and I have
seen firsthand the crucial role that nurses play in our
nation’s health care system. And just to recall a story,
I will never forget the time back in Chicago, when
Sasha was then a baby, she was just about
four months old, and one day she just
began to cry inconsolably. And up until that time,
Sasha was a healthy, happy baby who rarely
cried for no reason. So of course we knew
something was wrong, and we immediately
took her to the ER. And as you all can imagine,
when a child gets sick, you are scared, and we were
certainly scared when we got to the hospital. And we were even more
frightened when Sasha was diagnosed with meningitis. But what made that difficult
time so much easier to bear was really all of you. It was the nurses. And don’t get me wrong, the
doctors did a phenomenal job. But the nurses were the ones
communicating with us every single step of the way, using
their expertise not just to comfort our little baby
girl, but to comfort us. And thank God, everything turned
out okay, and Sasha is healthy, as everyone knows. But it’s because of that
experience we will always be grateful to the nurses who
helped us then and to all our nurses across the country who
provide such outstanding health care each and every day. And I know that so many
Americans have their own stories to tell about
the skill, the care, the compassion that
nurses showed them during difficult days. We all have these stories
because in moments of need, nurses are on the front lines
of America’s health care system. We all have these stories
because in moments of need, nurses are the ones
who make things work. And that’s the reason
we’re talking today. You all play such a critical
role in helping patients understand what’s going
on with their health care, giving them the information they
need not just to get better, but to stay healthy. And right now, there’s some very
important new information that we really need to
help pass along. Last week, we hit the
six-month anniversary of the Affordable Care Act. That means that we’re starting
to see more of the reforms take effect, including new
protections and benefits in the Patient’s Bill of Rights. So for example, insurance
companies can no longer discriminate against
kids because they have a preexisting condition. Patients can no longer be
dropped by their insurance companies because they get sick. People suffering from a serious
illness like breast cancer can focus on their treatment because
they no longer have to worry about hitting their
lifetime limit on coverage. And college kids and young
adults just starting out on their own can now get coverage
through their parents’ plan. Now, all this means that
individuals and families have more control over
their health care. But here’s the important point:
These reforms aren’t abstract theories that just make
for good talking points. These are real changes that
will benefit Americans all across the country. And some of the biggest new
changes and benefits are the reforms that deal with
preventative care, because we all know,
everyone on this call, that the best way to keep
families healthy and cut health care costs is to keep
people from getting sick in the first place. And, as a result of the
Affordable Care Act, that’s going to be easier
because many preventative services are now covered
at no out-of-pocket costs. Things like mammograms, cervical
screenings, colonoscopies, childhood immunizations,
prenatal and new baby care, high blood pressure treatment,
all of these are included in new insurance plans with
no deductible, no co pay, no coinsurance, nothing. These steps are crucial because
they can help combat preventable conditions that can have
serious health consequences later in life. Take childhood
obesity, for example, an issue that’s of particular
concern to me as First Lady and as a mother. It’s an epidemic that’s sweeping
the country and it’s one that I’ve been trying to
combat through our “Let’s Move” initiative. These new reforms are critical
in addressing this challenge because we know that
preventative care, at least certain steps if
taken early in a child’s life, can help reduce obesity and
improve a child’s prospect for a healthier future. We know, for example, that
breastfeeding can have an impact on a child’s health. That’s why the Affordable Care
Act makes it easier for a mother to breastfeed once
she’s returned to work. We know that prenatal care and
early childhood screenings can have a dramatic effect on a
child’s chances of becoming obese later in life. So the Affordable Care Act
covers screenings for an array of conditions that affect
pregnant women and their babies. We know that kids getting their
BMI checked is an easy step that can help parents make
better decisions about their children’s health. So the Affordable Care Act
covers BMI screenings. And it’s not just
childhood obesity. Preventative measures like these
can have a major effect on so many chronic illnesses like
diabetes and heart disease or high blood pressure. So those are just some of the
examples of what’s in the law. But in order for this law to
make a real difference in people’s lives, we have to
make sure that people know about these reforms and that
they take advantage of them. And that’s why we need your
help in spreading the word. So we’re asking you
all to get involved in this outreach effort. Talk to your patients about how
these reforms can help them. Also, talk to your colleagues
about the best ways to inform patients about what this
new law means for them and for their families. But in closing, just let me say
this to all of you on this line. So many of you have played
such an important role throughout this process. From the very beginning, it’s
been nurses who have sat at the table sharing your
ideas, sharing your concerns and your experiences. And as a result, all of
you have helped to make this law even better. So I want to thank you for that. And we needed your help then
and we need your help again to spread the word. So, again, thank you everyone
for the work that you’ve done, thank you for the work that
you’re going to do and all the things that you do every single
day to make this country a healthier, more secure place. And with that, I’m going to turn
it back over to Mary Wakefield who will provide a few more details
on some of the other reforms. Thanks, again. Dr. Wakefield:
Thanks, so much, Mrs. Obama. It is wonderful to hear your
thoughts about the Affordable Care Act’s impact on improving
the health of the nation, and also to hear your
support for nurses and the work that they do. And as a nurse, from my
perspective, I greatly appreciate the Obama
Administration’s strong support for nurses. And I know my nurse colleagues
across the nation do, as well. That support is clearly
evident throughout the Affordable Care Act. Earlier today, in fact, I joined
HHS Secretary Kathleen Sebelius to announce $253 million in
Health Resources and Service Administration grants that were
released under the Affordable Care Act’s Public Health
and Prevention Fund. Bolstering our primary care
workforce and included in that announcement were two
sets of nursing grants. And I think they each merit
mention; one of them, a $31 million allocation under
the Advanced Nurse Education Expansion Program that as of
today will go to 26 schools of nursing to increase full-time
enrollment in primary care nurse practitioner and nurse
midwife programs. We expect these funds to
support 1,300 primary care nurse stipends over five years
and to fully train 600 nurse practitioners and
nurse midwives by 2015. Additionally, we announced this
morning $14.8 million to fund 10 nurse-managed health clinics
to provide primary care. These clinics, managed by
advanced practice nurses, provide primary care or wellness
services to under-served, vulnerable populations. Funding is for three years and
it will provide access and training — access to primary
care and training for more than 900 advanced practice nurses. More broadly, the Affordable
Care Act makes an historic investment in primary care by
expanding the Health Resources and Services Administration’s
supported network of health centers across the country. These centers provide a range
of primary care services to patients, and they treat anyone
who comes through their doors. Health centers are slated to
receive an additional $11 billion over the next five
years, to double by 2015 the current patient base
of 19 million people. And this influx of support
follows on the heels of a $2 billion investment made through
the Recovery Act stimulus funds just last year that expanded
health centers and the services that they deliver. Right now, we have about 15,000
nurses that work in health centers, including hundreds
of advanced practice nurses. So looking forward, you can
imagine the opportunities for nurses that will emerge over
the next few years as we work to expand the primary care system. The Affordable Care Act also
invests $1.5 billion in the National Health Service Corps
over the next five years. That’s in addition to $300
million invested in the National Health Service Corps last year
under the Recovery Act to boost the number of clinicians who
work in under-served areas. Advanced practice nurses are
eligible to join the National Health Service Corps. And in fact, of the 4,700
National Health Service Corps clinicians currently in the field, 15% are advanced practice nurses. But we have standing vacancies
for about 1,700 more health care professionals at 1,400 locations
now across the country. So for advanced practice nurses
looking for an opportunity to serve those who are in most need
of primary care, and have the government help to pay off their
student loans while they work, I’d urge them to go online
on at HRSA — that’s HRSA.gov — and visit the National
Health Service Corps site. Lots more opportunities
as a result of the Affordable Care Act. And there are other Affordable
Care Act provisions that are also important to highlight. If nurses are to play an
expanded role in a reformed health care system, clearly then
access to nursing education programs is of
paramount importance. The Affordable Care Act
reauthorizes and it significantly increases
funding for all seven of the Health Resources and
Services Administration’s nursing programs, programs that
represent the primary source of federal funding for
nursing education. And faculty shortages are a
leading factor in admissions backlogs at schools of nursing. At present only 13.2% of RNs have a graduate degree, and only 12% of those are employed in educational settings. While the Affordable Care Act
addresses this challenge by updating the Advanced Education
Nursing Traineeship and the Nurse Anesthetist Traineeship
Program, prior to the Affordable Care Act the Health Resources
and Services Administration was prohibited from granting more
than 10% of those funds to doctoral students. But fortunately the Affordable
Care Act eliminates this cap, and support for training and
advanced education practice is also highlighted in the Nursing
Workforce Diversity Program. Similarly, the Nurse Faculty
Loan Program provides funds to schools that enable them to
offer loans for Masters- or Doctoral-level nursing
students that are interested in becoming teachers. The combination of increased
fiscal year 2010 appropriations and additional funding from last
year’s Recovery Act means that this program, the Nurse Faculty
Loan Program, is significantly larger now than it
has been in years. And the Nursing Student Loan
Program gives students with limited financial resources
access to long-term, low-interest loans. It also provides partial loan
cancellation for nurses who work in shortage areas. The Affordable Care Act
increases the amount that student nurses may borrow by almost 25% — to a maximum of $17,000. And the Affordable Care Act also
expands the Nurse Education Loan Repayment Program
to include faculty. The overall impact of these
changes associated with the Affordable Care Act will, I
think, be a continuation of the positive trends that were
reflected in HRSA’s most recent national sample survey of
registered nurses, which found that while demand still outpaces
supply, the nursing profession is growing, we’re better
educated than ever before, and we’re becoming more diverse,
more reflective of the patient populations that we serve. Even so, though, we have gaps to
fill in each of the areas, which is why these investments that
I’ve just mentioned are so important to going forward. To keep up with the pace of
reform and to learn more about how the Affordable Care Act
helps you and your family, and to direct your patients to
a rich source of information, I would encourage everyone on
the line to go to the website, healthcare.gov — “healthcare,”
all one word, “dot-gov.” This is a government website
that allows users to compare the value of insurance plans
available in their states, to compare the performance of
nearby hospitals, for example, and to learn about
ways to stay healthy. That site, that website, is
totally geared to the needs of consumers, and it is
remarkably easy to navigate. In addition, it has been
structured to evolve and expand as consumers use it. And comments to website
administrators are much welcome so we can figure out even
new ways to improve it. Remember, it’s healthcare.gov. So thank you very much for this
opportunity to share a bit more information on the
Affordable Care Act. And I’d like to invite
Jillian Roth, a nurse, to speak to all of us. Jillian? Ms. Roth:
Good afternoon. My name is Jillian Roth and I’m
pleased to join Mrs. Obama and Dr. Wakefield for this
important conference call. Let me add my greetings to the
thousands of registered nurses and nursing students who
are on this call, as well. As nurses, patients look to us
for important information about how they can stay healthy and
how they can access important health care services. I’ve been a registered
nurse since 2007. I currently work in a hospital
in Northern Virginia in labor and delivery. I chose nursing because it
challenges my intellect and it allows me to make a
difference in people’s lives. I love my work and I feel
privileged to be with the women and their families at such
important times in their lives. I care for women from
all walks of life. And at times I see women who
have experienced complications during delivery, and these
complications oftentimes could have been avoided with better
management of their care, or if they have had
access to prenatal care. That’s one reason I got actively
involved in the American Nurses Association’s efforts to help
pass health care reform. Recently, I cared for two women
who had no prenatal care because they lacked insurance. When both of these women arrived
at the hospital in labor, they had no idea how many
weeks along they were. In the first case,
the baby was preterm. Had we known this, we would
have had a neonatologist available during her delivery. The second case was a young
woman who thought she was 34 weeks along, yet it turned out
she was post-dates, so we ended up having to do a C-section and
delivering a very large baby. We are fortunate in both cases
that the deliveries went okay, but it’s challenging when your
patients arrive at the hospital and there is little
to no information. It’s hard to predict what kind
of complications may occur, and those kinds of
surprises can lead to devastating consequences. That is why access to
primary and preventive care is so important. One in eight infants
born today is premature. Premature babies often require
long and costly stays in the NICU, and they experience
many health issues and developmental delays. High quality prenatal care can
go far to reduce the number of premature births. I also have a husband who has
diabetes, so on a personal level I understand the role of
disease management and controlling his diabetes and
preventing complications. We know that diabetes and other
chronic diseases are on the rise and that we will be seeing an
increase in chronic diseases as our population ages
unless we take action. As nurses, we really understand
how to prevent — how preventive and primary care services can
help avoid complications. That’s why I believe the health
care law is important, and I’m excited about the new benefits
that will help people access insurance and many of these
important health care services. Thank you. Dr. Wakefield:
Thank you very much, Jillian. I think we’ll turn now
and take some questions. So the first question, I think,
is coming from Kay Ball. Kay — and if you’d let
folks know where you’re from, and then we’d delighted
to hear your question. Ms. Ball:
Kay Ball, and I’m Associate
Professor of Otterbein University in Westerville, Ohio. And I want to say hello to
the First Lady Obama and Dr. Wakefield. And we’re on the campus right
now, and I’m joined on this call with many of my
nursing faculty colleagues. So as you know, nursing is the
number one trusted profession in the United States. And because of this, we’ve been
able to form a very strong bond of confidence with our
patients and their families. And we also know, as you
said, that there are a lot of unhealthy lifestyles existing
in America today and that many diseases and conditions
today are preventable. With all this in mind, how
can nurses actively and collaboratively work with
the White House to promote prevention and healthy
lifestyles for all? And how can we as nursing
faculty help our nursing students carry this
message into the future so it can be sustained? The First Lady:
Well, Kay, thanks so
much for your question. Thank you and your
colleagues for your work. I think that it’s a
wonderful question. Let me just say that, first
of all, you all are doing — already doing so much to
partner and support this reform and the White House. And I guess at first blush
it’s just keep doing what you’re doing. I mean, as you said, Americans
rely on nurses for advice and for guidance, and I think the
best thing we can do is make sure that people understand the
prevention services that are out there; continue to educate
people about the importance of disease prevention early on. All of us have members in
our family who are afraid of medical care. They don’t go to the doctors,
they don’t go to nurses. Everybody here is nodding
their heads in agreement. We all have experienced that,
and I think that sometimes a conversation with a physician
feels a bit more intimidating. But the folks in your profession
can have the conversations and to just remind people that we
can stop this train, many of these disease trains, from
heading down the track. And again, we’ve got to just
let people know about these new health insurance reforms; that
if people purchase plans now that they’ll receive the
recommended preventative care with no out-of-pocket costs. That’s really important
for people to understand. That’s one of the reasons why
reform has tried to make these provisions easier to access. And I would also just like to
add that it’s important to remind patients that next year
Medicare beneficiaries will get free preventative care
as well under the act. So that’s another benefit that’s
going to come along next year. So I think we’re asking you to
spread the word, to use your — not just your professional
channels, the channels that you have working with patients in a
medical setting, but also your personal channels as well. Nurses are regular folks who go
to church and go to the grocery store, they have kids at
school, they’re on boards. Use those avenues as a way
to continue to educate your communities about these reforms
and to continue to push preventative care, because no
longer will insurance be a barrier to this kind of care. The stories that Jillian has
told can be eliminated because of these reforms. And I know that all of you who
are working in labor rooms around the country know the
importance, for example, of seeing mothers who have
gotten good prenatal care. Now they can do that, it’s
easier, and we just need to — we need your help
in spreading the word. So thank you so much for
all that you’re doing, and just keep it up. And we’ll take
the next question. Ms. Ball:
Thank you. Dr. Wakefield:
And I think the next question
is coming from Marlene Heier. Marlene, I hope I’m pronouncing
your last name correctly. If you let us know where you’re
from, and ask your question. Ms. Heier:
Yes, thank you. First, I would like to say it’s
a privilege and an honor to be a participant in the forum. I am an orthopedic nurse from
Ketterine Medical Center in Dayton, Ohio; have been in the
orthopedic field for nine out of my 22 years in nursing. Actually our concern on the
orthopedic unit — I understand that it seems almost that the
Affordable Care Act pertains a lot to the younger populace
and preventive medicine. I understand that there will
be more free preventative care provided to the
Medicare populace. But our concern is will
patients’ reimbursement be decreased to a point where
patients such as ours will be either discouraged or
unable to continue to have elective joint repairs? A lot of them have reached a
point of immobility and extreme pain because of the necessity
for the joint repairs, and we’re not talking about fractures
and repairs due to trauma. The most — I’d say 80% of our patients are Medicare recipients, so our reimbursement comes mostly from the Medicare populace. And so the decrease in the
reimbursement, our hospital would impact our nursing staff
as well, and that directly impacts patient care. So I guess our concern is how is
this going to impact Medicare and the amount of reimbursement? Dr. Wakefield:
Thanks so much for that question, Marlene, and it was nice to hear your
referencing your practice in orthopedic nursing. I have practiced for a period
of time in orthopedic nursing, as well, so I have some
appreciation for what you and your colleagues face in terms of
delivering care both to younger patients but also to Medicare
beneficiaries that find their way to hospitals for
orthopedic intervention. And the question that you raise
is a really, really important one, and I’m happy to
answer to this question. It’s important because there’s
a lot of misinformation and confusion about what Medicare
beneficiaries are entitled to and how the Affordable Care Act
impacts the Medicare program. So I think I’d like to make
a few comments about it. First of all, for Medicare
beneficiaries and the care that they receive from you and in
other parts of the health care delivery system, guaranteed
Medicare benefits will not change, whether a senior citizen
gets those benefits through original Medicare or through
a Medicare Advantage plan. Guaranteed benefits
are protected and they will be protected. In addition to that, in addition
to ensuring that guaranteed Medicare benefits do not
change under the law, there are also new benefits. So senior citizens have
access to new services. Some of you have perhaps heard
about some of them that we’ve talking about most recently
that has to do with the Medicare Part D program. So, for example, if a senior
citizen on Medicare enters the Part D doughnut hole this year,
they will receive a one-time $250 rebate check. And as of this month, around
September 20th or so, we have about $1.2 million Medicare
enrollees that have already qualified for that rebate
and that have already been sent that check. We know how important
prescription drugs are to the health of
Medicare beneficiaries. That’s a very
important expansion of health care services. And on that front, I think it’s
probably also worth noting that looking forward, next year,
seniors on Medicare will get a 50% discount on brand-name drugs when they hit the doughnut hole. So in other words, beneficiaries
who enter the doughnut hole in 2011 will save on average
over about $500 on their brand-name prescription drugs. And as you continue to track the
impact of the Affordable Care Act going forward, we’ll see
even more efforts to close the doughnut hole until it’s
completely closed in 2020. And it’s probably worth just
reiterating the point that the First Lady made just a minute
ago, and that is that senior citizens will be receiving
free preventive care and a free annual wellness visit
beginning next year. So the Medicare program writ
large is strengthened and the benefits for individual Medicare
beneficiaries are expanded. This new law includes very
important tools to help strengthen access to
health care services for Medicare beneficiaries. I really do want to thank you
for that question because I think, personally, that senior
citizens have gotten a lot of bad information about the new
law and I hope that as nurses you’ll take the opportunity
to answer their questions and ensure that senior citizens have
information that they need and honestly that they deserve. So thanks a lot for letting
me set the record straight a little bit on that front. And I think that we have
time for one more question. I think Pennie Branden, you’re
next in line, if you’d like to ask your question and please do tell us where you’re from. Ms. Branden:
Hello, and thank you, Dr.
Wakefield and Mrs. Obama, and hello to all of my nursing
colleagues across the country. I am a certified nurse midwife
and an Assistant Professor of Nursing at Southern
Connecticut State University. And I just wanted to ask about
the fact that all nurses are aware of the nursing faculty
shortage, as Dr. Wakefield mentioned earlier. And in regard to that,
I have two questions. Firstly, what is the future goal
of the administration to reduce the shortage of nurses
and nurse educators? And secondly, is the
administration actively involving educators on the
ground to strategically address the faculty shortage? Dr. Wakefield:
Great questions, and I can
probably help to answer that. Pennie, thank you for them. First of all, you’ve heard a
fair amount of conversation about strengthening the
primary care workforce. That’s really critical, both to
have faculty that are prepared to educate that next generation
of primary care nurses, and you see those provisions in the
Health Resources and Services Administration strengthened
specifically, and I talked a bit about those earlier. For example, with the
availability of new funding, through the Prevention and
Public Health Fund that the Secretary — Secretary Sebelius
and I just announced earlier today — those resources that
will help prepare the health system to meet what we know is
going to be increased demand for primary care services as many
more individuals have access to primary care, in a lot of
cases for the very first time. But combined with those
investments that I talked about earlier, you see the Affordable
Care Act markedly expanding part of the — different parts of the
division of nursing programs that support the production
of nursing faculty. We just released last week
data from our every-four-year, quadrennial survey on
the nursing workforce. And we can see pending
shortages in nursing faculty. So they’re not necessarily
getting better. So it’s just in time that the
Affordable Care Act is expanding the major programs available
through the Health Resources and Services Administration that
support nursing faculty, that support nurses to choose
a career in teaching the next generation of nurses. So there are
expansions in programs. We’ve also made recent
investments that we’ve announced just about a month ago,
and we’ll be making more investments as we go forward. So yes, we’ve got a clear eye
on the importance of ensuring access for students,
access to nursing faculty. And we are expected and we
certainly are working closely with nursing faculty
across the country. We also, for those of you who
are on this call, we welcome your input about how we can do
an even better job of deploying these new resources. So we do our work in partnership
with folks across the nation. That’s the expectation
of this administration. And we invite and we welcome
your input as we now have new resources to strengthen our
primary care workforce and to strengthen our
investments in faculty. And — please. The First Lady:
Just one other thing, and I
could have mentioned this in my answer — this is Mrs.
Obama, Michelle Obama — but, you know, I would
just encourage you all, particularly in these tough
economic times, as we’re talking to young people and people, you
know, who are looking for career changes — and this is
something that I say to young people all the time
— the health profession is the growing sector. This is where the
jobs are going to be. And when I — I met a young girl
through Make A Wish Foundation just last week, I think it was,
who said she wanted to be a nurse, and I told her that
that was an outstanding choice because she’d probably
always work in this economy. So I would urge you all to
spread the word to young people and people who are looking for a
career change, people who may be out of work and need to think
about where the next sort of sector of jobs is going
to be: It is right here. And again, with preventive
service expansion, more nurses, more RNs, more certified nursing
assistants are going to be needed to fill this void,
which will be great. And again, there are resources
to get educated, to get your degree, to become a teacher. This is where — this is
the future of medicine in so many ways. So we need you to help just
spread that word to young people starting out, to people who are
making the change, because we’re going to need nurses big
time in the years to come. So just wanted to add that,
and I’ll turn it back over to Dr. Wakefield. Dr. Wakefield:
Thanks so much for those
observations, Mrs. Obama. And I want to thank nurses
from across the country for joining us today. That’s about all the time
that we have for questions. But I do want to underscore
that if there’s anything from this call that you need
some clarification about, or you want some additional
information about the Affordable Care Act, as I mentioned earlier, please do go to that website, healthcare.gov — “healthcare,” all one word — healthcare.gov. And in addition to thanking the
nurses who participated in the call all the across the nation,
I want to extend from — and on behalf of nurses, very,
very special thanks to you, Mrs. Obama, both for your
leadership in terms of the health of the nation and for
joining the thousands of nurses from across the country who
participated in this call today to discuss with us some of the
very important provisions of the Affordable Care Act. So thanks to you for
being here with us. The First Lady:
It’s an honor. Thank you, thank you, all.

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