United States Health Care Reform

Mitigation of Hospital-Acquired Infection (HCAI)
April 23, 2024
Health Hazards and Solutions
April 23, 2024
Show all

United States Health Care Reform

In March 2010, the Affordable Care Act (ACA), a comprehensive healthcare reform measure, was signed into law (Obama, 2016). The Affordable Care Act worked to expand access to affordable health care for more people, to expand Medicaid to include all persons with earnings less than 138 per cent of the Federal Poverty Line, and to encourage innovative patient care management approaches aimed at reducing healthcare costs (U.S. Centers for Medicare & Medicaid Services, n.d.). Since then, the Act has transformed the American healthcare system, expanding population coverage and saving thousands of lives. This essay aims to discuss the contributions of the ACA in reforming and restructuring the US healthcare delivery system. The article will highlight the effects of this Act on the nursing practice, the impact of quality measures and pay for performance on patient outcomes before offering predictions on the growth and transformation of nursing over the next five years.

Nurses have a tradition of using innovation and professionalism to adapt to healthcare policies and financing changes. The Affordable Care Act (ACA) addressed nurses’ concerns while highlighting the country’s inadequate healthcare system. The new paradigm emphasized expert practice responsibilities and nursing edification, which increased organizational and policy skill advance in nursing courses and institutional training (Cleveland, Motter & Smith, 2019). Notable impacts of ACA are nurses’ gradual transition into administrative positions in hospitals and insurance companies and governing bodies of health-related agencies, training institutions, and regulatory offices. Also, since ACA emphasizes results, with more weight on nurses to exhibit competence in giving effective care, the need for APNs and RNs has increased. A shortage of nurses has resulted from an increase in healthcare demand, which has resulted in nurses being overworked due to pitiable nurse-to-patient ratios. These unintended outcomes jeopardize care continuity and patient well-being.

Quality measures are critical tools for evaluating and quantifying healthcare processes, outcomes, patient expectations, and the operational process and mechanisms associated with providing high-quality care. After the Affordable Care Act (ACA) introduced the Hospital Readmission Reduction Program (HRRP), patient readmissions due to insufficient level of care and a shortage of coordinated care transitions declined dramatically (Fonarow et al., 2017). The directive resulted in a Value-Based Purchase (VBP) model that grounds healthcare payments on the quality of care cost-efficient and patient and family-centered. Furthermore, the Hospital-Acquired Disease Reduction Program (HACRP), which penalizes hospitals that tend to have unfavorable patient outcomes as a result of hospital-acquired diseases such as CLABSI and CAUTI, has resulted in a reduced rate of CAUTI, CLABSI, post-surgical site infections, and 30-day readmissions (Fuller et al., 2016). Thus, quality measurement approaches have improved patient outcomes as providers are reviewed before being reimbursed for their safety, clinical practice, efficacy, and cost-cutting.

Similarly, the Pay for Performance (P4P) model rewards healthcare facilities that attain predetermined efficiency and patient loyalty targets with incentive payments (Mendelson et al., 2017). For these models to be successful, patients, providers, and care delivery must be linked across and beyond the many moving cogs of the healthcare system. Nurses are more efficient because they use their exclusive spot within the healthcare system to correlate, interpret, and renovate procedures both within and beyond the organization. In this environment, nurses serve as care administrators, controllers, and informatics advisors, overseeing process progress and evidence-based practices vital to accurately quantifying and measuring these superiority indicators (Mendelson et al., 2017). The outcomes associated with these roles and activities go beyond cost reduction by maximizing performance and demanding procedures to move quality and safety systems forward faster than anticipated. Since nurses are committed to delivering compassionate care and empowering patients to express themselves openly, the results greatly exceed expectations. Moreover, nurses contribute towards improving patient outcomes through EBP as they have the best knowledge regarding the best practices for special patient care.

As a result of healthcare developments and transformation, there is a need to boost RNs’ leadership skills, strengths, and abilities and develop individualized patient delivery and coordination competencies with a more holistic capability set tailored to changing clinical leadership imperatives. Following the introduction of ACA and VBP, there has been an urgent need for imagination and innovation in nursing leadership. (Joseph & Huber, 2015). Nurses are at the forefront of optimizing patient outcomes, performance, and safety, particularly when they have the clinical leadership skills to guide and coordinate treatment through multidisciplinary units. Clinical leadership influences point-of-care innovation and reform of corporate structures and individual care practices to achieve consistency and secure patient outcomes (Joseph & Huber, 2015). The current interdisciplinary practice models necessitate the advancement of programmatic and strategic leadership by credible and innovative clinical leaders to alleviate the healthcare infrastructure in the United States.

Clinical leadership blends the RN’s expertise with broad leadership experience, overseeing patient delivery at the point of care, and focused problem-solving and outcome-management skills using evidence-based approaches. There is a clear need for clinical leadership in nursing due to the many and diverse point-of-care service challenges that remain (Joseph & Huber, 2015). Delays in treatment may occur due to poor planning, a staffing shortage, or overworked nurses, for example, jeopardizing patient safety and quality of care. Discharge transfers are often hampered because both the transmitting and receiving areas fail to coordinate, and inconsistencies in multidisciplinary patient care can impede prescribing coordination, resulting in medication errors (Joseph & Huber, 2015). As a result, closing these gaps at the point of treatment necessitates constructive steps centered on best practices, teamwork, patient management, and technical leadership competencies.

As the healthcare climate changes and the physician shortage worsens, there are many consistent nursing career and practice trends. First, if the nurse shortage worsens, nurses will retire later, and online nursing education programs will become more common. Due to the demand for nurses and increased job security, pundits project an increased demand for further education (Purdue University Global, 2020). Consequently, more learning institutions will provide online education programs tailored to nurses, enabling them to obtain a degree while working full-time to pursue higher education at their own time. Furthermore, nurses will move into community outpatient settings, resulting in increased specialization (Purdue University Global, 2020). RNs that practice in specialist fields of medicine, including psychiatry, obstetrics, and others, are in high demand. Nurses specializing in a particular service area become experts in that field, which lets them advance in their careers.

The Affordable Care Act has made noteworthy treads in addressing long-standing problems with the US healthcare system, such as coverage, cost, and quality of care. After the Act’s enactment, the uninsured rate has declined, and figures suggest it expanded access to treatment, improvements in nurses’ employment in the healthcare sector, and improved patient outcomes. Nurses’ approaches to assisting patients in being happier change and develop as the need to manage healthcare costs increases and better healthcare options emerge.



Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing24(2).

Fonarow, G., Konstam, M., & Yancy, C. (2017). The Hospital Readmission Reduction Program Is Associated With Fewer Readmissions, More Deaths. Journal Of The American College Of Cardiology70(15), 1931-1934. https://doi.org/10.1016/j.jacc.2017.08.046

Fuller, R., Goldfield, N., Averill, R., & Hughes, J. (2016). Is the CMS Hospital-Acquired Condition Reduction Program a Valid Measure of Hospital Performance?. American Journal Of Medical Quality32(3), 254-260. https://doi.org/10.1177/1062860616640883

Joseph, L., & Huber, D. (2015). Clinical leadership development and education for nurses: prospects and opportunities. Journal Of Healthcare Leadership, 55. https://doi.org/10.2147/jhl.s68071

Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., & Freeman, M. et al. (2017). The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care. Annals Of Internal Medicine166(5), 341. https://doi.org/10.7326/m16-1881

Obama, B. (2016). United States Health Care Reform. JAMA316(5), 525. https://doi.org/10.1001/jama.2016.9797

Purdue University Global. (2020). Top 10 Nursing Trends for 2021. Purdue Global. Retrieved 8 May 2021, from https://www.purdueglobal.edu/blog/nursing/top-10-nursing-trends/.

U.S. Centers for Medicare & Medicaid Services. Affordable Care Act (ACA) – HealthCare.gov Glossary. HealthCare.gov. Retrieved 8 May 2021, from https://www.healthcare.gov/glossary/affordable-care-act/