For Bangor nurse practitioner Miki Macdonald, a short-notice invitation to the White House was too good to pass up. The call came on Sunday, and on Tuesday, Macdonald was seated in first lady Michelle Obama’s office, taking part in a national dial-in conference on health care reform.

“I was booked to see patients all day, but this was an incredible opportunity,” Macdonald said during a phone interview later Tuesday afternoon. She hoped her patients at St. Joseph Internal Medicine would understand.

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Macdonald, a 1998 graduate of the nurse practitioner master’s degree program at the University of Maine, said the White House was looking for a handful of nurses and nurse practitioners who work directly with patients and not in administrative or policy-setting roles. Macdonald was one of only five nursing professionals — two nurse practitioners and two registered nurses — selected to visit the White House on Tuesday.

Before meeting the first lady, they were filmed in an informal discussion of the Affordable Care Act, the Obama administration’s hard-won attempt to overhaul the U.S. health care system.

“They filmed us having a conversation about how these changes will affect patient care,” Macdonald said. That video may be featured on the White House web site, she said.

Then, the group was ushered in to meet the first lady.

“We were all nervous about meeting Michelle Obama,” Macdonald admitted, “but they got all the nervousness squeezed out of us with that filming.” After greeting Mrs. Obama, they joined her and Mary Wakefield, director of the Health Resources and Services Administration as they hosted a national call-in conference with more than 5,000 nurses and nurse practitioners from around the country.

“The idea of having us at the table was to get nurses more involved in promoting the Affordable Care Act, to help explain it in our communities and to our patients,” Macdonald said.

Macdonald said the health care reform plan is generally well-supported by nurses and nurse practitioners, who perceive that it will improve the quality and affordability of health care for all Americans while providing access to basic care for millions who currently lack insurance.

“It’s about time. We need this,” she said. “When we can’t get our patients the help they need, we feel the stress ourselves. So in many ways, this will help us do our jobs with less stress.”

But some patients, Macdonald said, are uneasy about the reforms. Some with comprehensive insurance coverage, she said, “express a sense of being threatened, like something will be taken away from them, which we don’t think is the case.”

Macdonald said the atmosphere of the teleconference was relaxed and informal, with Wakefield and Obama leading the discussion. The conversation focused on provisions of the Affordable Care Act that already have taken effect, including the ability to keep young adults covered on their parents’ plans until their 26th birthday, a $250 Medicare rebate for medications, and several consumer protections against insurance company practices such as refusing to cover children with pre-existing medical conditions.

The teleconference lasted about 45 minutes, Macdonald estimated. Afterward, the five visitors had a group photo taken with Obama before they left the White House.

Macdonald said her name probably came up as a candidate for the event visit because of her role as the state representative to the American Academy of Nurse Practitioners. The group has been active in promoting more flexibility and autonomy for nurse practitioners in response to the growing demand for primary care providers, she said. That demand is expected to explode in 2014 when the Affordable Care Act will extend health care coverage to all Americans.

Macdonald’s visit to the White House on Tuesday was her first.

“I’m glad I saved it for this occasion,” she said.

She expected to catch an early flight back to Bangor today.

The American Academy of Nurse Practitioners paid Macdonald’s travel expenses to Washington and back.


Meg Haskell

Meg Haskell is a curious second-career journalist with two grown sons, a background in health care and a penchant for new experiences. She lives in Stockton Springs. Email her at