Prompt: Why is it important for nurses to be aware and involved in health care policy and economics? 

Response and Reflection:

In my first policy discussion I responded to this question so : Nurses are supposed to be patient advocates and for this reason it is important for nurses to keep on top of new health care propositions as they are presented. If a healthcare bill or policy is presented, we need to be vocal if we feel its passing would compromise patient care. Also, as nurses we must be cost effective in our care , and this is where attention to economics plays a role. As the text points out there are four stages to becoming politically competent in nursing policies, so while one should not expect to become an expert overnight, one should actively work through the stages to build competency ( Mason, Isaacs, & Colby, 2011).

I still agree with the above sentiments, but I feel that my appreciation and understanding of the importance of policies and economics in the healthcare setting has grown. Through this course I have been enlightened many times. As I proposed before, it is our duty to be vocal. This course provided that opportunity via the advocacy letter assignment and I hope my classmates intend to submit their letters to their intended parties. This course also provided insight to new policies and procedures that are affecting today’s nursing, such as the PPACA. It was insightful to see how this Act has both positively and negatively impacted our healthcare system. From this course I have learned that good policies and economics evolve and adapt over time to provide the best quality care and that whether we wish to admit it or not it is something we as nurses need to pay attention to.

Reference:

Mason, D. J., Isaacs, S. L., & Colby, D. C. (Eds.).  (2011).  The nursing profession: Development, challenges, and opportunities.  San Francisco, CA: Josey-Bass.

Policy Focus Paper:

Patient Protection and Affordable Care Act (PPACA) :

Exploring the Multifocal Impact of Mandatory Health Insurance

Jasmin Smith, RN

College of Central Florida

Patient Protection and Affordable Care Act (PPACA) : Exploring the Multifocal Impact of Mandatory Health Insurance

          The Patient Protection and Affordable Care Act (PPACA), is a rather recent reform in healthcare that was presented in 2010 by Congress and then signed into law by President Barack Obama; and, after a two year overview it was voted to be upheld as a health care law by the Supreme Court on June 28, 2012 (U.S. Department of Health & Human Services, 2015). Due to President Obama’s key role in implementing this healthcare reform, the PPACA is sometimes referred to as “Obamacare” (Obamacare Facts, n.d.). The proposed goals of the PPACA were to provide more Americans the opportunity to afford healthcare, to curb excess healthcare spending, to stop discrimination, and at the same time confront our nation’s debt (Obamacare Facts, n.d.). Understandably, such a reform has met much debate in a variety of areas and the purpose of this paper is to explore how the PPACA has impacted healthcare as a whole, focusing on: nursing, economics, and both the insured and uninsured populations.

           Since nursing is sometimes referred to as the heart of healthcare, one can only imagine that this profession has been directly affected by the PPACA. Nursing is very centered around providing nondiscriminatory, holistic care to patients so one would imagine, based upon its goals, this profession is embracing the new reform; however, the healthcare act has not been welcomed by all with open arms. Some benefits of the PPACA in the realm of nursing is that it recognizes the need for nurses and has allotted different grants, such as the Nurse Education, Practice, and Retention program, in order to help nurses to pay off student loans. Most of these programs require the nurse, nurse midwife, ARNP, etc., to commit to working in an underserved area for an allotted amount of time in order to receive funds for loan repayment (Wakefield, 2010). Since the PPACA is making an effort to reduce discrimination, people with pre-existing conditions now have the opportunity to obtain health insurance at an affordable cost. While this is an amazing opportunity for patients, nurses could see an influx of higher acuity patients due to previously untreated chronic healthcare concerns such as diabetes, HIV/AIDS, cancer, etcetera (Clavreul, 2010). Another frustration is that the PPACA has created a shift in patients seeking care outside of the hospital. While an upside for community nurses, the downside is that with less patients seeking hospital care hospitals have to cut down on nurses, resulting in higher patient to nurse ratios. And while overall hospitals have seen a decline in patients warranting admittance, the ER has seen a surge in patients, who now having access to healthcare are seeking care. The increase in patients presenting via the ER has extended wait times and put more stress on ER nurses due to increased patient loads (All Nursing Schools, 2016). So as one can see, the PPACA has created opportunities as well as dilemmas for the nursing profession.

            Like nursing, the uninsured population has also voiced conflicting opinions regarding the PPACA. A plus side for this population is that those who were previously denied insurance, due to preexisting medical conditions, can no longer be discriminated against and at the same time the coverage is to be more “affordable” than previously. According to Obamacare Facts the PPACA “helps over 32 million Americans afford health care who could not get it before – and makes coverage more affordable for many more” (n.d.). “Obamacare” is structured as a four tier coverage plan where individuals can purchase bronze, silver, gold, or platinum packages which correlates with a 60, 70, 80, and 90% coverage (Rosenthal, 2016). Unfortunately there does not seem to be a “perfect package” as either the premium is too high or the provider list is too narrow. According to Rosenthal, “a study in the policy journal Health Affairs found that out-of-pocket prescription costs were twice as high in a typical silver plan -- the most popular choice -- as they were in the average employer offering (2016, p. News: p1(L) ). Furthermore, “in research conducted with the Robert Wood Johnson Foundation, Dr. Polsky found that 41 percent of silver plans offered a ‘narrow or very narrow’ selection of doctors, meaning at best 25 percent of physicians in an area were included” (Rosenthal, 2016, p. News: p1(L) ). Another con associated with the PPACA is that it mandates individuals to have health insurance, and while it claims affordability some uninsured individuals remain uninsured due to financial concerns.

            This brings us to those who were already insured or who are now insured via the PPACA. Insured individuals have typically seen a rise in premiums since the enactment of the PPACA, which can be correlated to companies requiring to provide more packages covering a wider variety of services (Johnston, 2015). This rise in premiums seems to contradict the purpose of the PPACA. Unfortunately, in 2014, the PPACA instituted a fine via the IRS and those that are deemed that they can afford healthcare insurance are fined either 2.5% of their annual income or $695.00 per adult and 347.50 per child, whichever is greater, if they do not choose to comply with coverage (HealthCare.gov, 2016). It is one thing to offer health insurance for those unable to have it in the past, but is it ethical to mandate this service?

There is no doubt that economically the PPACA has made a stir in healthcare. On a national level Obamacare is projected to reduce “the deficit by more than $100 billion over the next ten years, and more than $1 trillion over the second decade, by cutting government overspending and reining in waste, fraud and abuse” (Obamacare Facts, n.d.). However on a local level, physicians have not seen a high rise in economic gain.

Despite 10 million Americans gaining health insurance coverage since the start of 2014, the proportion of new patient visits to PCPs grew from 22.6% in 2013 to 22.9% in 2014--a relative increase of 1.3%. Pediatricians and OB-GYNs saw similarly small increases in their numbers of new patient visits

(Bendix, 2016, p. 61).

Also, a lot of hospitals have switched, or have had to consider the fact of switching to “for profit,” due to the PPACA. Remaining not for profit with this healthcare reform, can place financial strain on hospitals where “Medicare accounts for a significant portion of their organization's revenue” (Lemon, 2016).

As one can decipher there are both pros and cons associated with the PPACA at each healthcare focal point. Many agree no one should be denied healthcare, but at the same time should healthcare insurance be forced upon all? No healthcare system is perfect, so rather than focusing on the negative aspects of the PPACA, nurses should try to embrace the positives, and use their talents and voices to overcome and propose solutions to current shortcomings.

References:

All Nursing Schools. (2016). Obamacare and Nursing | How the Affordable Care Act Affects Nurses. Retrieved from http://www.allnursingschools.com/nursing-careers/article/obamacare-and-nursing/

Bendix, J. (2015, May 10). Study probes affordable care act impact on primary care visits. Medical Economics, 92(9), 61. Retrieved from http://db04.linccweb.org/login?url=http://go.galegroup.com.db04.linccweb.org/ps/i.do?p=AONE&sw=w&u=lincclin_cfcc&v=2.1&it=r&id=GALE%7CA416116381&asid=e0489587ed0e9867fc3c41d75ca393b4

Clavreul, G. M. (2010). What Health Care Reform Means for Nurses - Articles Archive - Nursing Jobs, RN Jobs, Career Advice at Working Nurse. Retrieved from http://www.workingnurse.com/articles/What-Health-Care-Reform-Means-for-Nurses

HealthCare.gov. (2016). Individual Mandate Penalty You Pay If You Don't Have Health Insurance Coverage | HealthCare.gov. Retrieved from https://www.healthcare.gov/fees/fee-for-not-being-covered/

Johnston, M. (2015, June 16). How Obamacare Affected The Insurance Industry (AET, CI) | Investopedia. Retrieved from http://www.investopedia.com/articles/personal-finance/061615/how-obamacare-affected-insurance-industry.asp

Lemon, M. (2016). The affordable care act's impact on hospitals: Any discussion of economic viability for healthcare organizations should consider payer mix and regulatory conditions that affect industry. Revenue Cycle Strategist, 9, 5. Retrieved from http://bi.galegroup.com.db04.linccweb.org/essentials/article/GALE|A312790843/06d0c4d8cfc0ba19d6118199ee3ea6c8?u=lincclin_cfcc

Obamacare Facts. (n.d.). Affordable Care Act Summary. Retrieved from http://obamacarefacts.com/affordablecareact-summary/

Rosenthal, E. (2016, May 15). Sorry, we don't take obamacare. The New York Times [New York City], p. News: p1(L).

U.S. Department of Health & Human Services. (2015, August 28). Read the Law | HHS.gov. Retrieved from https://www.hhs.gov/healthcare/about-the-law/read-the-law/#

Wakefield, M. K. (2010). Nurses and the Affordable Care Act. AJN, American Journal of Nursing, 110(9), 11. doi:10.1097/01.naj.0000388242.06365.4f