Department: Editor's Memo
On October 1, 2013 open enrollment beganfor the insurance marketplace in compliance with rules for implementing the 2010 Patient Protection and Affordable Care Act (ACA); coverage will start as soon as January 1, 2014 for some. The media often reminds us about the substantially increased numbers of insured individuals who will be seeking access to healthcare services in 2014. The insurance marketplaces are designed to provide consumers with the factual information they need to make appropriate decisions regarding coverage, particularly by comparing different plans and costs, including premiums, deductibles, and out-of-pocket estimates. What I find very exciting is that all qualified health plans must cover the minimum 10 specified categories of essential health benefits, which include ambulatory patient services. Nurse practitioners are at the forefront of collaboratively creating innovative healthcare delivery systems that, with adequate numbers of facilities and providers, will be able to accommodate the influx of the newly insured.
All 50 states and the District of Columbia have made decisions about insurance exchanges–whether to declare a state-based exchange, plan apartnership exchange, or default to the federal exchange. With respect to Medicaid expansion, 24 states are moving forward, 21 are not moving forward, and six states are still debating. The most current data are available from The Henry J. Kaiser Family Foundation (kff.org) as well as interactive maps and other easy-to-use tools. The foundation is a “private, non-profit operating foundation focusing on the major healthcare issues facing the country as well as its role in global health policy.” Several other resources (not all inclusive) are available to help us decipher the Washington legislative language. All providers are encouraged to visit the Department of Health and Human Services (HHS) website (hhs.gov) to take advantage of the resources at the link to the ACA. You can search by state to learn useful facts, such as the estimated number of uninsured who are eligible for coverage through the insurance marketplace, described alsoby age, gender, and race/ethnicity.If you do not already receive regular updates and press releases about the ACA, register for the HHSlist serve. The Health Insurance Marketplace atthe Centers for Medicare and Medicaid Services (CMS) site at marketplace.cms.gov provides a wealth of information for consumers and providers. Providers are able to order materials toshare with their patients to help them understand and navigate through theapplication process. There are numerous suggestions for community engagement with downloadable slide presentations and videos to facilitate programming. One final resource I will mention is a continuing-education module developed by Medscape titled, What the Healthcare Marketplace Means for Practices and Patients. Earn credits while you learn what you and your practice need to do about this latest rule.
Managing the uninsured
I often struggle, as I am sure many of you do, to manage uninsuredpatients based on evidence and recommended standards of care. How often have you heard a patient say, “I can't do 'X' because I can't afford it?” The ACA will not solve all the individual or collective dilemmas related to healthcare access, but it is the right step, in the right direction, at the right time.
This is my 100th editorial memo. I joke that the deadline for monthly expressions in words rolls around faster than any monthly bill. Although I will never reach 100 years as an editor, I can enjoy the beginning of a new century with The Nurse Practitioner. Thank you.
Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP