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Presentation Policy Change:  Affordable Care Act (ACA)

Name of the Student Institutional Affiliation

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Officially known as the Federal Patient Protection and Affordable Care Act (P.L. 111-148). It was signed by President Obama in March 31, 2020, as amended by the Health Care and Education Reconciliation Act ( Buerhaus , 2020). Popularly known as ‘Federal Health Reform’ since the over 900 pages of the act includes major health reforms in US’s healthcare system. Overall,  Buerhaus  (2020) explains that the provisions in the ACA aim at: Expanding access to insurance Increasing consumer protections Promoting prevention and wellness Improving quality and system performance Expanding the US health workforce Curbing rising cost of healthcare.

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Mainly, the aim of the ACA is to make quality care more accessible to a more people in the United States. According to Gaffney and McCormick (2017), the Federal government (the architect of the ACA) designed this healthcare policy reform as a solution to curb the high costs of healthcare and at the same, increase the quality of healthcare in the US. In this regard, the ACA’s main target population is the vulnerable communities. Therefore,  Gaffney and McCormick (2017) explains that the ACA;   It removed all barriers to access of healthcare, especially the uninsured. It compelled all ACA-compliant health insurance plans to cover essential health benefits

What precipitated introduction of Affordable Care Act?

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Breastfeeding Emergency Services Ambulatory patient services Family planning Laboratory services Hospitalization Pregnancy ( pre and post maternity care) Mental health and Substance use disorder services Prescription medications Pediatric services Preventive and wellness services Chronic disease management Rehabilitative and  habilitative  services

ACA-compliant Health Insurance Plans cover the following Essential Health Benefits

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Typically, the ACA has enabled an unprecedented number of people to access health insurance. Therefore, the US healthcare system has experienced an influx of patients, a feat that has amplified the existing decades-old shortage of nurses. In fact, a study by  Degtyar  and Hsieh (2019) indicates that the increasing access to affordable healthcare in US will increase the demand to an all-time high of 139, 000 healthcare practitioners by 2033. Thus, ACA:  Tasks nurse practitioners with a more work load due to a high number of patients per shift. Spend more time with each patient, leading to a demand for nursing care services to many other patients.

Nurse practitioners are more important than ever

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Contrary to the predictions of many healthcare experts, the increased accessibility to health insurance has led to an increase in ER visits. According to  Degtyar  and Hsieh (2019), the US healthcare system had over 1.4 billion hospital visits from 2006 to 2016, with the ER experiencing an increase of 2.3 million visits every year.  Thus, the increased number of ER visits has led to long delays in the waiting rooms, and a high workload for nursing practitioners.

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According to  Cowell  et al. (2018), ACA recipients are being directed to local outpatient healthcare facilities to cut medical costs, a trend that has enhanced healthcare experience among the vulnerable, especially through religious, ethnic and gender diversity. Also,  Cowell  et al. (2018), explain that the utilization of outpatient healthcare facilities has reduced the number of hospital visits, and enabled specialized nurses to provide nursing services to patients with urgent and acute medical needs.

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Mainly, ACA has continually increased the number of insured vulnerable population leading to an unprecedented demand for healthcare practitioners. According to Ortiz et al. (2018), nurses are becoming essential care providers in communities that have acute shortage of family medicine physicians.  In this regard, many Registered Nurses (RNs) are enrolling for Nurse Practitioner Degrees to bridge the demand for family medicine physicians, a trend that promotes their professional and career growth, and promote the well-being of the vulnerable population in local communities.  Notably, Ortiz et al. (2018) argue that many patients prefer to visit a Nursing Practitioner since they focus on holistic care. The NPs, therefore, can educate and advocate for vulnerable but ACA qualified patients to take advantage of the ACA and promote positive health outcomes.

ACA has created Increased Opportunities for Nurses

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Typically, ACA offers nurse practitioners a chance to practice patient advocacy. In American Nurses Association (ANA) Code of Ethics, nurse practitioners are expected to promote, advocate for, and protect the rights, health, and safety of individual patients (ANA, 2020). Since ACA offers increased access to quality healthcare to the vulnerable population, nurses can advocate for children, mentally ill patients and patients who remain uninformed about their rights and healthcare benefits, especially the ACA health reforms (Cleveland,  Motter  & Smith, 2019). Notably, Cleveland et al. (2019) explain that patients usually trust their nurses for unpartisan support and opinions, an opportunity that nurses utilize to encourage the patients to seek information on the wide benefits of ACA, which promotes access to quality healthcare and improved positive health outcomes.

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Mainly, most of the ACA’s benefits to the vulnerable population result from the ability of these patients to access quality and affordable care. According to Thomas et al. (2019), the United States healthcare system has over 1,400 community health centers (CHCs) that provide primary care and other essential care services to an estimated 26 million people. The target population for CHCs is disproportionately low-income individuals, most of who are under-insured or publicly insured.  Since Bush administration, CHCs have continuously received increased funding which has promoted their growth. Also, the federal government’s Medicaid expansions under ACA have increased the enrollment of previously uninsured CHC patients ( Thomas et al., 2019) ). Still, ACA has made CHCs eligible for enhanced Medicaid fees compared to the standard Medicaid rates for higher levels of hospital facilities. ACA, therefore, has increased funding for community health centers, bringing essential health services closer to the vulnerable community.

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Low Literacy Levels Typically, most of the vulnerable population in the United States has lower literacy levels than the normal population.  According to  Makhlouf , (2020), this particular demographic provides a challenge for ACA’s efforts to increase health insurance coverage due to the following: Inability to read Medicaid application forms.  Failure to seek medication for fear of humiliation during hospital visits. Challenges in obtaining Equitable Care Patients from vulnerable populations receive reduced treatment options than whites.  Although disparities in insurance coverage may explain the health inequalities in the United States, they may not fully explain the disparities in access to quality care ( Rooddehghan ,  ParsaYekta  &  Nasrabadi , 2019)).  Rooddehghan  et al. (2019) explain that a significant number of patients and families from vulnerable populations may not challenge healthcare providers, especially regarding their patient experiences and satisfaction.

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Legislators should consult healthcare stakeholders, especially the nurses, on the challenges to equitable care among the vulnerable population. When nurses participate in influencing such healthcare legislations, they can provide practical solutions to promoting accessibility of healthcare.  Some of the possible changes to improve ACA’s applicability to Nursing practice would be: Increased funding of CHCs Incentives to motivate nurses increase their knowledge in cultural competence Conducting a nationwide campaign to educate the vulnerable population on the benefits for enrolling in Medicaid. A concerted effort among all stakeholders to helping individuals from vulnerable population in filling applications forms for Medicaid. (Thomas et al., 2019)

Appropriate Changes to Improve ACA’s Applicability to Nursing Today

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Nurses can help in enhancing data collection of the vulnerable population, especially regarding race, ethnicity, sex, native language and disability status. Nurses should increase their knowledge in cultural competence through enrolling for cultural competence capacity building workshops and seminars.  Besides, nurse leaders should inspire and guide nurses to becoming culturally competent nursing practitioners.  Also, nurses can help the vulnerable population to benefit from ACA by advocating for integration of lower level of illiteracy materials, especially application forms and materials that explain the benefits of Medicaid. Finally, the nurse leaders can ask the management of the hospital organizations to use the media, especially the TV, radio and digital media to reach low literacy populations in efforts to educate them on benefits that they can receive from Medicaid enrollment. ( Rooddehghan  et al., 2019; Thomas et al., 2019

Role of Nurses in Applying Proposed ACA’s Changes

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Since its enactment, ACA has successfully increased the access to quality care, especially among the vulnerable population.  Also, ACA has had a lot of impact to nursing practice due to : Increased demand of nursing staff High number of ER visits More Outpatient Treatment Centers Increased opportunities for nursing advocacy. Among the vulnerable population, ACA has: Led to expansion of CHS, which primarily serve the vulnerable population. Increased the number of Medicaid beneficiaries among the vulnerable population. Despite the many benefits of the ACA to nursing practice and vulnerable population, there is need for improvement of healthcare policies, especially to promote equitable care among the US population.

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Buerhaus , P. I. (2020). Demystifying National Healthcare Reform Proposals: Implications for Nurses.  Nursing Economic$ ,  38 (2). Cleveland, K.,  Motter , T., & Smith, Y. (2019). Affordable care: harnessing the power of nurses.  Online Journal of Issues in Nursing ,  24 (2). Cowell , A. J.,  Prakash , S., Jones, E.,  Barnosky , A., &  Wedehase , B. (2018). Behavioral health coverage in the individual market increased after ACA parity requirements. Health Affairs, 37(7), 1153-1159. Degtyar , A., & Hsieh, D. (2019). 290 before and after the Affordable Care Act: Overall trends in emergency department utilization.  Annals of Emergency Medicine ,  74 (4), S115.  https://doi.org/10.1016/j.annemergmed.2019.08.248 Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity.  The Lancet ,  389 (10077), 1442-1452. Makhlouf , M. D. (2020). Laboratories of Exclusion: Medicaid, Federalism & Immigrants.  NYUL Rev. ,  95 , 1680. Ortiz, J.,  Hofler , R., Bushy, A., Lin, Y. L.,  Khanijahani , A., &  Bitney , A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In  Healthcare  (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. Rooddehghan , Z.,  ParsaYekta , Z., &  Nasrabadi , A. N. (2019). Equity in nursing care: A grounded theory study.  Nursing ethics ,  26 (2), 598-610. Thomas, L., Parker, S., Song, H.,  Gunatillaka , N., Russell, G., & Harris, M. (2019). Health service brokerage to improve primary care access for populations experiencing vulnerability or disadvantage: a systematic review and realist synthesis.  BMC health services research ,  19 (1), 1-17.

Presentation
Policy Change: Affordable Care Act (ACA)


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 Buerhaus , P. I. (2020). Demystifying National Healthcare Reform Proposals: Implications for Nurses.  Nursing Economic$ ,  38 (2). Cleveland, K.,  Motter , T., & Smith, Y. (2019). Affordable care: harnessing the power of nurses.  Online Journal of Issues in Nursing ,  24 (2). Cowell , A. J.,  Prakash , S., Jones, E.,  Barnosky , A., &  Wedehase , B. (2018). Behavioral health coverage in the individual market increased after ACA parity requirements. Health Affairs, 37(7), 1153-1159. Degtyar , A., & Hsieh, D. (2019). 290 before and after the Affordable Care Act: Overall trends in emergency department utilization.  Annals of Emergency Medicine ,  74 (4), S115.  https://doi.org/10.1016/j.annemergmed.2019.08.248 Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity.  The Lancet ,  389 (10077), 1442-1452. Makhlouf , M. D. (2020). Laboratories of Exclusion: Medicaid, Federalism & Immigrants.  NYUL Rev. ,  95 , 1680. Ortiz, J.,  Hofler , R., Bushy, A., Lin, Y. L.,  Khanijahani , A., &  Bitney , A. (2018, June). Impact of nurse practitioner practice regulations on rural population health outcomes. In  Healthcare  (Vol. 6, No. 2, p. 65). Multidisciplinary Digital Publishing Institute. Rooddehghan , Z.,  ParsaYekta , Z., &  Nasrabadi , A. N. (2019). Equity in nursing care: A grounded theory study.  Nursing ethics ,  26 (2), 598-610. Thomas, L., Parker, S., Song, H.,  Gunatillaka , N., Russell, G., & Harris, M. (2019). Health service brokerage to improve primary care access for populations experiencing vulnerability or disadvantage: a systematic review and realist synthesis.  BMC health services research ,  19 (1), 1-17.

Presentation Policy Change: Affordable Care Act (ACA)

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