Pondering the Affordable Care Act: What’s Next?

After spending a year consulting for an organization on the front lines of the Affordable Care Act (ACA) implementation, I have learned several things about the effects of the ACA on healthcare, particularly nurses. I struggle, as many do, to make sense out of all of the details and to absorb many folks’ rage at the implementation of this law. The ACA offers several significant pieces to the US healthcare “quilt.” Regardless of how you feel about the ACA, you need to learn about it. Nurse.com did a great job of outlining the forecast of the future in their July 2014 issue (Damrose, Cathryn, p. 20-21). In addition I believe the following:

  1. People have always had access to healthcare. The law says anyone can go into an emergency room and be seen for anything. Who pays for it has been the age-old issue.
  2. Folks in unusual places are eligible for insurance coverage, e.g. inmates in prisons, jails, and residential mental health facilities. This will change how care for inmates is managed and paid for.
  3. Many people who have had no insurance coverage are now eligible for expanded Medicaid and community health services that they didn’t have previously. Many will utilize services that haven’t before.
  4. Prevention of disease and/or complication is the focus of care; not treating illness.
  5. Hospitals will again face pressure to keep inpatient admissions at a minimum~like they did when capitated medical plans first came to light 30 years ago. An empty hospital is a profitable hospital!
  6. Care management of chronic diseases is critical, and will be applied to large populations to eliminate need for hospitalization.
  7. Mental health care and management will be part of the services available.
  8. Care will be based in the community~ much like the community clinics of the 60’s.
  9. Hospitals will see more outpatient-based diagnostic testing, surgical intervention and prescriptions for these newly insured patients~and make money from them.
  10. The implementation of ACA will force healthcare organizations to focus on both clinical and business components of healthcare-not one at the exclusion of the other! APNs will need to provide both clinical care and business support to facilities.
  11. Private contractors will offer “turn-key” care management and chronic disease management.
  12. The RN role will change. They will become even stronger choreographers of care and prevention. New roles for RNs will be developed to integrate care management of different providers and facilities.
  13. RNs will need more education. What they need to know requires a BSN at a minimum. Public health, population management and chronic disease management are all detailed in bachelor’s level curricula.

I will explore some of these issues further in future blogs. One last thing to remember…As J. Paul Getty once said, “in times of rapid change, experience could be your worst enemy.” We might be at that crossroads. We are definitely not in Kansas anymore, and acting like we are will cause all sorts of frustration and no good results. Learn about the ACA and determine how it affects you personally and what you do.

Posted by Susan Odegaard Turner- MentorRN