The Affordable Care Act
The patient protection and affordable care act (ACA) is an integrated healthcare legislation that took effect in 2010. Though it sparked a heated debate within political circles, its intention was to have tangible impacts on health by transforming healthcare service delivery. Coincidentally, the ACA’s implementation occurred when there was increasing interest in advanced nursing practice. The ACA is now a mainstay in the US health system, while advanced nursing practice is still growing, with strong establishments in some areas. Therefore, this article reviews ACA’s components integral to advanced practice nurses (APNs). It also assesses their implementation in Texas and evaluates how the decision to implement/not implement has affected healthcare in the state.
Components of the ACA Important to APNs
Some of the ACA’s components that are significant to advanced nursing practice include Medicaid expansion, quality-driven reimbursement, and healthcare reform. Medicare expansion refers to the easing of eligibility restrictions to make Medicaid coverage more accessible. This expansion mainly targeted low-income earners who could not afford premium/private coverage but still earned more than Medicaid’s traditional threshold. Consequently, ACA’s implementation reduced the coverage gap and lowered the country’s percentage of uninsured adults. The next component, quality-driven reimbursements, entails adjusting the amount of money that public insurance pays to care providers based on quality metrics (Bowling et al., 2018). For instance, hospitals that report high readmission rates for certain conditions receive lower reimbursement. This approach encourages care providers to provide high-quality services, improving clinical outcomes and reducing costs. The ACA also focuses on health reforms that aim at optimizing healthcare delivery. One such reform is the creation of accountable care organizations to offer integrated care delivery for low income-earners through shared savings and losses.
Importance of the ACA Components to Advanced Nursing Practice
Medicaid Expansion
Medicaid expansion is important to APNs since it increases the demand for healthcare services. Consequently, APNs have a critical role in complementing and substituting doctors and other senior specialists in delivering clinical interventions such as diagnosis, prescription, and follow-up (Bin Abdul Baten & Wehby, 2022). The expansion also led to the rise of new Medicaid enrollees whose sociocultural status translates to complex needs such as limited financial capacity and low health literacy levels. Consequently, APNs are now essential healthcare leaders. They must rely on their nursing discipline principles of communication, patient-centeredness, and care coordination to lead healthcare teams in addressing consumers’ clinical, emotional, and cultural needs. Doing so will allow them to deliver holistic healthcare services and achieve optimal outcomes across all domains.
Quality-Driven Reimbursement
Quality improvement through reimbursements is important to APNs since it establishes the quality standards that care facilities must attain to maximize their compensation. APNs as independent practitioners or working in an interprofessional organization are integral to attaining these quality standards. For example, in the case of thirty-day readmission for heart failure, caregivers must implement several interventions, including seven-day follow-up, phone calls, and one-on-one patient education (Nair et al., 2020). APNs are the most qualified to deliver these services since they understand the patient’s non-clinical needs while appreciating the clinical requirements for continuous improvement of the condition. Therefore, the push for higher-quality care compels APNs to engage in establishing and maintaining standards.
Healthcare Reforms
The ACA healthcare reforms require competent leadership. APNs unique combination of diverse skills and knowledge makes them integral to managing these programs, some of which are nurse-led. Furthermore, their clinical competencies make their contributions necessary to interprofessional programs such as patient-centered medical homes (Park & Dowling, 2020). Hence, these reforms have redefined the role of nurses in healthcare, with APNs being critical to successful care delivery processes and administrative management.
ACA Implementation in Texas
ACA implementation in Texas remains low, with the state failing to ratify Medicaid expansion. This non-conformity also makes it difficult for the Centers for Medicare and Medicaid Services (CMS) to implement quality-driven reimbursement measures (Norris, 2023). However, the reforms are more common. Their benefits to consumers may still be low, but at least they enhance access and provide higher-quality services than before the ACA.
How ACA Non-Implementation Impacts Healthcare in Texas
The decision not to implement Medicaid expansion is a detriment to healthcare in Texas. The state has the highest percentage of uninsured adults in the country, with the number exceeding 700,000 individuals (Norris, 2023). The challenges in implementing quality-based reimbursement mean that the state continues to offer subpar services to consumers. The clinical outcomes are poor, and in some cases, patients pay more for healthcare due to readmissions and the overuse of emergency health services.
Conclusion
The affordable care act is an important policy in the US healthcare system. It contains various components whose impact on healthcare professionals, specifically APNs, has revolutionized their role as independent practitioners or as part of interprofessional teams. The act has facilitated higher-quality care and better patient clinical and cultural outcomes. Unfortunately, Texas is lagging in implementing the ACA. This reluctance has seen the state struggle with a large coverage gap and poor health services. Therefore, the state’s leadership and legislators should reconsider their position and advocate for the act’s full implementation, coupled with the necessary APN policies to improve health delivery.

References
Bin Abdul Baten, R., & Wehby, G. L. (2022). Effects of the ACA Medicaid expansions on access and health by nurse practitioner scope of practice laws. Nursing Outlook, 70(2), 228–237. https://doi.org/10.1016/j.outlook.2021.12.011
Bowling, B., Newman, D., White, C., Wood, A., & Coustasse, A. (2018). Provider reimbursement following the Affordable Care Act. The Health Care Manager, 37(2), 129–135. https://doi.org/10.1097/HCM.0000000000000205
Nair, R., Lak, H., Hasan, S., Gunasekaran, D., Babar, A., & Gopalakrishna, K. V. (2020). Reducing all-cause 30-day hospital readmissions for patients presenting with acute heart failure exacerbations: A quality improvement initiative. Cureus, 12(3), e7420. https://doi.org/10.7759/cureus.7420
Norris, L. (2023, Jan. 29). Medicaid eligibility and enrollment in Texas. https://www.healthinsurance.org/medicaid/texas/
Park, J., & Dowling, N. M. (2020). Do nurse practitioner-led medical homes differ from physician-led medical homes? Nursing Outlook, 68(5), 601–610. https://doi.org/10.1016/j.outlook.2020.05.010