The Effect of the Affordable Care Act on Medicare: Opportunities for Advanced Practice Nursing

The Affordable Care Act (ACA) was signed into law in 2010 and, when challenged, was upheld by the Supreme Court as constitutional. Its purpose is to provide uninsured Americans a means for affording health insurance, but it also contains legislation reforming how providers and healthcare institutions are paid by Medicare. Medicare provides insurance coverage for US seniors over 65 years of age or for certain disabled individuals. The components of Medicare medical coverage include Part A, which provides coverage for hospital stays, post-hospital nursing facilities, and home healthcare; Part B, which pays most routine doctor and lab costs, medical equipment and supplies, additional home healthcare, and physical therapy; Part C in which beneficiaries are enrolled in private health plans that are approved by Medicare; and Part D, which pays some of prescription medication costs.1 Although Medicare recipients do not participate in the ACA per se, the ACA does impact them in a variety of ways, through enhanced preventive care coverage, lowered costs on prescription drugs, reduced or stable monthly premiums, and improved quality and access to care.2 Payment reforms in Medicare, brought about by the ACA, are changing how providers and institutions are reimbursed for providing healthcare to Medicare beneficiaries, focusing more on the quality of the healthcare received, thereby, tying good practice to good reimbursement rates. In addition, the ACA is impacting Medicare by enacting new programs to reduce fraudulent claims, enhancing the Medicare program overall.2 What will be the impact of the ACA on Medicare, and what are some of the opportunities for advanced practice nurses (APNs) in this new healthcare environment?