What’s at Stake in U.S. Health Reform: A Guide to the Affordable Care Act and Value-Based Care

Abstract

The U.S. presidential election of 2016 accentuated the divided perspectives on the Patient Protection and Affordable Care Act of 2010, commonly known as Obamacare. The perspectives included a pledge from then candidate Donald J. Trump to “repeal and replace on day one”; Republican congressional leaders’ more temperate suggestions in the first weeks of the Trump administration to “repair” the Affordable Care Act (ACA); and President Trump’s February 5, 2017 statement—16 days after inauguration—that a Republican replacement for the ACA may not be ready until late 2017 or 2018. The swirling rhetoric, media attention, and the dizzying rate of U.S. health and payment reforms both within and outside of the ACA makes it difficult for nurses, both United States and globally, to discern which health policy issues are grounded in the ACA and which aspects reflect payer-driven “volume to value” reimbursement changes. Moreover, popular and controversial elements of the ACA—for example, the clause that prohibits insurance carriers to deny coverage to those with preexisting health conditions and the more controversial individual mandate that bears Supreme Court support as a constitutional provision—are paired in ways that might be unclear to those unfamiliar with nuances of insurance rate determination. To support nurses’ capacity to maximize their impact on health policy, this overview distills the 906-page ACA into major themes and describes payment reform legislation and initiatives that are external to the ACA. Understanding the political and societal forces that affect health care policy and delivery is necessary for nurses to effectively lead and advocate for the best interests of their patients.