D223 Task 2 Final: Analyzing the Affordable Care Act and Its Impact

Student Name

Western Governors University

D223 Healthcare Policy and Economics

Prof. Name:

Date

D223: Healthcare Policy and Economics

A1. Federal and State Public Healthcare Policy

What is a key federal healthcare policy affecting patient care and healthcare delivery?

One of the most influential federal healthcare policies is the Affordable Care Act (ACA), enacted in 2010. Commonly known as Obamacare, the ACA was designed to improve healthcare accessibility, affordability, and quality across the United States. It includes crucial provisions such as Medicaid expansion to cover more low-income populations, the creation of health insurance marketplaces where individuals can compare and buy insurance plans, and the establishment of essential health benefits that insurance plans must cover. Furthermore, the ACA promotes value-based care models, emphasizing preventive services, coordinated care, and improved health outcomes.

What is an important Nevada state healthcare policy that impacts healthcare delivery?

Nevada’s significant state policy in this area is Nevada Health Link, the state’s official health insurance marketplace. This platform enables residents to explore and enroll in health insurance plans tailored to their financial situations, with subsidies provided based on income. Nevada Health Link aims to increase health insurance coverage among residents, thereby reducing the uninsured rate and encouraging timely preventive care. By doing so, it supports healthier communities and improved access to necessary medical services.

A2. How Does Each Policy Work?

Affordable Care Act (ACA)

The ACA operates through several mechanisms to enhance healthcare access and quality:

Individual Mandate: Initially required most Americans to maintain health insurance or face a tax penalty, encouraging broader coverage. This mandate was repealed in 2017, removing the federal penalty for lacking insurance.
Health Insurance Marketplaces: Created state or federal platforms for individuals and families to compare and purchase insurance plans, with income-based subsidies to reduce costs.
Medicaid Expansion: Enabled states to broaden Medicaid eligibility to include more low-income adults who previously fell into coverage gaps.
Essential Health Benefits: Required insurance plans to cover a core set of services including preventive care, mental health, maternity care, and prescription drugs.
Protections for Pre-existing Conditions: Prohibited insurers from denying coverage or charging higher premiums based on existing health conditions.
Dependent Coverage Extension: Allowed young adults to remain on their parents’ insurance plans until age 26.

These provisions collectively aim to create a more equitable and comprehensive healthcare system focused on prevention and quality outcomes.

Nevada Health Link

Nevada Health Link functions as a user-friendly marketplace for residents to access ACA-compliant insurance plans from multiple private insurers. Key features include:

Plan Comparison and Enrollment: Residents can evaluate various plans based on coverage details, cost, and benefits.
Financial Assistance: Subsidies and premium tax credits are available for eligible individuals and families to reduce financial burdens.
Medicaid Eligibility Screening: Assists individuals in determining if they qualify for Medicaid or other assistance programs.
Support Services: Navigators and customer service representatives help residents understand options and complete enrollment.

While participation is voluntary, the marketplace encourages enrollment by simplifying access and connecting residents to financial support.

A3. What Are the Impacts of Each Policy on Different Populations?

Population	Benefit from ACA and Nevada Health Link	How They Benefit	Potential Negative Impact	How They Are Impacted
Low-income individuals and families	Gain increased access to affordable insurance through Medicaid expansion and subsidies on marketplace plans.	Reduced premiums and out-of-pocket expenses enable better access to comprehensive healthcare, including preventive services and chronic disease management.	Individuals in states without Medicaid expansion may remain uninsured.	These individuals fall into coverage gaps, unable to afford private insurance and not qualifying for Medicaid.
Young adults	Coverage extension on parents’ plans up to age 26 offers safety nets during transitional life stages.	Maintains continuous insurance coverage during education or early career stages.	Young, healthy individuals may face higher premiums due to risk pooling.	Before the repeal of the individual mandate, some young adults faced penalties or increased premiums for opting out of insurance.
Individuals with pre-existing conditions	Guaranteed coverage without denial or premium hikes.	Access to necessary medical care without fear of discrimination or financial barriers.	Higher premiums could affect certain groups depending on market adjustments.	Some healthy individuals may experience increased premiums to offset costs of broader coverage.
Small employers	Encouraged to provide coverage through employer mandates and subsidies.	Better access to employee health coverage, which can improve workforce health and productivity.	Compliance challenges and cost increases.	Small businesses may struggle with added regulatory requirements and costs.
Vulnerable and underserved populations	Outreach and education promote enrollment and culturally competent care.	Reduces disparities by improving access and tailoring services to diverse needs.	Limited reach if barriers such as language or digital literacy exist.	Some populations may still face difficulties enrolling or utilizing coverage despite policy provisions.

Both the ACA and Nevada Health Link seek to reduce health disparities by offering financial assistance, promoting preventive care, and mandating culturally competent healthcare delivery. Their combined efforts aim to foster health equity within communities.

A4. What Evidence Supports These Policies?

The ACA was crafted in response to evidence highlighting that millions of Americans lacked affordable insurance, resulting in deferred or missed medical care. Jacobson and Pilch (2019) emphasize that the ACA’s marketplace provisions ensure access to comprehensive insurance without denial based on pre-existing conditions, which has expanded coverage and consumer protections.

Nevada Health Link builds upon this foundation with evidence tailored to state-specific needs. The passage of Senate Bill 420 (SB420) in 2021 introduced a public option plan to fill coverage gaps for uninsured Nevadans who don’t qualify for Medicaid or marketplace subsidies. Beerman (2021) notes this plan is priced below marketplace alternatives to improve affordability.

Kelly (2019) highlights that universal coverage facilitates early intervention, chronic illness management, preventive care, and dignity for vulnerable populations, reinforcing the public health rationale for these policies.

Do the Evidences Suggest Policy Modifications?

While evidence supports both policies’ goals of expanding access and improving quality, gaps remain, especially for low-income populations excluded from Medicaid or subsidies. Suggested modifications include:

Expanding subsidy eligibility to better assist moderate-income individuals.
Increasing financial assistance to address persistent cost barriers.
Strengthening incentives for preventive care and addressing social determinants of health.
Innovating cost-containment strategies to keep insurance affordable.

These refinements could enhance equity, affordability, and overall health outcomes.

B. The Role of Nurses in Policy Development and Administration

Nurses play a vital role in healthcare policy by leveraging their frontline experience to advocate for patient-centered policies and improvements.

Advocacy: Nurses highlight disparities, promote patient safety, and push for equitable care policies.
Expert Consultation: Their clinical insights inform policymakers about practical challenges and evidence-based solutions.
Research and Data: Nurses conduct and contribute to research, strengthening the evidence base for policy decisions.
Collaboration: Working with interdisciplinary teams and community stakeholders, nurses influence legislative advocacy and policy implementation.
Education: Nurses educate policymakers, patients, and the public about health policy implications.

At the federal level, nurses engage through professional organizations, advocacy campaigns, and interactions with congressional representatives to influence national policy. At the state level, they participate in state nursing associations, collaborate with legislators, and advocate for reforms tailored to local healthcare needs.

B1. What Barriers Do Nurses Face in Policy Engagement?

Policy Area	Barriers
Development	Time constraints due to demanding clinical workloads, lack of formal policy training, and limited access to policy resources reduce nurse participation.
Administration	Bureaucratic resistance, limited influence within healthcare organizations, staffing shortages, and budget constraints hinder nurses’ ability to manage policy implementation effectively.
Revision	Political opposition, power imbalances favoring other stakeholders, resistance to change within institutions, and perceptions of limited nursing influence create obstacles to policy modification efforts.

B2. How Will I Engage with Healthcare Policy in My Future Nursing Practice?

Policy Area	Planned Engagement Strategies
Development	Actively advocate for nursing perspectives in policy-making, collaborate with nursing and advocacy organizations, and use research to inform evidence-based policy proposals that promote equity and patient care.
Administration	Lead nursing initiatives that align with policy goals, work with healthcare teams to implement policies effectively, and contribute to monitoring and quality improvement efforts.
Revision	Advocate for updates based on clinical evidence and frontline experiences, engage with stakeholders to gather feedback, and support educational initiatives for policy adoption and organizational change.

References

Beerman, L. (2021). Nevada’s public option continues healthcare’s cost versus coverage debate. Healthcare Leadership Review, 40(8), 6-8.

Jacobson, G. P., & Pilch, S. (2019). The Affordable Care Act (ACA): It gets personal, very quickly. Journal of the American Academy of Audiology, 30(8), 656-658. https://doi.org/10.3766/jaaa.30.8.1