With nearly 50 million Americans with no medical-care insurance coverage, the need for accessible, affordable and quality health care in Pennsylvania and America has never been greater. It is in both the state and federal governments' interest to promote increased access to health care because people without a regular source of health care pose a costly, long-term burden on our nation.

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So it is not an understatement to say that Gov. Ed Rendell's announcement of an ambitious plan to bring health insurance to the more than one million Pennsylvanians who are left vulnerable and uncovered offers the most significant and meaningful change in this state's health-care system in memory. The governor's plans to expand health-care coverage and buck rising health-care expenses through a series of cost-containment measures demonstrates great fortitude, but his leadership will require support from critical stakeholders throughout the state.

One of the most promising areas of Gov. Rendell's cost-containment proposal is his plan to increase access to nurse practitioner care. This is a timely, much-needed strategy considering that more than 141,000 nurse practitioners around the country currently are helping to fill the growing gap in primary health and preventive care. The federal government and most states recognize nurse practitioners as highly qualified primary health-care providers. They provide high-quality care, many studies have shown, and can prescribe medications in 50 states. Allowing nurse practitioners to help expand access to care in both community and health-care settings will have far-reaching benefits, especially considering the larger context of health care in the United States.

From my perspective at the National Nursing Centers Consortium, the governor gets it. The lack of access and insurance is no longer just the burden of the poor; disparities have widened. With or without insurance, we are all affected by the staggering costs of health care through the widespread lack of access to basic care. Nurse practitioners already are providing integrated, holistic, high quality, comprehensive care to thousands of consumers across our great state through nurse-managed centers, in family physician offices, in hospitals and in other health-care venues.

Despite nurse practitioners' desire to expand access to care for all, they continue to hit arbitrary practice, reimbursement and regulatory barriers. This must change. On behalf of the National Nursing Centers Consortium, I urge the governor to support our call for insurance companies, medical providers and decision-makers to support nurse-managed care and nurse practitioners. This is a solution that will directly improve access to these important providers and address the problem of Pennsylvanians lacking access to quality and affordable care.

		Tine Hansen-Turton is the executive director of the National Nursing Centers Consortium and vice president of Philadelphia Health Management Corporation (tine@nncc.us).

As a long-time advocate for nurse-managed care and greater access to quality care for vulnerable populations, the nursing consortium has worked tirelessly with other organizations to help facilitate the type of change the governor will now champion. The opportunity for change is ripe, and we're fully behind the governor to make sure his plan gains support. The governor has said he felt "compelled to act," with the number of uninsured climbing as quickly as our unprecedented health-care costs.

Few working Pennsylvanians can afford to pay for their health care if they are seriously ill or injured, or for insurance even when they can obtain it. Employers pay about half of health-care costs, which are rising faster than inflation.

We know that more leadership is required -- from legislators, medical providers, health insurers and advocates to correct this disgrace. They must come together if we are to improve care in Pennsylvania and ultimately our nation. I hope that every Pennsylvanian affected by rising health-care costs will join me in demanding change, and that other governors across the nation will stand up and take notice.