Monday September 16th 2019

ACA progress report

Nurses need to lead and promote health care reform

By Alice Benjamin, MSN, RN, ACNS-BC, PCCN-CMC

Almost four years after being signed into law, the most highly anticipated portion of the Affordable Care Act (ACA) has come to fruition. On Oct. 1, 2013, state and federal health insurance marketplaces, or exchanges, began to accept health coverage applications during the six-month open enrollment period ending March 31, 2014. Together, two staples of the law—health exchange enrollment and Medicaid expansion—are expected to dramatically decrease the number of uninsured and underinsured Americans. To date, there are 17 state-based marketplaces, seven partnership marketplaces and 27 federally-facilitated marketplaces, as well as 26 states and the District of Columbia expanding Medicaid. Two states plan to expand Medicaid after 2014, and 23 states do not plan to move forward at this time.

Mary Wakefield with Alice Benjamin

Although the enrollment launch was initially plagued with website technical glitches and a 16-day government shut down, millions of Americans are now enrolled in health plans and have access to health benefits previously unattainable. This marks the swinging of the health care pendulum from an acute care focus to one rooted in early identification, health and wellness, which over time will help to control the rising costs of health care. The United States, although one of the richest countries in the world, spends the most money on health care per capita at nearly $8,000 per person and yet still has some of the worst outcomes according to an international comparison of supply, utilization, prices and health care quality study conducted by the Common Wealth Fund.

Thanks to the ACA, we now have stronger rights and patient protections, better access to quality health care, more affordable coverage for many and a strengthened Medicare. The law provides a range of other benefits, as listed on, including:

  • 105 million Americans no longer have lifetime dollar limits on their coverage.
  • More than 17.6 million children with pre-existing conditions can no longer be denied coverage.
  • Private insurers that provide coverage for nearly 174 million Americans must now justify double-digit premium increases, and nearly 76 million Americans are covered by insurers that are now required to spend at least 80% of premium dollars on health care.
  • 360,000 small businesses received a tax credit in 2011 to help them pay for health insurance for an estimated 2 million workers.
  • 54 million Americans now can receive free preventive services, such as cancer screenings, through their private insurance plan.
  • 3.1 million young adults have coverage on a parent’s plan through age 26.
  • 3.6 million people received a 50% discount—worth an average of $604 each—on brand name prescription drugs after hitting the Medicare donut hole in 2011.
  • More than 32.5 million seniors received one or more free preventive services.
  • The average person with Medicare will save about $4,200 from 2011 to 2021. Those with high prescription costs will save up to $16,000.

In February, the Centers for Medicare & Medicaid Services (CMS) announced that approximately 4 million people had signed up for health insurance. Nearly 3.3 million state and federal marketplace health plans have been selected from October through early February. The latest Health & Human Services enrollment report (to date) states young adult enrollment grew by 65 percent in January, from 489,460 at the end of December to 807,515 as of Feb. 1, while all other age groups combined grew by 55 percent. So although the Obama administration may fall short of the original unofficial target established by the Congressional Budget Office of signing up 7 million people, the fact remains that Americans have signed up and millions are benefiting from the new health care law. (Updated monthly full enrollment reports are released by – please visit the website for latest statistics.)

Considering the great divide that the health care law initially caused in our nation, one thing is clear, as referenced by U.S. Vice President Joe Biden in a conference call days before the health exchanges opened: “Nurses are the heartbeat of health care that help keep our patients alive. You (nurses) are in the best position to inform patients about the importance of the law and getting health care coverage.”

It’s no secret; nurses provide extraordinary patient care and are capable of doing much more as it relates to health. With role models such as CMS Administrator Marilyn Tavenner, a registered nurse, and HRSA (Health Resources and Services Administration) Administrator Mary Wakefield, PhD, RN, nurses are leading at the helm to help shape health care reform.

In January, at the National Black Nurses Association Day on Capitol Hill Conference, Dr. Wakefield put out a call to hundreds of nurses, emphasizing our crucial role. She discussed the importance of nurses not only understanding the law, but sharing information with patients, assisting patients with enrollment and taking part in helping to shape the law.

In Los Angeles, RNs have been a part of collaborative efforts to educate and enroll patients. The Council of Black Nurses, the Urban League, and faith-based groups sponsored by AARP created a one-stop shop for consumers in underserved communities to provide basic screenings, education on the importance of health care coverage and help signing up.

So, what role will you play in health care reform? Nurses are natural leaders, the largest portion of the health care workforce, and with patients “24/7.” Who else better to shape health care reform?

— Alice Benjamin is a clinical nurse specialist, Critical Care Services,
Coronary Care & Advanced Heart Failure Units at Cedars Sinai Medical Center and an ANA\California member.


Listen to an open enrollment call-to-action video message from ANA President Karen Daley.

Health Insurance Marketplaces

Access these publications and resources online.

For healthcare providers

  • Ten things providers need to know
  • Ten things to tell your patients
  • Training materials and presentations

For consumers (Spanish:

  • Health Insurance Marketplace basics
  • State-specific information
  • Resources in other languages

Social Media Resources: (Spanish: on Twitter, @HealthCareGov (Spanish: @CuidadoDeSalud).

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