DNP Role Development for Doctoral Advanced Nursing Practice, Second Edition

(Nandana) #1
18: DNP-PREPARED NURSE’S ROLE ■ 419

health care is a benefit of citizenship. The Department of Health and Human Services
(DHHS, 2014) reported that 4 years after the Patient Protection and Affordable Care
Act (PPACA) had been enacted the number of uninsured adults decreased by 10.3 mil-
lion. However, 5 years after the passage of the PPACA of 2010, the employer- based
commercial health plans remain the major source of health insurance for the major-
ity of American workers and their families (Kaiser Family Foundation [KFF], 2014a).
The aged, the poor, the totally and permanently disabled, and special populations such
as active duty military and their dependents, and veterans participate in health insur-
ance programs supported by the federal and state government insurance plans. At the
time of the enactment of the PPACA, it was estimated that approximately 47 million
Americans (18% of the population) were underinsured (KFF, 2014b). Despite its com-
plexity and the engagement of the government and the private sector, American health
care faces three persistent policy challenges: the iron- triangle of access, cost, and quality
(McClellan & Rivlin, 2014).


ACCESS


Without health insurance there is limited access to health care services unless a person
has the ability to pay his own health care bill. For the majority of Americans, health insur-
ance is obtained through enrollment in: employer- supported health insurance plans;
plans purchased from private sector insurance brokers; the ACA’s health exchange;
or government- sponsored health plans such as Medicare and Medicaid. Each option
requires that enrollees and their dependents meet eligibility requirements, adhere to
enrollment timelines, and pay required premiums and fees. As the major purpose of
the PPACA (2010) is to reduce the number of uninsured Americans, the law includes
mandates to enable all people to obtain affordable health insurance. These mandates
affect: employees, insurance providers, employers that offer insurance plans, and all
under- or uninsured citizens. Those who fail to comply with the mandates pay fines.
These mandates are not popular; efforts to rescind them or challenge their constitution-
ality have been engaged at all levels of government. The PPACA is an issue in the 2016
Presidential election; members of Congress have introduced repeated bills to rescind
the ACA and/ or change some of its provisions; the Supreme Court has ruled on its
constitutionality in The National Federation of American Business (NIFIB) v. Sebelius , 2012
and King v. Burwell, 2015 (Center for Health Law, 2012; Scotus Blog, 2015). Although
anyone who works in, profits from, or cares about personal or population health care
is a stakeholder, education in health policy is required to actualize this responsibility.
Essential V urges nurses, especially APNs, to actively participate in health policy devel-
opment and evaluation.


COST


Another important goal of the PPACA is the reduction in the growth of health care
costs. Although America has the highest health care costs in the world and invests
17% of its gross domestic product (GDP) in health care (World Bank, 2011– 2015),
cost control is challenging. McClellan and Rivlin (2014) suggest three complemen-
tary strategies to slow cost escalation: avoid wasteful spending, especially waste
linked to inefficiencies; increase market competition; and improve population health.
Waste reduction is a popular political theme, because waste accounts for about 20%

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