“Please don’t admit me to the hospital,” she sobbed. Another overnight hospital stay, she explained, would add to the mounting healthcare bills that threatened to bankrupt her family. She didn’t want to be a burden. She was status post-kidney transplant—and only 12 years old.
This happened just a few months ago, and her family was unaware that the Patient Protection and Affordable Care Act (ACA) of 2010 had eliminated the restriction that meant children younger than 19 could be denied coverage based solely on a preexisting condition. No 12-year old should be burdened with adult financial nightmares.
Enacted a little over 1 year ago, the ACA may be one of the most underappreciated pieces of legislation by the public, including nurses. Regardless of your political affinity, you should know that the ACA aims to remove barriers to affordable health insurance coverage, broaden the rights and benefits of care for everyone, and provide incentives to reward prevention and quality, not volume and illness. It’s tragic that this law, with the capacity to do so much good in terms of providing affordable, high-quality health care, is being used as political fodder for partisan gamesmanship.
For the elderly who hailed Medicare prescription drug coverage but found themselves unable to pay for drugs once they reached the threshold known as the “doughnut hole,” the ACA provides funding that was shortchanged in the original legislation. I have witnessed an elderly woman at a prescription counter tell the pharmacy technician she couldn’t afford to pay for her prescriptions and then walk away without the drugs—with no means to return with money to buy the drugs and no one to follow up on the impact of her not taking the prescribed medication. Between now and 2020, Medicare recipients will be less likely to choose between filling prescriptions and filling their dinner plates. Already close to 4 million have received $250 rebate checks and many have become eligible for a 50% manufacturer’s discount on brand-name drugs.
Starting in 2010, the ACA has provided many other benefits and consumer protections, such as annual wellness visits for Medicare recipients, tax credits for small businesses offering health insurance, continued coverage of young adults up to age 26 on most insurance plans, lifting of lifetime insurance limits, monies for states to enhance consumer assistance programs on health insurance coverage, out-of-network emergency-department coverage, and help for employers to provide early retiree reinsurance. Nurses and others who work in underserved areas have benefitted from additional scholarships and loans.
The ACA aims for better quality and value, driving changes to create a safer, more efficient, and more affordable healthcare system. The newly formed Center for Medicare and Medicaid Innovation (CMMI) will test new delivery models and ideas to slow the rate of rising healthcare costs. Over the next 3 years, initiatives such as accountable care organizations, hospital value-based purchasing, and the shared savings program will reward value—linking payments to outcomes resulting from better coordinated care and team work across settings. Future efforts will target reducing waste, paperwork, and administrative costs. One of the less popular provisions is disallowing Medicaid payments for conditions that patients should not acquire in hospitals—similar to the curtailments Medicare has made since 2008. A stepped-up crackdown on fraud is helping fund the new initiatives, as are such programs as Medicare’s Community Care Transitions, which helps reduce readmissions through improved communication and planning for hospital transitions.
In 2014, health insurance exchanges will make insurance available for individuals, and tax credits for the middle class will help make insurance more affordable. ACA is under constitutional challenge for its most controversial requirement that all individuals acquire health insurance. The White House has signaled increased flexibility for implementing this part of the law by allowing states to create their own coverage systems if desired.
The ACA mirrors the motto and brand strategy of the Salvation Army—“Doing the most good.” In the words of the Salvation Army’s first female General, Evangeline Booth in 1919, “There is no reward equal to that of doing the most good to the most people in the most need.”
We can all agree the system is in need of reconditioning. The ACA takes major steps to address the needs of many. We will have to grapple with the issues of individual rights, achieving proposed savings to pay for new programs, enacting malpractice reforms, and the most difficult of all—curtailing rising Medicare and Medicaid costs, which consume huge portions of our federal and state budgets.
As nurses, we have an obligation to understand and educate others about the changes needed in health care. I urge you to support ACA initiatives that will drive an agenda for more affordable, equitable, high-quality care. That’s not partisan politics. It’s part of taking responsibility for our profession’s role in leading change and advancing health. For detailed information on the ACA, visit www.Healthcare.gov and click on “Understanding the Law.”