Study Guide Health Care ReformHealth Care Reform OverviewWhe.docx

Study Guide: Health Care Reform
Health Care Reform: Overview
When it comes to healthcare in America, we seem to believe
that more is better--but does more healthcare result in better
health? As a nation, we spend more on healthcare per person
than any European country, yet our health outcomes are worse.
The PBS documentary, Money and Medicine was aired in 2012,
and addresses one of the key issues of healthcare reform--the
cost of health care. Watch the trailer below, or the entire
episode here: http://video.pbs.org/video/2283573727/
(Links to an external site.)
http://youtu.be/a9oEtRwoVxs
The Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), passed
in 2010, is a collection of laws that were created to reform
health insurance and healthcare.
The ACA significantly impacts nurses both personally and
professionally. Bedside nurses are impacted by organizational
changes that affect patient care, and may be providing
information and resources to patients and caregivers about the
ACA. However, as Hynds, Hatch and Samuels (2014) noted,
nurses indicate they need more knowledge to understand the
ACA policy implications of their practice.
Now, you can either read the 974 pages of the law itself, or you
can watch this short, animated video produced by the Kaiser
Family Foundation, and visit the helpful online resources
below:
http://youtu.be/JZkk6ueZt-U

The YouToons Get Ready for Obamacare
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Affordable Care Act: Five Years Later
The Commonwealth Fund has developed several online,
interactive resources to illustrate the impact of the Affordable
Care Act in its first five years of implementation. Through
personal stories, population and health systems data analysis,
and graphics, the Commonwealth fund paints the picture of the
impact of the ACA on individuals, businesses, providers and
healthcare systems. Take some time to explore these resources
in preparation for this week's discussion board. Link: The
Affordable Care Act: A Look Back at the First Five Years.

Review the two interactive digital features: Coverage Reform
and Delivery Reform
.
Value-Based Purchasing--"Pay for Performance"
Increasingly, hospitals and healthcare providers are reimbursed
not just for the amount of services provided (fee-for service),
but for the results that are achieved for a particular patient
population. As nurses, you may have observed policy changes
that emphasize patient experience, prevention of hospital-
acquired infections, and effective discharge planning to avoid
unplanned re-admissions. In hospitals, we hear a lot about
Hospital Consumer Assessment of Healthcare Providers and
Systems--more likely known for its acronym: HCAHPS. We also
hear the term "Core Measures," which refers to a national
standardized performance measurement system. Health system
performance reports are easily accessible to the public on the
Centers for Medicare and Medicaid Services (CMS) website,
where consumers can compare the performance of local
hospitals and providers.
Activity:
Visit the CMS Hospital Compare website:
http://www.medicare.gov/hospitalcompare/search.html
Look up the hospital where you work or live. Explore the
performance measures across the various categories, especially
"Survey of Patient Experiences" and "Timely and Effective
Care." Consider how your work is affected by these measures.
Accountable Care Organizations and Medical Homes
Hospitals and healthcare providers are reimbursed for Medicare
services based on their performance on key measures. In order
to improve results, providers have organized Accountable Care
Organizations and Medical Homes to provide a more
comprehensive, coordinated approach to achieve better health

and lower costs. Many organizations have established
partnerships to collectively be responsible for a group of
patients (Accountable Care Organizations) and provide a
"Medical Home" approach to improve patient care outcomes.
The Kaiser Family Foundation has created a brief video to
explain Accountable Care Organizations:
http://bcove.me/si8pqctw
The Cleveland Clinic video below describes such an approach:
http://youtu.be/_31k2gotfB8
Medicaid Expansion
Originally, the Affordable Care Act mandated expansion of
Medicaid to include a larger sector of the population--up to
138% of the Federal Poverty Level, with federal dollars funding
the vast majority of the related costs of coverage. However, the
Supreme Court ruled that the decision to expand Medicaid rests
with the states. Florida was one of the states which has not
expanded Medicaid (at least at this writing); the issue has
become a hot debate in the 2015 legislative session. The
following articles from the Kaiser Family Foundation provide a
little background to learn more about Medicaid expansion and
the experience of states who have expanded coverage:
Video: Expanding Affordable Care through Medicaid
How Well Does Your State Perform?
The Commonwealth Fund's Scorecard on State Health System
Performance (2014) assessed states on 42 indicators of health
care access, quality, costs and outcomes from 2007 to 2012.
This interactive tool (link below) will show the gains that your
state could achieve by improving its performance to the level of

better-performing states, as well as the losses that would result
if your state failed to sustain its performance. Take a look--
how does your state perform?
Commonwealth Fund Scorecard on State Health System
Performance Interactive Tool
What does the Affordable Care Act mean for Nursing?
You will respond to this question in this week's discussion
forum, based on an article by Brenda Luther and Sara
Hart: What does the Affordable Care Act mean for nursing?,
and the articles and resources you used to develop your Health
Care Reform paper. The American Nurse's Association has
developed an excellent summary of how the ACA impacts
nursing: http://nursingworld.org/MainMenuCategories/Policy-
Advocacy/HealthSystemReform/AffordableCareAct.pdf
Additional Resources:
Here are several excellent resources to increase your knowledge
about the ACA, in preparation for this week's Discussion Board
on Healthcare Reform.
1. U.S. Department of Health and Human Services:
http://www.hhs.gov/healthcare/
2. Kaiser Family Foundation: Health Reform:
http://kff.org/health-reform/
3. The Facts on Medicare Spending and
Financing: http://kff.org/medicare/fact-sheet/medicare-
spending-and-financing-fact-sheet/
4. Read Article: Summary of the ACA: http://kff.org/health-
reform/fact-sheet/summary-of-the-affordable-care-act/

5. Read Article: What does the Affordable Care Act mean for
nursing? (Luther & Hart, 2014)
I hope this study guide was helpful in gaining a better
understanding of the Affordable Care Act. You will apply this
information as you participate in this week's paper and
discussion on Health Care Reform.
Reference
Hynds, R. L., Hatch, J. L., and Samuels, J. G. (2014). The
Affordable Care Act 2010: Educational needs of bedside nurses.
Journal for Nurses in Professional Development, 30(6), 281-6.
Doi: 10.1097/NND.0000000000000101
306
Orthopaedic Nursing
•
November/December 2014
•
Volume 33
•
Number 6
© 2014 by National Association of Orthopaedic Nurses
Copyright
©
2014
by
National

Association
of
Orthopaedic
Nurses.
Unauthorized
reproduction
of
this
article
is
prohibited.
Orthopaedic Nursing
•
November/December 2014
•
Volume 33
•
Number 6
305
© 2014 by National Association of Orthopaedic Nurses
Copyright
©

2014
by
National
Association
of
Orthopaedic
Nurses.
Unauthorized
reproduction
of
this
article
is
prohibited.
What Does the Affordable Care Act Mean for Nursing?
Brenda Luther ▼ Sara Hart
1.5
CEANCC
Contact Hours

Nurses are ethically bound to engage in efforts of improving
health and healthcare delivery and, even more important, nurses
recently have been called out as key leaders in the reform of
healthcare delivery, including many components of the Patient
Protection and Affordable Care Act. The Patient Protection and
Affordable Care Act, its history, and what healthcare will look
like during and after implementation are addressed in this
article. A discussion of the role and value of nurses in
healthcare reform accompanies knowledge-building and action-
oriented resources available to nurses and clients.
As nurses, we are watching and experiencing healthcare reform
as both professionals and citizens. The nursing profession is
now placed in a unique position to facilitate development
of patient coordination including identification of key points in
client care to manage wellness and illness as well as systematic
measurement of health outcomes. In this article, we present a
review of the Patient Protection and Affordable Care Act
(ACA).
When President Obama signed the Patient Protection and
Affordable Care Act on March 23, 2010, a collection of laws
was created that, as a whole, put in place comprehensive
healthcare and health insurance reform. The development of
these laws began much earlier with legislation and regulation
designed to create a patient’s a bill of rights, encourage the use
of evidence-based best practices, and increase access to
affordable healthcare. The resulting ACA legislation focused on
building change into our existing system and is the most signifi-
cant reform of how we pay for and deliver healthcare since the
1965 adoption of Medicare and Medicaid (Jost, 2014). This
legislation represents a complex series of changes.
The major goals of the ACA are to build on our current system

by (1) expanding Medicaid, (2) preserving
surance they have personally selected and are personally
paying for (Congressional Budget Office, 2014). It is predicted
that new and younger people entering the healthcare market will
drive the costs of healthcare down. Recent analysis by the
Congressional Budget Office now predicts that the costs of
implementing the ACA are even lower than previously reported
(Stein & Young, 2014). Still, to date, many of the benefits of
the ACA remain largely unseen.
The costs of delivering healthcare in our country have become a
major concern, with the overall costs of now at 23% of the
federal budget and 20% of most household budgets (Centers for
Medicare and Medicaid Services, 2014; Hartman, Martin,
Benson, & Catlin, 2013). Healthcare costs have risen to a point
that 32% of people with insurance have difficulty paying their
medi- cals bills, must pay healthcare over time, or are unable to
pay at all (Pollitz & Cox, 2014). The No. 1 cause of personal
bankruptcy for middle-class, insured, working
U.S. citizens is healthcare costs (Himmelstein, Thorne, Warren,
& Woolhandler, 2009). By addressing the cost of healthcare, as
well as issues of access to healthcare, better health and
financial stability are possible for individuals, businesses, and
government.
Historically, U.S. healthcare has been complicated by the
inherent competition set up between systems of payers,
providers, users, and regulators. Effective healthcare and good
and affordable health for any population result from high-
quality, affordable, and accessible care (Lamb, 2014). These
three points are frequently represented by disparate and
disconnected industries, often industries that are competing
with each other rather than working together to maintain good
health for their clients. The “triple aim” of health reform, and
of the ACA, is to (1) improve the patient experience with higher
quality care, (2) increase access to care, and (3) control
healthcare costs (Institute of

both employer/job-based coverage and Medicare, and
(3) promoting state control of insurance markets. The ACA has
had early success in implementing these re- forms and
preserving the structure of care (Jost, 2014). Thirty-four percent
of new enrollees are under 34 years of age; during the first
enrollment period, more than 8 million people have obtained
coverage through the ACA Health Insurance MarketPlace, and
even many more private pay nonelderly people are covered with
in-
Brenda Luther, PhD, RN, Assistant Professor, Director Care
Management Programs, College of Nursing, University of Utah,
Salt Lake City.
Sara Hart, PhD, RN, Assistant Professor, College of Nursing,
University of Utah, Salt Lake City, and Gold Humanism Scholar
from the Harvard Macy Institute.
The authors and planners have disclosed no conflicts of interest,
financial or otherwise.
DOI: 10.1097/NOR.0000000000000096
Medicine, 2011). The ACA has attempted to deal with more
than just payment and cost of healthcare by improving the
quality of care delivered and access to pre- ventive care and
early intervention.
Competition between disconnected organizations is
demonstrated in our traditional fee-for-service healthcare
system. When more services are provided, more rev- enue is
generated. But more care does not necessarily result in higher
quality care or better health outcomes. Services must represent
appropriate interventions and expected outcome based on the
client’s goals of care. While quality is inherently measured and
valued in healthcare, it has not often been paid for or
incentivized. The economic risks of healthcare costs have

traditionally fallen most heavily on third party payers (insurers
and the state and federal governments), not the providers.
The ACA and the New Roles for Nurses
The ACA promotes healthcare that is designed within co-
ordinated, orchestrated, and value-based care models. Value-
based care incentivizes healthcare providers to keep population
groups healthy by focusing on outcomes of care rather than
volume of service of care. Value-based care incentivizes
healthcare organizations to meet benchmark health outcomes for
their clients. This also creates healthcare systems that are
focused on wellness, prevention, minimizing repetition, and
unnecessary costs. Nurses are key players in this component of
healthcare reform. Uniquely situated on the front lines of pa-
tient care, as well as within healthcare payer and supplier
agencies, nurses have the expertise and obligation to in- fluence
practice and policy (Institute of Medicine, 2011). Nurses
promote health, navigate chronic illness, and pre- vent the
development of secondary conditions, all of which align with
the triple aims of healthcare reform.
As hospitals, insurance providers, and provider groups align to
be a part of value-based payment systems, the roles of nurses
become integral to promoting these changes. Care managers,
care coordinators, and informatics experts—nurses—are vital
leadership for directing care process changes, quality and
evidence-based interventions, and measurement of care
outcomes (Lamb,
2014). Nurses have a demonstrated history of leadership in
team-based care processes. Nurses have patient- centered care
as a core professional standard and compe- tency. Nurses are
pivotal to care quality and patient satisfaction, as well as
efficacious use of resources to provide patient-centered and
evidence-based care.
What Are the Health Insurance MarketPlaces?

Health Insurance MarketPlaces are centralized sources for state-
level information on the options and costs for individuals and
small businesses when purchasing affordable healthcare
coverage. Individuals use the MarketPlace to determine whether
they qualify for insurance premium subsidies (subsidies are cost
sharing reductions or government-sponsored programs based
on income). People liv- ing between 130% and 400% of the
Federal Poverty Level typically qualify for subsidized policies
(Sommers, Graves, Swartz, & Rosenbaum, 2014). States were
given the option to develop their own State MarketPlace or to
use a state- based but federally developed MarketPlace. In
October 2013, the Federal MarketPlace launched with many
tech- nical challenges. Yet most stat-developed MarketPlaces
were up and functioning with little problems. As of May 2014,
more than 8 million new, subsidized enrollees were processed
through the MarketPlace and, unexpectedly, more than 12
million private, self-pay clients found affordable healthcare
they could purchase (Stein & Young, 2014). People will
continue to access the online MarketPlace individually but in-
person navigators are also available to help individuals
understand their options and the enrollment process. Open
enrollment via the MarketPlaces officially closed March 31,
2014. Until the next open enrollment period, the MarketPlace
remains open for enrollment for individuals and families experi-
encing qualifying events such as job loss and changes to family
composition.
Sources for Educating Ourselves and Our Clients
As nurses, we are always challenged to teach clients about the
healthcare delivery system and the ACA has
T
ABLE

1.
D
EFINITIONS
Cost-sharing reduction A discount given for insurance
through the MarketPlace exchanges based on income and health
plan type Deductible The amount the consumer owes for
services before the health plan will begin to pay
Federal poverty level Levels of personal income used to
determine a client’s eligibility for Medicaid, Children’s Health
Insurance Program, and Subsidized Coverage of ACA
Fee-for-service Paying providers for each service they perform
rather than the quality of services provided Job-based coverage
Insurance coverage offered to employees and often their
dependents
MarketPlace A resource to learn about coverage options,
compare plans, and enroll. Some are run by the state and others
by the federal government
Navigator Trained individual or organization to help consumers
and small businesses look for healthcare coverage. Services are
free to consumers
Qualified health plan An insurance plan certified to provide
the essential benefits and established limits on costs such as
deductibles, copay, out-of-pocket
Value-based care Linking provider payments for services to
the quality of care they provide
T
ABLE
2.
L
INKS FOR
C
LIENT

Q
UESTIONSwww.healthcare.gov Need to get ready to enroll?
Or, find a
local navigator?
Why should a client be covered?
What are different types of health insurance?
www.dol.gov Consumer Information on the Affordable Care
Act
significantly increased the need for these efforts. Many clients
are confused with their options and the processes for obtaining
and accessing health coverage. For example, new users may be
surprised that the plans they selected are low cost in monthly
premiums and una- ware those will typically translate to higher
deductibles, even though the deductibles are typically below
policies outside of those offered at the MarketPlace (Jost,
2014). Nurses may find themselves overwhelmed by the educa-
tion and information needs of their clients. Below are three
tables: a list of definitions (see Table 1) and lists of resources
for client questions (see Table 2) and valuable resources for you
as a nurse (see Table 3).
Are There New Services Offered Under the ACA?
There are new requirements for the healthcare benefits offered
in any Qualified Health Plan. Enrollment in a Qualified Health
Plan is required by the Individual Mandate of the ACA. No
longer can policies be offered that do not provide “Essential
Benefits” such as preven- tive care or comprehensive care or
maternity benefits, for example (see Table 4). Previous to the
ACA individual insurance policies often lacked these basic
levels of coverage. Coverage of the essential health benefits, as
mandated under the ACA laws and regulations, expanded
effective and affordable, quality healthcare coverage for
millions of Americans, but some have predicted this may also
drive up costs of insurance premiums. This controversy
continues to play out in the reform debate, but what is also

being discovered is how
many people were purchasing ineffective, low-cost/low- benefit
policies that actually did not save them money when they
needed coverage for essential services.
Interesting components of these essential services are worthy of
discussion. For instance, the additional requirement of mental
health and behavioral health, including counseling and
psychotherapy, has resulted in many primary care organizations
developing integrated physical and mental health services for
their clients. Those with chronic illness now have access to
ongoing therapy services to help them achieve optimal function.
New wellness and prevention and behavioral health services
are quickly being expanded into the traditional service lines of
primary care, medical homes, family practice, and outpatient
services.
Key Elements of an Accountability Care Organization
Accountable care organizations (ACOs), a Medicare Pilot
Program under the ACA, is a way of organizing care delivery
that establishes a system of value-based payment contracts for
large populations of the insured. The ACO model allows
Medicare, and other payors of healthcare, to contract with
providers for services based upon benchmark health outcomes
for their clients. Though still a fee-for-service model, the ACO
payment structure is based on financial incentives to improve
benchmarks. For example, an ACO may negotiate that a
majority of their clients will have controlled blood pressure
levels. If the ACO attains the agreed-upon benchmark for their
population of their clients, the ACO will share in the savings
achieved rather than the insurer keeping all those savings.
Incentivized, benchmarked, value-based outcomes system is the
heart of creating an ACO framework as a method of healthcare
reform.
To set and measure benchmarks for quality and cost, we must
first reach agreement on accurate measures of quality. This

requires available informatics systems ca- pable of tracking and
reporting outcomes data in an ACO. This highlights the
importance of new health information technology requirements
rolled out in the ACA. Many clinical groups and providers did
not have
T
ABLE
3.
V
ALUABLE
L
INKS FOR
H
EALTHCARE
R
EFORM
R
ESOURCES
American Nurses Association: “professional organization
representing the interests of the nation’s 3.1 million registered
nurses”
Centers for Medicare and Medicaid Services: governmental
website with client and provider Medicare and Medicaid
information
http://www.nursingworld.org/http://www.cms.gov/
Institute of Medicine: “an independent, non-profit organization
working outside of government to provide unbiased and
authoritative advice ftor decision makers and the public”

Kaiser Family Foundation: an independent, non-profit
foundation focusing on providing research and knowledge about
major healthcare issues
http://www.iom.edu/
http://kff.org/
http://kff.org/health-reform/faq/health-reform- frequently-
asked-questions/
National Council of Nonprofits: a resource and advocate for
nonprofit agencies http://www.councilofnonprofits.org/public-
policy/federal-policy-issues/health-care- reform
U.S. Department of Labor: information related to employment-
based health plan coverage related to the ACA
http://www.dol.gov/ebsa/healthreform/
T
ABLE
4.
E
SSENTIAL
H
EALTH
P

LANS
B
ENEFITS
M
UST
I
NCLUDEAmbulatory services Emergency services
Hospitalizations
Maternity and newborn care
Mental health and substance use disorder services including
behavioral health treatment
Prescription drugs
Rehabilitation and habilitation services Laboratory services
Preventative and wellness services
adequate systems for ACO participation; thus, the ACA also
offered provider networks funding to upgrade and implement
information systems.
An ideal model for healthcare delivery reform addresses four
key concepts integral to the sustainability:
(1) access, (2) care coordination, (3) healthcare information
technology, and (4) payment reform (Patient- Centered Primary
Care Collaborative, 2011). Table 5 briefly presents these
concepts based on what we know from trends, data, and
evidence (Patient-Centered Primary Care Collaborative, 2011).
Nursing and Integrated Care Teams and ACOs
For nurses, being a part of an ACO means being a part of
integrated, interdisciplinary teams collecting meas- urements of
health outcomes, being aware of how those outcomes are cared
for in their system, and assuring the interventions provided to
clients are effective, efficacious, and evidence-based.
Important to nursing and healthcare science is that we focus on

preventing illness and promoting wellness in our care teams by
using evidence-based strategies (Grady, 2014). Integrated
teams of care providers will play a major role in applying evi-
dence-based practice to the populations we care for.
Now as new services become available to our clients, such as
behavioral and mental health, care teams are challenged to
integrate services across disciplines. Coverage of obesity
counseling for orthopaedic clients can be paid for under the
ACA, coverage for substance abuse, smoking cessation, or other
services not previ-
ously covered services, are now being provided. This pushes us
as nurses to care for our clients in more holis- tically ways,
rather than providing only sick care spe- cialty services as we
may have in the past. As the client moves between all types of
care services offered, care managers will be monitoring health
outcomes and con- necting to services. For example, a nurse in
an outpatient orthopaedic clinic or a clinician at a behavioral
health counseling session could also be monitoring and
coordinating efforts to address a client’s hypertension.
Integrated clinics specializing in personalized healthcare are
showing up in our communities. Integrated care means that
nurses may be working in an internal medicine clinic as a care
manager, navigating patients through bundled care services and
assuring the care bundle developed by their organization are
being completed for each client. An integrated, personalized
care structure may mean that all the diabetic clients of the
clinic’s population have a group of ideal outcomes to be
accomplished such as controlled A1C levels less than 8%, blood
pressure levels less than 140/90 mm Hg, low-density
lipoprotein level less than 100, microalbumin check yearly, and
eye exami- nation yearly. A variety of clinicians are needed to
achieve the goals of this care bundle. To support measuring the
outcomes of a bundle, systems need informatics, tracking,
assessment, and a team of coordinated care providers. Care
managers will be monitoring all of the clients, but they may be

supervising medical assistants calling clients for check-ins or
scheduling appointments; thus, leaving their time for one-on-
one sessions reviewing needed teaching or scheduling a
healthcare advocate to make home visits to assess a client’s
falls risk.
Healthcare providers are becoming connected in new ways. One
example may be that the pharmacy would note that a client has
not picked up a refill of a medica- tion, and alert the care
management team to initiate a call to the client to see what they
can do to help the client stay on their medications. Another
form of connection would be a care manager alerting a primary
care provider when their clients are within the goals of health
outcomes and prompt the primary care providers about what
could be discussed or revised for the client to improve these
goals. Gone are the days when one care provider can be
expected to track, remember, and measure all of the outcomes
that are now known as basic care for diagnoses or conditions.
Teams are needed to provide quality, evidence-based best
practices, examine evidence, make system changes, and
ultimately interface with the client to bring quality healthcare to
their lives.
T
ABLE
5.
K
EY
E
LEMENTS OF AN
A
FFORDABILITY
C
ARE

O
RGANIZATION
Access Addressing access to primary care providers means to
have off-hours or same-day access as improving those decreases
emergency department use and improves patient and clinician
satisfaction.
Care coordination Care coordination improves exchanging
information between systems and improving accountability of
systems to each other and to their clients.
Health information technology
Healthcare information technology offers healthcare providers
immense outcomes tracking as well as innovative clinician–
provider communication and ultimately improves patient self-
management.
Note.
Data
from
Patient-Center
Primary
Care
Collaborative,
2011.
Retrieved

from
http://www.pcpcc.org/sites/default/files/media/
better_best_guide_full_2011.pdfPayment reform Quality is
rewarded over quality in a new value-based, shared outcomes
setting. Many valuable but unreimbursed services can be
provided included such as e-visits and phone visits; RN,
pharmacy, health educators, and coaches.
The examples described previously highlight where nurses are
uniquely situated to affect patient outcomes within the work of
an ACO. Nurses possess a theoretical base of biophysical,
psychosocial, and developmental knowledge. Nurses, in these
roles, must expand their skills to effectively support behavior
change in clients to achieve quality health outcomes, skills such
as motiva- tional interviewing, understanding the stages of
change, knowing the challenges of an individual’s personal de-
velopment, and being an expert in interprofessional
communication are essential. All are skills that nurses have and
can continue to develop.
Conclusion
The ACA of 2010 enacted a large group of laws that brought
change to processes, systems, payers, and users of healthcare.
This is not the first time that reform of our private, market-
based healthcare system has been attempted. Presidents Teddy
and Franklin Roosevelt, Harry Truman, John F. Kennedy,
Richard Nixon, and Bill Clinton all ventured into lobbying and
legislation for reforming healthcare delivery. These leaders, and
others, settled for incremental changes to the system and no
comprehensive reform occurred; this left us with fractured,
disconnected, and competing systems paying and providing
healthcare to our nation. This magnitude of collaboration and
broad inclusion of stakeholders of the ACA is creating forward
thinking health planning and something that will most likely be
seen as uniquely American.

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effects of the insurance coverage provisions of the Affordable
Care Act, April 2014. Retrieved from www.
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from http://www.cms.gov/Research-Statistics-
Data-and-Systems/Statistics-Trends-and-Reports/
NationalHealthExpendData/Downloads/tables.pdf
Grady, P. (2014). Charting future directions in nursing re-
search: NINR’s innovative questions initiative. Journal of
Nursing Scholarship, 46(3), 143–143. doi:10.1111/ jnu.12078
Hartman, M., Martin, A., Benson, J., & Catlin, A. (2013).
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but some payers and services show signs of acceleration. Health
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Himmelstein, D. U., Thorne, D., Warren, E., & Woolhandler,
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Advancing-Health.aspx
Jost, T. (2014). Implementing health reform: Four years later.
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Lamb, G. (2014). Care coordination: the game changer.
Silver Springs, MA: American Nurses Association.
Patient-Centered Primary Care Collaborative. (2011). Better to
best: Value-driven elements of the patient centered medical
home and accountable care organizations. Retrieved from
http://www.pcpcc.org/sites/default/
files/media/better_best_guide_full_2011.pdf

Pollitz, K., & Cox, C. (2014). Medical debt among people with
health insurance. Retrieved from http://kff.org/ private-
insurance/report/medical-debt-among-people- with-health-
insurance/
Sommers, B. D., Graves, J. A., Swartz, K., & Rosenbaum, S.
(2014). Medicaid and marketplace eligibility changes will occur
often in all states; policy options can ease impact. Health
Affairs, 33(4), 700–707. doi:10.1377/ hlthaff.2013.1023
Stein, S., & Young, J. (2014). CBO: Obamacare will cost less
than projected, cover 12 million uninsured people this year.
Huffington Post. Retrieved from http://
www.huffingtonpost.com/2014/04/14/cbo-obamacare-
report_n_5146896.html
For 74 additional continuing nursing education articles on
professional issues, go to nursingcenter.com/ce.
NUR 3805 Dimensions of Professional Nursing Practice
Health Care Reform Paper
Purpose: The Patient Protection and Affordable Care Act (ACA)
was a sweeping health reform statute signed into law by
President Obama in March of 2010. The ACA is the most
significant government expansion and regulatory overhaul of
the health system since the advent of Medicare and Medicaid.
The intent of the law is to expand insurance coverage, control
health care costs, and to improve healthcare delivery systems.
Even as the ACA rolls out, much of the population (including

nurses) lack understanding of the ACA, and question the value
of the law in achieving its intended results. This assignment
gives students the opportunity to explore how healthcare is
organized and financed, and discuss how the Affordable Care
Act affects population health, patient care quality and safety,
and the practice of nursing.
Prepare: Complete the “Health Care Reform” study guide, watch
videos and read the articles provided in the module.
Content: For the Health Care Reform PAPER, select ONE of
the following questions that addresses/explores one aspect of
the ACA. Write a brief (2-3 page) paper in APA format that
provides a clear description that answers the question, AND
reflect on why this information is important to you in your
practice as a nurse, as a family member and/or as member of
your community.
Choose ONE topic/question:
1. Describe the Affordable Care Act (ACA), including the major
goals and features of the law. How does the ACA differ from
government-run healthcare in other countries?
2. What are the Health Insurance Marketplaces, and how do
consumers enroll in health insurance? How do the exchanges
work?
3. Describe the Medicare program, including eligibility, and
program elements (Parts A, B, C, D). Describe Medicare
expenditures for the most recent year.
4. Describe the Medicaid program, including eligibility by age
and income. Explain Medicaid Expansion programs proposed
under the ACA, and the current status of expansion programs in
the United States.
5. One of the goals of the ACA is to decrease the number of
uninsured people. How well has this goal been achieved? What
population groups have been impacted the most by this
increased coverage?

6. Define the concept of Hospital Value-based Purchasing (also
known as pay-for-performance or performance-based
reimbursement. Provide examples of how hospitals are affected
by value-based purchasing policies.
7. Define Medical Homes and Accountable Care Organizations.
How can these approaches improve population health, improve
the quality of healthcare and lower costs?
Format: Apply APA format and style guidelines to write a 2- to
3-page paper, which should include a minimum of three
references, one or more of which is an article from a peer-
reviewed journal. No abstract is required for this paper.
Discussion:
See Discussion assignment instructions; students will post one
substantive post and one substantive peer response to the
following question: What does the Affordable Care Act mean
for nursing? Base your initial post on information described in
your Health Care Reform paper, supplemented by the Luther
and Hart article (and/or more resources)! Grading will be
evaluated by the Discussion Board Grading Rubric.
Health Care Reform Paper Grading Rubric
Criteria
Ratings
Explain concepts introduced in question, including and citing
reliable sources (government organizations, reliable
foundations, peer-reviewed journal articles).
Narrative demonstrates understanding of concepts and programs
described; information cited from reliable sources =50
Description of concepts lacks accuracy or clarity or extensive
use of quotations = 35
Minimal description of concepts introduced in question; sources
are not adequately cited and/or are not reliable =10
Why this information is important to you
Thoughtful reflections of why healthcare program or reform is

important to you as a nurse, as a family member and/or as
member of your community = 30
Little reflection on what was presented in the paper or extensive
use of quotations = 15
Minimal or missing reflection = 0
APA and Scholarly Writing
Follows APA style and format with rare and minor exceptions;
scholarly and objective writing = 20
APA and writing have a few mistakes OR body of paper exceeds
3 pages by one additional page = 10
More than a few APA errors; OR body of paper exceeds 4 pages
= 0
Possible Points = 100

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