HEALTHCARE POLICY ANALYSIS (ANSWERED)

QUESTION

COMPETENCIES

Analyze Public Healthcare Policies and Federal and State Laws

The learner analyzes public healthcare policies, federal and state laws, and the resulting impact to patients and healthcare delivery.

INTRODUCTION

Policies in healthcare have an impact on individuals, whether at the institutional, local, state, or federal level. As a profession, nursing has the opportunity to influence health policies on all levels. By understanding healthcare policies, nurses can be advocates for patients as a unified group.

Although the majority of healthcare professionals are nurses, nursing has many opportunities to increase their involvement in healthcare policy. Healthcare and nursing practice are influenced by policy. Policy affects care delivery, patient preferences, and reimbursement. Nurses are in a unique position to influence policy due to the holistic care model and patient-centered care.

For this task, you will analyze a federal and state policy that relates to a current area of focus in healthcare. You will discuss how the federal and state policies influence patient and healthcare delivery. You will consider the population impact of the policies and if the policies are equitable at both the federal and state level.

Your goal in this task is to discuss how a nurse can impact policy at the state and federal level. You should consider the role of the nurse in the development of policy at the state and federal level and how the nurse will support or influence improvements to the policy at each policy level.

REQUIREMENTS

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, One Drive, etc.,unless speciﬁed in the task requirements. All other submissions must be ﬁle types that are uploaded and submitted as attachments(e.g.,. docx, .pdf,.ppt).

A. Compare public healthcare policies at the federal and state level that affect the provision of patient care and healthcare delivery by doing the following:
1. Describe one federal and one state public healthcare policy that affect the provision of patient care and healthcare delivery.

2. Explain how each policy works (e.g., Is it mandatory? Will enforcement be necessary? Who is responsible for administering the policy?).

3. Discuss each policy’s impact on the population(s) by answering the following questions:
• What populations will benefit?
• How will they benefit?
• What populations will be negatively impacted?
• How will they be impacted?
• Does the policy impact health disparities and health equity?

4. Discuss the evidence that informs each policy, including two scholarly evidence sources published within the last five years to support your discussion.
a. Discuss whether the evidence identified in part A4 supports the chosen policies, including any modifications that should be made to each policy based on the identified evidence.

B. Explain the role of the nurse in policy development and how the nurse could impact the administration of, or the revision of, a policy at
both federal and state levels.
1. Reflect on barriers to the nurse’s engagement in each of the following healthcare policy areas:
• development
• administration
• revision

2. Reflect on ways that you will engage with healthcare policy in each of the following areas in your future nursing practice:
• development
• administration
• revision

C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.

D. Demonstrate professional communication in the content and presentation of your submission

ANSWER

Public Healthcare Policies and Federal and State Laws

A1. Description of Policies

The Affordable Care Act (ACA) is a federal policy that affects the provision of patient care and healthcare delivery in the United States. Obama enacted the ACA in 2010 to promote quality healthcare and reduce health disparities (Serakos & Wolfe, 2018). This policy has provisions for subsidized Marketplace coverage, Medicaid expansion, reduction of healthcare costs, and the removal of cost-sharing for essential preventive services. The first ACA component is Medicaid expansion. It expanded coverage of dependents, i.e., young adults up to age 26 would be covered by their parent’s health plan. The ACA also stipulated that patients with pre-existing conditions should not be denied coverage (Serakos & Wolfe, 2018). It also removes cost-sharing for essential preventive services, among many other provisions.

California’s Nurse-to-Patient Ratio Law is a state policy that affects patient care and healthcare delivery. The legislation was enacted in 2004 and stipulated the maximum number of patients a registered nurse can care for on any shift. For example, the nurse-patient ratio in intensive care units is 1:2, and the ratio in the medical-surgical unit is 1:5 (Speakman, 2016). The legislation outlines the maximum nurse-patient ratio for other hospital units as well.

A2. How they Work

The ACA is a federal policy that applies to all states in America. The CMS operates the health insurance marketplace by collaborating with state agencies and insurers to ensure the insurance market works appropriately. It also enforces consumer protections, oversees the expansion of Medicaid, and conducts outreach and educational programs to inform the public to understand their health insurance options. The initial provision mandated all states expand their Medicaid coverage, but the Supreme Court reversed this mandate in 2012. Currently, states can opt to expand Medicaid under the ACA or keep their pre-existing Medicaid benefits. Therefore, each state has the discretion to determine how many services within the ten categories Medicaid will cover.

The California Department of Public Health (CDPH) administers and enforces the California Nurse-to-Patient Ratio Law. It investigates complaints and performs hospital audits to ensure all hospitals and health settings comply with the established ratios. It is also responsible for establishing penalties for law violations, such as fines and revocation of healthcare facilities’ licenses. This policy is mandatory, and all hospitals in California must comply with the stipulated guidelines. Thus, enforcement is necessary.

A3. Impact of the Legislations: ACA

Beneficiaries and how they benefit from the ACA

The ACA benefits individuals with pre-existing conditions, young adults, the elderly, retired citizens, women, low-income individuals, and lawfully present immigrants. Due to these provisions, millions of Americans can access healthcare, especially the elderly, young adults, and patients with pre-existing conditions (Arguelles & Sabharwal, 2018). ACA also reduced the overall healthcare costs as many Americans reported that cost is no longer a barrier to seeking healthcare (Arguelles & Sabharwal, 2018). These populations gained from increased insurance coverage, healthcare access, and reduced healthcare costs.

Populations Adversely Affected by Law and how they are impacted?

ACA does not provide insurance protections for all populations, e.g., undocumented immigrants, mixed-status families, Deferred Action for Childhood Arrivals (DACA) recipients, and nursing home residents. Serakos and Wolfe (2018) indicate that these populations account for approximately two million people. The ACA has also negatively affected insurers; some have withdrawn from the insurance marketplace. Due to the lack of a comprehensive insurance plan, they may be required to pay higher out-of-pocket costs and premiums than their counterparts (Serakos & Wolfe, 2018). This situation may prevent them from accessing essential health services, causing adverse health outcomes.

Impact of ACA on health disparities and health equity

The ACA expanded Medicaid coverage and increased access to preventive care services. Low-income individuals benefit the most from these provisions because high healthcare costs historically barred them from accessing primary care (Serakos & Wolfe, 2018). Medicaid also requires insurance plans to cover essential health services, reducing health disparities. However, it is essential to note that ACA has not fully resolved health disparities, and there is still more to achieve health equity for all populations.

Impact of California’s Nurse-to-Patient Ratio Law

Beneficiaries and how they benefit

The Nurse-to-patient Law benefits nurses and all patients receiving care from California. The law provides provisions for the minimum staffing levels required to ensure quality patient care (Speakman, 2016). Therefore, all patients in California hospitals, nurses, and organizational managers can benefit from the law because it enhances patient outcomes. These laws ensure that health settings have enough nurses to care for each patient. When nurses have a high patient volume, they have little time to pay attention to each patient’s needs. Burnout may affect the nurses’ mindfulness, resulting in medication errors, lengthened hospital stays, hospital readmissions, and even patient mortality (Speakman, 2016). However, this law ensures that all hospitals consider staffing levels and other resources before admitting patients.

Populations adversely affected the California Laws and how they are impacted.

This law is difficult to implement in rural areas where nurses and other medical professionals are sparsely distributed. This law also negatively affects individuals living in areas with high acuity levels. In rural areas, health settings may not have enough qualified nurses to meet the mandated nurse-patient ratio, which could contribute to poor patient outcomes. Patients will be affected if hospitals cannot meet the staffing ratio demands. They will have to wait longer to receive care, their hospital stay may be lengthened, and patient dissatisfaction may increase.

Impact of the California Law on Health Disparities

The nurse-to-patient ratio law may enhance health equity, ensuring all patients receive safe healthcare. Some critics argue that this legislation can result in nurse shortages, limiting access to patient care (Henderson, 2021). The critics claim that this law may force financially constrained hospitals to make tradeoffs by restricting care access (Henderson, 2021). These practices may cause health disparities and increase inequity in care provision. However, some studies have reported conflicting findings, stating that staffing legislation cannot create nursing shortages or disrupt quality healthcare access (Lasater et al., 2021). These conflicting reports indicate that further inquiry into this area is needed to establish the impact of nurse-patient ratio laws on health disparities and equity.

A4. Evidence informing the ACA

The Affordable Care Act is informed by various research studies that have demonstrated the effectiveness of its provisions in enhancing healthcare outcomes. Empirical research indicates that the ACA has improved access to primary care, preventive healthcare services, and patient health outcomes, particularly for low-income individuals (Arguelles & Sabharwal, 2018 & Serakos & Wolfe, 2018). According to Arguelles and Sabharwal (2018), the uninsured rate dropped from 18% to 13.4% less than a year after the ACA was enacted. The authors report that the ACA increased Medicaid coverage for up to 17 million Americans by 2020 (Arguelles & Sabharwal, 2018). All these outcomes have been achieved with little financial strain on the Medicaid beneficiaries.

How the Evidence Supports the Legislation and Recommended Modifications

These sources support the ACA as they demonstrate its impact on the healthcare system, particularly in improving healthcare outcomes and reducing health disparities. Although ACA has improved insurance coverage and healthcare outcomes, one common theme emerged from the above studies. The ACA has not fully remedied the insurance-based disparities. Serakos and Wolfe (2018) report that the ACA excludes about 3.5 million non-elderly adults and 2 million legal permanent residents and others from Medicaid coverage. Other studies have reported consistent health outcome disparity among Medicaid beneficiaries compared to private insurance (Arguelles & Sabharwal, 2018). Therefore, researchers recommend that the existing ACA policies be revised to include marginalized groups and excluded patient services such as long-term care and prescription medication to ameliorate health disparities.

Evidence informing the California Law

A prospective study by McHugh et al. (2021) showed that nurse-to-patient legislations are a feasible strategy for improving health outcomes with a good return on investment. According to the authors, nurse-to-patient legislation can help improve patient outcomes, reduce hospital readmission costs, and shorten the length of stay. Another cross-sectional study conducted by Lasater et al. (2021) had similar findings. After adjusting for possible confounders, the authors found that 4370 lives and $720 million were saved when a nurse-patient ratio of 1:4 was used in study settings (Lasater et al., 2021). The hospital length of stay and readmissions were also avoided due to these nurse-patient ratios. These studies demonstrate that the California Law could save many lives, and shorter hospital stays could lead to cost-savings for hospitals.

These studies support the California nurse-to-patient legislations. Lasater et al. (2021) found a considerable variation in the nurse-to-patient ratio in medical and surgical units. The authors suggest having a universal staffing ratio appropriate for all hospital units to enhance healthcare outcomes. The studies above advise that the legislation be adopted in other to improve healthcare outcomes nationally.

Role of the Nurse in Policy Development:

Nurses are uniquely positioned to influence healthcare policies. They have direct contact with patients and their families; hence, have in-depth understanding of patients’ and communities’ need. Nurses can participate in policy development through advocacy efforts and as subject matter experts. Their clinical expertise, education, and training gives them expert authority to provide meaningful insights into policy development and influence decision-making.

Nurses can impact federal- and state-level policy development by advocating for health-related policies. Nurses can identify gaps or inefficient practices resulting from harmful health policies and advocate for change. They can do this by participating in the legislative process or joining an advocacy group or professional nursing organizations that lobby for health-related causes. Nurses can also provide policy insights by sharing their professional and personal experiences with policymakers. Nurses can also write to their representatives at the state level regarding pertinent or pressing issues.

Barriers to Nurse Engagement in Healthcare Policy development, administration, and revision

Nurses may lack the knowledge and skills required for policy development and administration. This lack of skills and knowledge makes it challenging for them to comprehend how to navigate and participate in complex policy processes. Time and resource constraints are other factors barring nurses’ engagement in policy development, administration, and revision (Safari et al., 2020). They may not have the resources to fund their travel, advocacy materials, and support staff, discouraging them from participating. Organizational culture may not value or support nurses’ participation in policy development or administration. The political climate and fear of repercussions may make nurses hesitant to participate in policy revision (Safari et al., 2020). Most policy revisions require a change in status quo, and many nurses might restrain from revising policies for fear of backlash or criticism from their peers and employers as

Ways to Engage with Healthcare Policy in Future Nursing Practice:

Development: I can engage in policy development by joining professional organizations and advocacy groups and attending legislative hearings on health-related matters. These organizations provide discussion forums, allow nurses to participate in policy development by giving them voting rights, and provide advocacy training. I can leverage these resources to participate in policy development.

Administration: I can engage in policy administration by leading the implementation of health-related policies at the organization. I can prepare the organization for change and provide the necessary support in implementing the new policies. I can participate in continuous monitoring and evaluation of the implemented policy.

Revision: I can leverage my position in the groups mentioned above to provide feedback on the effectiveness of implemented policies. These groups provide unique opportunities for nurses to acquire valuable skills and experience in policy development. I may use my newly-acquired skills to advocate for revisions through social media channels so that my voice is heard.

References

Arguelles, A., & Sabharwal, M. (2018). Health Care for All: An Overview of the Affordable Care Act’s Medicaid Expansion in the USA. Indian Journal of Public Administration, 64(2), 174–192. https://doi.org/10.1177/0019556117750895

Henderson, E. (2021, September 10). Study compares three types of state legislations aimed at ensuring adequate nurse staffing. News-Medical.net. https://www.news-medical.net/news/20210910/Study-compares-three-types-of-state-legislations-aimed-at-ensuring-adequate-nurse-staffing.aspx

Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Anusiewicz, C. V., Martin, B., Reneau, K., Alexander, M., & McHugh, M. D. (2021). Is hospital nurse staffing legislation in the public’s interest? Medical Care, Publish Ahead of Print(5). https://doi.org/10.1097/mlr.0000000000001519

McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905–1913. https://doi.org/10.1016/S0140-6736(21)00768-6

Safari, M. B., Bahadori, M., & Khalil, A. (2020). The related factors of nurses’ participation and perceived benefits and barriers in health policy making. Journal of Nursing Research, 28(4). https://doi.org/10.1097/jnr.0000000000000385

Serakos, M., & Wolfe, B. (2018). The ACA: Impacts on Health, Access, and Employment. Forum for Health Economics and Policy, 19(2). https://doi.org/10.1515/fhep-2015-0027

Speakman, E. (2016, November 6). The importance of the optimal nurse-to-patient ratio. Wolters Kluwer. https://www.wolterskluwer.com/en/expert-insights/the-importance-of-the-optimal-nursetopatient-ratio#:~:text=The%20right%20nurse%2Dto%2Dpatient%20staffing%20ratio&text=For%20example%2C%20the%20nurse%2Dto,receiving%20treatment%2C%20the%20law%20states.