The Affordable Care Act (ACA)

The Affordable Care Act (ACA) stands as a landmark piece of legislation that has transformed the way Americans access and receive healthcare services today. As one of the most important healthcare reforms in American history, ACA was enacted in 2010 for various reasons. It was meant to expand healthcare coverage, control healthcare costs, and solve issues related to equitable healthcare delivery (Neiman et al., 2021). Advanced Practice Nurses (APNs) are well positioned to oversee the implementation of ACA and improve its efficiency in promoting quality care. This discussion deals with the key provisions of the Affordable Care Act, examining its impact on APN practice, and the extent of its implementation at the state level.

APN and ACA

The Affordable Care Act is made up of many provisions that hold the potential to improve care and access to services for uninsured individuals. The first component that is present in the Act is an expansion of health insurance coverage. The Act expands access to health insurance coverage through provisions like the establishment of health insurance marketplaces and the expansion of Medicaid in participating states (Neiman et al., 2021). For example, the law requires employers to cover their workers and expands Medicaid coverage to low-income individuals. The second component of the Act is an emphasis on preventive care and wellness promotion. The law requires insurance plans to cover preventive services like immunizations and it provides grants for health promotion through the Prevention and Public Health Fund (Neiman et al., 2021). The third key component of ACA is quality improvement. The law requires investment in health information technology and provides guidelines for minimizing errors. It also promotes preventive health screening at all ages and it requires oversight of health insurance premiums and practices.

Why Important

The three components align with APN practice through its core principles and the creation of opportunities to contribute meaningfully to healthcare reform. The first component talks about the expansion of health insurance coverage to increase access to healthcare and reduce disparities. APNs are concerned with the issue of healthcare access and how healthcare policies can improve this area. For example, the policy competence for APNs requires the nurse to advocate for policies like ACA which promote access, equity, quality, and cost (D’Aoust et al., 2021). Secondly, this component deals with improving access to all individuals regardless of their financial income to reduce health disparities. APNs are aligned to this component because they mostly serve in underserved areas, playing a crucial role in addressing these disparities by providing quality care to vulnerable populations.

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The second component of ACA is an emphasis on preventive care and wellness promotion. APNs are tasked with providing preventive care services across the lifespan and wellness promotion through holistic approaches. For example, the APN is trained to provide screening services, health education, and immunizations to prevent certain diseases. This component also relates to the aspect of reducing cost which is a key area of focus for advanced nurse practitioners (D’Aoust et al., 2021). APNs’ expertise in preventive care contributes to early detection, management, and education, leading to improved health outcomes and cost savings. The third component talks about quality improvement by focusing on technologies and practices to monitor costs. Quality improvement is among the core competencies of APN practice, requiring them to evaluate relationships between access, cost, quality, and safety (D’Aoust et al., 2021). APNs work with interprofessional teams to oversee healthcare expenditure and contribute to meaningful utilization of resources.

Your State and the ACA

Michigan is among the States that have adopted the Affordable Care Act provisions to a certain degree. The state has implemented several provisions of the ACA and is in the process of meeting other requirements. The first component of expanding healthcare coverage has been implemented through the Michigan Department of Health and Human Services (MDHHS). For example, starting in January 2024, the department expanded Medicaid coverage to include community health workers (State of Michigan, 2024). This expansion is among other strategies like targeted case management, health homes models, and Medicaid Health Plan contracts that exist to increase access to healthcare services in the State.

The second component of preventive care and wellness promotion has been adopted in Michigan. There exist several funding programs aimed at increasing preventive services in the State. Through the established Prevention and Public Health Fund (PPHF) program, Michigan has already received $215,878,959 from FY10 to FY22 (The Michigan Department Of Health And Human Services (MDHHS), 2022). The State also utilizes the Preventive Health and Health Services (PHHS) Block Grant to support preventive services for chronic diseases like diabetes and cardiovascular problems. The funds are also utilized to address issues like healthy foods and fighting gun violence.

The Transition of Care from A Hospital to A Skilled Nursing Facility

The third component of improving quality through enhancing patient care and accountability oversight for funds has been partially adopted in Michigan. Several quality improvement programs have been adopted to ensure good care is given to patients. ACA requires States to increase Medicare reimbursements to 100% to support better ambulatory and preventive care. However, Michigan has set the Medicare reimbursement rate at 80% of the cost of providing services (MDHHS, 2022). Although some specific services have a higher rate, the State is working to ensure compliance with the ACA provisions to improve quality and patient safety.

The State of Michigan has decided to implement the three components and this has a huge impact on healthcare delivery. Firstly, implementing the components has increased healthcare access to those in rural areas and marginalized communities. Their implementation has reduced the rate of noninsured individuals from 11% to 4.5% (State of Michigan, 2024). With an emphasis on preventive care and wellness promotion, Michigan has seen improvements in public health outcomes. The number of individuals who are seeking screening for chronic conditions has increased and more communities have been engaged in the fight for unhealthy living. Regarding the aspect of improving quality and financial accountability, the State has invested in technology. For instance, 100% of Michigan hospitals and 83% of Michigan’s eligible professionals have taken advantage of the EHR incentive programs.

In conclusion, the Affordable Care Act (ACA) has profoundly shaped the landscape of healthcare in Michigan. The three key components of ACA that have been implemented in the State include expansion of healthcare coverage, preventive care and wellness promotion, and quality improvement. APNs have played a pivotal role in these advancements, leveraging their expertise to provide high-quality, patient-centered care, and contributing to collaborative efforts aimed at improving healthcare access and outcomes.

References

D’Aoust, R. F., Brown, K. M., McIltrot, K., Adamji, J. M. D., Johnson, H., Seibert, D. C., & Ling, C. G. (2022). A competency roadmap for advanced practice nursing education using PRIME-NP. Nursing outlook, 70(2), 337-346.

https://doi.org/10.1016/j.outlook.2021.10.009

Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The affordable care act at 10 years: Evaluating the evidence and navigating an uncertain future. Journal of Surgical Research, 263, 102-109.

https://doi.org/10.1016/j.jss.2020.12.056

State of Michigan. (2024). MDHHS expands Medicaid coverage starting January 1 to include community health worker services.

https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2023/12/07/chw-benefit

The Michigan Department Of Health And Human Services. (2022). Michigan Health IT roadmap: “Bridge to better health” report. https://www.michigan.gov/mdhhs/-/media/Project/Websites/mdhhs/Doing-Business-with-MDHHS/Boards-and-Commissions/Health-Information-Technology-Commission/CY2022-Bridge-to-Better-Health-Report_Adopted_Final-Aug22.pdf?rev=4dd6bf50a4d24d71a049c15f7032b524