Managed Care and Affordable Care Act

Introduction

The main goal of different health legislations and nursing practices is to provide the best health care to the people. Different nursing theorists and scholars have explained why “patients’ outcome” should be the most important consideration for medical practitioners. President Obama signed the Affordable Care Act (also called The Patient Protection and Affordable Care Act) into law in 2010. According to President Obama, the Act would improve the quality of insurance and reduce healthcare expenses and costs for both the citizens and the government. Experts projected that the Affordable Care Act (ACA) would have numerous implications for the current “managed health care” in the country. That being the case, the purpose of this study is to show the impact of how managed care will be with the Affordable Care Act.

Background Information and Problem Statement

In the United States, “managed care” is a term used to describe various techniques used to provide quality care, support, and various health benefits (Murdock, 2012). Managed care also refers to different health insurance types. The insurers have contracts with citizens to offer the needed care at reduced costs. Patients and organizations can join different networks depending on their healthcare expectations (Murdock, 2012). In the country, a network plan will usually restrict a person’s choice of health services. A flexible network plan will usually be costly for the individual.

The Affordable Care Act will ensure more people get insurance coverage. However, this will significantly affect the nature and structure of the current “managed health care” in the country. As well, there is a need to ensure the Affordable Care Act offers new opportunities to more people. Jean Watson is one of the admired theorists whose ideas are evident in the nursing practice. Watson’s theory combines four critical concepts towards the best nursing practice. These concepts include “the society, health, nursing, and human beings” (Daniels, 2003). The theory has been widely used as a human science that seeks to promote the health of individuals through the restoration and prevention of diseases.

This discussion examines the impact of managed care on the Affordable Care Act. As well, it explores how Jean Watson’s “nursing theory” supports the study to ensure more people get the best care. This is necessary because the goal of medical practice and the ACA is to ensure more individuals get the right provider, right support and care, right resources, and at the right cost (Murdock, 2012).

Research Questions

This study seeks to examine and answer these research questions:

  • What is the impact of managed care in regards to the Affordable Care Act?
  • What opportunities exist for patients and Americans from the passage of the Affordable Care Act?
  • How can caregivers and insurers use Jean Watson’s nursing theory by the Affordable Care Act towards better health care?

Impact of Managed Care in Regards to the Affordable Care Act

There are three “managed care” plans in the United States. The first one is the Health Maintenance Organizations (HMO). This plan only caters to care within the specific network. Patients and citizens will choose a specific doctor to coordinate their specific care. The second one is the Preferred Provider Organizations (PPO) whereby patients tend to pay more to get the best care within their network. The plan pays some cost f the individual goes to another network (Murdock, 2012). The third one is the Point of Service (POS). This is a flexible plan whereby a patient chooses either a PPO or HMO depending on the needed care.

The passage of the Affordable Care Act will change the nature and structure of insurance in the United States. With the ACA, managed care in the country will take a new twist because of certain changes. To begin with, it is agreeable that most of the uninsured people and patients in the country will become eligible for insurance cover in the coming years. The other implication of this Act for “managed health care” is that many people will have no access to proper health care (Murdock, 2012). As well, more people will need more training to get the best coverage and identify the best “managed care” option.

There are different opportunities from the Affordable Care Act. To begin with, there are new options for the uninsured today. It is notable from the ACA that more people will not have to satisfy some of the current requirements. Such categorical requirements include conditions such as disability or having children to access insurance cover. The Affordable Care Act ensures “childless” adults can access Medicaid (Murdock, 2012). This means that many people in the country stand to benefit from the available healthcare options. History shows that most of the people who get new insurance cover tend to benefit from better and quality health care (Murdock, 2012).

As well, the new ACA gives individuals an opportunity to acquaint themselves with the available plans such as the Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO). With proper education and guidance, the new individuals targeted by this Act will work their way towards better care. They will also consider some of the critical factors needed when selecting the most appropriate plan for them. The other important observation is that more patients in the country will encounter various challenges in an attempt to access insurance cover (Murdock, 2012). However, statistics show that 30 million citizens will still be uninsured by 2020 (Murdock, 2012).

The main goal behind the Affordable Care Act is to ensure more people and the government can access insurance at a lower cost. It would be necessary for providers and healthcare organizations to educate their patients. The approach will ensure more people get insurance coverage. Healthcare institutions should assist their patients to enroll or apply for the existing programs or “plans”. The new incentives will educate patients about the existing options and benefits of having a proper insurance cover (Murdock, 2012).

From this study, it is notable that the new Act seeks to help individuals get the right provider and get insurance cover at the right cost. Jean Watson presents essential “creative” factors to ensure individuals get the best care (Daniels, 2003). The first factor entails the formation of a humanistic approach that embraces the needs of others. As well, the theory embraces the use of scientific methods to make decisions and solve problems from a socio-cultural perspective. Watson’s theory explains why assistance and care should be by “human needs” (Grove et al., 2012).

The wider medical practice and nursing seek to provide corrective and protective strategies to address the needs of the people (Daniels, 2003). According to Watson’s theory, nursing should promote the health of citizens, prevent existing diseases, care for patients, and eventually restore their health. With this concept, medical practitioners and health care organizations should work hard to guide their patients and promote their health. The important thing is to use a “holistic approach” to make nursing meaningful (Grove et al., 2012). By the Affordable Care Act, insurance agencies and health care organizations will be required to provide adequate education on how the insurance policies work. Some vital information includes “cost-sharing, insurance networks, and benefits of such cover” (Grove et al., 2012).

The above research explains why professionals can combine the provisions of the Affordable Care Act and nursing theories to provide quality insurance cover and health care to patients. The strategy will make nursing an effective and sustainable profession. With these ideas, it can be possible for nurses and caregivers to provide quality support to their patients (Daniels, 2003). The available insurance options and “managed care” plans can be beneficial to the wider nursing profession. The research explains why the Act is necessary towards addressing the problem of healthcare in the country.

Conclusion

As Watson’s theory suggests, caregivers should use a “holistic approach” to address the illnesses and issues affecting different people in the environment. Although the Affordable Care Act will not cover all the uninsured patients in the country, it still provides a solution to the current shortage of quality health care. Nurses and health care organizations will find the ACA relevant towards better nursing practice. In the future, the profession of nursing will benefit from Watson’s “nursing theory” and the opportunities presented by the ACA.

Reference List

Daniels, R. (2003). Nursing Fundamentals: Caring and Clinical Decision Making. Cengage: Delmar Cengage Learning.

Grove, S., Burns, N. & Gray, J. (2012). The Practice of Nursing Research: Appraisal, Synthesis, and Generation of Evidence. New York: Saunders.

Murdock, K. (2012). Affordable Care Act: Obamacare. New York: GRIN Verlag.