On Thursday, June 28, 2012, the Supreme Court handed down their decision, largely upholding the Obama Administration’s Affordable Care Act. Although the ACA is not a perfect piece of legislation, it is a clear and definite step forward, and a vital step towards ensuring each Oregonian, and each American, has access to quality and affordable health care.
ONA and ANA have worked together to promote and support the Affordable Care Act since it was first drafted and passed in 2010. We were excited that a number of the provisions vigorously pursued by the nursing community were upheld. All in all, more people will have access to affordable care, and the law’s structural and financial incentives to promote innovation in quality and delivery of care, remain in place. We may not yet realize all the ways the court’s ruling will directly impact you, your family, and every patient you serve.
One of the most controversial portions of the law, the mandate provision, was validated and upheld by the court. The mandate was included as a solution to address the cost-shifting problems we have with our current health care system. Beginning in 2014, individuals who do not carry or purchase insurance will be required to pay a tax to help defray the taxpayers’ burden of paying for future care. This provision will encourage people to carry insurance, discourage people from waiting to purchase coverage until they need treatment, and increase access to primary and preventive care services, which will ultimately help to keep the cost of care from spiraling out of control due to untreated conditions.
The ACA also included a number of consumer protection provisions to prevent insurance companies for denying coverage to those who need it most. Portions of the law have already gone into place and will continue to go into effect through 2014. For example, children can no longer be denied coverage due to a preexisting condition; this provision will extend to adults in 2014. In the meantime, adults who have been denied coverage in the past now have access to a high-risk insurance pool. Similarly, insurance companies can no longer cap your annual or lifetime medical expenses, kick young adults off their parents’ insurance plan before the age of 26, and they must provide access to most primary and preventive care with no co-pay.
Although the majority of the ACA remains intact after the court’s ruling, the court did strike down one portion of the law. They determined that Congress does not have the authority to leverage a state’s current Medicaid matching dollars to encourage participation the ACA’s Medicaid expansion program. However, that does not prohibit Congress from encouraging each state’s participation with additional funding. As the law stands, states that expand Medicaid coverage through the ACA provisions will receive federal assistance to cover 100 percent of the cost of expansion.
Oregon’s statewide health transformation process is well underway and setting an example for other states that are interested in taking advantage of federal assistance to expand Medicaid coverage, ensuring a large portion of the 600,000 uninsured Oregonians will soon have access to care. So what happens to individuals in who live in states that do not opt to participate in the expansion? The ACA allows individual who are unable to gain access to Medicaid coverage at the state level to apply for federal assistances, or for a waiver to avoid being penalized.
Nurses worked hard to ensure the final version of the ACA included opportunities to improve quality and access to care for every patient, emphasizes primary and preventive care, and focuses on wellness and prevention services. The ACA will allow for increased access to primary care in a number of ways, including improved reimbursement rates for NPs, CNMs, and CNS, and increased funding for nurse-led health centers and federally qualified health centers. The law also establishes and sustains the Center for Medicare and Medicaid Innovation (CMMI). The CMMI is charged with promoting health care innovation through research and grants to develop new ways to pay for and deliver care. The first two sets of grants have already been awarded to registered nurses and other healthcare professionals and organizations.
Nursing education and workforce development was not overlooked when lawmakers crafted the ACA. Additional funds are now available for registered nurses seeking to continue their education. The law authorized spending for advanced nursing education grants, workforce diversity grants, and grants for nurse education, quality, and retention. Additional grants and scholarship opportunities have been created for nurses pursuing doctorate or advanced degree in geriatrics, long-term care, or chronic care management. Nursing loan repayment programs have been put in place for nurses pursuing the specialty of pediatric mental and behavioral health, and the Nursing Student Loan Program has increased loan amounts.
Congress also took this opportunity to address the nursing community’s concerns regarding the nursing shortage by providing for incentives that will attract and retain quality nurse educators. The Loan Repayment and Scholarship program has been expanded to provide loan repayment for nurses who serve at least two years as a nurse educator at an accredited school of nursing.
As front line workers in our health care system, nurses are trusted voices in the national conversation about health care reform. Here is what Nurses across the state of Oregon had to say about the court’s ruling:
"I am very excited about the Supreme Court Decision. The Affordable Care Act is a gigantic leap forward toward healthcare for all. I am passionate about its provisions for Prevention and Promoting Wellness. "Wellness” will never make anybody rich, like treatment of disease, but it goes a long way to prevent and/or control chronic disease, which is a major source of healthcare expense, while alleviating an enormous amount of human suffering.” – Alan Helyer, RN, MPH, MBA (Hillsboro)
"The Supreme Court ruling is truly something to celebrate. This decision is a victory for each and every American, regardless of politics. I’m tremendously proud of the work that has been done to increase access to healthcare for every American, and grateful that the ACA remains intact. Thank you, President Obama, for giving me the opportunity to provide care to those who need it most, for giving me a chance to make a difference in the lives of my patients, and for helping make the future better for us all.” – Rebecca Tilley, RN (La Grande)
"This decision is a clear vindication of the Affordable Care Act and is a powerful boost for individuals, families and businesses who face skyrocketing health care costs and decreased access to health care all across the nation. As nurses, we see first-hand, every day, the effects of our broken health care system. This ruling helps to ensure that all American’s can look forward to increased access to care.” – Susan King, MS, RN, CEN, FAAN Executive Director of the Oregon Nurses Association (Portland)
"The Governor’s Health Care Transformation efforts, and Oregon’s Health Insurance Exchange, are already well underway and will have a dramatic impact on our state’s ability to provide care to our citizens. With the Supreme Court’s decision, I hope that states all across the country will follow Oregon’s lead and explore similarly innovative approaches to ensuring access to health care for all.” – Steve Rooney, RN President of the Oregon Nurses Association (Bend)
ONA wants to hear from you! Do you have questions about the Affordable Care Act? Do you want to share a story about how the Supreme Court’s decision impacts you, your family, or your patients? Click here to join other ONA nurses in responding to the Court’s decision.