DNP-840A- Leadership for Advanced Nursing Practice

Bonnie Flores

The implementation of the Affordable Care Act (ACA) was a huge benefit to the American population; however, while there were many benefits that came out of it, barriers continue to exist. The passage of the ACA enabled people with pre-existing conditions to purchase health coverage for a reasonable amount of money, and it allowed those who were ineligible due to pre-existing conditions to purchase insurance (Harvard, 2017). For middle-class Americans, being able to purchase a plan or receive a health plan from work enabled them to keep their children on their plan until the age of 26 for lower medical premiums (Harvard, 2017). Medicaid benefits were also greatly expanded under this program, but these benefits vary depending on where you live. For example, Medicaid coverage was expanded in most states; however, twelve states elected not to expand coverage (Alio et al., 2022; Harvard, 2017). Some of these states do not allow for Medicaid benefits unless you are well below the poverty line; Texas does not allow for Medicaid coverage unless a single parent earns less than $6,000 annually, for those with no children, you do not qualify for Medicaid unless you are disabled (Harvard, 2017). This illustrates the point that healthcare can be inequitable depending on where you live and shows how many disparities exist due to racial stigmatization of Medicaid since their health systems are highly politicized and do not advocate for health equity (Alio et al., 2022; Harvard, 2017). Additionally, Medicaid reimburses providers at a lower rate than Medicare, which reduces the number of physicians who take the coverage (Alio et al., 2022). This adds to continued health inequities in poor and minority populations, thus continuing a cycle of health disparities based on structural racism Alio et al., 2022).

As a doctoral leader, I would advocate for increased reimbursement for Medicaid recipients so that providers would not have to choose between Medicare and Medicaid. Increased reimbursements or incentives to take on Medicaid recipients would allow for minorities and those with lower socioeconomic means to be treated as equally as everyone despite their geographical location. An additional intervention would be to advocate for medical centers to adopt the Street Nurse Program so nurses could go into the community and treat those who live in homelessness. The Street Nurse Program in California helps those living with housing and food insecurities and gives access to basic healthcare needs by sending a nurse to homeless encampments to tend to basic medical care (American Organization for Nursing Leadership, 2021). This program aligns with my worldview to ensure that health access is equitable for all humans despite the ability to pay for services.

References

Alio, A. P., Wharton, M. J., & Fiscella, K. (2022). Structural Racism and Inequities in Access to Medicaid-Funded Quality Cancer Care in the United States. JAMA Network Open, 5(7), e2222220-e2222220.

American Organization for Nursing Leadership. (Host). (2021, May). Street nurse program delivering care to meet patient [Audio podcast episode]. In Today in Nursing leadership. SoundCloud.

Harvard University. (2017, October 6). It depends what state you're in: Policies and politics of the US health care system – Part 1 [Video]. YouTube.

Shabnampreet Kaur

There are many barriers to healthcare delivery resulting from state and federal laws. One such barrier is the lack of Medicaid expansion in some states. Although the Affordable Care Act was enacted to increase the coverage for healthcare insurance for all Americans, the decision by the Supreme Court in 2012 gave the option to states to opt out of the Medicaid expansion(Singer & Rozier, 2020). As a result of this decision, many states chose not to expand Medicaid coverage, leaving millions of people without healthcare coverage. Many low-income Americans and immigrants cannot access health care due to affordability issues. This issue is giving rise to poor health outcomes and increasing healthcare costs by leading to chronic disease and adverse events, which could be preventable with proper primary care. Lack of Medicaid expansion can lead to a vicious cycle of poverty. A recent study(Baicker et al., 2023) discussed some strategies to achieve universal health coverage in the country. These strategies include determining how much insurance and healthcare access society wants based on the health benefits generated by a service. It also should consist of payment models for the type of services, and the authors gave examples of Medicare Advantage Plans and social insurance in the Netherlands and Switzerland. Then, the authors talked about cost-sharing options. As advanced practice registered nurses, Doctor of Nursing Practice (DNP) prepared nurses are uniquely positioned as leaders and educators to advocate for Medicaid expansion in all states. The learner can work with the national and locally accredited nursing bodies to prompt discussions on the strategies discussed in the study mentioned above. Another way the learner can recommend change to the policy is to make Medicaid expansion mandatory for all states. This would ensure everyone can access affordable health care regardless of income level or location. It would also reduce the number of uninsured individuals, reducing the burden on hospitals and healthcare providers currently caring for uninsured patients. During the pandemic, Medicaid expansion for all the states was discussed. In a report(Blumberg & Mann, 2020), the economic aspect of this issue was discussed in detail. This task is complex, but the learner can lobby, educate the public, develop innovative healthcare models, and conduct more research on this topic to make the officials aware. The potential positive impact of the mandatory Medicaid expansion is undoubtedly an improvement in patient care with easy access to primary care focusing the preventative care, reduced hospitalization, and ER visit rate.