Part 1: Nurse Perspectives on the Affordable Care Act
By Danielle Schroth

Nurses are on the frontlines of healthcare and often have the closest view of changes and impacts to patients. So what do nurses think about how healthcare issues are being addressed during this 2016 presidential election? InCrowd conducted a microsurvey to ask them about the Affordable Care Act, impediments to quality patient care, and the candidates’ healthcare policies. Over the next few weeks, we will explore nurses’ perceptions and reactions in a special 3-part blog series.

We begin with the Affordable Care Act (ACA), signed into law by President Obama in 2010. Ever since, healthcare reform has emerged as a divisive topic in every subsequent presidential and midterm election. The 2016 election cycle is no different, with each side making respective calls to either expand or repeal the law. But what has the law wrought on the frontlines of healthcare delivery?

Perceived Flaws with ACA
Of the nurses we surveyed, nearly half or 48 percent, said the ACA has had a negative effect on how they are able to provide patient care. Many of these nurses said the increase in insurance coverage has led to longer wait times, difficulty booking appointments and shorter visits with healthcare providers. “Giving someone an insurance card does not help if there is little/no provider access,” said an Ambulatory Care nurse from Ohio. “The doctor and nurse shortages are getting worse especially with burnout from too much paperwork.” A geriatric nurse in Oregon said, “there are many more patients now with no increase in nurse staffing.”

A large number of nurses said that while the ACA has reduced costs for a portion of patients, overall healthcare costs have increased for both patients and providers. Respondents noted that the high cost of deductibles and prescription drugs have led many patients to face penalties, rather than elect coverage. Other patients with low-end coverage have faced high out-of-pocket costs, amounting to a higher number of “underinsured” patients.

Another perceived flaw of the ACA is the emphasis the law places on patient satisfaction. “Many patients are only satisfied if they get what they want,” said a nurse in Kentucky. “What many patients want is for their doctor not to tell them they need to lose weight, stop smoking, reduce alcohol intake, exercise, eat right. Hospitals are not spas, and reimbursement based upon how well we placate patients is not going to improve our outcomes and patients’ lives.”

Positive Effects Resulting from ACA
About 18% of nurses surveyed said that the Affordable Care Act (ACA) has had a positive effect on their ability to deliver quality care. The most frequently mentioned reason from this group of nurses was that more patients now have insurance, allowing them to access the care they need and be proactive with their health. This was seen as particularly important for children, college-age adults and patients with chronic diseases who have many healthcare needs and may have previously been denied coverage for preexisting conditions.

One nurse practicing in Minnesota said that “kids who have asthma can come in to be seen and learn to prevent the terrible consequences of uncontrolled asthma like hospitalization and school absenteeism. Patients can be seen in the clinic to take control and learn to manage their conditions to prevent expensive complications and unnecessary hospitalizations. This saves money and promotes healthy people and better outcomes.”

Some nurses pointed out how the changes in insurance coverage have positively impacted their everyday roles. “More patients are able to have access to care than ever before, which limits those using the emergency room as their primary care physician,” said an ER nurse from New Jersey. “This allows us to focus on those who need emergency care instead of tying up those resources with primary care needs.”

Some Remained Neutral
Thirty-four percent of nurses surveyed said that the ACA has had no impact, positive or negative, on their ability to provide quality care to patients. “It has always been the case that, regardless of insurance or lack thereof, those needing health care have received it,” says an Obstetric nurse from Pennsylvania. “I don’t see that the ACA has had any impact on patients’ ability to access healthcare or my ability to deliver quality care.”

Up Next Week: What Nurses Say Impedes Delivery of Quality Patient Care

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Crowd Team Intern Nicole Stevenson also contributed to this report.

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