Fast forward to 2009: Barack Obama is elected president and upholds his stance on health care reform, with a vow to institute a universal or near-universal health insurance program during his administration. As he said in his remarks to Congress, “I am not the first President to take up this cause [the issue of health care], but I am determined to be the last.”5 Hearing that an NHI program would cost $900 billion over 10 years was a bitter pill to swallow for some.5 But we couldn’t afford not to undertake it.
Since the enactment of the ACA, 18 million uninsured people have gained health coverage.6 The law has also improved access to health care services provided by NPs and PAs, evidenced by the nondiscrimination provision acknowledging us as primary care providers. The shortage of physicians and the increase in the number of newly insured persons seeking health care created an unprecedented opportunity to increase the utilization of NPs and PAs throughout the health care system.
Reflecting on the cost of the ACA, I have always maintained two positions: First, we pay for health care at often the most expensive place (the ED) or time (end-stage disease) … so it is a case of “pay me now or pay me later.” Second, we must gain control over the overall cost of health care. Providing access to primary care services for everyone is a step toward getting that control.
I have been a supporter of an NHI system all my adult life. I consider myself lucky to have had continuous access to health care. But I have cared for many who have not been so fortunate, and I have seen a minor illness become a major event because the family has no access to care. Without universal access to care, these cases increase—and with them, the cost of care.
Is the ACA the perfect solution? Even six years later, I think the jury is still out. But what I know for sure is that it was the first step in the right direction. You no doubt have opinions on this topic; please share them with me at NPEditor@frontlinemedcom.com.
References
1. Heinrich J. Organization and delivery of health care in the United States: the health care system that isn’t. In: Mason DJ, Leavitt JK, eds. Policy and Politics in Nursing and Health Care. 3rd ed. Philadelphia: Saunders; 1998:59-79.
2. US Department of Health and Human Services, Health Resources and Services Administration. Hill-Burton Program (July 2010). www.hrsa.gov/gethealthcare/affordable/hillburton/hillburton.pdf. Accessed April 11, 2016.
3. Altman S, Schactman D. Power, Politics, and Universal Health Care: The Inside Story of a Century-long Battle. Amherst, NY: Prometheus Books; 2011.
4. Steinmo S, Watts J. It’s the institutions, stupid: why comprehensive national health insurance always fails in America. In: Harrington C, Estes CL, eds. Health Policy: Crisis and Reform in the US Health Care Delivery System. 5th ed. Burlington, MA: Jones and Bartlett; 2008:30-36.
5. White House Office of the Press Secretary. Remarks by the President to a Joint Session of Congress on Health Care, September 9, 2009. www.whitehouse.gov/the-press-office/remarks-president-a-joint-session-congress-health-care. Accessed April 11, 2016.
6. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. Health insurance coverage and the Affordable Care Act, September 2015. https://aspe.hhs.gov/pdf-report/health-insurance-coverage-and-affordable-care-act-september-2015. Accessed April 11, 2016.