Question

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March of 2010. Identify the impact of this legislation on your nursing practice by choosing two key nursing provisions outlined in the topic material "Nursing and Health Reform." Discuss how these two provisions have impacted, or will impact, your current practice of nursing.

Answer 1

ANSWER:

The Patient Protection and Affordable Care Act , amended by the Health and Education Reconciliation Act, became law on March 23, 2010. Full implementation occured on January 1, 2014, when the individual and employer responsibility provisions take effect, state health insurance Exchanges begin to operate, the Medicaid expansions take effect, and the individual and small-employer group subsidies begin to flow. Along the way are a series of crucial intermediate steps.

The Affordable Care Act is a watershed in U.S. public health policy. Through a series of extensions of, and revisions to, the multiple laws that together comprise the federal legal framework for the U.S. health-care system, the Act establishes the basic legal protections that until now have been absent: a near-universal guarantee of access to affordable health insurance coverage, from birth through retirement. When fully implemented, the Act will cut the number of uninsured Americans by more than half. The law will result in health insurance coverage for about 94% of the American population, reducing the uninsured by 31 million people, and increasing Medicaid enrollment by 15 million beneficiaries. Approximately 24 million people are expected to remain without coverage.

Health insurance coverage reforms

The Affordable Care Act represents an effort to reframe the financial relationship between Americans and the health-care system to stem the health insurance crisis that has enveloped individuals, families, communities, the health-care system, and the national economy as a whole. It is also this basic reinvention of Americans' relationship to health insurance that lies at the epicenter of the legal battle over the law's constitutionality. This is because the question of whether the law falls within Congress' constitutional powers rests on whether the courts come to view the legislation as regulating our economic approach to the purchase of health care (because we all use care, the issue becomes how to pay for it), or instead (as the law's opponents argue) as a law that forces individuals, as passive non-economic actors, to buy a product they do not want.

IMPACT ON NURSING:

The Affordable Care Act (ACA), also known as Obamacare, is in full effect and its impact on the nursing industry has come in. Some reports are good, such as job growth; whereas others stress that nurses have bigger patient loads resulting in diminished care for patients.

Let’s take a closer look at how the largest group of health care professionals is faring.

What Has Changed?

More—and Sicker—Patients Have Entered the System
Since the Affordable Care Act began, the health care system experienced a rise in the number of new patients, as expected. What wasn’t expected is that some of these patients have chronic illnesses that have been neglected and thus require more care.

According to Amy Dertz, a registered nurse in Oakland, Calif., “Some haven’t had care in a long time (or ever). Some may have pre-existing conditions that enabled insurance companies to refuse them coverage. As they enter my care, their needs may be more complicated.”

The extra time and care it takes to improve the health of these new patients have placed a strain on nurses and hospitals.

Emergency Room Visits Have Increased, Not Decreased
In the past, the uninsured may have been reluctant to go to emergency rooms for treatment. But now that patients have insurance, some facilities are experiencing increased ER visits. As a result, wait times and patient loads have also increased for nurses and doctors.

Health Care Has Shifted Away from Hospitals
To save money, the Affordable Care Act wants to keep patients out of hospitals in favor of outpatient care provided within communities. Although this creates more outpatient workplaces for nurses, the opposite is true for inpatient nurses.

According to Dertz, “If the ACA is successful in contributing to keeping patients out of the hospital, inpatient care will be reserved for patients with acute, severe illnesses and the number of hospital nurses will drop dramatically.” Her hospital has already proposed nursing cuts, which would result in nurses working harder with less resources.

What’s the Job Outlook for Nurses?

Very good. According to the Bureau of Labor Statistics, employment for registered nurses is estimated to grow by 15 percent through 2026—much faster than average for all occupations. The Arizona Capitol Times reported that more than 10,000 jobs have been added to Arizona’s health care industry in 2014.

The growth is twofold:

• As baby boomers age, there’s an increasing need for health care, particularly from geriatric nurses.
• Because health care is moving away from hospitals to outpatient care in the community, nurses have more workplaces to choose from. In community health centers alone, more than 4,500 nursing positions have been added nationwide since the ACA began. Nurses specializing in home care, care management, case management and community health care are in high demand.

For nurses looking to advance their training in these and other areas, the Affordable Care Act helps cover training costs.

THANK YOU