While listening to the president’s address to Congress on September 9, I found myself remembering discussions I’d had with Senator Kennedy and the hope we shared that one day the system would be “fixed.” I was a staunch supporter of the senator. I campaigned for him and never missed a chance to see him when I was in Washington, DC. When he was in Boston, I frequently took the opportunity to update him on the progress (or lack thereof) of health care bills that directly affected access to the services of NPs and PAs.
I always enjoyed the “day on the Hill” when fellow NPs would join me in a visit to his DC office. Senator Kennedy was quite the host. He took the time (as though he had nothing else on his calendar) to sit and talk with us, asking visitors to tell him the most challenging part of being a health care provider. He always seemed somewhat in awe of what we did. In one session, he even took notes about an NP who was struggling to keep open a clinic where homeless people could receive necessary health care.
He was always interested in improving access for those unable to afford the care that he and his family could. In the late 1960s, after visiting a health center in a Massachusetts housing project and being impressed with the clinic’s ability to provide treatment to low-income populations, the senator successfully secured funding for a nationwide program of community health centers. He introduced an amendment to the Economic Opportunity Act, garnering $51 million to start 30 additional centers. There is now a network of more than 1,200 sites across the United States—a direct result of Kennedy’s hands-on approach to health care access for the most vulnerable.
In 1988 (or thereabouts), when Title VIII of the Public Health Service Act (the Nurse Education Act) was under review, word got out that the new provisions included significant penalties for defaulting on student loans—but only those held by nurses and NPs. Many students in the health professions had been awarded loans with the understanding that they would work in underserved areas once they graduated. For the most part, NPs were in competition with physicians for those placements, and often the physicians were selected to fill the positions. Despite the growing (even then) number of underinsured or uninsured people, communities needing providers were not always considered underserved.
With the help of NPs across the US, we bombarded the senator’s office with phone calls and faxes. Senator Kennedy soon learned (not that he didn’t know before) that NPs were a force to be reckoned with and that we were not about to take the proposed changes sitting down. With the threat of a “march on Washington,” Senator Kennedy reached out to determine why his normally supportive constituents were so upset.
I had the distinct privilege of giving him that information (perhaps not very politely) and suggested some alternatives to increase the number of eligible sites where NPs could work for loan repayment. During our conversation, Senator Kennedy and I discussed the logic of having health centers be considered “loan repayment sites.” I thought it would be a wonderful complement to the work he had already done to establish health centers and would enable the centers to benefit from a pool of qualified, affordable providers ready and willing to make a positive impact on the health of the people.
In 1995, other NPs from Massachusetts and I visited Kennedy in Washington. In extending my sympathies for the recent loss of his mother, I told him that I too had lost my mother that January. As though we were old friends, he welcomed me to sit down and we talked (albeit briefly) about our mothers and how, on a daily basis, we sorely missed them. As we both stood to walk outside for a group photograph, he put his arm around my shoulder. We didn’t need to say anything; we understood each other’s loss.
Years later, I called his office to make an appointment, telling his staff that it was important that the senator grant us a few minutes of his time. Just a quick meet and greet, I said, no hot issues. When I arrived with my colleagues, we held up our end of the bargain. As we were leaving, the senator commented that I didn’t have an agenda, asking why. I corrected him by admitting that I did have an agenda: One of my colleagues had promised me a meeting with Senator John Glenn if I could get him a meeting with Senator Kennedy. I can still hear his laugh!
In his Congressional address, President Obama read from one of Senator Kennedy’s last letters: “[H]ealth care … is above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”1 Just as Ted Kennedy believed, I too believe that this is the year we will finally realize health care reform. And when the bill is passed, we will all hear his laugh and his hurrah for business no longer “unfinished.”
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1. Transcript of President Obama’s address: “I Still Believe We Can Act” (September 9, 2009). www.kaiserhealthnews.org/Stories/2009/September/09/transcript-Obama-speech.aspx.