ACA and the Affordable Care Act's Impact on Nursing Practice

Introduction

One of the milestone pieces of legislation that President Obama signed into law in 2010 was the Affordable Care Act (P.L. 111-148) and the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). This policy, commonly referred to as the comprehensive healthcare reform, has been widely supported by several nursing organizations, including the American Nurses Association and the American Academy of Nursing. The bid to reform the health sector has been a central agenda since the mid-20th century, culminating in several legislative changes geared toward building a better healthcare system. The most recent significant change has placed practicing nurses at the forefront, and the daily contribution and impact of nurses in ensuring the policy's success is considerable (Institute of Medicine, 2010).

The healthcare reform policy passed in 2010 is mainly aimed at providing all Americans with access to cost-effective, high-quality care, as well as helping shift the American health system toward preventive care and primary healthcare. These priorities have been central to the nursing profession since the 1965 inception of the Medicaid program, when such ideas were far from mainstream in the post-World War II period. A similar trend of supporting health reform was seen among nurses in the 1990s, when the Clinton administration proposed federal health reform — though it was ultimately defeated — and in the years leading up to the current policy signed in 2010. This consistent support for policies that advance healthcare reform is a clear indication that the nursing profession as a whole is both shaped by these changes and plays a significant role in implementing them.

Primary Care Expansion and the Role of Nurses

With the new policy in place, greater emphasis will be placed on medical homes and health homes to ensure the provision of primary healthcare. This means that more primary care providers will be required to fulfill the policy's goals. APRN-managed practices will be relied upon to deliver the needed primary care to a broad range of patients, including chronically ill patients who are most often found within underserved communities. Registered nurses and APRNs are well-positioned to provide these services, and the policy will therefore significantly shape their operations in this sector.

Medicaid Health Homes and Chronic Disease Management

Under Section 2703 of the ACA, states are given the option to establish Medicaid health homes. To qualify for these homes, an individual must have at least two chronic conditions, have one chronic condition while being at risk of developing a second, or have a serious and persistent mental health condition. In these health homes, the policy calls for high-quality, comprehensive care management services. This requires a team of healthcare professionals capable of managing complex chronic diseases — among them nurses and nurse care coordinators. This provision is a direct indication that the policy's implementation will significantly affect nursing practice and will increase demand for nurses as more health homes are established to serve chronically ill populations.

Conclusion and Implementation Considerations

From the various provisions of the policy discussed above, it is evident that nursing practitioners are central to ensuring that the policy is well established and successful. At the same time, the policy offers reciprocal benefits to nurses by helping professionalize their practice over the coming years of implementation.

For the policy to be comprehensively and successfully implemented within the nursing profession, several issues must be addressed. There is a need to ensure a seamless transition from current nursing practice to one that aligns with the new policy provisions. This can be accomplished through seminars and training programs that help nurses understand the holistic vision of the policy. There is also a need to ensure that patients and the general public understand the provisions of this comprehensive healthcare reform, which will make it easier for nursing practitioners to implement the policies effectively. While the policy advocates for increasing the number of enrolled nurses and investing in nursing research and prevention, it is equally important that trained nurses have adequate equipment and facility resources to carry out necessary procedures — since knowledge of a procedure offers little benefit if it cannot be applied in practice.

Overall, the Affordable Care Act of 2010 represents a transformative shift in American healthcare that places nursing at the center of delivery, quality, and outcomes — making its provisions deeply consequential for the profession's future.

References

American Nursing College. (2010). Implementing health care reform: Issues for nursing. Retrieved January 30, 2015, from http://www.aannet.org/assets/docs/implementinghealthcarereform.pdf

Barclay, L. (2010). Healthcare reform legislation effects on nursing: An expert interview with Rebecca M. Patton, MSN, RN, CNOR. Retrieved January 30, 2015, from http://www.medscape.com/viewarticle/720857

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Retrieved January 30, 2015, from http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx