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Abstract
The U.S congress broadly debated the healthcare plan under the umbrella of the Patient Protection and Affordable Care Act (PPACA) and has now been signed into law. The new legislation aims at reducing the cost of basic healthcare to all citizens while at the same time alleviating the various costs involved in healthcare coverage. One of the most skeptical issues surrounding this new law is whether the amendments should create an alternative of purchasing a health insurance plan from the public. The Levin Group and the Urban Institute unanimously come to an agreement that the public alternative would lower the overall costs incurred in healthcare needs in the United States.
Consequently, this will save a lot of government spending which has often been directed towards this sector. There is a projection of up to forty-seven billion dollars being saved on an annual basis. In this case, costs will be redirected to private insurance firms. For this reason, employers are more likely to drop the private option in favor of the public one. On the other hand though, whether this reform will eventually lower costs incurred or make the situation worse is still unknown. President Barrack Obama and his administration need to follow the key and fine steps to ensure that the recommendations in the healthcare plan become successful.
Nonetheless, there are several provisions that are contained in the law which affect Advanced Practice Nursing in one way or the other. For instance, there are legal provisions that highlight the need to offer loans and grants to nursing students so that the training of these medical professionals can be increased to cater to the high nursing demand. Over and above this, a careful evaluation of PPACA reveals a lot of other issues that range from socio-political to economic and which arise from the adoption of the new law. Moreover, this health care policy analysis paper also offers some recommendations to the new law in regard to the effect it has on Advanced Practice Nursing and how this legislation can be implemented to benefit this vital profession.
Introduction
The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Barrack Obama in March 2010. The American health care system will have to undergo significant changes due to the signing of this Act alongside the Healthcare and Education Reconciliation Act of 2010 which was also signed into law. This piece of the legislation marks a major landmark in the healthcare sector in addition to Medicaid and Medicare which have already been adopted into the health care system (Bodenheimer & Pham, 2010).
This Act is meant to improve the basic healthcare system for American citizens by ensuring that all residents can afford the cost of healthcare in addition to thorough access to medical cover. The states have a noble role to play in the implementation of the Patient Protection and Affordable Care Act due to its complex nature. The successful implementation of the Act in the next couple of years will largely depend on the participation of each state. Hence, federal reform will be of great importance if this new law will be beneficial to the targeted American residents. This paper explores and analyses the health care policy under the provisions of the Patient Protection and Affordable Care Act (PPACA).
Environments influencing PPACA
Economic
About $ 143 billion will be cut down from the initial health care budget with the adoption of this new law governing health care plans for the American residents (Bodenheimer & Pham, 2010). This is expected to take place within the first ten years after the onset of the implementation process. Furthermore, an additional $1.2 trillion is projected to lower the likely deficit in the health care budget before the close of the second decade of its implementation. These estimates have been critically worked on and revised quite a number of times by CBO (Pipes, 2010). During the first decade of operation, the health care Act is expected to draw close to $940 billion from the treasury, marking a significant drop and the usual deficit which is usually characteristic of the U.S health budget.
The six years of implementation is equally expected to witness a surplus in revenue compared to spending levels. Due to the high degree of uncertainty in the projected data, CBO does not provide a statistical forecast on the outcome of the new law beyond one decade. This has been considered to be necessary due to the fact that there are a lot of changes that may be on the way in the course of implementing the new piece of health care legislation.
The Social/cultural environment
The Congressional Budget Office (CBO) projects a significant drop in the number of U.S citizens who have no medical cover of any nature. An additional 32 million residents are expected to benefit from the implementation of the Patient Protection and Affordable Care Act. Despite this major breakthrough in terms of medical coverage, there will still be an estimated 23 million people not medically insured under any scheme (McWilliams, Meara, Zaslavsky & Ayanian, 2007). The social implication is that those who have not been admitted to Medicaid although they qualify are among the U.S residents who will not have been catered for under this new law. Moreover, the annual penalty will not be paid by those whose medical coverage costs would go beyond 8 percent.
Political
The new health care Act, even before it was signed into law was politically instigated and aligned with Obama who used the bill as one of his campaign platforms. Later, the name Obamacare came into use in reference to PPACA and its provisions. However, it was later adapted for use with a positive context after the bill was successfully debated by Congress and signed into law by U.S president Barrack Obama.
An earlier opinion poll before the bill could eventually be voted by Congress revealed that 59 percent were against the proposed legislation while a mere 39 percent gave it a nod. Those who opposed the bill argued that it had a very open end could be twisted at will by interested parties while 13 percent did not like the bill on the grounds that it lacked adequate liberty (Greenwald, 2010). About 56 percent of the respondents felt that the government had an upper hand in controlling the contents of the bill due to its over-involvement in health matters. This poll was conducted courtesy of CNN. Another poll carried out by Gallup and USA Today revealed that 49 percent of those polled had a positive look at the bill and felt that it was good (Greenwald, 2010). Although successive polls carried out depicted a rather weak and dwindling support for the proposed law, it was eventually passed by Congress courtesy of the majority Democrats.
Ethical
One of the main ethical issues addressed in the new legislation is an old ethical practice that has persisted for a considerable length of time whereby individuals with pre-existing conditions were secluded or discriminated against by insurers or were sometimes imposed heavy premiums due to their conditions(Pipes, 2010). The Act prohibits this practice and considers it ethically unacceptable.
History of the New Law
The 2008 campaigns by the Democrats were dominated by the need to carry out radical reforms in health care. Both Hillary Clinton and Barrack Obama were in a tight race to win the presidential primaries and this was their main campaign agenda (Pipes, 2010). Each of the candidates had a solid plan on how the estimated 45 million American residents who are not medically insured could be catered for by a comprehensive medical plan.
After clinching the nomination as a Democratic presidential hopeful, Obama promised a comprehensive health care plan for all American residents and that he would make it a priority upon winning the Presidency. A joint Congressional session was announced by Obama soon after he was inaugurated as the U.S President. This session was meant to chart the way forward for a health care plan and reform. Most of the stakeholders in the health care sector held several meetings with President Obama in a bid to start the reform process. Quite a number of relevant bills had been enacted on the floor of the House of Representatives by July 2009.
During the August recess, a lot of public deliberations were made on the proposed legislation by the House Committee. Several protests by the Tea Party Movement followed during the recession period owing to the fact that they were against some of the proposals made and they wanted to voice their concerns (Patrick, Grembowski & Durham et al., 1999).
As a result, Obama had to hold another meeting with the joint Congress to reiterate his earlier stand and proposals on the health care reform agenda. He did this to respond to the mounting opposition. Consequently, the Affordable Health Care for America Act was voted through by the House on 7th November 2009 and later handed over to the Senate for approval. The Patient Protection and Affordable Care Act was the bill adopted by the Senate. After the Senate voted for the bill, it had a breakthrough and was eventually signed by President Barrack Obama into law despite the numerous attempts to block the bill by the opposing groups.
Supporting stakeholders
Although the bill faced a lot of opposition both at the initial and progressive stages, there were some stakeholders who really gave it a lot of support throughout the developmental stages. One such organization was the Business Roundtable. This organization is comprised of a group of Chief Executive Officers. This association authorized the drafting of an analytical report on the pros of the proposed bill. The report was compiled by Consulting Company Hewitt Association and it emerged with positive details asserting that if adopted, it would reduce the cost of insurance premiums by an average of 3000 dollars (Institute of Medicine, 2009). The cost of health care could also be reduced in the future if the bill was adopted. Hence, the Business Roundtable supported not just the enactment of the bill into law but also a thorough implementation of the same.
Another supporting stakeholder was the Congressional Budget Office (CBO). It argued out that the enactment of the proposed bill would create a viable platform for the majority of American residents to obtain insurance cover on health. Additionally, CBO maintained that the creation of subsidies would substantially reduce the cost of health care especially in regard to the purchasing of insurance cover.
Opposing stakeholders
The Centers for Medicare and Medicaid Services was strongly opposed to the health care reform bill from the very beginning. A report released by this group in April 2010 asserted that although the Patient Protection and Affordable Care Act (PPACA) would definitely increase medical coverage by the U.S residents, it was bound to sky rocket health care spending by a margin of 1 percent in the next one decade. The report gave further warning that the increment in health care spending would even be higher than the quoted value due to the suggested lowering of the costs incurred in Medicare. According to the report, such proposals would be too enthusiastic and ambitious and therefore difficult to attain (American Hospital Association, 2010). Moreover, there was a higher likelihood of indebting about 15 percent of health care units. The report insisted that this would endanger the accessing of medical services by those who are seniors.
Evaluation
The evaluation of the Act reveals that there are a lot of areas within the legislation which directly and indirectly affects the Advanced Practice Nursing. The provisions contained in the Patient Protection and Affordable Care Act (P.L. 11-148) H.R. 3590 touches on Advanced Nursing Practice in a variety of ways. For instance, the need to expand the nursing workforce has been highlighted in several sections (American association of Colleges of nursing, 2010).
This expansion is meant to be achieved through a loan program for nursing student so that the majority of them can access higher education and facilities necessary for their training. In addition, there are grants which the Advanced Nursing students are supposed to benefit from. Nurses who wish to pursue or further their education are encouraged to do so through the available scholarship programs besides loans and grants. The federal governments are entitled to set up loan repayment programs for those students who have benefitted from the educational loan scheme.
Moreover, a workforce commission which is mandated to carry out its operation on a nationwide scale is to be established (Institute of Medicine, 2009). This commission will review the hiring program of nurses for the entire nation to ensure adequate workforce in the healthcare sector.
Recommendations
In spite of the provisions contained in the Patient Protection and Affordable Care Act (PPACA), the Advanced Practice Nursing still needs more attention. To begin with, more funds should be chipped in to establish a grant program which is sustainable. This will ensure continuous training of the Advanced Nursing workforce without over relying on loans. Besides, the APN needs to be recognized owing to its momentous achievement. This can be done by creating career awarding system to boost the morale of the workforce. Additionally, the Certified Nurse Midwives payment should be improved to a better rate than it is now.
This should go a long way in increasing the registration of nurses who are in advanced practice. As a result, the continuum of nursing care will not only be bridged but expanded as well. Finally, APNs should only operate within their level of education and the degree to which they are certified (McWilliams, Meara, Zaslavsky & Ayanian, 2007).
References
American association of Colleges of nursing (2010). Healthcare Reform.AACN supported provisions: Improving Access to Quality Care. Web.
American Hospital Association (2010). Summary of Health Reform Legislation. Web.
Bodenheimer, T. and Pham, H.H. (2010). Primary Care: Current Problems and Proposed Solutions. Health Affairs 29(5): 799-805.
Greenwald, P.H. (2010). Health Care in the United States: Organization, Management, and Policy, MA: John Wiley & Sons.
Institute of Medicine. (2009). Americas Uninsured Crisis: Consequences for Health and Health Care. Washington, DC: The National Academies Press.
McWilliams, J. M., Meara, E., Zaslavsky, A.M. and Ayanian, J.Z. (2007). Health of Previously Uninsured Adults After Acquiring Medicare Coverage. JAMA 298(24):2886-2894.
Patrick D.L, Grembowski D., Durham M.,et al. (1999). Cost and Outcomes of emdicare reimbursement for HMO preventive services, Health care Finacing Review, 20(4): 25-43.
Pipes, C.S. (2010). The Truth About Obamacare, Washington D.C: Regnery Publishing Inc.
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