Bill Overview
Title: I CAN Act
Description: This bill allows other health care providers besides physicians (e.g., nurses) to provide certain services under Medicare and Medicaid. Among other changes, the bill (1) allows a nurse practitioner or physician assistant to fulfill documentation requirements for Medicare coverage of special shoes for diabetic individuals; (2) expedites the ability of physician assistants, nurse practitioners, and clinical nurse specialists to supervise Medicare cardiac, intensive cardiac, and pulmonary rehabilitation programs; and (3) allows nurse practitioners to certify the need for inpatient hospital services under Medicare and Medicaid.
Sponsors: Sen. Merkley, Jeff [D-OR]
Target Audience
Population: Medicare and Medicaid beneficiaries
Estimated Size: 15000000
- The bill affects providers like nurse practitioners, physician assistants, and clinical nurse specialists who will have expanded roles.
- Patients who are part of Medicare and Medicaid will be impacted as they may receive services from a wider array of healthcare providers.
- The changes could affect diabetic individuals who need special shoes, patients needing cardiac, intensive cardiac, and pulmonary rehabilitation programs, and those requiring inpatient hospital services.
- The bill affects health services in the U.S., specifically those provided under Medicare and Medicaid.
Reasoning
- I targeted a diverse demographic to capture the policy's varied effects since Medicare's beneficiaries are primarily older adults, while Medicaid caters to lower-income individuals, including families, pregnant women, and people with disabilities. This distribution captures those who are more likely to be immediately impacted by increased access to services.
- Since Medicare and Medicaid have different beneficiary demographics, I sought perspectives from both high-impact cases (like individuals with chronic illnesses requiring ongoing management) and low or no impact cases (such as healthy individuals with minimal current healthcare engagement).
- The majority of people impacted will likely be those already seeing nurse practitioners or physician assistants, so I included those familiar with these healthcare relationships.
- Expansion of any healthcare provider's role may face resistance from traditional hierarchies in medical services, so an interview with a traditional healthcare provider who may oppose the act seemed relevant.
Simulated Interviews
Retired school teacher (Austin, TX)
Age: 66 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 8/20
Statement of Opinion:
- I think it's great that my nurse practitioner can do more for me without needing a doctor to sign off on everything. It makes my care faster.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Retired factory worker (Chicago, IL)
Age: 72 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- If having more nurses help speeds up my appointments, I'm all for it! Access to my pulmonary rehab could improve.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Freelance graphic designer (Raleigh, NC)
Age: 34 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- I mainly see nurse practitioners at the clinic, so it's comforting to know they'll be able to handle more things directly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 5 |
Retired lawyer (Miami, FL)
Age: 80 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Knowing my nurse can certify certain needs makes me feel less worried about future hospital visits. It's a relief.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 6 | 4 |
Nurse practitioner (New York, NY)
Age: 55 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- I welcome the change; it acknowledges our abilities and allows us to directly impact patient care, saving time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 6 |
| Year 20 | 9 | 5 |
Physician (Los Angeles, CA)
Age: 45 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- I'm concerned there could be less oversight and a potential devaluation of my role. It needs careful implementation.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 8 |
| Year 2 | 7 | 8 |
| Year 3 | 7 | 8 |
| Year 5 | 7 | 8 |
| Year 10 | 7 | 8 |
| Year 20 | 7 | 8 |
Community health worker (Detroit, MI)
Age: 30 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- This should improve access for many of my clients, which is a positive step forward in healthcare equity.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 9 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 8 | 6 |
Retired librarian (Boston, MA)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- I think it's fantastic! These healthcare professionals are more than capable, and this could streamline processes significantly.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 5 |
IT specialist (Phoenix, AZ)
Age: 39 | Gender: male
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 5/20
Statement of Opinion:
- I don't think this affects me at all currently. Perhaps in the future, as my needs change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired nurse (Seattle, WA)
Age: 83 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 7/20
Statement of Opinion:
- Anything that helps me get through diabetes management more efficiently is good. It's about using resources wisely.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
Cost Estimates
Year 1: $500000000 (Low: $400000000, High: $600000000)
Year 2: $510000000 (Low: $410000000, High: $610000000)
Year 3: $520000000 (Low: $420000000, High: $620000000)
Year 5: $540000000 (Low: $440000000, High: $640000000)
Year 10: $570000000 (Low: $470000000, High: $670000000)
Year 100: $1000000000 (Low: $800000000, High: $1200000000)
Key Considerations
- The scope of services that nurse practitioners and physician assistants can perform is being expanded, potentially reducing waiting times for patients.
- There is a potential for increased administrative efficiency and reduced costs associated with documentation requirements.
- Initial setup costs will be required for training and changes in administrative procedures.