What does the Affordable Care Act mean for Nursing


Study Guide: Health Care Reform

Health Care Reform: Overview

When it comes to healthcare in America, we seem to believe that more is better–but does more healthcare result in better health? As a nation, we spend more on healthcare per person than any European country, yet our health outcomes are worse.  The PBS documentary, Money and Medicine was aired in 2012, and addresses one of the key issues of healthcare reform–the cost of health care.  Watch the trailer below, or the entire episode here: http://video.pbs.org/video/2283573727/

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The Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), passed in 2010, is a collection of laws that were created to reform health insurance and healthcare.

The ACA significantly impacts nurses both personally and professionally.  Bedside nurses are impacted by organizational changes that affect patient care, and may be providing information and resources to patients and caregivers about the ACA.  However, as Hynds, Hatch and Samuels (2014) noted, nurses indicate they need more knowledge to understand the ACA policy implications of their practice.

Now, you can either read the 974 pages of the law itself, or you can watch this short, animated video produced by the Kaiser Family Foundation, and visit the helpful online resources below:

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The YouToons Get Ready for Obamacare















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Affordable Care Act:  Five Years Later

The Commonwealth Fund has developed several online, interactive resources to illustrate the impact of the Affordable Care Act in its first five years of implementation.  Through personal stories, population and health systems data analysis, and graphics, the Commonwealth fund paints the picture of the impact of the ACA on individuals, businesses, providers and healthcare systems.  Take some time to explore these resources in preparation for this week’s discussion board.  Link:  The Affordable Care Act: A Look Back at the First Five Years.

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Review the two interactive digital features:  Coverage Reform

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and Delivery Reform

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Value-Based Purchasing–“Pay for Performance”

Increasingly, hospitals and healthcare providers are reimbursed not just for the amount of services provided (fee-for service), but for the results that are achieved for a particular patient population. As nurses, you may have observed policy changes that emphasize patient experience, prevention of hospital-acquired infections, and effective discharge planning to avoid unplanned re-admissions.  In hospitals, we hear a lot about Hospital Consumer Assessment of Healthcare Providers and Systems–more likely known for its acronym: HCAHPS. We also hear the term “Core Measures,” which refers to a national standardized performance measurement system.  Health system performance reports are easily accessible to the public on the Centers for Medicare and Medicaid Services (CMS) website, where consumers can compare the performance of local hospitals and providers.


Visit the CMS Hospital Compare website:  http://www.medicare.gov/hospitalcompare/search.html

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Look up the hospital where you work or live.  Explore the performance measures across the various categories, especially “Survey of Patient Experiences” and “Timely and Effective Care.”  Consider how your work is affected by these measures.

Accountable Care Organizations and Medical Homes

Hospitals and healthcare providers are reimbursed for Medicare services based on their performance on key measures.  In order to improve results, providers have organized Accountable Care Organizations and Medical Homes to provide a more comprehensive, coordinated approach to achieve better health and lower costs.  Many organizations have established partnerships to collectively be responsible for a group of patients (Accountable Care Organizations) and provide a “Medical Home” approach to improve patient care outcomes.

The Kaiser Family Foundation has created a brief video to explain Accountable Care Organizations:


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The Cleveland Clinic video below describes such an approach:

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Medicaid Expansion

Originally, the Affordable Care Act mandated expansion of Medicaid to include a larger sector of the population–up to 138% of the Federal Poverty Level, with federal dollars funding the vast majority of the related costs of coverage. However, the Supreme Court ruled that the decision to expand Medicaid rests with the states.  Florida was one of the states which has not expanded Medicaid (at least at this writing); the issue has become a hot debate in the 2015 legislative session.  The following articles from the Kaiser Family Foundation provide a little background to learn more about Medicaid expansion and the experience of states who have expanded coverage:

Video:  Expanding Affordable Care through Medicaid

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How Well Does Your State Perform?

The Commonwealth Fund’s Scorecard on State Health System Performance (2014) assessed states on 42 indicators of health care access, quality, costs and outcomes from 2007 to 2012.  This interactive tool (link below) will show the gains that your state could achieve by improving its performance to the level of better-performing states, as well as the losses that would result if your state failed to sustain its performance.  Take a look–how does your state perform?

Commonwealth Fund Scorecard on State Health System Performance Interactive Tool

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What does the Affordable Care Act mean for Nursing?

You will respond to this question in this week’s discussion forum, based on an article by Brenda Luther and Sara Hart: What does the Affordable Care Act mean for nursing?  , and the articles and resources you used to develop your Health Care Reform paper.  The American Nurse’s Association has developed an excellent summary of how the ACA impacts nursing:  http://nursingworld.org/MainMenuCategories/Policy-Advocacy/HealthSystemReform/AffordableCareAct.pdf

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Additional Resources:

Here are several excellent resources to increase your knowledge about the ACA, in preparation for this week’s Discussion Board on Healthcare Reform.

1.  U.S. Department of Health and Human Services: http://www.hhs.gov/healthcare/

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2. Kaiser Family Foundation: Health Reform: http://kff.org/health-reform/

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3. The Facts on Medicare Spending and Financing: http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/

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4. Read Article: Summary of the ACA: http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act/

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5.  Read Article: What does the Affordable Care Act mean for nursing?  (Luther & Hart, 2014)

I hope this study guide was helpful in gaining a better understanding of the Affordable Care Act.  You will apply this information as you participate in this week’s paper and discussion on Health Care Reform.


Hynds, R. L., Hatch, J. L., and Samuels, J. G. (2014). The Affordable Care Act 2010: Educational needs of bedside nurses.  Journal for Nurses in Professional Development, 30(6), 281-6. Doi: 10.1097/NND.0000000000000101

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