Topic 1: Patient Protection and Affordable Care Act (PPACA)
The Patient Protection and Affordable Care Act (PPACA) was signed into law in 2010 to increase health insurance coverage in the U.S. PPACA has reduced the uninsured adult rate up to 12.4% in 2018 (McIntyre & Song, 2019). PAPCA is at the forefront of health policy in 2019, and it continues to polarize the public. PPACA left an indelible mark in the healthcare system; it represents a significant stride towards universal health coverage in the U.S.
PPCA impacted the health policy by increasing coverage in two ways. First, it gave subsidies to low-income families and individuals with income up to 400% of the federal deficiency line (McIntyre & Song, 2019). PPACA also got rid of some of the eligibility requirements for the Medicaid package so that more people could enroll in Medicaid. Consequently, the number of uninsured people has reduced by 20 million since 2010.
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PPCA continues to endure legislative challenges. According to McIntyre & Song (2019, p. 2), “The House of Representatives advanced over 50 bills to repeal the ACA in whole or in part.” PPACA was the brainchild of the Obama administration, and President Trump has been vocal about his desire to repeal PPACA. The last attempt was in the summer of 2017 when the effort to repeal PPACA endured a narrow defeat of 49-to-51. Trump administration has been making policies that undermine PPACA, such as getting rid of funding for cost-sharing falls. The government has also cut the resources for enrollment outreach and education. Trump’s government has made it easy for the US to change their Medicaid plans leading to lower enrollment for PPACA. The Supreme Court decision in 2012 also scaled down Medicaid growth giving states the power to be in charge of the expansion. The prospects for a repeal of PPACA are now lower as Democrats are regulate the House of Representatives. Trump administration might decide to leave the policy alone or continue modifying it in the future.
Topic 2: How Does Policy Impact Nursing
Policy has a significant impact on nursing. Policy refers to the decisions endorsed individuals in power and authority to regulate how people behave. Arabi et al. (2014, p. 315) define nursing policy as, “choices of society or a part of society or organization, with consideration of purposes, health priorities, and ways of resource supply to reach purposes.” There are three sources of policy: organizational, professional, and public sources. Public sources of policy include federal, state, and local governments, whereas organizational policy makers include healthcare organizations, insurers, suppliers, and volunteer organizations. Professional sources of policies include healthcare disciplines, educational, accrediting, and certifying organizations such as the American Nurses Association (ANA).
Health/nursing policies serve various purposes, including spelling out the roles and standards of nursing, procedures, and nursing education, staffing levels, among other provisions. The nursing policy is a collection of knowledge on what is mandatory for a regular nurse and determines the lowest standard of expertise. Policy affects everyday nursing activity by covering issues of patient safety, nursing qualification, standards, staffing levels, among other issues. The nursing policy has a positive impact on nursing, as it is responsible for setting standards of operations to guide nursing. Nurses must abide by these policies to show that they are indeed qualified to provide quality patient care. According to Arabi et al. (2014), there should be more consultation between nurses and policymakers. While nursing organizations such as ANA represent nursing interests in policy creation, some policies fail to reflect on the everyday challenges facing nurses and patients.
Topic 3: Strategizing and Creating Change
The healthcare environment is continually changing, thus the need for new approaches and mockups of healthcare to achieve positive patient results and reduce cost. Effective decision making within the healthcare system is crucial. According to Elf et al. (2015), shared decision-making is the process where health practitioners and patients work together in making decisions and treatment and care plans based on clinical evidence to improve patient outcomes. Shared decision-making (SDM) is crucial in the implementation of a person-centered cared.
The most crucial step before the implementation of SDM is the planning and design phase. In this phase, stakeholders come together to discuss ideas and requirements for the model. Also, innovative models are evaluated and integrated into the plan. The implementation of the SDM starts with educating health practitioners and patients about SDM. Education is carried out through decision aids such as pamphlets, videos, and computerized tools to empower patients. Elf et al. (2015) list the following critical factors for the success of SDM implementation, including collaboration, integration evidence, emphasis on results, use of certifications, and assessment of healthcare settings.
According to Elf et a. (2015, 115), “SDM is based on integrating evidence, and end-users’ perspectives will have a profound impact on the quality of healthcare.” SDM implementation is also influenced by the changes in the healthcare body. The planning and implementation of the SDM requires a careful balance of the needs of different stakeholders and working towards defined goals. Collaboration in healthcare is also evident in mentorship programs and the creation of hospital boards. Mentorship programs strengthen nursing competency. There is a need to adopt an effective mentorship model that incorporates the human variables of knowledge, experience, skill, and leadership to increase nurse-delivered patient care.
Topic 4: Advancing the Cause
Nurses should take action in shaping the future and the future of their patients. As discussed in topic 2, health policy affects all aspects of nursing from nursing education to practice. Therefore, nurses should take an active role in policy making, either through political engagement, creating allies outside the profession, and running for government office. The article by Waddell et al. (2014) discuss the Legislative Action Interest Group (LAIG), a health policy medium where nurses explore the clinical inferences of prevailing health rules and guidelines. LAIG is beneficial to nurses interested in policymaking, as Waddell et al. (2014, p. 15) points out that, “Nurses participating in the LAIG forums build a working knowledge of health policy and can articulate the practice realities for policy decision makers.”
Nurses taking part in LAIG educated themselves about health policies and articulated their problems to policy decision makers. Nurses who want to shape their future through policy take time to understand the state legislative process, build policy advocacy skills, meet with state and federal legislators, and collaborate with them. With the LAIG model, nurses can organize tours in hospitals so that policymakers can have all the necessary information to guide the policymaking process. In becoming allies with policymakers, nurses gain knowledge which they can use in the future if they need to advance nursing participation in policy. Some nurses eventually run for Congress because they want to be more involved in making changes to the existing health policies. Their perspectives and experience as nurses are beneficial during health care debates. They can sponsor health-related policies to address issues in healthcare such as health professional licensure, mental health, insurance, among other health issues.
References
Arabi, A., Rafii, F., Cheraghi, M. A., & Ghiyasvandian, S. (2014). Nurses’ policy influence: A concept analysis. Iranian journal of nursing and midwifery research , 19 (3), 315.
Elf, M., Fröst, P., Lindahl, G., & Wijk, H. (2015). Shared decision making in designing new healthcare environments—time to begin improving quality. BMC health services research , 15 (1), 114.
McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Med 16(2): e1002752.
Waddell, A., Audette, K., DeLong, A., & Brostoff, M. (2016). A hospital-based interdisciplinary model for increasing nurses’ engagement in legislative advocacy. Policy, Politics, & Nursing Practice , 17 (1), 15-23.
