The Impact of the Affordable Care Act on North Carolina's Uninsured Population
Wendy Patterson
Walden University
Policy & Advocacy for Population Health
NURS 6050-13
Dr. Joan Moon
June 30, 2015

The Impact of the Affordable Care Act on
North Carolina's Uninsured Population

In a speech delivered in the Rose Garden, President Obama stated, “Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate -- we finally declared that in America, healthcare is not a privilege for a few, but a right for all” (US News, 2015). This paper will discuss the impact of the Affordable Care Act (ACA) on the population of North Carolina, the economic impact of providing care to patients from the provider’s point of view, how patients will be affected in relationship to cost, quality, and access to treatment, and what the ethical implications of ACA means for both the provider's and the patients.
The Impact of the Affordable Care
Act on the Population in North Carolina

According to a fact sheet published by the Kaiser Family Foundation, the ACA has the potential to extend coverage to many of the 47 million nonelderly uninsured people nationwide, including the 1.6 million uninsured in North Carolina (KFF, 2015). Although the ACA was signed into law declaring that it was a right for all to have health insurance, individual States had the option of whether to expand coverage for Medicaid recipients. “Being poor, unemployed, or homeless did not qualify a person for Medicaid if he/she was a childless adult in North Carolina” (Milstead, p.202). According to the U.S. Census Bureau, in 2010, when the ACA was signed into law, the population in North Carolina was 9,535,691. Of that number, 16% or 1,525,711 were uninsured (Medicine, 2015).
The Impact of the Economics of Providing Care to Patients
Along with the Affordable Care Act, came new issues for providing care to patients. The ACA implemented new guidelines for how hospitals received reimbursement for treating patients. Before the ACA, Medicare reimbursed hospitals by “measured plan quality, plans would be paid under the same formula regardless of their quality” (Medicare, 2015). Under the ACA, if hospitals fail to prevent problems such as harmful drug interactions, unnecessary hospitalizations, conflicting diagnoses and failure to connect people with community based services, Medicare has a right to not pay for the patient’s admission. However, if hospitals do well with the services mentioned above, then Medicare gives the hospital a bonus. In my opinion, nurses and physicians have been performing at these standards for a long time. I do not see why Medicare should be able to refuse payment. An example of this situation would be if a patient were admitted for high blood pressure. The physician increased or changes the patient’s blood pressure medication, and the patient is discharged. Within 30 days, the patient is readmitted for the same diagnoses because the patient decided that he did not like the way the new blood pressure medication made him feel. So therefore the hospital is penalized because the patient is non-compliant.
Another aspect of the spectrum is that rural hospitals are deciding to close their doors instead of comply with the new ACA guidelines. “According to the National Rural Health Association, 53 rural hospitals across the U.S. have closed their doors since 2011; most of those are in the South. Experts note several trends at play in Southern hospitals; in particular: Most states in the South declined to expand Medicaid as allowed for under the ACA, and small, struggling hospitals lost the revenue they would have gotten from newly covered patients – revenue they were depending on” (Haban, 2015).
How will Patients be Affected in Relationship to
Cost, Quality and Access to Treatment?

With North Carolina deciding not to expand Medicaid coverage, it has impacted the citizens in rural areas. Most of these closures have taken place in the south. “Since the beginning of 2010, 53 rural hospitals — with a total of more than 1,500 beds — have closed, according to data from the North Carolina Rural Health Research Program” (O’donnell, 2014). I live in a rural area. We have one hospital that treats patients from about five surrounding counties. The closest hospitals are about 45-60 minutes away. If the hospital closed in my area, what would happen to a stroke victim or stabbing victim in a 45-minute ambulance ride to the nearest facility that was capable of treatment? Let’s look at the small rural town of Richland, GA. The county has two ambulances. They are often tied up making the 90-mile round trip to the nearest hospital. (O’donnell, 2014) What about Walter Skellie who lives in Richland, GA? One of the town’s two ambulances reached Walter in plenty of time when he was showing symptoms of stroke. However, during the 45-minute ride to the nearest hospital, Walter became worse. Walter had two additional strokes hours later. (O’donnell, 2014) Would the hospital in Richland, GA been forced to close if the ACA had not been made into law? In my opinion, the ACA has been unkind to rural hospitals and the low-income patients that they serve.
The Ethical Implications of this Act for Both the Organization and the Patient

In my opinion, there are ethical implications for the ACA for hospitals and patients. In giving the States the authority to decide whether or not to expand Medicaid coverage is unethical. If Congress and Senate passed the ACA and the President signed it into law, I believe that all States should have to comply. Funding for the ACA should not be put on the individual States. In my opinion, people who have not attended medical school should not be allowed to make decisions for patients. Physicians take a Hippocratic Oath and nurses comply with the nurses’ code of conduct. We know what is best for our patients who are lying in the bed in front of us. The Federal or State government should not get to decide how we do our jobs.
Summary
The Affordable Care Act had a substantial impact on the population of North Carolina. The effects of economics on the State of North Carolina having to fund partially the ACA resulted in closings of rural hospitals. Patients were affected in relationship to cost due to the State denying the expansion of services in the Medicaid program. Due to closing of rural hospitals, quality and access to treatment were denied to low-income patients. Ethically, if the President of the United States is going to make a statement “that healthcare is not a privilege for a few, but a right for all” (US News, 2015), then every U.S. Citizen should have access to healthcare regardless of their family status, child status and income status.

References

Haban, Rose. "N.C. Mayor Aarives in D.C. on Quest to Support Rural Hospitals." North
Carolina Health News. N.p., 15 June 2015. Web. 30 June 2015.

How will the uninsured in North Carolina fare under the ACA? (n.d.).
Retrieved June 30, 2015, from http://kff.org/health-reform/fact-sheet/state-profiles-uninsured-under-aca-north-carolina/

Medicine, N. C. (n.d.). North Carolina County-Level Estimates of Non-Elderly Uninsured.
Retrieved June 30, 2015.

Milstead, J. A. (2004). Chapter 10. In Health policy and politics: A nurse's guide (p. 202).
Sudbury, MA: Jones and Bartlett.

O'Donnell, J., & Unger, L. (2014, November 13). Rural hospitals in critical condition. Retrieved
June 30, 2015, from http://www.usatoday.com/story/news/nation/2014/11/12/rural-hospital-closings-federal-reimbursement-medicaid-aca/18532471/

US News. (25 June 2015). "Read Obama's Full Remarks on Supreme Court Ruling." N.p.,. Web.
30 June 2015. <http://www.usnews.com/news/articles/2015/06/25/president-barack-obamas-full-statement-on-supreme-court-affordable-care-act-ruling>.

United States Census Bureau. (n.d.). Retrieved June 30, 2015, from http://quickfacts.census.gov/qfd/states/37000.html Walden University M.S. in Nursing
Formative Evaluation Criteria for Applications and Formal Papers

Categories and Criteria | | Points | QUALITY OF WORK SUBMITTED - 35 Possible Points | 1. The extent to which work meets the assigned criteria and work reflects graduate level critical and analytic thinking (0-30 Points) | Assignment exceeds expectations. All topics are addressed with a minimum of 75% containing exceptional breadth and depth about each of the assignment topics. | 25-30 | | Assignment meets expectations. All topics are addressed with a minimum of 50% containing good breadth and depth about each of the assignment topics. | 20-24 | | Assignment meets most of the expectations. One required topic is either not addressed or inadequately addressed. | 16-19 | | Assignment superficially meets some of the expectations. Two or more required topics are either not addressed or inadequately addressed. | 0-15 | | 2. Purpose of the paper is clear (0-5 Points) | A clear and comprehensive purpose statement is provided which delineates all required criteria. | 5 | | Purpose of the assignment is stated, yet is brief and not descriptive. | 4 | | Purpose of the assignment is vague. | 1-3 | | No purpose statement was provided. | 0 | | ASSIMILATION AND SYNTHESIS OF IDEAS - 50 Possible Points The extent to which the work reflects the student’s ability to- | | | 1. Understand and interpret the assignment’s key concepts (0-10 Points) | Demonstrates the ability to critically appraise and intellectually explore key concepts. | 9-10 | | Demonstrates a clear understanding of key concepts. | 8 | | Shows some degree of understanding of key concepts. | 5-7 | | Shows a lack of understanding of key concepts, deviates from topics. | 0-4 | | 2. Apply and integrate material in course resources (i.e. video, required readings, and textbook) and credible outside resources (0-20 Points) | Demonstrates and applies exceptional support of major points and integrates 2 or more credible outside sources, in addition to 3-4 course resources to support point of view. | 15-20 | | Integrates specific information from 1 credible outside resource and 3 to 4 course resources to support major points and point of view. | 10-14 | | Minimally includes and integrates specific information from 2-3 resources to support major points and point of view. | 3-9 | | Includes and integrates specific information from 0 to 1 resource to support major points and point of view. | 0-2 | | 3. Synthesize (combines various components or different ideas into a new whole) material in course resources (i.e. video, required readings, and textbook) by comparing different points of view and highlighting similarities, differences, and connections. (0-20 Points) | Synthesizes and justifies (defends, explains, validates, confirms) information gleaned from sources to support major points presented. Applies meaning to the field of advanced nursing practice. | 18-20 | | Summarizes information gleaned from sources to support major points, but does not synthesize. | 16-17 | | Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas unclear and/or underdeveloped. | 14-15 | | Rarely or does not interpret, apply, and synthesize concepts, and/or strategies. | 0-13 | |