NURS 8100 HEALTH CARE REFORM

A Sample Answer For the Assignment: NURS 8100 HEALTH CARE REFORM

The enactment of the Affordable Care Act in 2010 heralded reforms in health care that led to more Americans, about 25 million, who did not have health insurance coverage, getting insured. While the reforms from the passage of ACA 2010 led to increased access and quality of affordable care, they did not create universal health coverage to guarantee all Americans, irrespective of their socioeconomic status, access to quality care (Wilensky et al., 2020).

The recent COVID-19 pandemic has illustrated the need for in-depth reforms in the healthcare sector to be spearheaded by state and federal governments. The pandemic demonstrated the importance of having universal healthcare coverage to enhance access to all Americans. The U.S. recorded the highest caseload and fatalities from the COVID-19 pandemic because of the current health system despite being a developed country and spending over $4 trillion or about 12% of its gross domestic product (GDP) on healthcare (Auener et al., 2021).

Several studies have demonstrated that having universal health coverage would have enabled the U.S. to handle the pandemic better than it did (King, 2020). The purpose of this paper is to present a health reform plan that focuses on the implementation of universal health coverage with a single-payer model.

Conflict Between Federal and State Policies on Healthcare

Federal and state governments have different roles and responsibilities in healthcare provision. As such, there is no uniformity concerning policies between the federal and state governments. The existence of policy variations between these governments can lead to conflicts that require solutions to improve accessibility, reduce costs, and enhance the quality of care. State and federal governments jointly fund health care provision based on existing policies like Medicaid under the ACA 2010 (Wilensky et al., 2022).

Under this policy, states are free to take Medicaid and increase resources by developing their provisions. Such provisions may conflict with the federal mandates on Medicaid since the federal government hopes to offer access to care through the program (McClellan et al., 2021). However, due to differences in state laws and rules based on their legislations, some states do not have Medicaid programs implying that in such states, Americans cannot access healthcare services under the policy.

According to the Kaiser Family Foundation (KFF), ten states have not expanded Medicaid, implying that over 2.1 million people belong to the “coverage gap” or income level that makes them eligible for the program yet cannot access it due to their state policies (Tolbert et al., 2022). Such a conflict in policies implies that Americans in the ten states have limited options to access healthcare services. Again, it means that state and federal governments cannot implement a universal healthcare model that will address the coverage and access gaps.

Currently, the federal government funds fully the Medicare program that caters to older Americans,

those 65 years and above as well as Americans living with disabilities. Under the program, all state policies align with the provision since they do not fund costs, including prescription drugs. As such, these conflicts can only be solved through one healthcare plan as demonstrated by the Medicare program or the Veterans Administration (VA) healthcare plan.

Conflicting policies as demonstrated by the Medicaid program lead to limited access to health care and reduced resources to fight pandemics when they occur like the recent COVID-19 pandemic and other health emergencies (Hiam et al., 2021). Therefore, both state and federal governments should embrace a universal model like other developed countries with a single public-payer system where the federal government provides resources based on the state population’s healthcare needs.

Health Preparedness

The proposed health reform plan of having a universal health coverage plan that emphasizes primary care implies that more resources are allocated to the local health facilities within states and counties. Under this proposed plan, states will work with the federal government on the current model of both Medicaid and Medicare services based on the targeted population (Galvani et al., 2022).

The plan will entail having Medicaid-like coverage where all people get insured based on the resources that the federal government offers, and the state matches the same amount. For instance, based on the population levels, states will have different allocations and match half of that by evaluating their demand. The plan will expand access and ensure that populations and individuals previously not eligible become eligible in all states. The policy will ensure that states align their healthcare mandates with the federal government’s direction to improve access and quality of care.

The policy will entail allocating more resources to preventive and primary care interventions in the communities. These resources include investing in healthy food options, physical activities and exercising, giving nutritional information, expanding maternal care, and ensuring that all consultation services and physician visits are free (Wilensky et al., 2022). Imperatively, the plan is to ensure that Americans can access not just emergency care as provided under the EMTALA provisions but also physician visits and annual routine reviews. The plan will seek to reimburse physicians for value provided and not quantity.

Through these provisions, the proposed plan will enhance health preparedness, especially during public health emergencies as witnessed recently due to the COVID-19 pandemic. Since the plan will focus on primary care, it enhances the level of preparedness as it means that the entire public can access information and emergency services (McClellan et al., 2021). States would increase their allocation and build more facilities that prepare adequately for any health emergencies.

The new plan will ensure seamless sharing of health information, effective coordination, and teamwork based on the expertise and number of healthcare workers who will be deployed in communities. According to the American Public Health Association (2022), nations that had a universal healthcare system leveraged their models to mobilize resources and ensure the testing and care of their citizens and residents during the COVID pandemic.

Universal health coverage would reduce disparities and support vulnerable populations’ access to care. These two factors can help reduce the impacts of pandemics as demonstrated in the country since a majority of those who succumbed to the disease were vulnerable and experienced health disparities.

Percentage of GDP for Health Care

Investing in and rolling out a universal healthcare system would be a critical part of attaining accessibility, reducing overall costs, and improving the quality of care. Currently, models like value-based purchase (VBP) emphasize quality as opposed to quantity implying that the plan does not have to spend more on the GDP but will deploy international best practice standards. For instance, Canada spends about $9,000 per person on universal healthcare (Geyman, 2021).

With a higher GDP than Canada’s, the U.S. can spend about $10,000 per person using this model implying that it will only be about 10% of the nation’s GDP. This figure will allow the federal and state governments to provide comprehensive care to all people who require care throughout the year. States will match the funding by half to close any gaps and reduce bureaucratic aspects that affect the implementation of the program.

Conclusion

Reforming the health system entails developing models that will leverage the limited resources but guarantee high-quality care to Americans and residents. Evidence demonstrates that embracing a universal healthcare model will allow more Americans to access quality care and reduce wastage and additional spending that make it difficult for many to get services.

The proposed plan will ensure that more Americans, especially those experiencing disparities and vulnerability, access care and prepare adequately for public health emergencies like the COVID-19 pandemic and other epidemics like the current opioid crisis.

 References

Auener, S., Kroon, D., Wackers, E., Van Dulmen, S., & Jeurissen, P. (2020). COVID-19: a

a window of opportunity for positive healthcare reforms. International Journal of Health Policy and Management, 9(10), 419-422. DOI: 10.34172/ijhpm.2020.66

American Public Health Association (APHA) (2022). Lessons from the COVID-19 Pandemic:

The Importance of Universal Health Care in Addressing Health Care Inequities. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Lessons

Galvani, A. P., Parpia, A. S., Pandey, A., Sah, P., Colón, K., Friedman, G., … & Fitzpatrick, M.

2200536119. (2022). Universal healthcare as pandemic preparedness: the lives and costs that could have been saved during the COVID-19 pandemic. Proceedings of the National Academy of Sciences, 119(25), e2200536119. https://doi.org/10.1073/pnas.2200536119

Geyman, J. (2021). COVID-19 has revealed America’s broken healthcare system: What can we

learn? International Journal of Health Services, 51(2), 188-194. https://doi.org/10.1177/0020731420985640

Hiam, L., & Yates, R. (2021). Will the COVID-19 crisis catalyze universal health reforms? The

            Lancet, 398(10301), 646-648. DOI:https://doi.org/10.1016/S0140-6736(21)01650-0

King, J. S. (2020). Covid-19 and the need for health care reform. New England Journal of

            Medicine, 382(26), e104. DOI: 10.1056/NEJMp2000821

McClellan, M., Rajkumar, R., Couch, M., Holder, D., Pham, M., Long, P., … & Smith, M.

(2021). Health care payers COVID-19 impact assessment: Lessons learned and compelling needs. NAM Perspectives, 2021. https://nam.edu/health-care-payers-covid-19-impact-assessment-lessons-learned-and-compelling-needs/

Tolbert, J. & Drake, P. (2022). Key Facts about the Uninsured Population.

https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/

Wilensky, S. E., & Tietelbaum, J. B., (2020). Essentials of health policy and law (4th ed.).

Burlington, MA: Jones & Bartlett Learning.

Wilensky, G. R. (2022, January). The COVID-19 pandemic and the US healthcare workforce.

JAMA Health Forum, 3(1) pp. e220001-e220001. DOI:10.1001/jamahealthforum.2022.0001

The Affordable Care Act (ACA) was signed into law over 10 years ago and it has remained highly controversial by many law makers since its inception on March 23, 2010. Many law makers have tried to get rid of the ACA but have yet to find a health care system to replace the ACA that works with law makers and the public.

Even though people may not like the ACA it has improved the health care system, provided health insurance to the uninsured, provided more prevention program to help improve the overall health of the American people. There was so much resistance to passing the ACA since the President at that time was African American and a Democratic (Silberman, 2020). The Patient Protection and Affordable Care Act (ACA) was passed by a Democratic Congress and signed into law by a Democratic president in 2010.

Republican congresspeople, governors, and Republican candidates have consistently opposed the ACA and have vowed to repeal it during every election, but more than 50% of Americans support ACA. In the first year of ACA 10 million Americans gained accessed to health insurance. The ACA also eliminated the no coverage for prior conditions, it also decreased prescription drug cost and eliminated co-pay for preventive services.

When people are asked why they oppose the ACA they mention they do not like the government involved in their healthcare, but they pay into Medicare which is a mandatory federal government insurance. Despite positive changes the ACA has brought to many Americans many politicians and people oppose ACA and want to get rid of ACA(Silberman,2020).

While ACA has made great strides in improving health care, health disparity remains a major problem among people of color. The recent pandemic has shown the world once again that the health care system is even though Black Americans make up 13 percent of the US population over 23 percent of COVID deaths were Black Americans (USA, 2021).

In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than non-minorities and that, patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than non-minorities.

The Institute of Medicine (IOM) report from 2006 showed unequal treatment “racial and ethnic disparities in healthcare exist and, because that lead to worse outcomes in many cases. Minorities were provided less access to health care intervention, sources, and funding (Egede, 2006).

References

Egede, L. (2006). Race, Ethnicity, Culture, and Disparities in Health care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1924616/

Silberman, P. (2020). The Affordable Care Act: Against the Odds, It’s Working. North Carolina Medical Journal, 81(6), 364–369. https://doi-org.ezp.waldenulibrary.org/10.18043/ncm.81.6.364

USA FACTS. (2021).US COVID-19 cases and deaths by state

https://usafacts.org/visualizations/coronavirus-covid-19-spread-map/

Your work on health care reform is insightful and interesting. Indeed, politics is playing an important role in the US health care reforms and PPACA has remained controversial issue due to political differences.  The other challenge related to the passing of the PPACA is healthcare inequalities, which has disproportionately impacted the minority groups such as African Americans and marginalized groups (Yue et al., 2018).

While the PPACA coverage increased the progress towards universal coverage, the persistent high cost of various coverage options implies limited access to affordable health care among many Americans, especially the minority and marginalized groups (Gaffney & McCormick, 2017). These disparities lead to the gaps in health insurance coverage, poor health outcomes among minority and marginalized groups, and unequal access to services (Dickman et al., 2017).

The issue of healthcare inequalities and other challenges portray why health care reforms in the US have been difficult.  They characterize systematic health care challenges that indicate that the US health care reforms are not comprehensive and fail to capture the health care needs of all Americans.

References

Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. The Lancet, 389(10077), 1431-1441. https://doi.org/10.1016/S0140-6736(17)30398-7

Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet, 389(10077), 1442-1452. https://doi.org/10.1016/S0140-6736(17)30786-9

Yue, D., Rasmussen, P. W., & Ponce, N. A. (2018). Racial/ethnic differential effects of Medicaid expansion on health care access. Health services research, 53(5), 3640-3656. https://doi.org/10.1111/1475-6773.12834