NURSING: EVIDENCED-BASED PRACTICE PROJECT

After the Act was implemented in 2014, significant changes were experienced in the healthcare system. The Act aimed to achieve its goals through reforming the insurance market, expanding the Medicaid and to inform new ways for making decisions. All these objectives are based on private choices. The assumption for developing the policy was that groups and individuals would act within the reforms to improve the healthcare system. Over the years, low income individuals have been able to access affordable healthcare services in the United States. This indicates that the Act has been able to achieve its objectives. The policy had five main objectives, which are to:

1. Expand Coverage. To expand coverage, the policy creates marketplaces, which is known as exchanges. What it does is that it helps people to purchase health insurance and determine what they are eligible for including financial help. It is also divided into three types of marketplace:

a. federally facilitated marketplaces,

b. state-based marketplaces, and

c. state-partnership marketplaces.

They all have different responsibilities in the marketplace. While the exchanges have one single process that determines if an individual’s eligibility for tax credits to reduce the cost of his or her premiums, this comes in the form of cost sharing, Medicaid, or the Children's Health Insurance Program (National Academy of Sciences, 2015).

2. Reduce Health Care Costs. The policy was developed to improve health care quality, and it mandates several initiatives that include:

· A national quality strategy

· Increased reliance on value-based purchasing

· Expansion of meaningful use of electronic health records (EHRs)

· Better care coordination

· Development of quality measures for Medicaid and Medicare

· Measures of quality in the marketplace.

The policy also involves the creation of innovations that creates an avenue for improving quality. This initiative include projects such as Strong Start, which is a program that reduces early deliveries, specifically among Medicaid populations; nurse-managed care organizations; programs supported by Health Care Innovation Awards and the Community-Based Care Transitions Program; accountable care organizations (ACOs); and the Advanced Primary Care Practice demonstrations at federally qualified health centers (FQHCs). Additionally, the CMS and other organizations seeks to develop and test models to reduce health care costs, improve health care quality, and evaluate how well models work across different populations (Frazier, 2016). Some initiatives are also been used for improving population health, they include:

· Quality-of-care improvements,

· Employee wellness benefits,

· Preventive services for Medicare beneficiaries,

· Preventive services for women,

· A dental sealant program for children, and

· Community transformation grants.

3. Improve Health Care Quality: The policy also focuses on strengthening the health care by providing grants to institutions so that can train more physicians who will specialize in the fields of:

· family medicine

· general internal medicine

· general pediatrics

· physician's assistants

The policy also increased the funding that has been requested for a long time to train specialists in mental and behavioral health. It also removed the previous caps on the U.S. Public Health Service Commissioned Corps and the National Health Service Corps (Frazier, 2016)

4. Improve Population Health: The Affordable Care Act also made provisions to specifically reduce health disparities among the affected population especially the minority populations. By the year 2014, close to 50 million people were uninsured, especially among the African-American, Hispanic-American and the Asian-American communities. Compared to the years prior to the ACA, disparities in the quality of care among racial and ethnic groups have changed considerably due to the policies of the ACA (Gallegos, 2017).

5. Reduce Health Care Fraud and Abuse: One of the strong policies of the Affordable Care Act is preventing the corrupt and dishonest providers from participating in Medicare or Medicaid and imposing strict and heavy fines and penalties on them (Gallegos, 2017). The changes include:

· Provision of more money for preventing and fighting fraud

· Provision of better screening and compliance

· Created new fines and penalties

· Created better and formidable data sharing

Ethical Legal and Political Factors

The ACA was designed in such a way that it did not violate all ethical, legal, and political factors in the United States. The Act was enacted to ensure all Americans despite their social class can be able to access quality healthcare services. In addition, the act was designed to end the ignorance that prevailed in the US society about the importance of healthcare services. As a result, the Act promotes the ethical principle of equality. This ACT also promotes moral values within the healthcare system in the United States. It encourages healthcare providers to comply with all healthcare regulations (Hu et al., 2018).

The policy also has various political implications. The then President Barack Obama used it as a campaign tool for the presidential election. This played a significant role to his re-election as people from poor communities voted for him overwhelmingly. In addition, it made President Obama more popular since it revolutionized the US health system for the benefit of the whole society. While there were various drawbacks associated with the policy, the opposition could not successfully use them to discredit what the president had achieved. When implementing the policy, nurse practitioners must consider their profession as a calling and not a source of employment.

Health Goals Related to the Policy

The ACA has three main goals namely to reduce the cost of healthcare, to protect Americans from arbitration action from insurance companies and increase accessibility of healthcare insurance (Hu et al., 2018). Before the Act was developed, low income earners were unable to access quality healthcare services. This was attributed to the high costs associated with accessing these services in the country. Most people used to stay with their illnesses at home hoping to get well. As a result, the country lost many people who suffered from conditions that could be management effectively.

There were also a huge number of uninsured people because insurance companies were asking for so much money. The policy-makers aimed to ensure more people could be able to access insurance by developing the ACA. Most people particularly people of color and low-income earners were also unable to access these insurance covers. As a result, they could not be able to access healthcare services. The ACA also expanded Medicaid to cover more low-income families. In addition, the policy aimed to introduce coverage of preexisting conditions that were not captured in insurance policies before (Griffith, Evans & Bor, 2017).

This Act was designed in such a way that it could be able to achieve these goals. This is because policymakers came up with a well-thought-out structure for the implementation of the Act. Significant financial and human resources have also been identified and incorporated in the implementation process to ensure that the ACT achieves its goals. Additionally, there have been significant campaigns to create public awareness about the Act and what it aims to achieve. This has encouraged people to seek insurance covers to comply with the provisions of the Act.

Advocacy Strategies

This policy can only achieve its goals if there is effective communication among all stakeholders involved. One way to achieve this is to develop an education program aimed at creating awareness within communities concerning the Act. Through this program, I will be able to outline the benefits associated with the policy. I will also develop various conferences and workshops to ensure that the society gets important information concerning the full implementation of the Act. I will also come up with supervisory strategies to monitor the level of compliance within communities. This is particularly important in determining communities that need more education concerning the policy.

Professional and Moral Obligation

The bible teaches us that we should do whatever we are doing with all our hearts as if we are doing for the lord rather than for the people. Registered nurses should therefore perform their duties with all their hearts for the glory of God. Nurse practitioners also have both professional and moral responsibility to ensure that they comply will all the provisions of the Act to prevent and manage diseases in diverse populations. They should also use their skills to provide leadership in the implementation of the policy. This could involve training individuals and advocating to compliance to the policy for the good of the public.

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