Leadership and management nursing Essay
Identify one specific contemporary issue or trend that you are interested in learning more about. Choose from the categories below. For example you might want to learn more about why it is more difficult for some groups to receive care than others, which would fall under Client Access to Care. Or, you might want to compare nursing practice in the U.S. with how nurses practice in Japan, which would fall under the category of Global Healthcare and Nursing.
- Healthcare Reform
- U.S. Healthcare Financing
- Nursing’s Role in the U.S. Healthcare System
- Integrative Healthcare
- Nursing Leadership and Management
- Nursing Education
- Nursing Practice
- Nursing Professionalism
- Advancing Nursing as a Profession
- Client Access to Care
- Delivering Client Care
- Interdisciplinary Teamwork and Collaboration
- Ethical Practices in Healthcare
- Quality and Safety in Healthcare Delivery
- Health/Nursing Informatics
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Once the issue or trend is identified, find five important/significant facts about it, substantiated by an evidence-based article. Include the article in your submission.
Create an 8-10 slide PowerPoint presentation with speaker notes, in-text citations and a reference page slide.
LEADERSHIP AND MANAGEMENT: HEALTH CARE REFORM – ACA
Name:
Institution:
INTRODUCTION
Affordable Care Act (ACA) is perhaps one of the most debated health care reform topics in the USA. Close to a decade since was enacted, ACA remains at the forefront of public policy debates. Although representing a significant achievement in health care reforms, it remains persistently contentious with divisive opinions over the associated costs and benefits, and whether it should be repealed or replaced. It is undeniable that the legislation has had a profound effect on health care delivery in the country, through substantially reducing the number of uninsured individuals, increasing quality of care, and reducing costs. These benefits have been realized through efforts targeted at expanding insurance coverage and improving health care delivery systems. Despite the significant benefits, ACAs continued presence appears uncertain owing to the public policy debates on the legislation (McIntyre & Song, 2019).
FACT #1: EXPANDED INSURANCE COVERAGE
Created marketplaces for health insurance.
Encouraged choice and competition.
Subsidized insurance plans.
Expanded Medicaid program eligibility.
Targeted persons living below poverty line.
ACA has expanded insurance coverage in two ways. Firstly, it has created marketplaces for health insurance through encouraging choice and competition. This allows the market to compare between many insurers and choose a plan that best fits the existing needs. Additionally, it has provided subsidized insurance plans for persons living below the poverty line. Secondly, it has expanded Medicaid program eligibility so that persons living below the poverty line can access insurance. Since it was enacted, insurance coverage has increased by approximately 20 million people (McIntyre & Song, 2019).
FACT #2: RESHAPED PRIVATE INSURANCE
Established new consumer protections.
Protections against discriminations.
Protected persons with pre-existing conditions.
Abolished lifetime and annual limits.
Introduced dependent coverage provision.
ACA has improved private health insurance in three ways. It has established new consumer protections that have created a fairer market place. Under the legislation, private insurers are prohibited from discriminating against individuals on the basis of health status. Prior to the legislation, persons with preexisting conditions were required to pay higher premiums, and it was not uncommon for them to be denied insurance. In addition, the legislation abolished lifetime and annual limits on covered benefits. Besides that, the legislation introduced a dependent coverage provision that increased the age of children dependents up to 26 years of age thus allowing more young people to enjoy insurance coverage (McIntyre & Song, 2019).
FACT #3: LEGISLATIVE CHALLENGES
50 million attempts to repel the legislation.
Continued survival a testament to ACA’s durability.
Political debate challenging owing to vote implications.
The Senate and Congress have presented numerous legislative challenges targeted at ACA. For one, they have advanced more than 50 billion attempts to repeal the legislation either in part of whole. Its continued survival, although with slim legislative advantages, is a testament to the legislation’s legislative durability. Besides that, the political challenge of withdrawing health benefits for a significant proportion of the population has made the possibility of removing the bill insurmountable despite being on tenuous grounds divided along partisan lines (McIntyre & Song, 2019).
FACT #4: CHALLENGES FROM TRUMP ADMINISTRATION
Used presidential veto power to terminate funding for cost reductions.
Reduced resource allocations towards public education and outreach activities.
Eliminated some consumer protections.
The Trump administration has repeatedly undertaken regulatory actions to undermine ACA, arguing that these actions promote state innovation and consumer choice. Firstly, the administration has used presidential veto power to unilaterally terminate funding for cost-reductions. This has negatively affected insurance enrollment through reducing supplemental subsidies so that some low income households are no longer able to afford health insurance. This action has also destabilized the insurance market. Secondly, it has reduced resources allocated to public education and outreach activities, resulting in low insurance enrolment. Thirdly, it has eliminated some of the consumer protections, such as allowing states modify Medicaid by requiring that nondisabled beneficiaries join the workforce before qualifying for insurance benefits (McIntyre & Song, 2019).
FACT #5: JUDICIAL CHALLENGES
Threat to legislative sustainability.
Turned Medicaid expansion into a state option.
Judicial rollback of subsidies on ACA marketplaces.
Texas ruling of 2018 zeroed-out mandate as unconstitutional.
Judicial actions have been a threat to the legislation, particularly its sustainability. In 2012, the Supreme Court determined that Medicaid expansion was not a nationwide mandate but a state option. This has enabled some states to refuse to expand Medicaid program to include more persons living below the poverty line. Yet another challenge is judicial rollback of subsidies on ACA marketplaces. Another challenge in the Texas ruling of 2018 that made a ruling against the zeroed-out mandate as being unconstitutional. Since the mandate is an integral part of the legislation, then the implication is that the rest of ACA could also be scrapped. The case is currently before an appeals court, and there is a possibility of the judicial processes proceeding to the Supreme Court (McIntyre & Song, 2019).
LOOKING FORWARD
Possibility of repeal is dim.
Possibility of stabilizing ACA also slim.
Voter influence could have significant effects.
Debate is an opportunity to rethink the role of government as represented by judiciary, legislature and executive.
Although the possibility of repealing ACA appears dim since the democrats control Congress, the possibility of stabilizing the legislation similarly appear slim. This is especially so in the face of Trump administration opposing the bill. Besides that, health care remains an important issue among voters, and politicians must consider the political repercussions of taking a stance. Perhaps, the debate on ACA is an opportunity for the roles of the different arms of the government (judiciary, legislature and executive) in health care policy to be evolved.
RECAP
Reference
McIntyre, A. & Song, Z. (2019). The US Affordable Care Act: reflections and directions at the close of a decade. PLoS Med, 16(2), e1002752. DOI: 10.1371/journal.pmed.1002752. Retrieved from https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002752
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