Evolving Informed Understanding of the Health Care Reform Law

Throughout most of summer 2011, we heard debates about how to deal with the growing national debt and the need to raise the U.S. debt ceiling. Some legislators in Washington are saying that the Accountable Care Act and now law are part of the cause for the escalating national debt. This is not an accurate claim, but it has influenced views on health care reform and the Accountable Care Law. Views on the need for and impact of the Accountable Care Law continue to be divided, with a Kaiser Health Tracking Poll (July 2011) reporting 42% of Americans hold a favorable view and 43% an unfavorable view. According to the poll:

Even though previous Health Tracking polls have consistently shown that consumer protections were one of the least controversial and most widely supported provisions of the health reform law, the July poll finds that just one in five Americans think the law will lead to improvements in consumer protections for the average person with health insurance. Higher shares of Americans expect to see the law bring about improvements in access to health care (49%), health care costs (28%) and quality (26%). On the other hand, pluralities expect the cost of care for the nation as a whole (49%) and the quality of health care in the nation (41%) to get worse (Kaiser Family Foundation, 2011).

Views/opinions such as these are often developed based on sound bites heard or seen in public media that are polarizing and misleading. In prior columns, we have discussed the need for and availability of informative, relatively non-biased information posted online that helps explain the new Health Care Reform Law.

A January 2011 analysis from the Annenberg Public Policy Center opens with this statement: "The nonpartisan Congressional Budget Office states that repealing the health care law would worsen the federal deficit over the next 10 years — by $230 billion." The stark reality is that in the U.S. we have a growing population with chronic diseases, a growing obesity epidemic, as well as a growing elderly population who are living longer with chronic illnesses. If we do not provide early access and management of these populations, the costs of acute care in emergency departments and ICUs when individuals with these problems become acutely ill with complications will continually escalate our health care costs and we will have poorer outcomes, despite higher spending.

The only way to enhance understanding of the health reform law is to continue to use easily accessible and understandable information. There are many sites offering up-todate information that often show the opposing views with best estimates of truth. The Kaiser Family Foundation has developed a very well done nine-minute video that should be a "must see" for health care providers and their patients. This video does a good job of graphically representing major provisions of the health reform law with alternative views on each provision (see sidebar). In addition, the Foundation also offers a web-based, frequently asked questions (FAQ) section (see sidebar).

Ambulatory care nurses as well as other providers in ambulatory settings may wish to delve further into provisions of the health reform law. The Commonwealth Fund offers succinct issue briefs on the major provisions of the health reform law, discussing areas such as coverage for women, young adults, persons with disabilities, impact on costs, and coverage under Medicare Advantage (see sidebar). With provisions that provide for access to insurance, accountable care organizations, and patient-centered medical homes, the health care reform law offers hope for management of populations with chronic disease as well as enhanced quality and safety in care provided. As was discussed at the AAACN Annual Conference in April, ambulatory care nurses are crucial in these endeavors. "Care Coordination" is a major priority in health care reform and who is better prepared to do care coordination than ambulatory care nurses? Actually, ambulatory care nurses have been doing it for years (Haas, Hackbarth, Kavanagh, & Vlasses, 1995), but absence of documentation and few research studies in this arena have left this dimension of their role invisible.

In a 2010 report, the National Quality Forum (2010) endorses care coordination best practices to provide optimal patient care and provider communication (see sidebar, page 7). Ambulatory care nurses will find this report interesting and helpful as it provides direction for ways that the ambulatory care nurse’s role will evolve in accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). In the next Health Care Reform column, we will expand upon ACOs and PCMHs and the ambulatory care nurse’s role in them.

Sheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School of Nursing, Loyola University of Chicago, Chicago, IL. She can be reached at shaas@luc.edu

References
Annenberg Public Policy Center. (2011, January 19). A ‘budget-busting’ law? Republicans and Democrats both misrepresent the fiscal effect of the health care law. Retrieved from http://www.fact check.org/2011/01/a-budget-busting-law/

Haas, S., Hackbarth, D., Kavanagh, J., & Vlasses, F. (1995). Dimensions of the staff nurse role in ambulatory care: Part II - Comparison of role dimensions in four ambulatory settings. Nursing Economic$, 13(3), 152-165.

Henry J. Kaiser Family Foundation Health Reform Source, The. (2011). July Kaiser health tracking poll: Public still divided on ACA, few believe the law will improve consumer protections. Retrieved from http://healthreform.kff.org/scan/2011/july/kff-july-healthtracking-poll.aspx