Affordable Care And Nurses Responses Assignment
Affordable Care And Nurses Responses Assignment
What Could Happen If The Affordable Care Act Were Completely Repealed? What Could Happen If The Affordable Care Act was Completely Repealed? 1 What Could Happen If The Affordable Care Act Were Completely Repealed? The Affordable Care Act is a comprehensive healthcare reform law whose primary goal is to provide quality and affordable healthcare for all Americans. In 2017, the House of Representatives passed the American HealthCare Act to repeal components of the Affordable Care Act. Some of the changes of the ACA include, changing the amount of subsidies, eliminating the mandate for insurance, decreasing the expansion of Medicaid and capping the amount available in Medicare. (Renji, 2017). Other changes in this legislation included the end of the risk adjustment program (Kodjak 2018). The risk adjustment program was created to ensure that insurance companies provide payments for a substantial amount of ill individuals receiving funding from other insurance companies who have a lesser amount (Kodjak 2018). This program provided balance amongst insurance companies and allowed healthcare to remain affordable. If the Affordable care act were repealed, low-income individuals/families, clients with chronic conditions and the elderly population would be adversely affected. Groups that could benefit from this repeal include younger, healthier, middle-higher income Americans. The profession of nursing would experience a decrease in job opportunities and quality of care, private healthcare providers will experience changes and decreases in client demographics and major healthcare organizations will have to readjust prices due to the changes in subsidies that the federal government provide to individuals/families from certain socioeconomic statuses. Nurses can stay informed with this current legislation by joining
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organizations that lobby to support the cause of making healthcare accessible to all Americans and others. Groups that would be adversely affected if the Affordable Care Act were repealed include, low-income individuals/ families, clients with chronic health conditions and the 2 What Could Happen If The Affordable Care Act Were Completely Repealed? elderly population. (Obama, 2016) If the ACA were eliminated, low-income individuals/ families would have to deal with the lack of subsidizes/tax credits that the federal government provides based on income and manage the cost of paying high deductibles and premiums at market prices. Clients with chronic health conditions like Diabetes and Hypertension would be responsible to finance the cost of maintenance medications, lifestyle changes and procedures if necessary. (Ranji, 2017) Managing chronic health conditions would also be costly for the elderly, especially if they are retired and living on a fixed income and have medical insurance that provides partial coverage (ex, Medicare) on medications and medical services. (Obama, 2016) Groups that would benefit if the Affordable Care Act bill were repealed include younger, healthy people, and middle-higher income Americans. (Ranji, 2017) Younger and healthier people would partially benefit if the bill were repealed because they could select cheaper healthcare plans that offer less coverage such as the catastrophic health plan. The catastrophic health plan is a health insurance plan that offers people under the age of 30 who are in good health with the opportunity to purchase a plan that has low premiums but a high deductible cost because it is “emergency” insurance. (HealthCare. gov, 2019) The middle-higher income Americans could benefit from the repeal because more tax credits will be available to individuals that make more than 75,000 by the federal government. (Ranji, 2017) The healthcare reform efforts would threaten the nursing workforce, making it more difficult for nurses to provide high quality, safe, and efficient care to their clients. If the ACA of 2010 bill is repealed, the nursing profession will be deeply impacted. Undoing the gains made under the ACA would go against all of the American Nurses 3 What Could Happen If The Affordable Care Act Were Completely Repealed? Association’s Principles of Health System Transformation and would represent an enormous step backward in the march toward quality healthcare for all. Nurses will have bigger client loads resulting in diminished care for clients. It also will result in massive job losses. Nurses would have to deal with cuts in their work hours, which will impact their lifestyle and family members. If the Affordable Care Act is repealed, private healthcare providers will also be adversely affected. Since some families struggle with maintaining affordable healthcare coverage, private healthcare providers will receive fewer clients at their office. Clients have the option of visiting hospitals for services since they are required by federal law to treat them (Dobson, DaVanzo & Haught, 2016). As a result, uncompensated care will be a major issue for private healthcare providers resulting in financial deficits. Unfortunately, some practices may have to downsize or close their businesses due to the lack of clients with coverage. If the ACA bill is repealed, major healthcare organizations will be affected because they will have to adjust their healthcare plans due to limited or reduced subsidies from the federal government (Blumberg, Buettgens & Holahan 2017). As a result, there will be a strain to service the low-income and uninsured population. To manage the situation, major healthcare organizations will try to collect more funds through various strategies such as individual donations, corporate contributions, foundation grants, interest from investments, tax revenue, and membership dues and fees. Many healthcare organizations will also struggle with competitors due to their incapacity to respond to the healthcare needs of the uninsured population (Blumberg et al., 2017). 4 What Could Happen If The Affordable Care Act Were Completely Repealed? To utilize power and influence effectively, nurses need to develop awareness of the legislative process and gain a working knowledge of the political arena. Nurses also need to get informed about how the Affordable Care Act affects the constituents. Websites such The Library of Congress THOMAS; (which is a database) allows people to look up information about federal bills. GovTrack.us also informs the public about actions in Washington. This site requires registration. Www.Ballotpedia.org is “an interactive almanac of U.S. politics,” including neutral descriptions of federal and state measures. The New York State Board of Nursing (www.ncsbn.org) website often provides useful information on pending legislation. The BON’s legislative committee examines all measures and decides whether the board should support, oppose or watch each measure. Professional organizations such as The American Nurses Association (www.ananewyork.nursingnetwork.com) also monitors relevant legislation. These organizations’ information may be available only to members. Some professional organizations also organize “lobby days,” which are great opportunities for nurses to learn about important current issues and the political process in general. Every nurse should be a registered voter because it is important to understand how he or she is represented in Washington. Nurses can therefore get involved by using their power collectively. 5 What Could Happen If The Affordable Care Act Were Completely Repealed? References Affordable Care act and Reconciliation Act. (n.d.). Retrieved February 01, 2019, from www.Healthcare.gov Blumberg, L.J., Buettgens, M., Holahan, J. (2017). Implications of Partial Repeal of the ACA Through Reconciliation (Urban Institute, Dec. 2016). Dobson, A., DaVanzo, J., Haught, R. (2016). Estimating the Impact of Repealing the Affordable Care Act on Hospitals (Dobson, DaVanzo & Associates, LLC, Dec. 6, 2016). Hilliard, J. I., Lienbenberg, A. P., Lienbenberg, I. A., & Ruhland, J. (2018). The market impact of the Supreme Court decision regarding the patient protection and affordable care: Evidence from the health insurance industry [abstract]. Journal Of Insurance Issues, 135-187. Leavitt, J.K. Linking practice, policy and politics: Using nursing power to improve health. Presentation: Arlington, VA. Nurse in Washington Internship (NIWI) Program. New York State Board of Nursing (www.ncsbn.org) Obama B. (2016). United States Health Care Reform: Progress to Date and Next Steps. JAMA, 316(5), 525-32. Ranji, U., Rosenzweig, C., Salganicoff, A., & Sobel, L., (2017, May 08). Ten Ways That the House American Health Care Act Could Affect Women. https://www.kff.org/womens-health-policy/issue-brief/ten-ways-that-the-house-americanhealth-care-act-could-affect-women/ https://www.healthcare.gov/glossary/catastrophic-health-plan/ 6 What Could Happen If The Affordable Care Act Were Completely Repealed? The American Nurses Association (www.ananewyork.nursingnetwork.com) The Library of Congress THOMAS The State Of The Affordable Care Act [Audio blog interview]. (2018. July 18). Retrieved February 01, 2019, from www.npr.org U.S. Department of Health and Human Services (2017). About the Affordable Care Act. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html www.Ballotpedia.org www.GovTrack.us 7 Restrictions for Advanced Practice Nurses Restrictions for Advanced Practice Nurses 1 Restrictions for Advanced Practice Nurses 2 According to the Bureau Labor of Statistics, an Advanced Practice Nurse is defined as a nurse who “provides and coordinates patient care,” including “primary and specialty health care.” Advanced practice nurses work in a variety of settings depending on state level. There are four different APRNs, which includes clinical nurse specialists, nurse practitioners, certified registered nurse anesthetists, and certified nurse-midwives. Although these nurses are highly trained and able to provide a huge variety of services, they are they are not able to do so because of certain barriers. Are Nurses with Advanced Degrees Restricted in Their Practice? It has been proven that graduates of advanced practice degree programs have a harder time finding employment that would allow them to practice to the full extent of their education and training due to barriers of scope of practice. As advanced practice nurses transition from school to the working environment, they are faced with barriers imposed by the state of which licensure and certification was obtained. State laws, federal policies, insurance reimbursement models, and even culture stands in the way (Gutchell, 2014). The two main barriers that will be discussed are physician’s barriers and Payer’s Policy. As more nurses graduate with advanced practice degrees, it’s important for other health care professionals to know and understand their scope of practice. Some professional organizations such as the American Medical Association believe that nurse practitioners are not as qualified as physicians because of their lack of extensive trainings. It is also believed that nurse practitioners are not able to provide safe quality patient care. A nurse practitioner’s scope of practice is often misunderstood, which creates a barrier known as a “physician’s barrier” (Haine 2014). Although a physician and nurse practitioner have the same goal when treating a patient, physicians often feel that nurse practitioners are not qualified to make certain decisions. Restrictions for Advanced Practice Nurses 3 Creating an environment where nurse practitioners and physicians can work together will help overcome this barrier. Payer’s Policy is another barrier where NP’s are often not recognized as primary care providers. NP’s ability to practice independently are restricted by State practice regulation and licensure. NP’s cannot bill for their services directly. Because of this Restrictive scope of practice many NP’s find it difficult to perform their duties as a healthcare provider. Essentially, they are forced to work under physician professional organization. The Centers for Medicare & Medicaid Services state that “billing ‘incident-to’ requires that the physician establishes the initial plan of care and the nurse practitioner performs follow up care with the physician on site” (Hain et al., 2014). This type of barrier would prevent NP’s from practicing to the full extent of their education and training. According to the ANA journal, in 2014 legislative passed a bill that would allow New York State NP’s to complete 3600 hours and signed an attestation of collaboration agreement with a physician. Nurse practitioners are “recognized in state policy as primary care providers” (Scope of Practice Policy, 2019). There are three types of practices a nurse practitioner can be a part of: full practice, reduced practice, and restricted practice. Full practice is where the nurse practitioner is completely independent and provide all the patient care. The NP can evaluate, diagnose, order and interpret diagnostic tests, and can initiate and manage treatments for a patient. Reduced practice is where the NP can take part in at least one element of practice, but the physician’s oversight is required to provide patient care and prescribe medication. Restricted practice is where full physician oversight is required to take part in any element of practice. Twenty-three states that allows full scope of practice for a nurse practitioner. New York State is not one of them. Restrictions for Advanced Practice Nurses 4 New York state requires a “mandatory collaboration” relationship between a nurse practitioner and a medical doctor. Such a relationship is defined by a written practice agreement that can be as restricted or broad as the physician pleases. Unlike New York State, there are 18 other states (AK, AZ, CO, HI, ID, IA, ME, MD, MT, ND, NH, NM, OR, RI, UT, VT, WA, WY) that allow a nurse practitioner complete independence (Senate Bill S4611B, 2014). New York State’s law asserts that the practice of the nurse practitioner “may include the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures within a specialty area of practice, in collaboration with a licensed physician qualified to collaborate in the specialty involved, provided such services are performed in accordance with a written practice agreement and written practice protocols” (NYSED Professions, 2018). Written protocols must be developed, including “explicit provisions for the resolution of any disagreement between the physician and the nurse practitioner regarding diagnosis and treatment of patients” (Scope of Practice Policy, 2019), however if a conflict arises that cannot be resolved, the recommendation, diagnosis, or treatment of the physician ultimately triumphs. According to New York State law, advanced practice nurses can only prescribe in their specialty. They cannot provide initial certification for hospice care. However, nurse practitioners can recertify patients for their eligibility for hospice care. Informal Interviews with Advanced Practice Nurses As discussed in an informal interview with a certified registered nurse anesthetist, the top barrier faced is the anesthesiologist, whom does not want to give up his “power.” The anesthesiologist restricts certain procedures the CRNA can perform because by law they must provide supervision. Based on the informal interview, New York State prohibits CRNAs from performing tasks that allow them to practice to the full extent of their education and training. Restrictions for Advanced Practice Nurses 5 One example is that the anesthesiologist is responsible for the medical decisions made on the patient’s condition for the procedure. Also, they cannot provide services with a dentist because dentists are not considered “physicians” in New York state. Whereas in California they are more lenient with the roles CRNAs play in the healthcare setting. Another informal interview was with a current Assistant Director of Nursing of a medical surgical/stepdown department, who has recently received his degree in family nurse practitioner. He claims that he would have to take a pay-cut if he were to switch positions and work as a family nurse practitioner in the same facility. He explains that he would not be able to work independently right away, unlike the full autonomy he was taught to have while studying for his FNP degree. Upon speaking to a registered nurse that was employed in an emergency department while she was matriculated in a NP program, she confirmed that based on New York State law, she was restricted from practicing to the full extent of her training after receiving her advanced practice degree. Although she was secured a job as a nurse practitioner in the emergency department, she was not able to fully make decisions as a healthcare provider without first conferring with a physician. Conclusion Based on the IOM’s report, we are validating the statement that nurses who graduate from advance practice degree programs do have a difficult time finding employment that would allow them to practice to the full extent of their education and training based on the state laws under which they work, specifically in New York State. As more advanced practice nurses continue to obtain degrees, it’s important to develop an interprofessional relationship where physicians can work together with advanced practice nurses to provide patient centered care. We Restrictions for Advanced Practice Nurses 6 must continue to advocate for a universal bill that will remove such barriers discussed that many advanced practice nurses face. Restrictions for Advanced Practice Nurses 7 References Donaworth, S.L., (July 25, 2017) “Making the Case for Adult-Gerontology Critical Care Nurse Practitioner Fellowships” OJIN: The Online Journal of Issues in Nursing Vol. 22, No. 3. Gutchell, V., Idzik, S., & Lazear, J. (2014). An Evidence-based Path to Removing APRN Practice Barriers. The Journal for Nurse Practitioners, 10(4), 255-261. Hain, D., Fleck, L., (May 31, 2014) “Barriers to Nurse Practitioner Practice that Impact Healthcare Redesign” OJIN: The Online Journal of Issues in Nursing Vol. 19, No. 2, Manuscript 2. New York State Education Department. (2018). Section 6902. Definition of practice of nursing. NYSED Professions, Education Law (Article 139). New York. Available at: http://www.op.nysed.gov/prof/nurse/article139.htm The Nurse Practitioners Modernization Act, S4611B, Senate (2014). Available at: https://www.nysenate.gov/legislation/bills/2013/S4611 Scope of Practice Policy. (2019). New York 2019 Scope of Practice Policy. Health Resources and Services Administration of the U.S. Department of Health and Human Services. Available at: http://scopeofpracticepolicy.org/states/ny/ Sullivan-Bentz, M., Humbert, J., Cragg, B., Legault, F., Laflamme, C., Bailey, P. H., & Doucette, S. (2010). Supporting primary health care nurse practitioners’ transition to practice. Canadian Family Physician, 56(November 2010).
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