Introduction
The availability of health services is a critical factor affecting the population’s health. Since 2010, the Affordable Care Act (ACA) has been committed to meeting goals of healthcare accessibility, quality improvement, and cost reduction (Collins & Saylor, 2018). The law significantly transformed the health care system and influenced the practice of nurses at all levels. This paper examines the components of the ACA that have had the most significant impact on the practice of advanced practice nurses (APNs) and their implementation in California. Although California has adopted many measures and programs developed under the ACA, its influence on the practice of APNs may not be fully effective due to limitations in authority.
Influence of the ACA on APNs
Expanded Insurance Coverage
ACA implies changes in several directions to achieve the goals it has set. In particular, regarding the availability of healthcare services, the law introduced a new bill of rights for patients, expanding insurance coverage (Collins & Saylor, 2018). This component has increased access to services and demand for preventive care (“The nurse’s guide,” 2021). Such a situation impacts the practice of APNs, as patients prefer to cooperate with them for preventive services, which intensifies nurses’ workload and contributes to a greater demand for such specialists (“The nurse’s guide,” 2021).
Expanded Practice Scope
Moreover, the scope of practice for APNs was previously significantly limited, and expanding access to services increased the number of states that granted them full authority (Cleveland et al., 2019). This component is also essential for APN practice, as directing their activities toward preventive measures can significantly decrease the burden on the system and improve public health.
HVBP Program
Another influential component of the ACA is the Hospital Value-Based Purchasing (HVBP) program. It made hospital funding dependent on the quality of the services, not the amount of work (Collins & Saylor, 2018). As a result, providers must continually maintain a high quality of care to receive funding for their work. APNs should align their activities with the HVBP, following the guidelines from the Centers for Medicare & Medicaid Services (CMS) (Landin & Goudreau, 2022).
EBP
They should also implement evidence-based practices (EBPs) and act as leaders in transforming work processes to improve the quality of services (Landin & Goudreau, 2022). The importance of this component for APNs is evident, as it emphasizes their leadership role in implementing the EBP and improving the quality of services. Given specialists’ impact, giving them the appropriate authority is necessary.
GNE Demonstration Program
The ACA also led to the creation of the Graduate Nurse Education (GNE) Demonstration program. Within its framework, CMS provided reimbursement for several Medicare hospitals, enabling them to participate in consultations and training of APNs (Aiken et al., 2018). Although there were few program participants, it significantly increased the number of advanced practice graduates (Aiken et al., 2018).
The GNE Demonstration reveals policymakers’ understanding of the importance and impact of APNs. This component of the ACA is crucial for nurses, as increasing the number of such specialists will reduce the excessive burden on their colleagues and mitigate the impact of staff shortages. Moreover, sufficient APNs will improve public health and promote prevention over treatment.
ACA in California
Overview
Some states have adopted the ACA, its components, and programs to varying extents. In reviewing the California case, the state fully accepted Medicaid expansions (Kaiser Family Foundation, 2022). Moreover, California’s Department of Health Care Services (2022) implemented HVBP measures. However, state hospitals did not become participants in the GNE Demonstration (CMS, 2022). Such features have implications for the state health care system and APN practice.
Expanded Insurance Coverage and Nursing Practice Scope
Specifically, Medicaid expansion provided insurance to more people, making services more accessible and affordable. At the same time, California does not offer nurse practitioners full authority (“Nurse practitioner,” 2022). Therefore, the influence on nursing practice could be more effective in the case of full authority (Baten & Wehby, 2022). As a result, the law increased the load on all personnel without allowing APNs to be most effective and work independently.
HVBP Program and EBP
Adopting HVBP in California also affects the health care and practice of APNs. These measures can improve the quality of services, making the state healthcare system more efficient (Collins & Saylor, 2018). As in the case of expanding insurance opportunities, APN authorities are critical to achieving the most beneficial effect. Therefore, their practice aims to improve quality, but leaders’ roles in changes and implementing the EBP can be limited.
GNE Demonstration Program
Finally, participation in the GNE Demonstration could increase the number of APNs educated. Still, since California did not participate in the program, the state can experience more significant staff shortages.
Conclusion
Thus, the ACA has significantly transformed the American healthcare system and influenced the practice of APNs. This paper considered components such as expanding insurance opportunities, reforming the payment system with a focus on service quality, and creating a program that supports APN education. These measures have made services more accessible to the population, improved healthcare efficiency, and increased the number of APNs.
For nurses, these components increased the demand for specialists and underscored their role as leaders in enhancing the quality of services. California accepted the expansion and HVBP but was not a member of the GNE Demonstration. Due to authority restrictions, nursing practices are not as effective as they could be under the influence of the ACA.
References
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Kaiser Family Foundation. (2022). Status of state action on the Medicaid expansion decision. Web.
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The Department of Health Care Services. (2022). Value Based Payment Program. Web.
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