Exploring Recent Developments in US Healthcare

The Affordable Care Act 10 Years In: What Nursing Leaders Should Know

Arguments in Texas raise questions about the ACA's fate as enrollment holds steady and new state reinsurance waivers are approved.

The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to "repeal and replace on day one"; Republican congressional leaders' more temperate suggestions in the first weeks of the Trump administration to "repair" the Affordable Care Act (ACA); and President Trump's February 5, 2017 statement-16 days after inauguration-that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven "volume to value" reimbursement changes. Moreover, popular and controversial elements of the ACA-for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision-are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses' capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.

While analyzing the contentious debate over health care reform, this much-needed study also challenges the argument that treating medical patients like shoppers can significantly reduce health expenditures. This revealing work focuses on the politics surrounding the Affordable Care Act (ACA), explaining how and why supporters and opponents have approached the issue as they have since the act's passage in 2010. The first book to systematically examine public knowledge of the ACA across time, it also documents how that knowledge has remained essentially static since 2010, despite the importance of health-policy reform to every American. An important book for anyone concerned about the skyrocketing costs of health care in the United States, the work accomplishes three main tasks intended to help readers better understand one of the most important policy challenges of our time. The early chapters explain why congressional Democrats designed the Affordable Care Act of 2010 as they did, clarifies some of the consequences of the act's features, and examines why Republicans have fought the implementation of the law so fiercely. The study then looks at how the intersection of economics and politics applies to the ACA. Finally, the book details what the public knows―and doesn't know―about the law and discusses the prospects for citizens gaining the knowledge they should have about the overall issue of health-policy reform. Explains why the two political parties have staked out such different positions on health care reformDocuments what the public knows about the Affordable Care Act and how individuals' party identification significantly affects their knowledgeChallenges the arguments for consumer-driven health care plans by gathering evidence from numerous studies of consumer behavior under various kinds of insurance plansOffers a well-informed critique of the political arguments surrounding the expansion of Medicaid, showing how this policy diffusion leverages the weak arguments and evidence for consumer-driven health care plans

Long-Term Care Reforms Live On With Court Ruling

America, all things not being equal

Improving Value in Healthcare

Patient-Centered Outcomes Research: Early Evidence From A Burgeoning Field.

Background The Avon Breast Health Outreach Program (BHOP) supports community-based organizations to conduct education and outreach to link low-income and uninsured women to routine breast cancer screening and care. Through the Affordable Care Act (ACA), the number of uninsured individuals is expected to decrease as of 2014. While ACA implementation varies by state, BHOP grantees may benefit from understanding the health reform experience in Massachusetts (MA) in 2006 and its impact on the number and proportion of uninsured clients served over time. Objective Describe changes in client volume, health insurance status, and demographics following implementation of health reform in MA to anticipate upcoming impact of ACA on BHOP grantees. Methods Confidential client intake records of continuously funded BHOP grantees from 2004-2012 were analyzed; dataset included females aged 40-64, recruited for breast cancer screening. We compared records for 11,199 clients served by 4 ‘MA’ BHOP programs with 283,720 clients served by 52 ‘control’ agencies funded in the US during the same time period. We examined trends across years in agency-specific rates of health insurance coverage, and client volume adjusting for annual funding. Changes in key demographic characteristics over time were also analyzed. Results The proportion of uninsured MA clients decreased dramatically from 46.6% to 6.2% from 2004-2012, with the biggest decrease occurring in the 3 years following health reform (42.1% to 13.0% from 2006-2009); as compared to only a slight drop among controls from 2004-2012 (69.3% to 67.4%). After adjusting for changes in annual BHOP funding, MA experienced a 74% increase in client volume from 2006-2009, compared with a 15% increase among controls. From 2004-2012, the mean age of clients (53 years) remained stable and similar for MA and controls. The proportion of racial/ethnic minorities served increased considerably in MA, from 62.0% to 77.7%, versus a smaller increase of 60.1% to 63.0% in controls. Likewise, the proportion of clients born outside the US rose from 37.2% to 50.7% in MA, compared with 33.7% to 36.6% among controls. However, the proportion of low-income clients (annual household income <$25,000) decreased overall from 90.4% to 83.1% in MA, and from 83.1% to 79.1% for controls. Conclusion In BHOP, Massachusetts observed a marked decrease (most noticeably in the 3 years following health reform) in the proportion of uninsured clients served, while overall client volume and the proportion of racial/ethnic minorities and foreign-born women increased. Discussion Historically, many BHOP grantees have relied on funding from the CDC’s National Breast and Cervical Cancer Early Detection Program or charity funds to pay for screening services for uninsured clients. As more clients nationally gain access to health insurance, BHOP grantees need to be prepared for the changing landscape and potential increase in client volume, as experienced by MA. Additionally, grantees should plan to update systems that aid in health insurance eligibility determination, assist with enrollment, and strengthen provider partnerships and referral systems that accept multiple types of insurance. Citation Format: Lindsay Senter, Marvin R Aliaga, Yixin Hu, Kelly Morrison Opdyke, Kathryn Gates-Ferris, Marc Hurlbert. Anticipating ACA's impact on breast cancer screening for medically underserved women reached through the Avon Breast Health Outreach Program: Understanding the Massachusetts experience [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-17-01.

The current US health care system is expensive,1 provides an uneven quality of care,2 and leaves about 40% of US adults uninsured or underinsured.3 The medical education system in the United States may contribute to these problems through its emphasis on the treatment of disease rather than addressing patient safety, cost-effective health care delivery, and population health. Graduate medical education (GME) occurs at the fulcrum of clinical care delivery and medical school, and could play an important role in altering medical education to better address features of clinical quality, health care costs, and access to health services. In the process, GME could bring about needed improvements in the delivery of health care services and prevention of disease and injury. To accomplish these goals, GME will have to build bridges between the clinical and educational enterprises. GME could begin a radical reconceptualization of the medical education continuum through the blending of health services concepts and competencies with traditional biomedical, bioscience models. In doing so, the prioritization of time and effort for residents and faculty would have to change to allow excellence in clinical quality to become the driving force for GME, and ultimately for the continuum of medical education.

Where do poor people in the United States (US) go when they get sick? Often, they go to Federally Qualified Health Centers (FQHCs) and hospital emergency departments. Even after the implementation of the Patient Protection and Affordable Care Act (ACA), these safety-net health care organizations will continue to play a crucial role in the US health care system. FQHCs have long grappled with some of the biggest questions facing the US health care system and their leaders and clinicians face ethical challenges in everyday practice. Ethical and policy challenges in the US health care safety-net are not usually 'tragic choices' involving the allocation of transplantable organs, or ventilators during a pandemic. They are everyday choices with a tragic dimension because, even with the adoption of the ACA, the US has not yet decided whether poor people deserve a 'home' or a 'net' when they are sick, and whether even a net should be in good repair.

Health Reform and Beyond: Delivering Results for Children

The 2010 Affordable Care Act (ACA) improved access to healthcare in the United States. However, immigrants —especially those undocumented— still faced difficulties, which have increased during the Trump administration. In order to bring access to health services to its nationals, the Mexican government has implemented the Health Windows Program (Ventanillas de Salud, or VDS). The article reviews changes in the U.S. healthcare system from the ACA to date, and assesses the role of VDS. The methodology is qualitative, consisting of a literature review, interviews with community leaders and Mexican government officials, and questionnaires sent to four VDS: Arizona, Florida, Idaho and Texas. Results show that VDS provide reliable and affordable access to basic healthcare services, and detection of chronic and non-communicable diseases, especially within undocumented immigrants. Public policy recommendations are offered based on these findings. Limitations of the study include the data collected, which is non-representative of all VDS.

Who Is Paying for Us Now? Effect of Insurance Coverage on the Financial Burden of Healthcare (Pre and Post Implementation of Affordable Care Act)

This chapter examines the unique challenges and imperatives of effective management within the non-profit healthcare sector. Operating under a dual mandate to fulfill a social mission while ensuring financial viability and access, these organizations face escalating pressures from patient volumes, technological change, and a shift toward value-based care. The analysis establishes that proficient healthcare management encompassing planning, organizing, and leadership is the critical scaffolding for sustainable service delivery, acting as a strategic integrator between mission and margin. Key to this sustainability is a holistic approach that balances operational efficiency, quality of care, and environmental stewardship. Also, the chapter utilized a conceptual/literature-based analysis that links managerial effectiveness, employee engagement, sustainable healthcare management, and service quality as interdependent drivers of effective service delivery. Furthermore, the chapter highlights that managerial effectiveness is intrinsically linked to workforce engagement and the application of service quality models like SERVQUAL, which diagnose gaps between patient expectations and perceptions. Ultimately, it argues that in non-profit healthcare, effective management transcends mere administration; it is a vital clinical enabler that builds resilient systems, empowers caregivers, and ensures that compassionate, equitable care can be delivered consistently to communities. The chapter concludes that effective service delivery in non-profit healthcare is primarily driven by managerial effectiveness, which enhances employee engagement, sustainability, and service quality, resulting in improved patient care.