This public health policy paper will discuss and outline the Affordable Care Act (ACA) as well as barriers and controversies surrounding the policy and its relevance in nursing profession. The ACA will eventually affect everyone. Statistics reflecting United States health outcomes have proven the need for the initiation of policy formation within the United States healthcare system. “In March 2010, President Obama signed into law a comprehensive health reform, the Patient Protection and Affordable Care Act (ACA).” (Estes, Chapman, Dodd, Hollister, Harrington, 2013, p. 144) The ACA promotes preventive care—including related services and family planning—that should result in improved health outcomes and increased more accessibility and affordability for many Americans (Health & Human Services). Looming aspects of health care act will not only assist with issues of health care access, but also create greater accountability for practicing clinicians that should result in improved outcomes.
Access issues such as the lack of health insurance and being underinsured, can be exacerbated by the current shortage of health professionals that exists in many disadvantaged areas. Some physicians and other medical providers may have the unwillingness to treat persons with public insurance coverage because the reimbursement rate, as well inadequately trained medical providers. With public insurance growing, low-income individuals face barriers acquiring health care considering they don’t have the means to afford it. In some cases, people of lower socioeconomic status are sometimes unaware of symptoms that elicit medical attention and have difficulties explaining their symptoms to health professionals. Others experience language or cultural barriers when looking for care (Swartz, 2009, p. 1). “As a result of these existing barriers, efforts to assist low-income people and those that face cultural and language barriers obtain health care have expanded to include more funding for community health centers, public health clinics, language translators, and health education programs about health issues specifically targeted at the disadvantaged. The box below shows history of major efforts to provide health care to the poor since 1900. The figure shows historical contributions over the pass century of how health care assistance is administered.” (Swartz, 2009, p. 1)
1900-1935: Medical care assistance provided ad hoc by civic and religious groups, primarily to “deserving poor” 1935-1945: Social Security Act passed, rise of public hospitals and clinics for poor, beginning of two-tiered system of medical care 1945-1965: Private insurance coverage expands, setting the stage for Medicaid 1965: Medicare and Medicaid Implemented
1984-1990: Expansion of Medicaid
1990s: Efforts to slow Medicaid spending growth, waivers, and welfare reform 1997: Creation of the State Children’s Health Insurance Program (SCHIP) Early 2000s: Efforts to control Medicaid spending growth and state experiments to expand options for poor people (Chart cited from: Health care for the poor: For whom, what care, and whose responsibility?) Considering these information alone supports the need for law to continue to improve and change here in the United States. The fact that unlike any other economically developed country in the world, the United States has tens of millions of citizens who do not have adequate health insurance coverage and therefore go without needed medical care. There are programs that assist individuals that do not have adequate or who completely lack coverage when seeking medical attention. Because of this lack of knowledge or fear of mounting medical debt, the underinsured and uninsured both get sicker and are forced to incur greater significant medical costs when they do see a physician; increasing the United States morbidity and mortality rate. Evidence of Needed Change
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