U.S. health care reform has become law. Do you know what it means for you as a nurse or nursing student? The Patient Protection and Affordable Care Act (PPACA) was signed in to law by President Barack Obama on March 20, 2010 as Public Law (PL) 111-148 with little fanfare, and lawsuits were almost immediately filed by States in an attempt to limit the scope of the most talked about entitlement reform since Franklin D. Roosevelt signed the Social Security Act in to law on August 14, 1935, 75 years ago. The White House timeline for the implementation of the health care reform act is ambitious, showing that some of the law’s provisions for nursing will be ushered in beginning in 2011 (White House, 2010).
An analysis of the new law demonstrates the work of nursing leaders who have lobbied politicians to create change in the way advanced practice nurses do business and the need for funding for programs intended to decrease the nursing shortage that nurse activists have debated before legislative bodies for decades. PL 111-148 includes funding provisions in the law designed to increase the numbers of Master’s prepared nursing graduates to become nursing faculty, while funding education and loan repayment programs through incentives for nursing students and nursing graduates who agree to work for two years as nursing faculty.
The health care reform law requires Congress to appropriate funds through taxation and other budgetary vehicles in the future, which may or may not prevent some provisions from being enacted. Health insurance exchanges will provide insurance coverage to a large pool of Americans who have been otherwise uninsured under private insurance plans (Kaiser Family Foundation, 2010). One of the keys to the success of the law is to have enough primary care providers when the newly insured surge capacity of patients enters the U.S. health care system carrying government subsidized insurance plans. Although Congress must still find the capital to fund all provisions of the law, the federal mandate asks for $26.4 billion dollars over 10 years to support only the primary care physician and nurse practitioner provisions (The Washington Post, 2010).
So what does this mean for the nursing profession? Some would say more jobs for nurse practitioners; however, there are many other provisions in the law that affect nurses. The law has a provision to enhance the Nursing Student Loan Program with a cost of attendance increase; an Advanced Nurse Education Grant program which removes the 10% doctoral education cap; a Nurse Education, Practice and Retention Grant program that focuses on nurse retention programs, nurse education, practice, and quality; a Nurse Faculty Loan Program with priority funding to doctoral nursing students; a Workforce Diversity Grant program for ethnic and racial minorities to facilitate entry in to nursing school; the Comprehensive Geriatric Grant program that provides funding to nursing students who plan to train and then work in the field of geriatrics; Demonstration Grants for Family Nurse Practitioner Training Programs and Graduate Nurse Education; Nurse Managed Health Clinics run by advanced practice nurses; and the provision for a Patient Centered Outcome Research Institute.
The healthcare reform legislation provisions for nursing education and practice are summarized in an easy to read table format by the American Association of Colleges of Nursing (AACN, 2010) among a plethora of other nursing and non-nursing organizations and institutions. However, what no one has published yet is the answer to this question: What is the down side of PL 111-148 for the nursing profession? The answer to this question is yet to be seen. As nursing leaders and nursing students, remaining vigilant is necessary to continue to craft public policy through dialogue with all stakeholders like political leaders and colleagues, and to mandate a seat at the political decision-making health care reform table so that when the regulations that impact the nursing profession begin to take effect, the rules enhance rather than overload the nursing profession.
The American Association of Colleges of Nursing (AACN). (2010). Patient protection and affordable care act: PL 111-148 nursing education and practice provisions. Retrieved form http://www.aacn.nche.edu/Government/pdf/HCRreview.pdf
The Kaiser Family Foundation. (2010). Summary of new health reform law. Retrieved from http://www.kff.org/healthreform/upload/finalhcr.pdf
The Washington Post. (2010). Landmark: The inside story of America's new health Care law and what it means for us all. The Washington Post: Washington, D.C.
The White House. (2010). Implementation timeline. Retrieved from http://www.whitehouse.gov/blog/2010/05/14/affordable-care-act-implementation-update