Health Policy Issue Paper: PPACA Individual Mandate


The individual mandate that is defined within the Patient Protection and Affordable Care Act (PPACA), is touted as a major benefit in the eyes of the advanced nurse practitioner. He or she is now able to be more involved in the decision making process, craft policy, and impact when and how care is delivered to the patient at various stages in the patient's life. The focus of the individual mandate clause seems to be centered on increasing the number of people that see the nurse and can attain preventative care. This report highlights these aspects of the PPACA and provides background into the law.

Health Policy Issue Paper: PPACA Individual Mandate, Considerations for Implementation

Since the passage of the Patient Protection and Affordable Care Act, (PPACA) occurring in 2010, there has been a large amount of controversy surrounding many aspects of this bill's context. Hence, we must consider whether there is true substance for individuals to argue certain points about the act, therefore, should filter through the high-level of politics that surrounds this landmark piece of legislation. This report will be crafted in a manner that takes a non-partisan and purely factual account of the components of the law. The established interpretation of the law, as provided by the U.S. Governments briefing sources, will be used to identify the components of the law. Also, interpretations will be provided by observing actions as they occur and are documented in recently published peer-reviewed articles. In the body of this paper, one aspect of the law will be selected and thoroughly vetted to determine the impact that it has (in a practical manner) in the U.S. Healthcare system. The focus will be to consider how this aspect affects the ability of the nurse practitioner to deliver a high-level of quality care. Prior to selecting this one aspect of the PPACA, a description of its most notable components will be provided, as a background that is necessary to understand the full level of reach that the law has.

Discussion of the Patient Protection and Affordable Care Act (PPACA)

It is noted that the PPACA is often regarded as the key achievement of President Barack Obama. Signed into law in October of 2010, the act was touted for its ability to ensure that patients with "pre-existing" conditions can secure purchase of Health Care Policy and thus would have a greater ability to access the benefits of our encompassing system. According to a report published by the office of the U.S. Senate (2010) the essential components of the law include: (1) Quality, affordable healthcare for all Americans, (2) Defining the role of public programs, (3) Improving the quality and efficiency of health care, (4) Preventing chronic disease and improving public health, (5) Creating a more vast healthcare workforce, (6) generating transparency to create program integrity, (7) Improving access to innovate medical therapies, (8) Supporting community living services, (9) creating revenue provisions. The rose painted summary provided by the office of the U.S. Senate is in alignment with summaries by healthcare practitioners, however much of these key components are interpreted in a more realistic manner, as noted in a publication by Kline, Walthall (2010).

Discussion of a Specific Selected Aspect of the PPACA

The aspect of the PPACA that I intend to cover encompasses the defined components that can likely be grouped into number 1. An interpretation of "Quality, affordable health care for All Americans", may be translated into the statement "Individual Mandate". The controversy surrounding the individual mandate was addressed at the highest level in 2012 when the U.S. Supreme Court ruled that the clause was valid under the U.S. Constitution. Hence, the although this did little to quell the politics surround this component the aspect is now valid enough to consider it's long-term effects on the U.S. Healthcare system and more specifically primary care providers. The nurse's as a whole determine that this clause benefits their general body, such that it will force individuals to purchase plans that they are more likely to use because it has been purchased. Hence, this observation is made clear within Gostin, and Garcia's (2012) interpretation of the health care law. It is noted that prior to the law there were approximately 50 million adults and children that lacked sufficient access to health care, and this was almost always tied to the ability to attain coverage. Leaders within the nursing body praise their law because it not only spreads coverage across the U.S. but it also opens up the ability of the Nurse Practitioner to assume an even more comprehensive role in the healthcare process.

Critical Analysis of the Selected Aspect in Terms of Benefits and Risks

An observation predicted by the CHH (2011), was proven to be accurate after the U.S. Supreme Court upheld the individual mandate in 2012. At this time, the nursing body began immediately strategizing on how to coordinate better care for individuals and families. The efforts to implement policy and procedure that allow for more effective coordination of care, were enacted shortly after the passage of the law in 2010, however, once the Individual Mandate was upheld in 2012 nurses began increasing their ability to become better service providers.


In general terms, the body of nurses can better coordinate resources for patients and

families because the nurse can be more appropriately utilized to apply their knowledge and skills. A specific look Lathrop at this general term indicates that the following actions are now embraced by the nurse practitioner (as a result of the passage of the PPACA): (1) More extensive leadership roles, (2) Ability to strengthen preventative Services, (3) Access to more continuing education. Prior to the full implementation of the law, it is noted that our Healthcare system was notorious for devoting most dollars to developing methods to care for individuals at end-of-life and already noted to be in the disease state. As a result of the law, more emphasis is placed on preventive care, as this will likely reduce the negative impact to the solvency of the system, in terms of maintaining funding. Under the law, the nurse is given more ability to implement and practice preventative care methods, and to lead in these practices.


One notable risk of increasing the role of the nurse practitioner in such a manner brings into question the same knowledge and skills of the nurse. The fact that more high-level decision making will now be performed, some have questioned the ability of non-MS and PhD nurses to make informed decision that are based on proven evidence based practices and/or scientific rationale. However, these arguments are not always supported by fact as it is observed that the emphasis on preventative care in Nursing practices have been traced back to procedures that were implemented in the early 1900’s.

Impact of Selected Aspect on Healthcare Delivery and Services

In a nutshell, the individual mandate will greatly increase the number of individuals within the healthcare system. They must attain coverage or face taxation, and it is likely that they will utilize the coverage that they are forced to purchase. The influx of millions of new patients will require the system to have more primary care providers, and they should be well trained in coordinating care.

Impact of Selected Aspect on Advanced Practice Nurses

For the advanced practice nurse, more opportunity is created. Evidence-based practice can be implemented to prevent disease from occurring, and the nurse can embrace a more research led and hands-on approach for interacting with both patient and procedure. This is a necessary aspect to relieve the burden that may be faced by Medical Doctors, that may otherwise have to make these calls, according to Shi.


In summary, the PPACA is an encompassing law that has many components, which were designed with the intent of increasing coverage in the U.S. and providing a higher quality of care. It is uncertain at this time if the law will be effective to execute these tasks, but at the moment the advanced practice nurse is in prime position to leave school and immediately begin designing his/her strategies for implementing better preventative care and coordination policies. These policies certainly must be crafted to be in compliance with federal, state and institution laws/rules, however the nurse previously had little say in what was to be performed on the patient. Getting the patient prior to them having a disease state will also help to reduce the overall cost of care, and relieve the burden of payment that is absorbed by the U.S. Government. Private insurers must now step up to provide cost effective care, and the advanced practice nurse must step up to prevent to embrace the added responsibility.

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