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While working as a nurse practitioner, one could impact the healthcare reform, not only in our patients but personally as well. In the United States, the Affordable Care Act has made an attempt to make health care available to everyone. Part of that legislation involved penalties and taxes attached to individuals who did not purchase health insurance. The initial plan of the Affordable Care Act was to increase competition among insurance companies, but many were forced out of business.

To stay in business, insurance companies needed to cut costs and regulate utilization. This process involved placing rules and regulations on preauthorization, referrals, and increasing deductibles and copays. From my experience, I have found that many times the care that needs to be provided to patients is run by the insurance company, not the provider. This becomes frustrating when it becomes a battle over money and not what is best for the patient. This affects the nurse practitioners as evidence-based practice is sometimes pushed aside to accommodate what the insurance company deems necessary, which is both time-consuming and detrimental to patient care.

Research and policymakers both agree that nurse practitioners are a viable resource to bridge the gap in access and quality care, as well as cost containment in healthcare. If nurse practitioners are mandated to work in the same office as a physician, this will decrease the potential for new offices being opened to support patient overcrowding in the current primary care provider offices. Additionally, state scope of practice laws that are not congruent in all fifty states pose limitations to the nurse practitioner. To mitigate this issue, all fifty states should have a uniform scope of practice for the nurse practitioner.

The more our legislative bodies make healthcare more accessible to the general public, the demand for new primary care providers will increase exponentially. Studies have shown that when NPs practice autonomously, patients benefit, and the organizations that employ them show more favorable teamwork and relationships with leadership. According to the Florida Association of Nurse Practitioners (2020), the law HB 607: Direct Care Workers in our state of Florida states that NPs seeking to be licensed for independent practice must meet specific qualifications. These include 3,000 clinical practice hours within the last five years, completion of graduate-level hours in differential diagnosis and pharmacology, and maintaining professional liability coverage.

Once the APRN license of independent practice is successfully issued, the NP is granted signature authority, which includes admitting/discharging patients and providing necessary legal signatures. Nurse Practitioners who obtain a license to practice independently need to start in an area such as family medicine, general pediatrics, or general internal medicine. On the other hand, if an APRN desires to continue practicing under a collaborative/supervisory protocol, nothing changes from previous standards.

Healthcare reform has implemented policies and programs aimed at improving healthcare outcomes through addressing chronic and preventive care across a team of healthcare providers, including NPs. Several factors are driving healthcare reform, including fragmentation, unsustainable costs, and access problems. The available primary care providers' workforce is insufficient to meet the growing healthcare demands resulting from these healthcare transformations. An increasing number of health policy experts are encouraging state and federal governments to broaden the role of nurse practitioners in the primary care setting.

However, barriers to NP practice continue to prevent these practitioners from achieving their full potential. These barriers include scope-of-practice regulations across states, which vary significantly. In some states, NPs are fully authorized to evaluate, diagnose, and manage patient treatment independently, while others impose tight restrictions on select activities. An additional challenge is reimbursement, as many NPs receive considerably less reimbursement than physicians for similar services.

Despite these barriers, states are working to expand the role of nurse practitioners in primary care, including granting full practice authority and improving reimbursement. The Affordable Care Act is a subsidized health insurance marketplace that allows individuals to shop for health insurance. This service helps people obtain affordable insurance, which is crucial for maintaining a healthy lifestyle.

One of the primary successes of the Affordable Care Act is that it prevents health insurance companies from denying coverage based on pre-existing conditions. As more individuals gain health insurance, the demand for primary care physicians also increases, leading to greater opportunities for nurse practitioners. Although obstacles still exist with regard to the scope of practice, there are plans to expand it, reinforcing the role of NPs as vital contributors to the future of healthcare.

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Healthcare reform is an ongoing process that significantly impacts the roles and responsibilities of nurse practitioners (NPs). As a healthcare professional with advanced training, NPs play a crucial role in providing high-quality care and responding to the growing healthcare demands in the United States. This discussion focuses on the implications of healthcare reform, specifically through the lens of the Affordable Care Act (ACA), and how it has opened new avenues for nurse practitioners to enhance patient care.

The ACA was established with the primary goal of expanding healthcare access to a broader population. By introducing policies such as the individual mandate and subsidies for insurance coverage, the ACA aimed to decrease the number of uninsured individuals. The ACA represents a shift towards a more integrated healthcare system, emphasizing preventive care and chronic disease management. As a result of these changes, the demand for primary care providers, including NPs, has surged, creating a critical need for healthcare professionals who can operate independently.

One of the significant impacts of the ACA is the need for increased competition among insurance providers. While this competition was intended to benefit consumers through lower costs and improved services, it also led to challenges for healthcare providers, including NPs. Insurance companies often impose restrictions on care, driven by cost-containment strategies that prioritize financial considerations over patient needs. This tension between financial constraints and quality patient care highlights the importance of advocating for policies that allow NPs to practice to the full extent of their training.

Nurse practitioners have demonstrated their ability to provide comprehensive care autonomously, which benefits patients and healthcare organizations alike. Research suggests that when NPs are allowed to practice independently, there are improved patient outcomes and higher levels of satisfaction within healthcare teams. A study by Poghosyan (2018) highlights the positive effects that NP autonomy has on teamwork and relationships within primary care practices, further emphasizing the importance of legislative support for expanding NP roles.

Despite the potential benefits NPs bring to the healthcare system, several barriers remain. The inconsistency of state scope-of-practice laws creates disparities in the ability of NPs to provide care across state lines. Currently, some states allow NPs to practice independently, while others require supervisory agreements with physicians. These regulations can hinder the ability of NPs to respond to patient needs effectively, particularly in areas experiencing physician shortages. Efforts to create a uniform scope of practice across all states would enable NPs to offer more consistent and equitable care to their patients.

Furthermore, reimbursement policies often disadvantage NPs compared to their physician counterparts. Medicaid reimbursement rates for NP services can be significantly lower, which may discourage NPs from accepting Medicaid patients or participating in primary care altogether. Addressing these disparities in reimbursement is essential to ensure that NPs can continue to contribute to the primary care workforce efficiently.

The path forward involves legislative advocacy for policies that empower NPs, remove restrictive regulations, and improve reimbursement structures. By eliminating barriers to practice, states can ensure that NPs are a vital part of the solution to the pressing healthcare demands faced by the country. Research supports that expanding NP roles can lead to enhanced patient access to care, particularly in underserved areas. A study conducted by Yang and Meiners (2014) emphasizes the positive correlation between NP practice autonomy and improved healthcare access.

In conclusion, the intricate landscape of healthcare in the U.S. poses numerous challenges and opportunities for nurse practitioners. The Affordable Care Act has created a framework for increased access to care, yet many barriers remain that limit the full potential of NPs. Embracing legislative reforms that prioritize NP practice autonomy and fair reimbursement will be crucial in navigating the complexities of the current healthcare system. As the demand for healthcare services continues to grow, NPs stand prepared to meet these challenges head-on, thereby enhancing healthcare delivery for all.

References

• Bernazzani, S. (2016). Primary care providers and demand: The impact of healthcare reforms. Journal of Health Policy, 24(1), 56-78.
• Florida Association of Nurse Practitioners. (2020). New Laws for 2020.
• Kirkman, M. S., Wilkinson, J. S., & Scahill, M. D. (2018). Expanding the role of advanced practice registered nurses in primary care. Nursing Outlook, 66(4), 387-392.
• Pittman, P., Leach, B., Everett, C., Han, X., & McElroy, D. (2020). NP and PA privileging in acute care settings: Do scope of practice laws matter?. Medical Care Research and Review, 77(2), 150-165.
• Poghosyan, L. (2018). Federal, state, and organizational barriers affecting nurse practitioners workforce and practice. Nursing Economic$, 36(1), 43-45.
• Poghosyan, L., & Liu, J. (2016). Nurse practitioner autonomy and relationships with leadership affect teamwork in primary care practices: A cross-sectional survey. Journal of General Internal Medicine, 31(7), 813-820.
• Price, G., & Norbeck, T. (2017). The role of insurance companies in healthcare reform. Forbes.
• Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopedic Nursing, 36(5), 304-310.
• Sophia, B. (2016). How Healthcare Reform Is Impacting Primary Care. Retrieved from [URL].
• Yang, T. T., & Meiners, M. R. (2014). Care coordination and the expansion of nursing scopes of practice. The Journal of Law, Medicine & Ethics, 42(1), 93-103.