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Catherine Vink
Lawanda Dickens
English 3010-014
Literature Review
12 November 2015
Is Healthcare Reform Benefiting the Health Care System?
Introduction
The first healthcare reform has taken effect since 1993; this is the Affordable
Healthcare Act, along with the Affordable Care Act (ACA). These pieces of
legislature, introduced in 2009, have brought healthcare into the presidents
domestic agenda (Oberlander 1). With the passing of the Affordable Health Care Act
and the Affordable Care Act (ACA), a series of changes are beginning to take place
within the medical community. These changes offer a series of solutions, but also
introduce a new set of issues. One of these issues health care professions are now
dealing with is the overcrowding of hospitals and medical facilities. Now that health
insurance coverage is universal and more readily available, more people are able to
receive medical treatments. Many hospitals cannot handle the large amounts of
people who now want treatment. The passing of the Affordable Health Care Act will
cause substantial changes to the nursing community in addition to the entirety of
the medical community; professionals are divided on whether these changes are
beneficial or non-beneficial towards their discourse.
The Affordable Health Care Act, at its current status, has already prompted
those affected by it to propose a series of solutions. An example of a prominent

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solution posed by a group of professionals is the institution of nurse managed health
care centers. Will these solutions solve the problems the act will inevitably cause or
will these solutions create their own set of problems? How will the Affordable
Healthcare Act affect the departments within hospitals? How will these changes
affect employees within hospitals?

Overcrowding of Hospitals

With easier access to health insurance, many will begin to receive medical

care, that were previously not able to. Many hospitals are not prepared to take care
of the growing number of people who may now choose to receive treatments.
Robert Toth, a nurse at Harper Hospital in Detroit and graduate of Wayne State
University, said in an interview:
I believe that the Affordable Care Act will change nursing by giving more care
to people who would not usually be able to afford it. This can be good and
bad. Some people truly need to be in a hospital to get better and this act will
help them. Other patients can become comfortable with the system and
overuse it. (2)
Here, Toth expresses his worry that people may abuse privileges given to them by
The Affordable Health Care Act, leading to the overcrowding of hospitals, but
likewise, this piece of legislature will allow those who are truly in need to care to
receive treatment. Those who abuse this system may cause those who need this
reform to suffer.

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Healthcare professionals plan to and are beginning to deal with this problem

of overcrowding. Methods of coping with this issue include the creation of nurse
managed health care centers and a focus on preventative healthcare. These
solutions, professionals believe, do not completely resolve the problem.

Nurse Managed Health Care Centers

A large segment of the nursing community agrees that a major solution to the

over crowding of hospitals would be to implement a system of nurse managed

health care centers or clinics. Donna E. Shalala, the president of Miami University
and former Secretary of the United States Department of Health and Human
Services, insisted that, While increasing access to health insurance will help
improve access to health care, our nation's health care crisis cannot be solved by
insurance alone (Mitchell 180). She went on to say that increasing the nurses role
in healthcare would radically affect patients ability to access healthcare quickly and
affordably. Pamela Mitchell RN, PhD presented these opinions in her article,
Nurses in the Front Lines of Obama Health Care Reform Era, published in Nursing
Outlook. In her article, she emphasizes that financial reform itself cannot completely
transform the broken system of health care. The participation of nurse practitioners
must be increased.
In order to properly construct a system of nurse managed health care centers
and clinics, the proper federal funding would be needed. Insurance alone will not
solve the healthcare crisis that is taking place in America (Mitchell 180). Melinda
Ray, a registered nurse, in her article, published in the Emergency Nursing Advocacy

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Journal, Transforming the Health Care System: Nursing Visibility in the Era of Health
Care Reform, explains that nurses must be a key element of the healthcare reform.
Nurses are essential to this healthcare reform, Ray believes. Nurses will become
imperative through a system she calls minute clinics. These minute clinics will provide
patients with fast and effective care in retail locations. They will be staffed by nurse
practitioners and will allow patients hours of treatment outside those of their typical
doctors hours. Minute clinics will allow patients to receive treatment and avoid using
emergency departments for non-emergencies. Services received at minute clinics will be
paid out of pocket by patients, saving federal health care dollars (Ray 558).
Overall, with the construction of nurse managed healthcare centers, such as
minute clinics, the United States has a potential to become an overall healthier
nation. If these centers live up to their potential, patients will be able to manage
their health, detect future problems, and reduce their risk of developing future
problems (Mitchell 180-182).
Edward ONeil expresses in his article published in the Journal of Professional
Nursing, Four Factors That Guarantee Healthcare Change, that nurses currently
are employed largely in hospitals as opposed to community care centers, such as the
minute clinic or other nurse managed clinics. With this healthcare reform and the
implementation of nurse managed health care clinics, nurses will begin to find
employment mainly in community-based settings. ONeil insists that:
Most of this case for nursing should rest on prevention and management
rather than the usual focus on diagnosis and treatment. This battle will
inevitably draw conflict with medicine and is not necessary, as the system

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will struggle to better balance the distribution of resources and effort in the
coming years. (319)
He goes on to discuss that the way of educating nurses will need to be reassessed
due to the change in nursing employment. Nurses, in their education, should be
placed in community-based programs, such as the minute clinic model. Students, in
order for the reform to be effective, must shift their focus from acute care to the
effective use of information and care management technology (ONeil 319).

Effects of the Health Care Reform on Childrens Health Care and Preventative
Care

In addition to nurse managed health care centers and clinics, preventative

medicine is becoming anther way to combat costs in the medical discipline.

Professionals could see this as a positive effect of the Affordable Health Care Act, in
that it is opening up jobs in a newly popularized branch of medicine. Jobs may begin
to open up in fields such as medical research and nutritional science. The demand
for jobs in these fields will continue to grow, as the Department of Health and
Human Services, according to their website, www.hhs.gov, has announced that
preventative care will be covered under the Affordable Care Act (ACA). Nurses and
other health care professionals could view this as a positive effect of health care
reform, in that it will provide jobs and will keep the United States healthier.
Among the industrialized nations, the United States ranks 18th in preventable
deaths (Monsen 57). Those who have regular access to primary care doctors and
nurses are less likely to suffer or to die from a preventable disease or illness. Maria

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Mihalko MSN, RN, expresses in her article, Pediatric Ambulatory Nurses at the
Intersection of Healthcare Reform and Health Information Technology, published
in the Journal of Pediatric Nursing, that, Underutilized primary care resources have
contributed to an uncoordinated and expensive U.S. healthcare system (Mihalko
611). In order to increase the amount of patients utilizing primary care resources,
the Affordable Care Act (ACA), plans to provide 8.3 billion dollars. This sum will be
devoted to increase the Medicaid reimbursements to primary care physicians.
A cause of this is lack of medical treatment, especially among children. In
1997, Speak Now for Kids was established. Today, Speak Now for Kids focuses on
issues affecting children of low-income families. Their website outlines the issues
they focus on such as Medicaid for children, the childrens health insurance
program, Tricare, access to pediatricians, and the Affordable Care Acts effect on
childrens health insurance coverage. www.speaknowforkids.org states that, While
it has been the subject of intense debate since its passage, the Affordable Care Act
(ACA) of 2010 provides many benefits to children and their families, which are
being implemented over a number of years. Some of these benefits include
authorizing the funds of CHIP (the Childrens Health Insurance Program), covering
preventative care, and providing more pediatric care.
Problems Revolving Around the Nurse Managed Health Care Center

With the establishment of nurse managed health care centers, other medical

centers may begin to lose their patients. This is especially true for emergency
departments. An emergency department is a place where anyone can go to receive
treatment. Gary P. Young MD and David Sklar, states in his article, Healthcare

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Reform and Emergency Medicine, published in the Annals of Emergency Medicine,
EDs [emergency departments] also have become the only guaranteed source of
acute medical care for the nearly 40 million uninsured Americans (Young and Sklar
666). An emergency department can refuse no one with substantial need for
treatment. The emergency department, for many, is considered a safety net due to
its policy that it cannot refuse patients. Although there is the problem of
overcrowding hospitals surrounding the Affordable Health Care Act, if nurse
managed health care centers reach peak popularity, the opposite may take place.

In the event that emergency departments lose patients to nurse managed

clinics, patients will begin to be redirected from emergency departments to other

primary care and community care sites. If this were to happen, the viability of
emergency departments could be in danger. When it comes to the safety and future
of emergency departments, any type of healthcare reform should be carefully
analyzed. Professionals believe that the emergency departments of hospitals are
crucial in that they provide easy access and acute care (Young and Sklar 666).

Conclusion

Although the Affordable Health Care Act and the Affordable Care Act (ACA)

has its flaws, its goal promotes the benefit of all citizens. The goal of the Affordable
Health Care Act is to provide a system in which people can receive health care and
insurance coverage in a way that is affordable to them. In implementing a system
such as this, the number of preventable deaths in the United States may decrease,
more medical professionals will find employment, and people will be able to lead
healthier lives. Overall, the goal of this reform is to fix what many health care

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professionals believe is a broken system of not only health insurance, but the
healthcare system as a whole.

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Works Cited
Mihalko, Maria C. Pediatric Ambulatory Nurses at the Intersection of Healthcare Reform
and Health Information Technology, Journal of Pediatric Nursing, Volume 28,
Issue 6, NovemberDecember 2013, Pages 611-612, ISSN 0882-5963,
http://dx.doi.org/10.1016/j.pedn.2013.09.002.
Mitchell, Pamela, H., Nurses in the front lines of Obama health care reform era, Nursing
Outlook, Volume 57, Issue 4, JulyAugust 2009, Pages 180-182, ISSN 00296554, http://dx.doi.org/10.1016/j.outlook.2009.05.004.
Monsen, Rita Black, Kids and Health Care Reform, Journal of Pediatric Nursing, Volume
25, Issue 1, February 2010, Page 57, ISSN 0882-5963,
http://dx.doi.org/10.1016/j.pedn.2009.08.002.
Oberlander, Ph.D., Jonathon. "Great Expectations- The Obama Administration and
Health Care Reform." The New England Journal of Medicine 360.4 (2009): 32123. Web. 12 Nov. 2015.
ONeil, Edward. Four Factors That Guarantee Health Care Change, Journal of
Professional Nursing, Volume 25, Issue 6, NovemberDecember 2009, Pages
317-321, ISSN 8755-7223, http://dx.doi.org/10.1016/j.profnurs.2009.10.004.
Ray, Melinda, Mercer. Transforming the Health Care System: Nursing Visibility in the
Era of Health Care Reform. Journal of Emergency Nursing , Volume 35 , Issue 6 ,
556 558
Toth, Robert. Personal Interview. 17 September 2015.
Young, Gary P, Sklar, David, Health Care Reform and Emergency Medicine, Annals of
Emergency Medicine, Volume 25, Issue 5, May 1995, Pages 666-674, ISSN

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0196-0644, http://dx.doi.org/10.1016/S0196-0644(95)70182-6.