Do we have health reform in the US, or don’t we?

As of February 3, 2015, the US House of Representatives voted for the 56th time to repeal or restrict the Affordable Care Act of 2010, otherwise known as health reform.  A current Supreme Court case will decide whether 34 states with federal-run insurance exchanges will lose subsidies for persons seeking insurance, thus potentially leaving about 8 million Americans uninsured.

In March 2013, over two years ago, I discussed ways that health reform would affect nurses.  This two-part series  compares my 2013 observations to the current status of health reform and its implications for nurses.

One: Changes in Health Benefits

The benefits I mentioned in 2013, including dependent coverage until age 26 and preventive care benefits, have so far continued to be implemented as part of health reform.  A Gallup Poll published in January 2015 reports that the uninsured rates for American adults averaged 12.9% in the fourth quarter of 2014.  This is down from 17.1% in 2013, and the lowest Gallup and Healthways have reported since beginning to track this measure in 2008.

An April 2015 Kaiser Health Tracking Poll found that an estimated 43% of Americans report a favorable view of health reform, compared to 42% reporting an unfavorable view.  There are even some predictions that Republicans may be dropping their push to repeal health reform.  It’s possible that health reform is moving from limbo to greater certainty.  On the other hand, the law may still face more changes and restrictions.

Many nurses are now managing the challenges of increasing patient volume as more Americans get health coverage.  If the political battle over health reform subsides, more Americans are likely to get private insurance or Medicaid benefits and seek health care they formerly could not afford.  Nurses must be prepared to offer expanding services while maintaining high standards for the quality of care.

Two: States Will Expand Medicaid Coverage

A 2012 Supreme Court ruling allowed states to opt out of health reform’s Medicaid expansion to Americans with incomes under 133% of the federal poverty level.  However, in 2013 I predicted that over half the states were likely to expand their Medicaid programs, effective in 2014.  Currently, 30 states including the District of Columbia have expanded their Medicaid programs under health reform.  Five states are discussing the decision to expand, and 16 states have not expanded Medicaid.

As already mentioned, nurses in states that expand Medicaid coverage may need to manage an increased volume of newly covered patients seeking health care.  Nurses in states that do not expand Medicaid coverage may experience financial impacts.  Hospitals and other providers in states that do not expand Medicaid may face cuts in reimbursement that are part of health reform, without the increase in Medicaid revenue received by providers in states that expand Medicaid.  Reductions in revenue impact staffing and budgets, with implications for nursing and patient care.

More to Come

It is clear from following health reform developments so far that many nurses must be prepared to manage in a time of growing health care demand.  Nurses in some part of the US may be facing resource shortfalls, especially if health coverage is not expanded in their state.  Part II of this series discusses the remaining points I made in March 2013, compared to the current status of health reform.

Susan J. Penner, RN, MN, MPA, DrPH, CNL, is the author of Economics and Financial Management for Nurses and Nurse Leaders, Second Edition (2013) and adjunct faculty at the University of San Francisco School of Nursing and Health Professions.