Healthcare Reform in Nursing

Nursing: Healthcare Reform

Changes in the healthcare system cause political and regulatory implications since the policies devised by the government to have to be followed by the healthcare professionals creating a direct impact on the quality of care and patient outcomes. For defining and measuring value in healthcare, system-wide improvements are to be made by the political policy changing so that all stakeholders could capitalize on the betterment opportunities. This paper discusses the Affordable Care Act (ACA), the changes introduced by it, and reviewing how American Nurses Association (ANA) is currently involved in the healthcare reform.

The Patient Protection and Affordable Care Act (ACA) was enacted on 23 March 2010, with its first part being implemented. Additional amendments were made on 30 March 2010 to make it fairer and easier to understand for the public for having health insurance coverage more affordable. The rights and protections were discerned so that the common public could unequivocally comprehend cost-sharing and premium tax credit. It further covers people with low incomes so that inexpensive options could be granted for a maximum number of citizens for the improvement of health in the entire country.

The changes and development of ACA are explained below:

After the first part was launched on 23 March 2010, a grandfather clause had to stay the same for the person who had taken insurance till that date. After this date, individuals who bought the plans had to buy new coverage insurances to meet the new Affordable Care Act standards. According to these principles, small businesses were eligible for the plan and the allocation of five billion dollars for those who could not even qualify for the plan. A reimbursement plan was initiated as temporary reinsurance for covering the costs of retirees’ health insurance. On 1 July 2010, those who were not qualified for the plan initially were also included in the plan later. A government website was launched to help the people gain information and search for suitable plans.

Moreover, the insured people were not allowed to get insurance plans for their children till 2010. In the year 2011, the patient was provided to have his choice of doctor. The coverage from ACA limited the lifetime coverage. In light of this, annual limits and maximum payouts were constrained. Claims for fraud and misrepresentation by the customer were to be checked under ACA regulations. In the year 2014, the monthly insurance plans were defined by the income people earned. The poverty levels and socio-economic status were considered for offering the best acceptable prices of the plans. Adults aging from 19 to 64 years were eligible for getting the insurance. ACA required people to buy insurance beforehand rather than waiting to get sick and then buying the plan. From the year 2011 till 2014, the events that took place after the changes include a contraceptive mandate for women, uphold of major provisions of the Act by the US Supreme court, capping on annual spending after the re-election of President Obama, the ongoing technical difficulties and going offline after re-opening was done on 2 December 2013, an extension of the grace period of two-year for the grandfather clause, and a major increment in the number of people enrolling for the health insurance plans.

The American Nurse Association (ANA) involvement has been vigorous in the healthcare reform as it wants to improve care for all and that too with equity. The nursing values have been constantly instilled in the healthcare profession by ANA for future commitment. Since the healthcare costs have been soaring high at an increasing rate, the restructuring of the healthcare delivery system throughout the country remains a dilemma. For this purpose, ACA has indicated some implications for the nurses that should be followed based on the evidence-based guidelines for creating nursing progress and enhanced patient outcomes. The specific provision of ACA helps the ANA influence those regulations into the healthcare framework. Nurse practitioners utilize new programs, nursing education, training, and healthcare innovations for workforce professional development.

As ACA has determined three primary areas of healthcare reform encompassing decreased costs for healthcare services, raised standards of healthcare across the United States, and the resulting increased access to the citizens, the outburst of nurse leadership positions has been observed in the insurance departments, health, and non-health-related organizations, community programs along with certified roles in the government. The nurse leaders could be involved in the change by facilitating inter-professional and intra-professional communication for megamergers of healthcare agencies. ACA goals, reducing healthcare costs, should be applied in real clinical practice. Competitive pricing and higher service quality would be envisioned once the nurse leaders realize the power of consolidation and autonomy of the roles for cost reduction. The second goal of ACA for healthcare reform, the superior quality of care, could be instigated by the nurse leader by detecting the high-risk populations and targeting specialized interventions for cost efficiency and higher medical care quality. The nursing leaders could manage the resource allocation, referrals, and consultations via direct care, collaboration, and seamless communication between the subdivisions and organizations. The third goal of ACA, easy access to healthcare for all citizens, could be deployed by these leaders through care coordination and playing a part in informatics. The interactions in multidisciplinary teams should be led by the nurse leaders so that physicians, social workers, administrators, and pharmacists, etc., could come together for a unified goal, which is handling the paradigm shift in healthcare in contemporary times. The respective designations at which they work have been powerful enough to influence the policy-making for improving access to the vulnerable and underserved populations of the country.