Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), signed into law in 2010, brought several changes to the provision of healthcare, quality and cost. Three provisions that were enacted in 2014 include the expansion of Medicaid, the individual mandate, and the value-based purchasing programs (McGee & Breslin, 2021). These provisions affected healthcare in a number of ways, including raising the number of people with health insurance, changing the emphasis to preventive care, and tying payments to the quality of care. The changes have been significant for nursing and medical practice and have helped healthcare workers to work with more patients, improve care coordination, and adopt research-based approaches to patient care to eliminate the gaps.

Key Components of the Act and Their Impacts

Expansion of Medicaid

The ACA helped increase coverage for millions of low-income adults while raising Medicaid eligibility to 138% of the federal poverty level. This provision affected mainly the category of the population that was previously excluded from the insurance programs and helped to decrease the existing healthcare inequalities and improve the availability of necessary medical services (Dong & Miller, 2023). Expanding the population that can access preventive services through the ACA reduced the number of emergency department visits and enhanced health status. It also permitted states to get federal funding for extra enrollees, but some states declined, thus restricting its coverage. Although the increase in access has been observed, the uninsured population in non-expansion states still faces barriers to healthcare and adverse health outcomes.
Medicaid expansion also influenced the nursing and medical practice, especially in primary and emergency care. Nurses and physicians have reported higher patient loads and thus need to provide efficient care coordination and chronic disease management. The APRNs have also greatly contributed to responding to physician scarcity, particularly in areas of need, as they practice independently to do basic and health promotion (Dong & Miller, 2023). The rise in the need for healthcare services requires improved staff development, more personnel, and efficient processes of care delivery. Although the expansion has brought benefits to the patient side by increasing their access and enhancing their outcomes, the pressure on the healthcare system calls for the development of a sustainable workforce and policies for the healthcare workforce.

Individual Mandate
The individual mandate of the ACA required most Americans to get health insurance, or else they would have to pay a penalty so as to increase insurance coverage and reduce uncompensated care costs. This provision was aimed at the uninsured population, forcing them to obtain insurance through employer-provided plans, Medicaid, or the marketplace. It was designed to bring more people into the insurance pool to counterbalance the costs of the risky population, which in turn was to stabilize insurance markets (Song et al., 2021). While the provision helped decrease the rate of uninsured people, it was met with some resistance because of government mandates and financial penalties. It was later nullified in 2019 despite the changes that it brought about altered insurance participation.

The individual mandate was a key driver of change in the healthcare system as it was instrumental in expanding the pool of insured patients who sought preventive and routine medical care. Nurses have also been involved in the task of informing patients about insurance coverage, health systems, and the importance of preventive check-ups. Physicians have also had to change their scope of practice to handle more patients across the board, with a focus on long-term disease prevention and health maintenance techniques (Cai & Song, 2024). Although the provision helped to decrease the use of emergency departments for primary care, it brought about issues like longer waiting times and a shortage of providers. The repeal of the mandate has the potential to increase the uninsured population, thus, erasing the progress made in the area of healthcare and preventive care.

Value-Based Purchasing Programs
The ACA also brought into the picture value-based purchasing programs where reimbursement was based on the quality of services rather than the quantity. These programs encouraged healthcare providers to increase patient satisfaction, decrease hospital-acquired conditions, and increase productivity. It is only possible to get full reimbursement when the hospitals and healthcare professionals meet the set standards of performance, such as the number of readmissions, patient satisfaction rates, and compliance with best practices (Kim et al., 2022). This provision changed the healthcare system from fee-for-service to quality care. Although value-based purchasing positively impacted patients by enhancing patient safety and care quality, it added new record-keeping and performance evaluation hassles for healthcare facilities.

Value-based purchasing programs have impacted the nursing and medical field by promoting the use of evidence-based interventions and patient-centered care. To meet the factors embodied as metrics for the quality of care in a hospital, nurses must efficiently perform functions, including infection oversight, discharge planning, and coordination of care to patients. Clinicians are required to integrate their practice with performance standards in order to achieve the best possible results and sustainability (Song et al., 2021). Integrated care delivery and the focus on quality have also been fostered by the change to quality-based payments. However, there has been a rise in the number of administrative activities and performance measures that have challenged healthcare providers. Appropriate support through training and educating the healthcare professional is an essential element to retain the improvement and sustenance of quality in healthcare services and, therefore, high-value services.

Conclusion
The ACA’s Medicaid expansion, individual mandate, and value-based purchasing programs have changed nursing and medical practice by expanding access to health care, altering reimbursement mechanisms, and focusing on quality care. These provisions have forced healthcare professionals to deal with more patients, use preventive measures, and align clinical practice with the performance standards. Although these reforms have enhanced patient care, they have also brought about some issues, such as a shortage of workforce and bureaucracy. Nurses and physicians must be active in the continuous change in the healthcare system and policy to fight for appropriate, quality, and patient-centered care in various healthcare facilities.
 
References
Cai, C., & Song, Z. (2024). Protecting Patients And Society In An Era Of Private Equity Provider Ownership: Challenges And Opportunities For Policy: Article examines private equity provider ownership and patient protection. Health Affairs, 43(5), 666-673. https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2023.00942Links to an external site.

Dong, X., & Miller, N. A. (2023). The Effects of Medicaid Expansion Under the Affordable Care Act on Health Insurance Coverage, Health Care Access, and Health Care Use for People With Disabilities: A Scoping Review. Journal of Disability Policy Studies, 34(1), 86-96. https://journals.sagepub.com/doi/abs/10.1177/10442073221118124Links to an external site.

Kim, H., Mahmood, A., Hammarlund, N. E., & Chang, C. F. (2022). Hospital value-based payment programs and disparity in the United States: a review of current evidence and future perspectives. Frontiers in Public Health, 10, 882715. https://www.frontiersin.org/articles/10.3389/fpubh.2022.882715/fullLinks to an external site.

McGee, B. T., & Breslin, S. E. (2021). The Affordable Care Act 10 Years In: What Nursing Leaders Should Know. Nurse Leader, 19(1), 57-61. https://www.sciencedirect.com/science/article/pii/S1541461220300896Links to an external site.

Song, J., Kim, J. N., Tomar, S., & Wong, L. N. (2021). The impact of the affordable care act on dental care: an integrative literature review. International Journal of Environmental Research and Public Health, 18(15), 7865. https://www.mdpi.com/1660-4601/18/15/7865Links to an external site.