Health Policy and Health Promotion in Advanced Nursing Practice

Week 5 Discussion

Discuss the changing landscape of the US health care system through the ACA and specific initiatives that have been funded, enacted and currently implemented to improve health care for all Americans.

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Discuss the changing landscape of the US health care system through the ACA and specific initiatives that have been funded, enacted and currently implemented to improve health care for all Americans.

Over the past several years, the landscape of the health care system has changed dramatically. Currently, the health care system emphasizes improving the quality of care while reducing the overall costs. The most important health care legislation enacted within the U.S. to influence such changes in healthcare is the Affordable Care Act (Obama, 2016). By adopting this law, the implementation of comprehensive reforms designed to improve the accessibility, affordability, along with the quality of health care was developed. Since the ACA became law, the uninsured rate declined by 43%, dropping from 16% in 2010 to 9.1% in 2015, resulting in only 29 million without insurance as opposed to 49 million. The ACA also expanded Medicaid eligibility, created health insurance exchanges, and prevented insurance companies from denying coverage secondary to pre-existing conditions.

Not only do the health insurance plans available must cover specific “essential health benefits,” but also most of them focus on preventive care, providing these services at no cost (Obama, 2016). The passing of the ACA has also commenced the development of renovating health care payment systems, resulting in approximately 30% of traditional Medicare payments spread over unconventional payment models such as bundled payments or accountable care organizations. Also, rather than focusing on the fee-for-service approach (quantity of care), health care systems are slowly transforming to a value-based care approach (quality and efficiency), in addition to focusing on a more collaborative and integrated system.

Under the ACA, the law created National Prevention, Health Promotion, and Public Health Council and the $15 billion Prevention and Public Health Fund, representing the first comprehensive public health strategy, with dedicated funding (Chait & Glied, 2018). Due to budget cuts placed on the CDC, the Council and the Fund were designed to increase public health capacity. Targeted national initiatives developed as a result of the funding and law passing of the ACA were Tips from Former Smokers campaign and the National Diabetes Prevention Program. The Tips from Former Smokers campaign led to a 12% increase in quit attempts and lead to 100,000 smokers remaining abstinent from smoking long term. Furthermore, the National Diabetes Prevention Program was found to induce weight loss significant enough to reduce the risk of diabetes.

In 2011, the release of the National Prevention Strategy by the Council occurred and served as a useful delivery of the nation’s public health priorities (Chait & Glied, 2018). The focus of the National Prevention strategy included eliminating health disparities, creating healthy communities, providing preventive services in clinical settings, and the community, along with helping consumers make health decisions. The Council also influenced agencies and departments outside of the Department of Health and Human Services (HHS) to consider public health, hence the nationwide ban on smoking in public housing announced by the Department of Housing and Urban Development (HUD) in 2016. Another critical initiative created as a result of the ACA to improve population health and the delivery of health care while decreasing costs was the creation of the Center for Medicare and Medicaid Innovation (CMMI) within the CMS. This initiative created an avenue for states to receive millions of dollars to transform their health system. To date, the State Innovation Model (SIM) program has funded efforts in 34 states, 3 territories, and Washington, DC. As a result of the ACA, substantial benefits for Americans, greatly expanding insurance coverage, spurring delivery system reforms, has been born. The enactment of the ACA also generated great profess in the prevention of ill-health among Americans through increases in capacity, coverage, and incentives.

References

Chait, N., & Glied, S. (2018, January 24). Promoting Prevention Under the Affordable Care Act. Annual Reviews, 507-524. http://dx.doi.org/10.1146/annurev-publhealth-040617-013534

Obama, B. (2016, August 2). United States Health Care Reform Progress to Date and Next Steps. JAMA, 316, 525-532. http://dx.doi.org/10.1001/jama.2016.9797

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