This is a series on the Future of the Nursing Profession and its Role in Healthcare Reform.
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The Intent of the Affordable Care Act:
Providing Preventative Patient Centered Care
By Dana Sperle, RN
Content: The idea, formatting, and question content for this post was stimulated by Sara M. Ahten's (DNP, RN, Associate Professor at Boise State University) NURS 422 Care Coordination and Resource Management course.
Context: We were asked to pick a population of patients (or people) who would be affected by the Affordable Care Act. We were reminded that the Affordable Care Act's goal is to:
How this relates to the nursing profession:
The term "nurse" covers a broad range of qualified care providers. Nurses include:
Target Population Selected: Young Adults (late teens to mid to late 30s)
Will the young adult population benefit from the Affordable Care Act
which aims to provide prevention-focused care (Ahten, 2013)?
Edelmand and Mandle (2002) define young adulthood as the “period between the late teens and the mid to late 30s” (Potter & Perry, 2009). Young adult's could benefit from preventative-focused care related to lifestyle activities and environments (i.e. family and community influences) including:
Young adulthood is a transitional time in life. While some preventative education is provided through the public school system, parents, and pediatricians, many young adults end up in a world with little health care or health care supporting discussion. Young adult developmental activities include (but are not limited to) living alone for the first time, attending higher education, completing mature physical development, self-discovery, pregnancy, marriage, parenthood, and pursuing financial independence. With so much input to the brain, the concern of health is easily dropped or compartmentalized by supposedly healthy, invincible, young individuals.
Does the Affordable Care Act provide prevention-focused
healthcare opportunities to the young adult population (Ahten, 2013)?
Preventative care for the young adult is a twofold intervention. By increasingly educating (having discussions), screening, and encouraging healthier diets, activity levels, and lifestyle patterns, young adults will be better equipped to live healthier lives throughout their lifespan. Healthier lifestyles not only benefit immediate health, but also long term health. For example, if a young adult learns they are being exposed to chemicals at his work place which puts him at risk for long term lung damage (leading to lung disease or recurring pneumonias) hopefully he will be more likely to find other employment, or at least take precautionary measures to protect himself (i.e. wearing proper protective masks). Also, being in the young adult age range myself, I tend to follow advice or education more adhesively if I have been told why I should do something. I do not simply follow commands without incentive. I believe the young adults of today need reasonable and logical explanations before they will be motivated to action versus taking action because a person in a position of authority says to.
Are there obstacles to providing prevention-focused care to the young adult population?
How can these obstacles be mitigated (Ahten, 2013)?
The primary barrier to providing focused care through the Affordable Care Act (ACA) to young adults is the discrepancy of who is considered a young adult and the premiums attached to the discrepancy. According to CMS.gov (n.d.), 30 percent of young adults were uninsured prior to the enactment of the ACA. In order to relieve this 30 percent, the ACA allowed for any persons 26 and under to remain under the wings of their parents health insurance program. Certainly this allowance has provided many young adults increased access to reasonable healthcare, especially those who are single, already sick, non students, men, and under 26. However, the benefits of preventative care through the ACA stop on the last day a young adult turns 26 (Sommers, Buchmueller, Decker, Carey, & Kronick, 2013). The question remains, what about the rest of young adulthood? What about the young adults whose parents do not have health insurance to remain under? What about the single college graduate the ACA was trying to protect who found a $35,000 per year paying job (which is above the federal poverty level) without benefits, but does not qualify for help (subsidies) paying his premium and has $500 per month student loans, rent, and other necessary life bills?
Napala Pratini (2014) from NerdWallet Health, reported for abcnews.com that “being healthy (or being young) does not mean a discount on high insurance costs for young adults.” One of the points she made is that the ACA puts a cap on how much older and/or unhealthy adults can be charged for their health insurance premiums. While the limit makes the older population’s premiums more affordable, the cost is still there and needs to be covered. It appears that the cost is saturated into the young adults premiums. According to Levitt, Claxton, & Damico’s (2013) analysis: “Younger adults pay more than they would without any age rating limits and older adults pay less.”
So, the barrier lies in the expense of the ACA’s insurance for the young adult. The water is muddied. When faced with the choice to pay for insurance (with a perchance of need) in addition to students loans, car loans, rent, food, and other living expenses, will the young adults actually participate? It is through participation that preventative care can be administered. The goal is to ease the financial burden of healthcare, and yet through another mandatory life expense (at the risk of mounting penalties for non compliance), a heavy yolk has been placed on the young adult population.
While the water remains muddied and the wordy rhetoric of numbers and statistics fly, no one can really tell what the outcome of participation and premiums will be. However, it is important to remember and educate to the point: bodies need maintenance too. Metaphorically speaking, bodies are like cars. They need routine (preventative) maintenance. Bodies need their “oil changed” (good food) and “tires rotated” (check ups) if they are to continue to run smoothly. Ways to circumvent the hesitation of the financial barrier and ensure by-in from the young adult population (especially those over 26) may include:
Some Young People Won't Get Tax Help for Obamacare Insurance by Elana Gordon (March 18, 2014)
The Numbers Behind “Young Invincibles” and the Affordable Care Act by Larry Levitt, Gary Claxton,& Anthony Damico (December 17, 2013)
Young Adults and the Affordable Care Act by T.R. Goldman (December 16, 2013)
The Center for Consumer Information & Insurance Oversight: Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Families and Businesses at CMS.gov
How the Affordable Care Act Helps Young Adults By Maura Calsyn and Lindsay Rosenthal (May 20, 2013)
Ahten, S. M. (2013). NURS 422 care coordination and resource management: assignment #1 healthcare reform and new models of care: patient centered, interprofessional and outcome-focused [Class handout]. Retrieved from https://blackboard.boisestate.edu
Calsyn, M. & Rosenthal, L. (May 20, 2013). How the affordable care act helps young adults. Center for American Progess. Retrieved June 23, 2014 from http://americanprogress.org/issues/healthcare/report/2013/05/20/63792/how-the-affordable-care-act-helps-young-adults/
CMS.gov. (n.d.) The Center for consumer information & insurance oversight. Retrieved June 23, 2014 from http://www.cms.gov/CCIIO/Resources/Files/adult_child_fact_sheet.html
Levitt, L., Claxton, G, & Damico, A. (Dec 17, 2013). The numbers behind the “young invincibles” and the affordable care act. Retrieved June 23, 2014 from http://kff.org/health-reform/perspective/the-numbers-behind-young-invincibles-and-the-affordable-care-act/
Moyer, C. (March 26, 2012). Study calls for preventive health guidelines for young adults. amednews.com. Retrieved June 23, 2014 from http://www.amednews.com/article/20120326/health/303269959/4/
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (7th ed). St. Louis, Mo: Mosby Elsevier.
Pratini, N. (March 1, 2014). 4 reasons that young adults won’t sign up for the affordable care act. Retrieved June 23, 2014 from http://abcnews.go.com/Business/top-reasons-young-adults-sign-affordable-care-act/story?id=22690267
Sommers, B. D., Buchmueller, T., Decker, S. L., Carey, C., & Kronick, R. (2013). The affordable care act has led to significant gains in health insurance and access to care for young adults. Health Affairs, 32(1), 165-74. Retrieved from http://search.proquest.com/docview/1285127928?accountid=9649
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Random blurbs and discussions on topics, issues, and personal sentiments related to the current climate of the nursing profession.