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Nursing students are expected to understand how various legislations affect their practice. They are also required to writer synthesis papers on these legislation to demonstrate their understanding. Our APA Nursing Assignment Writers can help you write such analytical papers
APA Nursing Assignment Writers
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In a paper address the following items, based on your findings, for the Policy Change Plan Assignment:
- Identify an area of health disparity, and find a bill/policy affecting that disparity. This should be a bill/policy that is currently being reviewed or that has passed.
- State and explain your position on this bill/policy.
- Identify all stakeholders.
- Determine the impact of this bill/policy on each stakeholder including access, quality, and/or cost.
- Create a plan of action to affect the health care disparity. Describe specific actions you propose to take in this plan of action.
- How you will evaluate the effectiveness of this plan of action?
Solution
Disparities identified in U.S. healthcare have been termed as a genesis of significant policy and public health concern, with considerable evidence that low-income Americans and minorities encounter greater obstacles to care (Adepoju, Preston & Gonzales, 2015). Moreover, the evidence shows that they experience poorer health outcomes in diverse ways. One of the areas of disparities in the U.S. healthcare is health insurance, where coverage of all the citizens is unequal due to different factors affecting them. The adoption of the Affordable Care Act (ACA), also known as the Obamacare Act, was adopted with the aim of decreasing health disparities by promoting access to more efficient and equitable healthcare (Hall & Lord, 2014). Nevertheless, almost 5 years after the signing of ACA into law, scholars there are still aspersions related to healthcare outcomes, quality, and access (Sommers, McMurtry, Blendon, Benson, & Sayde, 2017). Nonetheless, some studies have shown that the ACA helped in achieving the intended goal. As such, it is important to evaluate the impact of ACA in terms of reducing the disparities in health insurance. This evaluation will focus on the stakeholders involved and the impact of ACA on each of them. Lastly, from the information gathered, a plan of action will be created to address the health insurance disparity in the United States.
The Affordable Care Act
The ACA achieved its first strategic goal in 2014, four years after its implementation. According to the Census Bureau, an approximated 9 million people acquired health insurance in 2014 (Salber & Selecky, 2014). As such, the policy was not only successful in decreasing the proportion of all racial groups without health insurance. Uninsured rates shifted in reaction to public policy, demographic shifts, and economic conditions. While it is hard to determine the proportion of the decline in the uninsured rates, most of the changes took place right after its implementation. Nonetheless, ACA is considered as the most reasonable explanation for this dramatic decline.
According to figure 1, all major ethnic and racial groups witnessed a decrease in uninsured percentage from 2013 to 2014. In fact, the decline for America’s ethnic and racial minorities’ insurance coverage was almost twice that of non-Hispanic whites. Blumenthal, Abrams and Nuzun (2015) assert that these figures significantly reduced the disparity of the uninsured rates between the Whites and people of color. These changes, which were greatly attributed to the ACA, demonstrate the possibility to establish policies that can benefit all Americans regardless of their racial or ethnic affiliation. As far as am concerned, the policy contributed to the advancement of the American ideals as it sought to offer universal health care to all citizens in order to decrease ethnic and racial disparities.
Figure 1. Illustration showing the percentage increase or decrease of uninsured people
between 2013 and 2014 (Blumenthal et al., 2015)
Stakeholders in the ACA and its Impact on them
Even though the full influence of this legislation on the healthcare system is not well recognized, the discourse concerning health care has essentially shifted since its passage. As a greatly visible local and national conversation, new anticipations were placed heavily on a deeply rooted health care system (Mason et al., 2016). Stakeholders, from providers to patients to politicians, now view this access to care in fresh ways, verifying actual costs and recognizing incentives to maintain successful systemic transformations. Four key stakeholders have been linked to the healthcare act. These include the healthcare providers, states, employers, and consumers.
Consumers
Close to 55% of the American citizens, acquire health insurance by means of an employer whereas 33% obtain insurance coverage on their own. Therefore, close to a third of citizens may not appreciate the impact of the Affordable Care Act (Hall & Lord, 2014). Nevertheless, according to the CBO (Congressional Budget Office), the number of nonelderly people that were not insured decreased from 55 million to 29 million in 4 years. Nonetheless, it was necessary to enhance marketing and publicity of health insurance among the young adult population. This would help in accelerating the success of the healthcare reforms in the U.S.
Housten et al. (2016) observes that the impact of the bill demonstrates that majority of the uninsured consumers were now able to access healthcare as they covered by insurance. According to a research conducted by the Kaiser Family Foundation, 58% of the 8 million citizens that registered in a marketplace plan were not insured beforehand. A comparison of low-income adults, particularly in states with health expansion programs versus those without, reveals that Medicaid was linked to a decrease in the uninsured rates. The quality of the healthcare insurance was evaluated based on the satisfaction levels of the consumers. A survey that was conducted by the Commonwealth Fund revealed that 82% of the consumers with new Medicaid or Marketplace coverage believed that it would enhance their capability to gain access to quality healthcare (Nix & Szostek, 2016). Above 58% of the consumers were satisfied with the quality offered after enrolling in the service compared to the situation before the implementation of ACA. With regard to access, 68% of the consumers identified that receiving an appointment with a primary care practitioner occurred within 1 to 2 weeks while 59% identified that it became possible to see a specialist within that duration. As such, access to qualified healthcare experts was promoted through the adoption of the Affordable Care Act.
Employers
Employers were among the stakeholders who gained from open competition among the providers of insurance from 2013. Nevertheless, a prerequisite of the ACA was imposed on the organizations that had above 50 employees to provide them with insurance cover. These employees were required to work over 30 hours weekly. With these conditions, Spivak (2014) observes that employers had to explore ways of reducing operational costs. As such, most of them adopted strategies such as competitive bidding of insurers, managed care, and self-insurance. Moreover, they shifted to innovative benefits designs intended to control costs. Some of these included consumer-directed high-deductible plans (CDHP) and defined-contribution plans. Both designs attempted to encourage employees to behave more like consumers by making decisions based on their preferences and prices.
Primarily, the CDHP model requires employers to seek healthcare services for their employees. They are subjected to high costs (approximately $2,500 for employees) and use an associated health savings account for tax (Spivak, 2014). The CDHP model usually provides information regarding the prices of different health service. Employers who enrol in the plan gain financially due to lower-cost options. CDHPs proponents maintain that it motivates employees to behave as consumers by being knowledgeable about the market conditions and how they can maximize their benefits.
States
In most cases, individual states are mandated to decide whether it is necessary to enforce certain ACA provisions. In 2013, 24 states as well as the District of Colombia implemented either an amalgamation of federally and state facilitated health insurance policies or state-run programs. The remaining 26 states were free to function as federally-facilitated exchanges (Larkin, Swanson, Fuller, & Cortese, 2016). For states that implemented the ACA, a significant increase in the number of citizens who gained access to insurance cover was notable.
According to studies, the individuals who received the new insurance coverage in all the states expressed their satisfaction with the quality of the coverage. Notably, three-quarter of this population who were seeking fresh appointments with specialists or primary care physicians succeeded within duration of 4 weeks or fewer days. In many states, the law enhanced the accessibility of health insurance through an assortment of mechanisms. First, states set a target of providing insurance cover to11.7 million Americans by 2015. Secondly, the federal government approved subsidies of up to 88% for individuals from low-income families. These subsidies were adopted across the states to ensure that more people gained access to cheap insurance cover. In fact, the Supreme Court approved these subsidies as a step towards reducing disparity in access to healthcare (French, Homer, Gumus, & Hickling, 2016). Lastly, the coverage of parents was also quite influential in helping their children to gain access to health insurance cover. In fact, this was important in helping reducing child mortality rates in the United States.
Providers
Regarding the implementation of the ACA, Nix and Szostek (2016) cite that it was anticipated providers would be encouraged to offer lower cost and higher quality healthcare. In order to make the provision of quality and efficient patient care an incentive, several policies were adopted in the beginning of 2013. Moreover, in an effort to augment access to preventive health and primary care services, physicians offering primary care services received assured reimbursement rates of 100% of the payment rates by Medicare (Housten et al., 2016). This reimbursement served as a compensation for the services offered. However, critics dismissed the ACA by claiming that it disregarded the need for restricting service delivery structure in the U.S. In particular, they stressed the need to restrict healthcare costs while enhancing its quality. Nevertheless, an evaluation of the law demonstrates that it was one of the most rigorous efforts in the country’s history to manage healthcare delivery system issues.
The ACA required healthcare providers to create new organizational arrangements identified as Accountable Care Organizations (ACOs). Essentially, these were aimed at promoting coordination and integration of post-acute, inpatient, and ambulatory services (Hall & Lord, 2014). At the same time, they were supposed to provide solid measures for controlling the quality of care for a defined population of beneficiaries registered under Medicaid.
Plan of Action to Affect the Health Insurance Disparity
The plan of action for reducing the health insurance disparities involves different strategies for improving the affordability of health insurance. According to several studies, improving the quality alone is not sufficient to eradicate the different issues that exist in the healthcare sector. In particular, disparity in access to healthcare appears to be correlated with ethnic and racial orientation of individuals. Nevertheless, it is possible to reduce the degree of this disparity by adopting several measures.
First, both state and federal governments can target intervention measures to specific populations that have been acquiring lower-quality care. In particular, such efforts should be focused on minority communities (King et al., 2008). For instance, a program should be designed with specific goals of enhancing quality and access of different populations in order to eliminate both systemic and structural obstacles at both levels of the government. Undoubtedly, it is impossible to guarantee healthcare affordability among the homeless populations unless the relevant authorities adopt deliberate measures to provide these individual with access to cheap and quality healthcare.
Secondly, the government should implement programs that target all patients while using strategies that are morally and culturally suitable to patients. Specifically, these programs should seek to meet their needs or address obstacles that limit access to health care. For instance, different insurance packages can be linked to a quality improvement intervention such as the care of mentally ill patients (French et al., 2016). This can be achieved by bringing together patients suffering from different mental conditions in order or provide affordable care for them.
The third intervention involves reducing disparities in healthcare quality. In particular, access to quality health care among individuals from ethnic and racial minorities is still below the expected standard. In order to enhance their accessibility to quality care, the government and private organizations should join efforts in establishing well-equipped facilities in areas occupied by the minorities (French et al., 2016). It is also crucial to adopt health plans in health insurance exchanges and competitive insurance markets for low-income individuals. This would help in establishing a quality improvement strategy. This approach would entail both non-financial and financial incentives to encourage all stakeholders work towards reducing disparities in healthcare. To this end, the government and health care institutions should undertake various activities such as health education, cultural competency training, community outreach, language services, evidence-based approaches, and wellness promotion to manage long-term conditions.
The fourth intervention is the use of research as a tool for informing and shaping policy. Research acts a tool that can offer the data available on the subject of health care reforms and identify the situation at hand. Therefore, it can be extremely important in helping to shed light on issues and pushing policymakers to action. Burkhardt and Nathaniel (2014) has differentiated lineage of nurses that have been at the forefront of influencing healthcare reform and policy using data from American midwives to Nightingale’s Crimean data. These forms of practice merged with the element of research help in playing a crucial role in establishing an environment that is suitable for policymakers to face different controversial and legal issues in the process of establishing strategies and plans for healthcare reform (Guido, 2014).
Evaluate the Effectiveness of this Plan of Action
The effectiveness of this plan will be measured using various strategies such as conducting surveys, undertaking continuous evaluation, and setting achievable goals.
Setting Achievable Goals
The key to monitoring the effectiveness of the plan is to be aware of the parameters being measured. As such, the outcomes will be compared against the set objectives of the plan. The program would be considered successful if the objectives are achieved within the set timeframe. Therefore, it is necessary to set achievable goals as determined by both the available financial and human resources.
Surveys
This form of research involves collecting information after the implementation of the plan in order to identify the views and perceptions of the consumers and providers about the efficiency of the action. Surveys are among the most effective evaluation strategies as they provide first-hand information.
Continuous Evaluation
In the process of implementation, specific targets comprised of measurable variables allow a team to keep continuous track of the strategy. This is measured against a predetermined parameter to identify the effectiveness of a given program. If actual results indicate unsatisfactory performance, the implementers should avail more resources, regulate the operations, and adopt other corrective actions.
Conclusion
Disparities in healthcare remain a pervasive issue in the U.S. The most common cases of inequalities in the country are related to health insurance. As such, the implementation of the ACA was aimed at reducing the different healthcare disparities, including health insurance. The minority were the most affected by this disparity as majority of them are composed of low-income individuals. As such, the ACA was intended to ensure that the rates of the uninsured decreased significantly through access to quality and affordable healthcare. Some of the stakeholders that were directly impacted by the program include consumers, employers, states, and providers. All these parties are influenced in different ways, particularly with regard to health insurance. The strategies for reducing the health insurance inequality involve different approaches for improving the accessibility of health insurance. For example, both state and federal governments can adopt intervention measures for specific populations. It is important to understand that the ACA cannot cover all forms of discrepancies that may be present in the healthcare system. As such, the included plan of action shows different strategies that come in handy in continuing the process of streamlining the healthcare and health insurance disparity.
References
Adepoju, O. E., Preston, M. A., & Gonzales, G. (2015). Health care disparities in the Post–
Affordable Care Act era. American Journal of Public Health, 105(Suppl 5), S665–S667. http://dx.doi.org/10.2105/AJPH.2015.302611
Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The Affordable Care Act at 5 years:
Health policy report. The New England Journal of Medicine. 2451-2458. http://dx.doi.org/1056/NEJMhpr1503614
Burkhardt, M. A., & Nathaniel, A. K. (2014). Ethics & issues in contemporary nursing (4th ed.) Stamford, CT: Cengage Learning. ISBN-13: 978-1133129165
French, M. T., Homer, J., Gumus, G., & Hickling, L. (2016). Key provisions of the Patient
Protection and Affordable Care Act (ACA): A systematic review and presentation of early research findings. Health Services Research, 51(5), 1735-1771. http://dx.doi.org/10.1111/1475-6773.12511
Guido, G. W. (2014). Legal & ethical issues in nursing (6th ed.). Upper Saddle River, New Jersey: Pearson Education Inc. ISBN-13: 978-0133355871
Hall, M., & Lord, R. (2014). Obamacare: What the Affordable Care Act means for patients
and physicians. The British Medical Journal. 349(7), 5376. http://dx.doi.org/10.1136/bmj.g5376
Housten, A. J., Furtado, K., Kaphingst, K. A., Kebodeaux, C., McBride, T., Cusanno, B., &
Politi, M. C. (2016). Stakeholders’ perceptions of ways to support decisions about health insurance marketplace enrollment: A qualitative study. BMC Health Services Research, 16(1), 634. http://dx.doi.org/10.1186/s12913-016-1890-8
King, R. K., Green, A. R., Tan-Mcgrory, A., Donahue, E. J., Kimbrough-Sugick, J., &
Betancourt, J. R. (2008). A Plan for action: Key perspectives from the racial/ethnic disparities strategy forum. The Milbank Quarterly, 86(2), 241–272. http://dx.doi.org/10.1111/j.1468-0009.2008.00521.x
Larkin, D. J., Swanson, R. C., Fuller, S., & Cortese, D. A. (2016). The Affordable Care Act: A case study for understanding and applying complexity concepts to health care reform. Journal of Evaluation in Clinical Practice, 22(1), 133-140. http://dx.doi.org/10.1111/jep.12271
Mason et al. (2016). Policy and Politics in Nursing and Healthcare (7th Edition), St. Louis, Missouri: Elsevier
Nix, T., & Szostek, L. (2016). Evolution of physician-centric business models under the
Patient Protection and Affordable Care Act. International Journal of Applied Management & Technology, 15(1), 1-20. http://dx.doi.org/10.5590/IJAMT.2016.15.1.01
Salber, P., & Selecky, C. (2014). Update on the impact of the Affordable Care Act on consumers. The American Journal of Accountable Care. 9(14), pp. 1-6. Retrieved from http://www.ajmc.com/journals/ajac/2014/2014-1-vol2-n3/update-on-the-impact-of-the-affordable-care-act-on-consumers
Sommers, B. D., McMurtry, C. L., Blendon, R. J., Benson, J. M., Sayde, J. M. (2017). Beyond health insurance: Remaining disparities in U.S. health care in the post-ACA era. Milbank Quarterly. Retrieved from https://dash.harvard.edu/bitstream/handle/1/29695273/MQ%20Post-ACA%20Disparities%20DASH%20Version.pdf?sequence=1
Spivak, M. (2014). The effects of the Affordable Care Act on large employers and the impact on the human resources function. Cornell HR Review, 1-8
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