Affordable Care Act is About Wellness & Prevention
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
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
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
Injury and Violence Free Neighborhoods
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
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
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.