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graduate RN is $45,000, a return on investment can be significantly dependent on a reduction in RN turnover . The actions of private insurance companies toward APRNs are having an effect on government-funded programs as well. Nurse-managed health centers have long provided care for populations served by Medicare, Medicaid, and children’s health insurance programs. However, federal and state governments are increasingly turning to the private sector to manage these programs (Hansen-Turton et al., 2006). The insurance companies’ continued policy of not The hottest valentine heart seamless all over print face mask  credentialing and/or recognizing NPs as PCPs—and the federal government’s refusal to mandate that they do so—creates a barrier for NMHCs as they seek to continue serving these populations (Hansen-Turton et al., 2006). Despite the shortage of PCPs that occurred after the Massachusetts legislature enacted health care reform in 2006, no private insurance companies listed NPs as PCPs in Massachusetts. As a matter of policy, one major New England carrier stated that it would not list NPs as PCPs unless required to do so by the legislature. This same carrier, however, listed NPs as PCPs in its service directories for the neighboring states of New Hampshire and Maine. Eventually, Massachusetts passed a second health care reform law in 2008 that amended the state’s insurance regulations to recognize NPs as PCPs in the private as well as the public market. Massachusetts was thereby able to expand the supply of its PCPs without changing its scope-of-practice laws . The policy differences among states may have to do with different scope-of-practice regulations or differences in the states’ insurance industries. There is some evidence that insurers are more likely to recognize NPs as PCPs in states where NPs have independent practice authority (Hansen-Turton et al., 2008). As noted in Chapter 2, many NPs and CNMs have cared for underserved

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