© Oncology Nursing Society. Unauthorized reproduction,
in part or in whole, is strictly prohibited. For permission to photocopy, post
online, reprint, adapt, or otherwise reuse any or all content from this
article, e-mail pubpermissions@ons.org. To purchase
high-quality reprints, email reprints@ons.org.
February 2013, Volume 17, Number 1
Editorial
Deborah K. Mayer, PhD, RN, AOCN®, FAAN—Editor
What Does the Affordable Care Act Mean for You?
The national elections are
over and we can now focus more on what changes will be occurring in health care
related to the Patient Protection and Affordable Care Act (ACA). Although we
may be familiar with these terms, we may not have paid much attention to the
details. The ACA was introduced to Congress in 2009, signed into law in 2010,
and was upheld by the Supreme Court in 2012. The ACA is the largest mandated
healthcare change since Medicare and Medicaid in 1965. Implementation began in
2010 and will continue to roll out through 2015 (see Figure 1). The main
aspects of the ACA include enhancing access to health care by increasing the
number of insured Americans, reducing overall healthcare costs, holding
insurance companies accountable to make care more affordable, and improving
outcomes while streamlining delivery (HealthCare.gov, 2013). These changes are
long overdue; the system has become increasingly unsustainable given how much
more money the United States spends compared to other developed countries while
still experiencing poorer outcomes (PBS Newshour,
2012).
As oncology nurses, we are
affected personally and professionally by many of the provisions.
Professionally, I believe we are the best positioned to take the lead on or
support many of the changes that are occurring. Personally, our children can
now stay on our health insurance until they are age 26. Preventive care,
including many cancer screenings, vaccinations, and health-promotion
counseling, will now be delivered without a copayment or need to meet a
deductible. Gender (i.e., being female) and preexisting conditions such as
cancer can no longer be reasons not to insure someone or to charge them more.
And, more people will be insured, have more choices regarding providers, and
not face a lifetime limit of coverage or worry about being dropped. That is all
good.
At the same time, the
healthcare organizations we work for are being asked to change many aspects of
how care is delivered and paid for to improve quality and outcomes while
reducing health disparities and costs. More efforts are being made to provide
primary care, strengthen community health centers, and increase care in
underserved rural communities. Nurses can provide leadership in all of these
settings to make our healthcare system person-centered.
Insurance services and costs
are being controlled more, and 85% of health insurance premiums must be spent
on health care and quality improvement. Medicare, Medicaid, and the Children’s
Health Insurance Program also will be improving quality of care while slowing
or reducing costs. Linking payments to quality outcomes means that we will be
paying more attention to transitions home after hospitalizations and improving
safety while reducing “never events” and hospital readmissions. More focus will
be placed on coordination of care and teamwork, as well as in delivering more
evidence-based care (Moy, Abernethy, & Peppercorn, 2012). You may already
be involved in or affected by some of these activities.
Personally, I am excited by
these changes. Having been in cancer care since the mid-1970s, I can attest to
the fact that we delivered cancer care within an irrational, broken healthcare
system. We have long recognized the many injustices in our healthcare system
while delivering cancer care—the person who presents with advanced cancer
because he or she didn’t get screened, or the person who can’t afford
chemotherapy or has to decline treatment so as to not bankrupt his or her family.
The ACA provides the carrot and the stick to get individuals, employers, and
healthcare organizations to make necessary changes. It will take time; however,
I have seen more movement toward these changes in the past few years than I
have seen during the rest of my career. I also believe that nurses can (and
should) be the movers and shakers for many of these changes. It will be bumpy,
but nothing this momentous happens smoothly. And, remember to keep the patient
with cancer at the center of these changes. If we all do that, there is no
telling how much better cancer care can be.
References
HealthCare.gov. (2013). Read the law. Retrieved from http://www.healthcare.gov/law/full/index.html
Moy, B., Abernethy, A., &
Peppercorn, J. (2012). Core
elements of the Patient Protection and Affordable Care Act and their relevance
to the delivery of high-quality cancer care. Retrieved from http://bit.ly/VKqIbM
PBS Newshour. (2012). Health
costs: How the U.S. compares with other countries. Retrieved from http://to.pbs.org/Rdn8aK
The author takes full responsibility for the content
of the article. No financial relationships relevant to the content of this
article have been disclosed by the editorial staff. Deborah K. Mayer, PhD, RN,
AOCN®, FAAN, can be reached at CJONEditor@ons.org.