Now What for Health Care? Post-election Predictions
Nursing leaders discuss the future of the ACA and its provisions
By Debra Wood, RN, contributor
Throughout the campaign, President-elect Trump vowed to repeal and replace the Affordable Care Act (ACA), or Obamacare. Now that he has won and met with President Obama, he has backed off, a little, indicating to The Wall Street Journal that he likes and may keep provisions that young people can stay on their parents’ insurance until age 26 and requirements that insurers cover people with pre-existing conditions.
“Whether the ACA will be repealed or undergo significant changes remains to be seen,” said Janet Mahoney, PhD, RN, APN-C, NEA-BC, dean of the Marjorie K. Unterberg School of Nursing and Health Studies at Monmouth University in West Long Branch, N.J. “One thing is for sure, it will be different.”
Trump’s transition website still calls for repeal of Obamacare. That would require Congressional support and 60 votes in the Senate, to block a Democratic filibuster. But once in office, Trump could refuse to fund ACA programs and suspend regulations with executive action.
What will that mean for nurses?
“The implications are not as direct for nursing as they are for the people we serve,” said Pamela F. Cipriano, PhD, RN, FAAN, president of the American Nurses Association (ANA).
Will Trump throw the more than 20 million people who now have coverage due to the ACA back into the ranks of the uninsured? No one knows right now.
“The people of this country have benefited from a lot of the changes in the Affordable Care Act, and their elected leaders know that,” Cipriano said. “We are anticipating there will be proposals to change the Affordable Care Act, possibly not repeal and replace, but to change major provisions and that has us on high alert.”
Cipriano said nurses will immediately see the consequences of any turning backward on the progress made under the ACA and will recognize those patients now lacking coverage who cannot pay for care. They will need to help people get the services they need and direct patients to safety-net providers.
“I am confident that the nursing profession has, and will continue to play a major role in educating patients about their choices regarding health care plans, presently and in the future,” Mahoney said.
RELATED: Nurses Again Named Most Trusted Professionals
The accounting and consulting firm PWC reports that repealing and replacing the ACA will negatively affect providers of care. USA Today reported on November 11, 2016, that Tenet Healthcare stock has been the “second worst performing stock in the S&P 1500 since Trump won, declining 28%. In fact, health care facilities companies account for four of the 15 worst performing stocks since the election, which is more than any other industry.”
“Any repeal or defunding makes the industry very vulnerable,” Cipriano said. She indicated it could have an effect on the nursing workforce, but many hospital officials now recognize that RN nursing care affects outcomes.
“The nursing staff in all of these hospitals will need to have crucial conversations with their leaders to say, particularly if we have constrained resources, to preserve and promote registered nurse staffing in organizations. That’s going to make the difference.”
While health insurance for more Americans is a mainstay of the ACA, it’s not the only provision. The ACA brought innovation to the Centers for Medicare & Medicaid Services. Value-based purchasing, bundled payments and accountable care organizations launched. The act also placed a focus on preventive care.
An emphasis placed on quality and safety is likely to stay in some form. Commercial insurers have embraced many of these metrics and have a vested interest in a continuing emphasis on quality while delivering health care more cost effectively.
“We don’t want to back off any provision that would threaten quality care,” Cipriano said.
“Nurses have been a pivotal force in indicators like reduction of 30-day readmission and reducing hospital-acquired conditions.” She encouraged nurses to step up and share with elected officials the positive effects of the ACA.
“We cannot back off our policy advocacy,” Cipriano said. “We want to make sure our voice is heard and amplified now.”
Mahoney added, “If a major overhaul of ACA is called for, I would like to see nurses at the table to voice their recommendations in shaping a renewed quality healthcare proposal.”
Put your nursing skills to work in your choice of locations across the country; sign up for travel nursing job alerts today!
© 2016. AMN Healthcare, Inc. All Rights Reserved.