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ADVANCE Perspective: Nurses

Affordable Care Act is About Wellness & Prevention

Published July 7, 2014 9:02 AM by Guest Blogger

By Elinor Abraham, MSN, APRN, BC, Nurse Coordinator, Federal Occupational Health Unit, Program Support Center, National Courts Building, Washington, D.C.

The Affordable Care Act (ACA) is designed to help health professionals like me have more time and opportunity to see our patients and help them remain healthy.

A large part of the ACA is about preventative Healthcare services. Indeed the law itself establishes a National Prevention, Health Promotion, and Public Health Council headed by the Surgeon General to coordinate federal prevention, wellness, and public health activities.

The Council is tasked with developing a National strategy to improve the Nation’s Health. In fact, the healthcare provider literature is full of evidence-based or research-based health interventions and screenings, and immunization programs reflective of the intent of the law and giving us guidance.

The focus of a National Strategy addresses chronic disease reduction in city, rural, and frontier areas of the country. The Prevention Council consists of 17 members of Government agencies, such as Housing, Transportation, Homeland Security, HHS, Education, Veterans, and EPA. 

Some Priorities of Chronic Disease Reduction are:

·         Tobacco Free Environment

·         Prevention of Drug/Alcohol Abuse

·         Healthy Eating

·         Active Lifestyle

·         Injury and Violence Free Neighborhoods

·         Reproductive/Sexual Health

·         Mental and Emotional Well-being

There will be funding for Community Care Centers especially in medically underserved communities providing physical, oral, behavioral, and pharmaceutical services. All children will be able to get the dental services needed at an early age.

A new model of providing care is the Accountable Care Organization (ACO) which allows a group of providers and suppliers to jointly coordinate care for Medicare patients. But this will not restrict a person’s choice of a primary care physician. Nurses will have a major role in Quality Improvement within the ACO.

There will also be School-based Health Centers so students and families can receive a full range of health services and even Home Visiting so that health professionals can provide services to pregnant women and small children to improve health outcomes. Areas with more poverty and fewer resources will not be left behind more fortunate areas of the country.

Academia and the Center for Medicare and Medicaid Services will partner to provide Inter-professional Education and Collaborative Team-based Practice and innovative programs to keep people healthy and out of the hospital. Some examples:  Controlling Blood Pressure and Cholesterol, Diabetes Self-Management, and not needing re-hospitalization after an illness or procedure.

As more people will be seeking primary care, we will need doctors, nurse practitioners, and physician assistants to meet the needs. I asked my own primary care doctor how he thought the Affordable Care Act would affect his practice. He said, “I am looking for answers and structure so I know. We need more primary care providers and assurance of how we will be reimbursed. Waiting time in offices may become longer.”

Graduate Educational Training Scholarships will be available for all health professionals with incentives to go into primary care roles. Funding will target the current Nursing shortage to schools, and hospitals and other facilities where nurses are employed. Facilities will be eligible for extra funding as nursing roles are expanded. Nurses will have roles in policy on State Health Exchanges and Wellness Education for patients, and education for perspective insurance enrollees.

The new law allows for a new trauma center program to strengthen trauma care capacity. This has many meanings. The law addresses that mental health issues will be treated with interventions and services that are on par with other medical illnesses. The Mental Health Community is talking about the trauma involved in the lives of the mentally ill. So access to Trauma Programs/Care is in the literature of Mental Health Recovery. Rehabilitation from a serious injury or illness is familiar to all of us, but the ACA is also calling for more ‘habilitation’ services to help people live with chronic illness such as multiple sclerosis.

 A new Public Health Commissioned Core Ready Reserve will be established to serve during national disasters. A Senior Care Volunteer Program will encourage Seniors to do more volunteering. The Indian Healthcare Improvement Act will be reauthorized to aid Native Americans.

Electronic medical records will be implemented and should make having all reports more seamless. E-Prescribing sends those pesky prescriptions directly to your pharmacy.  The goal is to take paper work away from providers, so they will have more time with you!

 All programs will be implemented over time as many of these innovations sound overwhelming indeed.

According to a contributor to Forbes magazine, 4 groups will benefit from the ACA:

Insurance companies will benefit the most from the new law. There will be a larger pool of insured people, so more customers. Insurance premiums have already increased, especially for people with more medical problems and fuller coverage. Some unhappy with cost increases ask “Should sicker people pay more?”

Hospitals will benefit as they will be compensated for services of indigent people who had no health insurance and now should be covered.

Fitness Clubs and Health Education Providers will benefit as wellness becomes an important part of healthcare and some insurance policies will offer discounts to people who join a fitness club or take courses on Healthy Eating for Heart Health. My own practice at Federal Occupational Health (FOH) focuses on Wellness programs and Safety for Federal Employees.

Government, local and federal, will benefit as more people will need to be hired to maintain compliance. And the IRS should be in the mix!

Getting people to sign up for insurance involves politics and the person’s ability to exercise their rights to enroll. This often is affected by the individual’s mental state. Scammers who portray themselves as Navigators or insurance companies are a threat to the vulnerable. Providers from actual healthcare centers that treat mental illness and substance abuse are discussing the difficulty getting their clients to trust and understand the new law.  Some states are even encouraging prisoners to sign up for health insurance. I have spoken with many people who are just waiting for all the website problems to be fixed and see what others are going to do before they sign up.

Different states have made the implementation of the law either user-friendly or not according to political beliefs about Obamacare. Those Governors against the program refuse to expand Medicaid, and may be hurting many vulnerable citizens. Virginia has not fully embraced the ACA and has little outreach to consumers, whereas DC has Healthlink and is reaching out to citizens with new programs for adults and children. Maryland has also set up its own health insurance exchange and has outreach to consumers.

The story is unfolding.  


%0d%0a%0d%0aThis is the truth about the "Affordable" Care Act.  This law was pushed through the senate via a loophole (it had to be done this way otherwise it never would have passed) with only only one party supporting it and with public consensus running strongly against it.  Whereas social security and medicare had public approval and was supported by both parties and involved simple transfers of monies, the contents of the ACA were so complex and convoluted that they were a mystery to not only voters but the politicians who supported it: Nancy Pelosi-"Let's just pass it, then we'll figure out how it works."  %0d%0a%0d%0aNow, not only is government saying you must have health insurance

Peter Digiuseppe September 26, 2014 12:51 PM

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