Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care, 3e
Chapter 2 – Evidence-Based Practice Questions
This activity contains 3 questions.
Evidence for Effective Leadership and Management
Citation: U.S. Senate. (2010). The Patient Protection and Affordable Care Act. Retrieved
from http://www.dpc.senate.gov/healthreformbill/healthbill04.pdf
Overview: The following is a summary of the key content areas found in the Patient
Protection and Affordable Care Act of 2010. The Patient Protection and Affordable Care
Act (ACA) will ensure that all Americans have access to quality, affordable healthcare
and will create the transformation within the healthcare system necessary to contain
costs. The Congressional Budget Office (CBO) has determined that the ACA is fully paid
for, ensures that more than 94 percent of Americans have health insurance, bends the
healthcare cost curve, and reduces the deficit by $118 billion over the next 10 years and
even more in the following decade.
Title I. Quality, Affordable Healthcare for All Americans
The ACA will accomplish a fundamental transformation of health insurance in the United
States through shared responsibility. Systemic insurance market reform will eliminate
discriminatory practices by health insurers such as preexisting condition exclusions.
Achieving these reforms without increasing health insurance premiums will mean that all
Americans must have coverage. Tax credits for individuals, families, and small
businesses will ensure that insurance is affordable for everyone. These three elements are
the essential links to achieving meaningful reform.
Title II. The Role of Public Programs
The ACA expands eligibility for Medicaid to lower-income persons and assumes federal
responsibility for much of the cost of this expansion. It provides enhanced federal support
for the Children’s Health Insurance Program, simplifies Medicaid and CHIP enrollment,
improves Medicaid services, provides new options for long-term services and supports,
improves coordination for dual-eligibles, and improves Medicaid quality for patients and
providers.
Title III. Improving the Quality and Efficiency of Healthcare
The ACA will improve the quality and efficiency of U.S. medical care services for
everyone, and especially for those enrolled in Medicare and Medicaid. Payment for
services will be linked to better-quality outcomes, and the ACA will make substantial
investments to improve the quality and delivery of care and support research to inform
Finkelman, Leadership and Management for Nurses: Core Competencies for Quality Care, 3e
Title IV. Prevention of Chronic Disease and Improving Public Health
To better orient the nation’s healthcare system toward health promotion and disease
prevention, a set of initiatives will provide the impetus and the infrastructure. A new
interagency prevention council will be supported by a new Prevention and Public Health
Investment Fund. Barriers to accessing clinical preventive services will be removed.
Developing healthy communities will be a priority, and a 21st-century public health
infrastructure will support this goal.
Title V. Healthcare Workforce
To ensure a vibrant, diverse, and competent workforce, the ACA will encourage
innovations in healthcare workforce training, recruitment, and retention and will establish
a new workforce commission. Provisions will help to increase the supply of healthcare
workers. These workers will be supported by a new workforce training and education
infrastructure.
Title VI. Transparency and Program Integrity
To ensure the integrity of federally financed and sponsored health programs, this title
creates new requirements to provide information to the public on the health system and
promotes a newly invigorated set of requirements to combat fraud and abuse in public
and private programs.
Title VII. Improving Access to Innovative Medical Therapies
Biologics Price Competition and Innovation. The ACA establishes a process under which
the FDA will license a biological product that is shown to be biosimilar or
interchangeable with a licensed biological product, commonly referred to as a reference
product. No approval of an application as either biosimilar or interchangeable is allowed
until 12 years from the date on which the reference product is first approved. If FDA
approves a biological product on the grounds that it is interchangeable to a reference
product, HHS cannot make a determination that a second or subsequent biological
product is interchangeable to that same reference product until one year after the first
commercial marketing of the first interchangeable product.
Title VIII. Community Living Assistance Services and Supports
Establishment of a national voluntary insurance program for purchasing community
living assistance services and support (CLASS program). The ACA establishes a new,
voluntary, self-funded long-term care insurance program, the CLASS Independence
Benefit Plan, for the purchase of community living assistance services and supports by
individuals with functional limitations. The HHS secretary will develop an actuarially
Title IX. Revenue Provisions
Excise Tax on High-Cost Employer-Sponsored Health Coverage. The ACA levies a new
excise tax of 40 percent on insurance companies or plan administrators for any health
coverage plan with an annual premium that is above the threshold of $8,500 for single
coverage and $23,000 for family coverage. The tax applies to self-insured plans and plans
sold in the group market, and not to plans sold in the individual market (except for
coverage eligible for the deduction for self-employed individuals). The tax applies to the
amount of the premium in excess of the threshold. A transition rule increases the
threshold for the 17 highest-cost states for the first three years. An additional threshold
amount of $1,350 for singles and $3,000 for families is available for retired individuals
age 55 and older and for plans that cover employees engaged in high-risk professions.
Title X. Strengthening Quality, Affordable Care
Title X made many improvements to the preceding nine titles, and descriptions of those
changes are included above.
1.
Do you think this law has left out any critical healthcare policy issues? If so, what has
been left out?
2.
Review each of the titles (topical issues found in the legislation). Select three that interest
you, and examine them in more detail. How do they relate to nurses and nursing care?
3.
If you had to select which title was the most important, what would you select and why?
Chapter 2 – ANSWER KEY Evidence-Based Practice Questions
1.
Answers will vary per student opinion.
2.
Answers will vary per student opinion.
3.
Answers will vary per student opinion.
Chapter number: 2