Category Archives: Affordable Care Act (ACA)
Cynthia Crone, MNSc, APRN, CPNP, is deputy commissioner of the Arkansas Insurance Department, where she created and now leads the state’s Partnership Health Insurance Marketplace. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses.
I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.
How Can Health Systems Effectively Serve Minority Communities? Promote Health In Community Settings.
To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Monica E. Peek, MD, MPH, assistant professor of medicine and associate director of the Chicago Center for Diabetes Translation Research at the University of Chicago, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Peek is an alumnus of the Harold Amos Medical Faculty Development Program.
With the health policy introduced by the Affordable Care Act, health systems have a unique opportunity (and admittedly, a challenge as well) to transform themselves in ways that promote health and not just treat illness. Such efforts are particularly relevant for racial/ethnic minorities, which disproportionately suffer from the morbidity and mortality of chronic diseases that are largely preventable in nature. Lifestyle changes (e.g. dietary patterns, physical activity, tobacco cessation, and limited alcohol intake) can prevent or help manage the majority of chronic diseases in the United States, which are disproportionately present within minority communities.
Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.
Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.
The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.
One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.
Much of the media coverage of the Affordable Care Act’s implementation has focused on the rollout of the state and federal health care exchanges. But in a new Robert Wood Johnson Foundation Clinical Scholars program video podcast, law professor Timothy Jost, JD, highlights some of the remaining challenges to the new law’s success. These include what he describes as the “huge problem of reconciliation.” For people with unpredictable annual incomes, including those with multiple part-time jobs or who move from job to job, the task of estimating their annual income for purposes of qualifying for federal subsidies is daunting, he explains. If their estimates turn out to be wrong, they could miss out on subsidies to which they’re entitled, or owe the government money at the end of the year.
Jost is the Robert L. Willett Family professor of law at Washington and Lee University. The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.
The video is republished with permission from the Leonard Davis Institute.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics.
In these early days of the Affordable Care Act, the uninsured rate has begun to sharply decrease. One recent estimate suggests 5.4 million adults gained insurance coverage in the first quarter of 2014. The Congressional Budget Office projects that enrollment in Medicaid and the health insurance Marketplaces will increase even more rapidly over the next two years.
The importance of increased health insurance coverage for improved access to health care justifiably receive much of the public’s attention, but the impact of coverage on the financial health of families may be equally important. Subsidized health insurance can increase the disposable income of families by freeing up money that was previously used to pay out-of-pocket for doctor’s visits and prescription drugs. Newly insured individuals also benefit from the risk-protection of health insurance since even people who use little or no health care are at risk of unexpected accidents or newly diagnosed diseases.
A recent study in Oregon that compared adults who received free health insurance through a lottery to those who applied but did not receive the free care found that the “winners” were much less likely to say that they needed to cut back on necessities to pay for health care. They also had much less medical debt and a lower likelihood of receiving a notice from a collection agency.
Nurses are “the backbone of efforts” to expand New Mexico’s primary care workforce, according to Gov. Susana Martinez, and they help ensure that people living in the state’s rural and underserved communities can get the high quality care they need and deserve. A video from the governor helped open the Robert Wood Johnson Foundation Academic Progression in Nursing meeting in Washington, D.C., this week, which brought together nurse leaders from around the country. In her remarks, Governor Martinez explains why New Mexico has implemented a common statewide nursing curriculum, made it easier for nurses in the state to further their education, and placed “a strong emphasis on nurses.”
This is part of the March 2014 issue of Sharing Nursing’s Knowledge.
“There has been tremendous growth in the nurse-managed health clinics, especially prior to the Affordable Care Act implementation, but certainly also now. I would go as far [as] to say that we won’t have a successful implementation of the Affordable Care Act if we don’t utilize nurse practitioners in primary care roles.”
--Tine Hansen-Turton, MGA, JD, CEO, National Nursing Centers Consortium, Nurse-Led Clinics: No Doctors Required, Marketplace Healthcare, March 5, 2014
“A lack of representative educators may send a signal to potential students that nursing does not value diversity. Students looking for academic role models to encourage and enrich their learning are often frustrated in their attempts to find mentors and a community of support. Clearly, we have a mandate to support and encourage nurses from minority groups in their quest to seek advanced degrees and to assume leadership roles in nursing education.”
--Jane Kirschling, PhD, RN, FAAN, president, American Association of Colleges of Nursing, Diversity in Nursing Education, Advance for Nurses, February 26, 2014
“The question for every nurse and every hospital board is how you go about promoting transformational change in which the emphasis is not on transitory, isolated performance improvements by individuals, but on sustained, assimilated, comprehensive change of the whole ... this report offers one answer: nurse leaders knowledgeable about how information technology can help redesign practices so that they are standardized, evidence-based and clinically integrated, and reinforce the values of a caring culture.”
--Angela Barron McBride, PhD, RN, FAAN, author of The Growth and Development of Nurse Leaders, TIGER Releases Study Aimed at Enhancing Nursing Informatics Education, Advanced Healthcare Network for Nurses, February 24, 2014
An interview with Nicole Lurie, MD, MSPH, the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, and an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program. She is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. The interview is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
Human Capital Blog: You write that the nation’s emergency care system is in trouble. What are the challenges facing emergency departments (EDs)?
Nicole Lurie: We’ve understood for at least a decade that the emergency system is in trouble. We ask a lot of this system, and as a result we have EDs that are really crowded and with long wait times, boarding times and throughput times. It’s become a de facto access point for many people who lack access to primary care or insurance, which wasn’t what it was originally set up for. Now, EDs have evolved to be more than places to treat life and limb threats and serve as default diagnostic and therapeutic entry points. But many people who end up in an emergency department may be willing to be treated in a different kind of environment. It is really up to us to build a system that accommodates their needs and ensure our emergency care system can do its important work.
And remember: We changed the way we deliver care in the U.S. from a hospital-based focus to an outpatient focus over the last few decades, but we never really built the infrastructure for it. Outpatient providers have had their visits shortened and group practice environments have changed the relationship between patients and their primary care providers. We hear about the shortage of primary care providers and the crisis of crowding and boarding in emergency departments, but we don’t always connect the dots to understand how we got here. It is a good time to start to have this conversation as payment models are encouraging us to recognize that generating health for our patients is a team effort.
HCB: How do you see the emergency care system evolving, particularly with respect to disaster preparedness?
Nicole Lurie, MD, MSPH, is the assistant secretary for preparedness and response at the U.S. Department of Health and Human Services (HHS), and Kacey Wulff, MPH, is special assistant to the assistant secretary, at HHS. An alumna of the Robert Wood Johnson Foundation Clinical Scholars program, Lurie is the co-author of “The U.S. Emergency Care System: Meeting Everyday Acute Care Needs While Being Ready for Disasters,” published in the December 2013 issue of Health Affairs, which focused on the future of emergency medicine. This is part of a series of posts featuring RWJF Scholars who authored articles in the issue.
As we approach the Affordable Care Act’s March 31 enrollment deadline, data is starting to emerge about how these reforms are making care more accessible, cost less, and, ultimately, Americans healthier. As these reforms take effect, and make our day-to-day health care system stronger, they also result in strengthening communities across the country to become more resilient and disaster-ready.
The gaps that inspired and propelled health reform like untreated chronic conditions and mental illness, and health disparities plague our health care system every single day. During a crisis, like a hurricane, earthquake, or attack, these issues can become magnified. As a result, the ability for individuals and communities to prepare, respond, and recover successfully is intrinsically linked to the strength of the underlying health care system.
The Affordable Care Act expands mental health and substance use disorder benefits and federal parity protections for 60 million Americans. As a result, many Americans who previously have not had coverage for mental health care will have greater access to this and other important aspects of health care. This will help to make the tools that support recovery from injuries sustained during disasters, whether illness, injury, or trauma, more accessible.
This boost in preparedness is important for responding to disasters big and small: the biggest indicator of how a person or community will fare during a disaster is how they were doing before the crisis struck. While health insurance doesn’t guarantee that you will be healthier, it does make health much more likely.