Running head: AFFORDABLE CARE ACT 1

Affordable Care Act

Tonya Bright

Jacksonville State University

NU 710

Health Care Policy and Finance

Dr. Leigh Keith

January 20, 2020

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Affordable Care Act

The purpose of the Patient Protection and Affordable Care Act (ACA) is threefold:

decrease the cost, increase access, and improve the quality of health care in America (O’Malley,

2013). The ultimate goal of reform is access to affordable health care and insurance with a

patient-centered approach focusing on the prevention of chronic disease (O’Malley, 2013;

Kokulak, 2014; Cleary & Wilmoth, 2011; Biener, Zuvekas, & Hill, 2018). The increased

coverage from the initiation of the ACA has increased the need for and exacerbated the shortage

of registered nurses (Arnold, 2013; Shindul-Rothschild & Gregas, 2014). Title IV of the ACA

established new training programs for nurses and health care professionals, which link payment

to quality outcomes (Cleary & Wilmoth, 2011). Title V established a National Workforce

Commission to ensure adequate numbers and skills for the workforce of the 21st century (Cleary

& Wilmoth, 2011). Cleary and Wilmoth (2011) project a shortage of 300,000 nurses and 90,000

doctors by 2020 (Kokulak, 2014). The health care delivery models in the ACA require a higher

educated workforce using evidence-based practice to improve the quality and decrease the cost

of health care while participating in multidisciplinary teams, leading community health

initiatives, and coordinating the transition of care (Cleary & Wilmoth, 2011). Title VIII of the

ACA provided funding for nursing education with grants, a loan repayment program, and

scholarships (Cleary & Wilmoth, 2011).

The Future of Nursing: Leading Change, Advancing Health from the Institute of

Medicine (IOM) in 2010 recommends the removal of scope-of-practice barriers for Nurse

Practitioners (NPs). Ruegg (2013) refers to several studies concluding NP clinical practice is

safe, comprehensive, cost-effective, and equivalent to the care of physicians in the same practice

setting. Medicare payment reform ties good practice to higher reimbursement rates, with 15%
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overpayment allowed for preventative services (Aoughsten, Johnson, Kuruvilla, & Bionat,

2015). Aoughsten et al. (2015) state there is a reduction in payment for hospitals with high re-

admission rates for heart attack, heart disease, and pneumonia. Reimbursement is reduced for

hospital-acquired conditions, like infections, falls, or stasis ulcers (Aoughsten et al., 2015).

Advanced practice nurses (APNs) can influence strategies, protocols, and guidelines to decrease

re-admission, decrease cost, and increase quality care delivery through nurse-led clinics, health

education, illness management, and disease prevention (Aoughsten et al., 2015).

The public school system emphasizes healthy living and prevention of illness. Federal

grants allow for vision screening and follow-up of all students in kindergarten, second grade, and

fourth grade. Senate Resolution 113 (2018) urges all K-12 schools to participate in flu

vaccination clinics usually held each fall. The Alabama Department of Public Health (ADPH)

requires a Tetanus, Diphtheria, and Pertussis (Tdap) vaccine before entering sixth grade. The

Jessica Elkins Act (2013) necessitates parent notification of the meningococcal conjugate

vaccine (MCV) for students in grades six through 12. Since 2019, the Center for Disease Control

and Prevention (CDC) recommends a human papillomavirus (HPV) vaccine starting at age 11.

Vaccination clinics for the Tdap, HPV, and MCV occur in the spring. Senate Joint Resolution

62, adopted pursuant to the Code of Alabama 1975, Section 16-29-1 requires scoliosis screening

for children in fifth grade to ninth grade (Alabama State Department of Education & ADPH,

2019). Nursing students facilitate the scoliosis screening of students in the public school system

annually. The physical education department employs fitness testing twice a year for all students.

Some schools hold a health fair and invite families from the community to participate.

This writer’s school sponsors “Workout Wednesdays” where teachers are allowed to

wear comfortable clothing and include extra recess or exercise time during the day, many taking
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advantage of the time to walk and increase their steps for the day. A running club meets after

school for any student interested in walking or running with friends. The Mercedes Marathon is

also encouraged, and the coach tracks the student’s progress through the year.

The counselor and school resource officer teach lessons on the negative impacts of

smoking, drinking, and drugs on the body. Coping strategies for stress and anxiety involve small

groups. Problem-solving skills and relationships with peers are discussed repeatedly throughout

the school year. Monthly assemblies transpire where the principal or high school students discuss

character traits, like honesty, loyalty, and integrity. The younger students listen and respond well

to high school teenagers. For students having difficulties, high school football players and

cheerleaders come to eat lunch them monthly for support and encouragement. Michelle

Obama’s (2010) “Let’s Move” initiative influenced changes in the Child Nutrition Program in

public schools. Vending machines no longer contain soft drinks for students to purchase. Instead,

sports drinks, juice, and water bottles are now available. Other changes include foods being

baked instead of fried, wheat bread replacing white bread, rolls, and buns, providing low-fat

milk, serving dessert twice a month, and offering fruits and vegetables daily. Students must

choose items from at least three of the four food groups to be considered a complete meal.

The changes implemented in the public school system are attempts to change lifestyle

choices to continue into adulthood. The school nurse plays a vital role in education and

preventative services for children in the school setting. This APN can influence policy and

implementation of new initiatives and standards of practice in the school setting. Working with

administration, teachers, physical therapy, occupational therapy, speech, special education, child

nutrition, and parents is one way this APN participates on a multidisciplinary team to evaluate,

plan, implement, and monitor the outcome of the health needs of the students in school.
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References

Alabama State Department of Education & Alabama Department of Public Health. (2019).

Alabama health services scoliosis guidelines. Retrieved from

https://www.alsde.edu/sec/pss/Health%20Medications/ALABAMA%20PUBLIC

%20SCHOOL%20SPINAL%20SCREENING%20MANUAL%20%202019.pdf

Aoughsten, J., Johnson, S., Kuruvilla, M., & Bionat, S. (2015). The effect of the Affordable

Care Act on Medicare: Opportunities for advanced practice nursing. Nurse Leader,

13(3), 49–53. https://doi-org.lib-proxy.jsu.edu/10.1016/j.mnl.2014.07.018

Arnold, H. (2013). The Affordable Care Act and international recruitment and migration of

nursing professionals. Indiana Journal of Global Legal Studies, 20(2), 1373–1391.

https://doi-org.lib-proxy.jsu.edu/10.2979/indjglolegstu.20.2.1373

Biener, A., Zuvekas, S., & Hill, S. (2018). Impact of recent Medicaid expansions on

office-based primary care and specialty care among the newly eligible. Health

Services Research, 53(4), 2426–2445. https://doi-org.lib-proxy.jsu.edu/10.1111/1475-

6773.12793

Center for Disease Control and Prevention. (2019).Vaccine for HPV. Retrieved from

http://www.cdc.gov/vaccines/spec-grps/preteens-adol.htm

Cleary, B., & Wilmoth, P. (2011). The Affordable Care Act: What it means for the future of

nursing. Tar Heel Nurse, 73(2), 8–12. Retrieved from http://search.ebscohost.com.lib-

proxy.jsu.edu/login.aspx?direct=true&db=rzh&AN=104889157&site=eds-live

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health.

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24983041

Kokulak, S. (2014). Wait and See. Benefits Magazine, 51(8), 26. Retrieved from
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http://search.ebscohost.com.lib-

proxy.jsu.edu/login.aspx?direct=true&db=f5h&AN=97491175&site=eds-liv

Obama, M. (2010.). Let’s Move. Retrieved from

https://letsmove.obamawhitehouse.archives.gov/about

O’Malley, D. (2013). The Affordable Care Act, science, and childhood adversity. Nursing

Administration Quarterly, 37(3), 216–221. doi: 10.1097/naq.0b013e318295f5d8

Ruegg, T. A. (2013). A nurse practitioner-led urgent care center: Meeting the needs of the

patient with cancer. Clinical Journal of Oncology Nursing, 17(4), E52–E57. https://doi

org.lib-proxy.jsu.edu/10.1188/13.CJON.E52-E57

Senate Resolution 113, 115 Cong. (2018).

Shindul-Rothschild, J., & Gregas, M. (2013). Patient turnover and nursingemployment in

Massachusetts hospitals before and after health insurance reform: Implications for the

Patient Protection and Affordable Care Act. Policy, Politics & Nursing Practice, 14(3/4),

151–162. https://doi-org.lib-proxy.jsu.edu/10.1177/1527154414527829

The Jessica Elkins Act. S. 75, 113 Cong. (2014).