The Affordable Care Act – an explanation
Please read this before Congress “throws the baby out with the bath water”!
By Donna Setterholm, RN, BSN, MA in HHSA – 02/21/2017, rev. 06/13/2017
Prior to the late 1970’s, hospitals operated with one administrator, usually a deacon, deaconess, or nun and a controller (the financial planner and accountant). The next two line managers were the Chief of Medicine, a doctor and the Director of Nursing, a nurse. Then medical directors (doctors) of various specialties, nursing supervisors and head nurses provided unit/specialty leadership. Hospitals were run with relative efficiency, affordability and caring. Circa 1974, business opportunists said, “We can create businesses from the health care industry.” And they did. Hospitals competitively consolidated or closed; mental health institutions and orphanages were permanently closed with few resources left for these humans to obtain care – hence the increase in homeless citizens. Equipment, supply and pharmaceutical companies profitably proliferated. The number of middle managers exploded. Insurance companies have become so powerful that they dictate the care to be given & for how long, what medications & treatments are allowed, as well as who can provide it, while increasing premiums beyond affordability. Lawyers have become active with malpractice suits, some as ambulance chasers, causing malpractice insurance for providers of health care & facilities to abound. So today, health care is no longer efficient, affordable, or logical and sometimes not provided with caring.
Choosing nursing or medical careers used to be considered a “calling”, vocation or profession. Since the turn of this century, more people enter the health care professions because that’s where the jobs are. Some people become nurses due to downsizing from their previous jobs/industry. Although they might be more mature, not all “older” nurses are seasoned or experienced practitioners and do require more training. The total clinical experience within our nursing schools is limited from 6 weeks to 6 months prior to graduation. Many new graduates are self-disciplined to learn on the job and become excellent care givers. But some dislike their jobs, clock out ASAP, do minimal tasks, or quit because the work is unpalatable or more difficult than expected.
Since, the late 1970’s, admission qualifications to medical and nursing schools along with subsequent education required for doctors and nurses has decreased. “RN” means that the nurse is registered with the state in which he/she works and has passed minimal competency tests. It does not define his/her education or experience. RNs may have an AD, ADN, diploma, BA, BS, BSN, MA, MS, MSN, or PHD education; but they are all called RNs. And some have a JD or a MBA. If the nurse’s name tag does not have educational credentials included, then patients, doctors, and visitors do not know the level of competency of that nurse. To earn any degree, one must prove competency by successfully passing various courses through testing. HR (human resource) departments tend to hire the least expensive RNs to fill their positions, with experience and education being a second and third consideration.
Interns do not rotate doing weekly 24/7 in-house “call” anymore due to labor laws. Although laws do protect them, they do not acquire the same varied experiences obtained from dealing with multiple cases over the course of their internship or residency. Due to a shortage of physicians, those training periods have not been increased, subsequently. Now we have the PA position (physician assistants who receive 1.5 years of health education) and the NP positions (nurse practitioners – with added 1-2 years of health education beyond their baccalaureate in nursing degree) to handle some of the physicians’ workloads.
The US Congress has been trying to deal with health care reform for 30 years. The Affordable Care Act had been in development prior to Obama’s presidency. It was finally put into law in 2010; hence President Obama receives the blame or credit even though he did not do the ground work. There are ten titles to the law. Title I deals with insurance reform. As a nation, we cannot get past this first law which is like “putting the cart before the horse” mentality. Titles II through X should be dealt with simultaneously with Title I to make any sense of affordability. Titles II – X of the law deal with HR reform so that best practitioners get the jobs, legal reform so that the industry isn’t getting sued every time a practitioner turns around, quality education requirements for doctors & health care workers, prevention of illness and adopting healthier lifestyles, improving quality and efficiency of health care & facilities, containing costs of medications, equipment & supplies (stop exploits), solving revenue provisions, and more.
Ironically, most US citizens, health care providers, educators, media and congressmen have no idea what the entire law entails. They only grasp the limited knowledge that the media reported. Since February 21, 2017, this article was sent to many senators, representatives, & the speaker of the house. Of the few responses received, it is clear they have not read this explanation, nor did they read the Affordable Care Act as published. We cannot solve the health care cost crisis if we do not understand the causes for unreasonable expenses and take responsibility for effective and well planned change. Our “first line” nurses and doctors involved in the day to day activities of healing disease and promoting health are our best consultants, yet they are seldom utilized to solve these complex problems.
The Affordable Care Act, Section by Section (For brevity, here is an outline of the ten titles of the law.)
- Title I. Quality, Affordable Health Care for All Americans
- Title II. The Role of Public Programs
- Title III. Improving the Quality and Efficiency of Health Care
- Title IV. Prevention of Chronic Disease and Improving Public Health
- Title V. Health Care Workforce
- Title VI. Transparency and Program Integrity
- Title VII. Improving Access to Innovative Medical Therapies
- Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
- Title IX. Revenue Provisions
- Title X. Reauthorization of the Indian Health Care Improvement Act
The entire law can be accessed on the http site shown below. If you click on each Title in the http link, you can read a brief summary of each. If interested, you can also read the entire law section by section.
http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html