How the ACA Will Affect Nursing

Affordable Care Act & Nursing There are a number of different provisions of the Affordable Care Act that were designed to improve the health care system -- well, all of the provisions were designed to do that. The most immediate improvements will be the provisions that low the cost of drugs (such as the Medicaid rebate for brand name drugs) and the generics approval change. The biggest change that affects the quality of care is probably the provision regarding readmissions.

The core of this provision is the idea that high rates of readmissions indicates a relatively poor standard of care is being given; so penalties for high readmission rates will encourage hospitals to have a higher standard of care in the first place, doing more for underlying conditions instead of just treating symptoms. Another beneficial provision is that plans now need to cover several types of preventative screening. There are a number of provisions that address the issue of disparity of access to health care.

The provisions surrounding insurance are all included, for example the fact that insurance companies are not allowed to deny coverage based on pre-existing conditions, and that there are a number of other coverage expansions. The insurance exchanges are another means by which the disparity of access is reduced because people will have set plan types that they can purchase, but then these can easily be compared. That everybody has to buy into one of these plans is technically going to increase access.

There are some provisions that will be quite challenging. The biggest challenges comes from the net effect of bringing more people into the insurance system. While it is relatively easy to have people sign up on an insurance exchange, what is more difficult is that this increase in demand will be tough to manage. Providers may have to reconsider how they do business, and certainly this will affect supply and demand for medical professionals.

There may be shortages of physicians, which would put more pressure on RNs, but many nursing specialties are also facing chronic shortages as well. Until the supply of professionals can be increased -- a process that can take years -- there may be significant system-wide personnel shortages that could compromise care quality. All of the various tax code changes may be tough to implement, such as forcing people to pay a penalty if they do not buy insurance -- enforcement of measures like that will be challenging.

If there are issues with things like collecting the fees and penalties, this could result in the system being underfunded. But there may also be challenges that arise because those penalties and fees will compel changes to coverage, for example with employers who might see the economics of providing health care for their employees change. The ACA represents a restructuring of the health care system, so there are definitely going to be some ethical trade-offs.

The penalty for not having insurance -- the mandate -- is one of the ethical issues that arises. But there are other such issues as well, including the provisions to curb re-admissions, because those could simply result in hospitals turning away chronic patients. For states that have decided not to provide adequate financing for Medicaid expansion, there are going to be some problems, though any ethical dilemmas will be more related to the blind opposition to the ACA than the law itself.

The reduction in payments to disproportionate share hospitals -- those that service a high number of indigent patients -- are being reduced, which also raises ethical issues because those hospitals may.