Health care reform is a high priority on the federal policy agenda. The authors present insights from their experiences as Robert Wood Johnson Foundation Health Policy Fellows working in Speaker Nancy Pelosi's office and on the House Committee on Ways and Means. Nursing has many opportunities at this juncture to engage in policy discussions and advance solutions for issues related to increasing quality and access while dampening the escalating cost of care. Strategies where nursing's voice can inform reform conversations include chronic disease management, prevention and health promotion, community-based care, nurse-managed care, interdisciplinary education, safety and quality, use of health information technology, and testing the comparative effectiveness of interventions and delivery systems.