Introduction
The healthcare field encompasses numerous policies that target vulnerable populations and aim to create conditions in which the public has access to affordable and equitable treatment. Among such policies are federal legislation, such as the Affordable Care Act (ACA), and state-level legislation, including the Certificate of Need (CON). Nevertheless, when meeting the needs of individuals, nurses often face barriers, such as limited resources, a lack of awareness, and challenges in advocating for policy changes, all of which must be addressed.
Public Healthcare Policies
Before delving deeper into the main effects of both policies, it is necessary to explore their essence. Starting with the ACA, the major healthcare reform bill passed in March 2010, also known as the Patient Protection and Affordable Care Act (U.S. Department of Health and Human Services, 2022). The main objectives are to increase access to affordable health insurance for more individuals, expand coverage for all individuals with incomes below 138% of the federal poverty threshold, and reduce healthcare costs (U.S. Department of Health and Human Services, 2022). The policy is mandatory, and most consumers are obliged by the Affordable Care Act to acquire health coverage (Fiedler, 2020). Federal agencies, including the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, administer the policy.
Another policy that can be observed is the one in Georgia, the CON, which is mandatory. Three objectives are the focus of the Certificate of Need policy. The first objective is to define and measure the need, the second goal is to control expenditures, and the final goal is to ensure access to healthcare services (Georgia Department of Community Health, n.d.). The policy applies not only to healthcare professionals but also to medical facilities and centers (Georgia Department of Community Health, n.d.). The overall goal is, therefore, to control healthcare costs and unnecessary duplication of services.
Each policy has a specific impact on the general population. For example, the ACA helped improve access to accessible health insurance benefits for groups that had previously experienced restricted access to medical treatment. Therefore, the groups that benefit the most are low-income people, the uninsured, and people with pre-existing ailments (Ercia, 2021). As a result, since the law offers consumer incentives that reduce household costs, millions of people were able to obtain coverage due to the Affordable Care Act (Ercia, 2021).
At the same time, young and healthy individuals may face higher costs associated with care due to community rating requirements. Moreover, representatives of racial and ethnic minority groups have less access to care and lower health outcomes due to these insurance coverage differences (Buchmueller & Levy, 2020). Therefore, issues might arise concerning the affected groups and inequality.
Regarding the Certificate of Need, there are also specific effects. This strategy in Georgia encourages the effective use of healthcare resources, which may increase access to better-quality care for impoverished or rural communities. CON can stop an overabundance of services in some places by limiting the growth of healthcare institutions (Fayissa et al., 2020).
It was discovered that, regardless of the kind of nursing home, the existence of CON policy results in substituting lower-quality care provided by certified nursing assistants for higher-quality care provided by licensed practical nurses (Fayissa et al., 2020). Those who live in areas where there is a genuine need for more services, on the other hand, may experience adverse effects. Thus, although the policy may have a favorable effect, it unintentionally restricts the construction of healthcare facilities in underserved or economically challenged areas.
Ultimately, considerable research has been conducted to identify any policy limitations that require attention. Research by Crowley and colleagues (2019) emphasizes that the Affordable Care Act is not flawless, and several repeal attempts, as well as poor administration, threaten to exacerbate the law’s issues. As a result, it is crucial to focus on further advances in insurance status, availability of care, and financial stability measures (Crowley et al., 2019).
In turn, research by Conover and Bailey (2020) illustrates that while cardiac surgery mortality is reduced, overall senior mortality and health expenditures are increased by CON. Although calculations are quite hypothetical, the cost-effectiveness analysis indicates that the costs of CON legislation somewhat outweigh their advantages (Conover & Bailey, 2020). Thus, initiatives still address the problems arising from the policies.
The Role of the Nurse in Policy Development
The role of nursing experts in policy development is crucial. However, many barriers might impede such engagement. For example, in terms of development, nurse engagement can be impeded due to a lack of knowledge as well as a dearth of resources (Hajizadeh et al., 2021). Moreover, the area of administration can pose several barriers, ranging from a lack of awareness concerning policies to few opportunities available for nurses (Hajizadeh et al., 2021).
Lastly, barriers connected to revision can involve challenges in advocating for policy changes due to complex sociopolitical systems (Hajizadeh et al., 2021). In this case, to address the issues, I will engage in healthcare policies by first staying informed about policies, which will help eliminate barriers at the development stage. Then, about administration, I will provide feedback on the effectiveness of the reforms. Finally, I will only advocate for changes and policies that align with the interests of patients.
Conclusion
In summary, nurses frequently encounter obstacles when addressing the needs of persons, including scarce resources, a lack of understanding, and difficulties in promoting legislative changes. All of these issues must be addressed. I will take an active role in healthcare policies to solve the problems by remaining knowledgeable about them, providing input on how well the reforms are working, and fighting for amendments and policies that reflect the needs of patients. The Affordable Care Act and Certificate of Need at the state level are two policy examples. The public is supposed to benefit from the provided policies by having their medical bills covered.
References
Buchmueller, T. C., & Levy, H. G. (2020). The ACA’s impact on racial and ethnic disparities in health insurance coverage and access to care: an examination of how the insurance coverage expansions of the Affordable Care Act have affected disparities related to race and ethnicity. Health Affairs, 39(3), 395-402.
Conover, C. J., & Bailey, J. (2020). Certificate of need laws: a systematic review and cost-effectiveness analysis. BMC Health Services Research, 20(1), 748.
Crowley, R. A., Bornstein, S. S., & Health and Public Policy Committee of the American College of Physicians. (2019). Improving the patient protection and Affordable Care Act’s insurance coverage provisions: A position paper from the American College of Physicians. Annals of Internal Medicine, 170(9), 651-653.
Ercia, A. (2021). The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas. BMC Health Services Research, 21, 1-9.
Fayissa, B., Alsaif, S., Mansour, F., Leonce, T. E., & Mixon, F. G. (2020). Certificate-of-need regulation and healthcare service quality: Evidence from the nursing home industry. Healthcare (Basel, Switzerland), 8(4), 423.
Fiedler, M. (2020). The ACA’s individual mandate in retrospect: What did it do, and where do we go from here? Health Affairs, 39(3), 429-435.
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: A systematic review. BMC Nursing, 20(1), 1-9.
Lee, B. P., Dodge, J. L., & Terrault, N. A. (2022). Medicaid expansion and variability in mortality in the USA: A national, observational cohort study. The Lancet Public Health, 7(1), 48-55.
U.S. Department of Health and Human Services. (2022). About the Affordable Care Act.