Income, Poverty, and Health Insurance Coverage, Research Paper Example

Introduction

My nurse manager is a PhD graduate who is focused on determining the impact of the Affordable Care Act on the quality of care of patients living in urban communities. Her expertise in this field has resulted in several potential publications that are currently being reviewed for submission. In order to gain a greater understanding of the impact of the implications of the Affordable Care Act on patient care, I elected to interview her. Our meeting took place on September 25, 2015 at the hospital. The engaged interview process provides the listener with a unique perspective of common health issues that are discussed in the clinical setting. In addition to determining how these policies impact individual practice, it is essential to determine how such policies impact the greater community. Therefore, the purpose of this report is to discuss information provided by my nurse manager to my colleagues in a manner that will positively impact their personal practice in addition to their understanding of the broader scope impact of the Affordable Care Act. Even though we engage in policy requirements and standards each day, it is essential to analyze why these standards are impacted and how they will contribute to furthering public health.

Description of Policy Issue

Many individuals were excited by the implementation of the Affordable Care Act because it appeared that this government issued plan would work to bring health benefits to those who were previously uninsured (Chaikind et al., 2011). Although Medicaid and Medicare programs were available for subsets of the urban population, the working poor often had a challenging time gaining access to the care that they required. According to my nurse manager “The working poor are those most affected by the Affordable Care Act because they, for the first time, were able to receive access to affordable care to promote their health and longevity”.  It is important to consider that the Affordable Care Act altered the way that we view health care. For the first time, health care professionals and policies were able to seriously consider whether the nation would benefit from having enhanced access to health care, and whether the current system is acceptable or should be altered (Feldman, 2011).

In spite of the seemingly widespread success of the Affordable Care Act, many individuals have questioned whether all members of the population truly benefit from such legislation. According to my nurse manager, evidence is overwhelmingly in favor of the Affordable Care Act in terms of the care that it is able to provide for a majority of the population. However, there are subsets of the population that are disproportionally negatively impacted by this plan.

Families tend to benefit most from insurance subscriptions provided due to the Affordable Care Act because they need to pay less money per family member to remain insured in most cases. However, single individuals that are uninsured have been having a difficult time coping with the Affordable Care Act because there are very few plans that are financially feasible for them. For example, uninsured individuals living in the state of New York have the option to subscribe to minimal coverage plans for approximately $350 per month or a high quality coverage plan for approximately $750 per month. Members of the working poor that are not provided with health insurance from their company are not able to afford these prices. In fact, even lower middle class working youth cannot afford coverage that would allow them to receive regular checkups or sick visits.  If these individuals do not subscribe to any care plan, they are subject to a hefty fine during tax season. Thus, it is apparent that these individuals have very few options available to them; they can’t afford care, and they have little money so being subject to a fine is problematic as well. Thus, it appears that the Affordable Care Act is beneficial for some members of the population but detrimental to others.

Presentation of Policy Analysis: Eightfold Path Policy Analysis of Affordable Care Act

Nursing researchers utilize Bardach’s (2011) eight-fold path of policy analysis to translate patient activation at both the government and individual level to the policy arena. This methodology to policy analysis begins with defining the policy problem in order to set the stage for the following steps, which include assembling evidence; pinpointing alternatives; culling specific criteria; forecasting outcomes; addressing any and all trade-offs; deciding; and narrating a story. Based on this analysis, researchers can identify pressing or significant nursing research questions that connect research, education, practice, and health policy.

State the Problem

The Affordable Care Act addresses various problems associated with the cost of healthcare in the United States. It sharply reduced the numbered of uninsured Americans by over twenty-five percent since the policy was implemented, thereby expanding access to healthcare insurance to over eight million Americans. The Congressional Budget Office even announced in 2012 that spending on healthcare dramatically, and the coverage provisions under the law costs over five billion dollars less than anticipated. Because of how invested American people, physicians, insurers and hospitals are in a universal healthcare, the system will be quite difficult to dismantle despite conservatives’ aspirations to do so. As such, lawmakers at the community and national level must accept the reality of ACA’s mandate and thwart the political gridlock in Congress to enhance its efficacy. The policy is so robust because it provides various correctives to various gaps in the healthcare landscape that had plagued Americans for decades by overhauling a chaotic yet highly structured market for health insurance in which the only buyers were employers. The ACA did so by vastly cutting costs for healthcare consumers, and those who remain uninsured after implementation are younger, wealthier, and healthier overall than those who were uninsured prior to implementation. Thus, the ACA addresses issue rhetoric, as there were too many uninsured Americans, and healthcare such as access to contraception was far too expensive for many women, thereby resulting in higher rates of teen pregnancy. The magnitude of the healthcare problem in the United States is directly addressed in this overhaul of the existing healthcare system in America.

Collect Some Evidence

Americans indeed have grappled with navigating a broken healthcare system that did not put patient care first, and after culling the evidence, it is clear that the ACA has benefited Americans and yielded positive outcomes. Millions of Americans lacking insurance struggled to afford even one visit to the doctor. Quality care which includes check-ups and preventative screenings in order to keep Americans healthy has hitherto been a luxury. Moreover, physicians were encouraged to prioritize the amount of healthcare they administered rather than effectively treating patients. The evidence unequivocally reveals the efficacy of the Affordable Care Act with regards to affordability, quality, and access to healthcare. In terms of quality, the evidence shows that patient safety has improved, as traumas, falls, patients harmed because of conditions within the hospital, and infections associated with central lines have been dramatically reduced by almost 20%. As a result, over 50,000 lives have been saved in addition to twelve billion dollars. There have also been less hospital readmissions, especially for those on Medicare. Americans covered by the ACA enjoy higher quality coverage that provide consumers with new, enhanced protections as Americans can no longer be turned away because they have pre-existing conditions or because they require emergency room and other preventative services. Indeed, the ACA transformed the way Americans receive healthcare and carries with it benefits that evidence supports are needed and embraced.

Construct the Alternatives

Bardach (2011) further reminds us that not all policy options are mutually exclusive, as alternatives are always present, especially because of the political sentiments surrounding the implementation of the ACA. One obvious alternative is maintaining the status quo, which has resulted in the political gridlock that continues to impede on the effective implementation of the ACA on a macro level. Accepting the status quo and believing that nothing can be done are two reasons why government policy remains problematic and often ineffective. Because of overt antagonism towards the ACA, Republicans have proffered alternative blueprints to the federal policy as a replacement that promotes traditionally conservative healthcare objectives. This alternative includes stripping funding to Medicaid, deregulating health insurance, and altering how healthcare packages are taxed. It is ambitious in nature while reforming the status quo in a limited fashion. This healthcare plan would extend healthcare coverage to those hampered by preexisting, although the coverage is limited in comparison to the ACA since it only protects individuals who maintain their coverage on a consistent basis. This plan would in theory expand access to quality healthcare coverage and lower costs by empower consumers and their families to make informed decisions about healthcare on their own. The Republican proposal also offers subsidies for low-income Americans so that they can purchase healthcare plans, which would help expand healthcare coverage, which is the primary outcome and accomplishment of the ACA. It also gets rid of the most of the prerequisites in the status quo with regards to benefits offered and any limitations on annual limits. This plan primarily focuses on restructuring how the federal government is involved in Medicaid for the poor because of the sentiment that the United States has become a welfare state that fosters dependency on federal funds. Instead, block grants restricting federal funding of Medicaid is how the program would function under this alternative. Finally, a central complaint about ACA is that it requires all Americans to have healthcare coverage with the threat of new taxes to those who do not comply. Rather, this plan would use the funds saved from Medicaid funding to offset the extension of subsidies to low-income consumers.

Select the Criteria

The criteria for assessing the ACA should look at its democratic currency, level of efficiency and cost-effectiveness, and its promotion of social justice. By looking at the outcomes of the ACA and the supporting evidence, the ACA unequivocally retains currency in various arenas beyond healthcare for all Americans. The legality of the ACA has been constantly questioned by members of the Republican Party, which has impeded the progress of passing meaningful healthcare reform that was inevitably come to pass. Despite the fact that it is only politically acceptable by one political party, an overwhelming majority of Americans support the policy because of how broken the American healthcare system has been for decades. The ACA was politically controversial from its inception, as Republicans discursively framed it as a proxy for the United States as a welfare state. However, such sentiments has done very little for the benefit of the average American. Americans suffer from personal bankruptcy largely because of medical bills, and rising costs in healthcare premiums far outpace average wages earned. This dissonance between Republican perceptions and reality underscore the political necessity of the ACA.

Project the Outcomes

The political volatility surrounding the implementation of the ACA highlights various tradeoffs and potential outcomes of the policy. By forcing all Americans to have healthcare, while it is still pricey, overall costs will be saved in terms of medical care. If Americans have healthcare access now, they can engage with affordable preventative healthcare so that larger medical problems do not develop in the future. Moreover, the enhancement of the efficacy of medical treatment has resulted in a net profit within the healthcare industry by eliminating avoidable accidents or injuries, especially within the hospital. The minimally acceptable efficacy of this policy is the expansion of healthcare to all Americans. The democratization of healthcare is at the core of the ACA, so given the billions of dollars invested in healthcare, statistics must show that more Americans are seeking healthcare due to the expansion of access to such services. Since its implementation, it is unequivocal that the ACA has positively impacted Americans on a macro level. While Republicans have portended the failure of ACA, the evidence demonstrates the erroneous nature of such intimations.

Confront the Tradeoffs

The passage and implementation of the ACA means that there is more federal regulation and costs for the expansion of healthcare to all Americans regardless of socioeconomic status. In addition, critics deplore the act as a traditional social welfare program in which money and outputs are transferred from the wealthy to the poor. From this vantage point, the trade-off is that healthy people–especially those with money and wealth–are now charged with the responsibility of paying for the healthcare of sick, low-income individuals. In addition, Americans who had non-comprehensive coverage before are forced to upgrade their healthcare plan according to the ACA. Members of the younger generation will also have to pay more so that the elderly are not hampered by skyrocketing premium prices.

Decide

Policy alternatives to the ACA may be embraced by critics of the seminal healthcare law, but policymakers must question why that alternative has not been pursued and enacted.  Decision-makers at the macro level are charged with the responsibility of passing initiatives that enhance the lives of the American people. While Republican lawmakers continue to stunt the implementation of the ACA because of its perceived socialist nature, maintaining the status quo simply does not serve the needs of the American public. An overhaul of the healthcare system is necessary to foment a more democratic society in which people have equitable access to necessary services.

Tell Your Story

It is unquestionable that the Affordable Care Act is a necessary policy for a broad American audience. Prior to such in-depth policy reform, many Americans could not access necessary healthcare services, especially those who were uninsured because they suffered from pre-existing medical conditions. The Affordable Care Act was formulated and passed in a stringently partisan environment and represents one of the most significant mechanisms during the twenty-first century of restributive justice.  As a public policy issue, it is overtly political in origin, and it defines a broad problem and effectively addresses it, although political dissonance is profound. A dialogue has opened up about public policies passed to solve certain social ills, as many Republicans conflate the notions of the public good and public welfare. Although welfare is imbued with paternalistic intimations, fairness refers to the intrinsic right to individual autonomy and freedom. It is ironic that Republicans perceive of the ACA as a threat to their liberty because it forces all Americans to get health insurance.  Such a frivolous and hostile reading of the law threatens to strip millions of Americans of healthcare if overturned.

Conclusion

In conclusion, it is apparent that there are many different factors that nurse need to consider to implement quality care as a result of the implementation of the Affordable Care Act. This legislation allows many people to acquire health care for this first time, which means that the health care system will need to adjust to handle a growing influx of clients. However, it is apparent that the Affordable Care Act is beneficial from a public health point of view. Because more people will be able to visit the doctor when needed, there will be less deaths as a consequence of preventable or treatable disease. It is important for nurses to remain aware of growing health care policy trends so they can ensure that they are able to help their patients in a manner that protects their well-being.

References

Bardach, Eugene (2000). A practical guide for policy analysis: the eightfold path to more effective problem solving. Chatham House Publishers, Seven Bridges Press.

Barr, Donald A. (2011). Introduction to U.S. health policy: The organization, financing, and delivery of health care in America. JHU Press.

Chaikind, Hinda; Copeland, Curtis W.; Redhead, C. Stephen; Staman, Jennifer (2011).

PPACA: A Brief Overview of the Law, Implementation, and Legal Challenges. Retrieved October 4, 2015 from https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

DeNavas-Walt, Carmen. (2011). Income, Poverty, and Health Insurance Coverage in the United States: 2010. Retrieved from https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act

Feldman, Arthur M. (2011). Understanding Health Care Reform: Bridging the Gap Between Myth and Reality. CRC Press.

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