By Debra Wood, RN, contributor
June 28, 2012 - A cheer rose from the crowd of a few thousand people waiting on the grounds of the U.S. Supreme Court on Thursday morning upon learning the justices upheld the constitutionality of the Affordable Care Act (ACA), ensuring greater access to care, and creating stability in the health care marketplace and opportunities for nurses, physicians and other providers.
“It was a big win for America,” said Jane Kapustin, Ph.D., CRNP, FAANP, professor and assistant dean for the MS and DNP Programs at the University of Maryland School of Nursing in Baltimore. “I had chills and tears in my eyes when they read the report.”
Justice John Roberts and Justices Ruth Bader Ginsburg, Stephen Breyer, Sonia Sotomayor and Elena Kagan voted to uphold the law, and Justices Antonin Scalia, Anthony Kennedy, Clarence Thomas and Samuel Alito dissented.
Robert Hasty, D.O., FACOI,approved of the court's decision to uphold the ACA, calling it the " best thing for healthcare in my generation."
“This is better than Medicare,” said Robert Hasty, DO, associate professor of internal medicine at Nova Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla. “It is the best thing for health care in my generation. It provides access to care for 32 million Americans and includes preventive medicine to decrease the burden on hospitals and the emergency department and improve overall health and reduce the burden for insurance companies and patients to compensate for care of the uninsured.”
All of those patients will need professional caregivers--nurses, nurse practitioners and physicians. Douglas Hough, Ph.D., associate professor at Johns Hopkins University Carey Business School in Baltimore, said there are not enough doctors to care for the additional patients as well as the newly insured.
Doug Hough, Ph.D., said the country will need to expand the number of health care professionals.
“We have to expand the number of health care professionals who can address the issues of the entire population, which will have to be nurse practitioners and physician assistants,” Hough said. “From an economic perspective and efficiency, people should be working at the best use of their preparation. It doesn’t make sense that physicians are spending time on things physician assistants and nurse practitioners could handle as well.”
In addition, it takes too long to train new physicians, said Jason Hwang, M.D., executive director of health care at the nonprofit/nonpartisan think tank Innosight Institute in Mountain View, Calif.
“We need to expand scope of practice for nurse practitioners and others so they can practice at the full extent of their licenses and skills,” said Hwang, adding that the act includes Medicare funding for graduate nursing education. “Without that, we would be in a deeper hole.”
The act also includes funding for primary care demonstration projects, Hwang said. That creates opportunities for nurse practitioners and cements their role, including leadership of the patient centered medical home.
Matthew D. McHugh, Ph.D., JD, MPH, RN, CRNP, said the states need to empower advanced practice nurses to practice to their full professional scope so that all patients have access to high-quality care providers.
“The promise and potential of health reform will rely on nurses,” said Matthew D. McHugh Ph.D., JD, MPH, RN, CRNP, assistant professor of nursing at the University of Pennsylvania School of Nursing in Philadelphia. “To meet the demands of a reformed health care system and increased numbers of insured Americans with increasingly complex health care needs, the nursing workforce must increasingly be educated at a higher level.”
American Nurses Association President Karen A. Daley, Ph.D., MPH, RN, FAA, also pointed out that the law enhances opportunities for nurse practitioners and nurse midwives to provide primary care and that registered nurses are well-positioned to lead in providing essential prevention and wellness services and care coordination for individuals and families.
“The role of nursing in coordinating care and delivering accountable care across the continuum cannot be overestimated,” said Jordan Battani, managing director for the Global Institute for Emerging Healthcare Practices at CSC, headquartered in Falls Church, Va.
McHugh encourages nurses in all roles to actively seek out leadership opportunities so that they can determine the path that reform takes and the effects it has on nurses and the patients for whom they care.
The greatest effect the ruling will have on nurses, Kapustin added, is that they will have a greater ability to properly care for people in need of health services; patients will no longer be separated into the “have” and “have not” groups based on insurance coverage.
Jane Kapustin, Ph.D., CRNP, FAANP, said the court’s decision keeps the country on the right path for the future.
“For nurses and nurse practitioners on the front lines of health care, I want to see health care outcomes improved and health care disparities eliminated as a result,” Kapustin said. “It will make our jobs more tolerable, because we won’t have to fight to get services. They will have access.”
And practices and hospitals will be paid for services they now are writing off or down, Hough said.
Rich Umbdenstock, president and CEO of the American Hospital Association (AHA), also praised the decision and the coverage for all Americans.
“The ruling gives hospitals clarity as they move forward with the way they provide care and work with their communities, but it opens up new questions,” Umbdenstock said. He added that hospitals have progressed in efforts to improve care and safety and streamline operations and encourage professionals to work as teams. He acknowledged a current and continuing shortage of nurses and physicians, but said many of the patients already are in the system, although they may request and receive more services once covered.
Many health care professionals have recognized the need to act more collaboratively and focus more efforts on prevention, Hough said, but those efforts are not compensated in a fee-for-service model.
Jordan Battani indicated nurses will be essential in coordinating and delivering care.
“Much of the reform act provisions that affect clinicians in the delivery of care are mirrored in the private sector,” Battani said. “There is tremendous pressure from other payors, besides Medicare, for value-based purchasing, accountable care, medical homes.”
Barclay E. Berdan, chief operating officer, Texas Health Resources, agreed that the decision provides some clarity, but added, “We anticipate that revisions to the law will continue. Texas Health will work with others at the local, regional and national level to improve the law and resulting regulations.”
Chief Justice Roberts wrote that the federal government does not have the power to force people to buy insurance, but the federal government does have the power to tax people who do not buy insurance. The court struck down the provision that states must expand Medicaid or will not be able to participate in the program, something the court said Congress can fix.
Senate Majority Leader Harry Reid acknowledged the law is not perfect and he is ready to work with Republicans to improve the ACA.
“There are problems with the act, but this is a statement by the country that this is what we are about,” Hough said.
While many health care professionals are pleased with the court decision and recognize the opportunities it offers, others are not.
Donald Palmisano, M.D., JD, FACS, called the Supreme Court’s decision shocking.
Donald Palmisano, M.D., JD, FACS, clinical professor of surgery and medical jurisprudence at Tulane University School of Medicine in New Orleans and spokesman for the Coalition to Protect Patients’ Rights, called the decision shocking and predicted it would harm the practice of medicine and patient care.
“It disrupts the patient–physician relationship,” Palmisano said. Even though the law was upheld, “I believe the act will fail because of regulation and micromanagement by the federal government.”
Palmisano suggested the country should allow insurers to sell across state lines and reform medical malpractice laws.
On the other hand, National Nurses United (NNU) issued a statement saying the decision should not be seen as the end of the efforts by health care activists for a permanent fix of a broken health care system.
“It’s not going to work,” said Jean Ross, RN, BSN, co-president of National Nurses United in Minnesota. “We want a single-payor system.”
NNU supports a financial transaction tax, which Ross said could raise $350 billion a year to pay for a Medicare-for-all program.
Until that happens, proponents of the law expect that people across the country will benefit from the ACA.
“The Supreme Court’s decision to uphold the ACA will keep our country on the right path to providing health care for all,” Kapustin said. “Today’s decision will solidify the wonderful provisions that the ACA mandates such as removing pre-existing conditions and extending insurance coverage for dependents.”
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