Affordable Care Act is a health reform law that was implemented in March 2010, and it is commonly known as Obamacare (National Council of State Boards of Nursing, 2014). The law has three primary goals: first, it aims at making affordable health insurance to be available to more people. Second, it expanded the Medicaid program to cover adults with income below 138% of the federal poverty level. Third, the law also supports innovative medical care delivery that is designed to lower the costs of healthcare (National Council of State Boards of Nursing, 2014). Affordable Care Act has a significant impact on nursing practice, considering that it expanded the number of people who were eligible for Medicare (National Council of State Boards of Nursing, 2014). Mainly, this implies that nursing care, especially among people above 65 years, would be more intensive as nursing homes will have more people who require attention. Also, the influx of individuals seeking care has increased over the years, in healthcare facilities, hence growing pressure among nurses (National Council of State Boards of Nursing, 2014).
Impact on Community, Nursing Profession, and Health Care System
The Affordable Care Act affects the community positively by ensuring that all individuals have access to quality and affordable health care. Moreover, it eliminated discriminatory practices such as pre-existing conditions exclusions. Also, it introduced tax credits for small businesses, individuals and families, which ensure that insurance is affordable to everyone, which has reduced the number of uninsured Texans significantly. In particular, this figure decreased by 20.9% between 2013 and 2016 (Edmonds, Campbell, and Gilder, 2017). Additionally, ACA expanded Medicaid eligibility to cover lower incomes and people with disabilities, who are not Medicare eligible. For example, Community First Choice is an optional Medicaid benefit that focuses on community health service to Medicaid enrollees with disabilities. Such benefits enable consumers in the community to receive care at home or community health centers instead of going to a hospital. Evidently, Medicaid enrollment in Texas amounted to 4.8 million in May 2017 (Edmonds, Campbell, and Gilder, 2017). Similarly, through the National Prevention Policy, the community has benefited from public health programs such as drug and alcohol prevention initiatives, injury and violence-free living, mental and sexual health, and healthy eating programs that have improved the well-being of most Americans by molding them into responsible citizens.
Similarly, ACA impacted the nursing profession positively through the introduction of educational incentives such as the Nursing Student Loan Program, and workforce training in community health centers. Education incentives have improved access to the nursing profession for qualified but disadvantaged individuals mainly from poor backgrounds and minority groups in the community (Edmonds, Campbell, and Gilder, 2017). Such initiatives have increased the number of nurses, an aspect that will reduce the workforce shortage in the nursing profession. On the other hand, such training programs have ensured nurses are well-equipped with knowledge, skills, and competencies relating to health promotion, chronic disease management, mental health, and preventive medicine, which has led to job growth among many Texan nurse professionals.
Nevertheless, ACA has a negative impact on the health care system, considering that it expanded the number of people who were eligible for Medicare (National Council of State Boards of Nursing, 2014). Mainly, this implies that nursing care, especially among people above 65 years, would be more intensive as nursing homes will have more people who require care. Also, the influx of individuals seeking care has increased over the years, in healthcare facilities, hence growing pressure among nurses and doctors (National Council of State Boards of Nursing, 2014). Evidently, the shortage of healthcare professionals continues to increase, especially in some rural stretches of South Texas, as more Texans become insured. The current nurses who are working in the healthcare facilities are working under high pressure, including handling more patients, due to increasing patient-to-nurse ratios, working under very long shifts, and also being in the burden of attending patients with various medical conditions (National Council of State Boards of Nursing, 2014).
Recommendations and Supportive Statements for the Legislation
Political Reasons for Supporting ACA
Before the Affordable Care Act policy was passed, the American Nursing Association backed it up, as it promised to address the challenges in the nursing workforces in several ways. First, the act provides increased funding for learning institutions to offer loans to nurses, who would eventually become nursing educators (National Council of State Boards of Nursing, 2014). Through the Nurse Faculty Loan Program, the nurses can receive funds to sponsor their masters or doctoral education programs thus becoming educators. In 2013 to 2014 alone, about 18,352 students were enrolled into Doctor of Nursing Practice programs to have advanced knowledge, policy and advocacy skills. Second, Affordable Care Act through the Nursing Student Loan Program together with the Nursing Workforce Diversity Program allows nurses from the disadvantaged backgrounds to tap resources thus allowing them to study nursing. Third, the Nursing Work Diversity Program provides stipends, traineeships as well as retention activities to improve cultural diversity in nursing, as well as to improve care to patients through a comprehensive representation of cultures (National Council of State Boards of Nursing, 2014). The Nurse Education, Practice and Retention program has been updated to include a refocused quality component, thus helping nurses with a stronger background in quality improvement assist mandated quality improvement in healthcare delivery process.
Clinical Reasons for Supporting ACA
Demand for healthcare services is increasing steadily in the United States due to the aging populations, and it implies that they have more medical problems than the rest of the community (National Council of State Boards of Nursing, 2014). The nurses will, therefore, have to be educated on how to care for patients with chronic conditions. Already, ACA offers education incentives and workforce training in the nursing profession, which imparts nurses with knowledge, skills, and competencies relating to health promotion, chronic disease management, mental health, and preventive medicine, which has led to job growth. Thus, I would recommend the State of Texas to adopt the proposed legislation to ensure more nurses access these incentives and training to help curb the workforce shortage already evident in the health care delivery system.
The proposed legislation that would offer a sustainable solution to the nursing shortages is the Title VIII Nursing Workforce Reauthorization Act 2017 that amended the Public Health Service Act (Congress.gov. 2017). The legislation offers aid for nursing employee programs and also grants. The eligibility for the award was enlarged to encompass education initiatives for the clinical nurse managers, and it combined registers nurse and degree initiatives. It also allowed for schemes for loan repayments and grants for the nurses, for the nursing department and geriatric care schooling (Congress.gov. 2017). The subsidies for raising the workforce diversity among nurses are also provided. The grants for profession ladder programs have been expanded to include promotion of career advancements for people to become advanced education nurses or registered nurses, and also to enhance internships and the residency programs thus encouraging mentoring and development of various specialties (Congress.gov. 2017).
Involvement of Local Legislative Office
An email was sent to Mr. Joyce of Ohio, who is the personal representative on the committee that proposed the legislation, but no response has been received yet.
Congress.gov. (2017). H.R.959 - 115th Congress (2017-2018): Title VIII Nursing Workforce Reauthorization Act of 2017. Congress.gov. Retrieved 27 January 2018, from https://www.congress.gov/bill/115th-congress/house-bill/959
Edmonds, J. K., Campbell, L. A., & Gilder, R. E. (2017). Public health nursing practice in the Affordable Care Act era: A national survey. Public Health Nursing, 34(1), 50-58.
National Council of State Boards of Nursing. (2014). Implications of the affordable care act on nursing regulation and practice. Journal of Nursing Regulation, 5(1), 26-34.
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