The full implementation of the Affordable Care Act (ACA) happened in 2014, introducing health insurance reforms and fresh health coverage options in Pennsylvania, California and other regions in the United States. Before the Affordable Care Act, under a waiver, California made several initiatives to expand the state’s Medicaid program – Medi-Cal – and made plans to restructure the health care delivery system within its safety net. Within the first two years after the ACA went into full effect, Medi-Cal, together with Covered California, which is the state’s health insurance Marketplace, facilitated the health coverage of millions of California residents. In Georgia, the Affordable Care Act also led to an increase in the number of residents having health coverage, albeit to a lower extent (Giaimo, 2016). Notably, the state has not implemented the Medicaid expansion; meaning, a majority of the adult population that receives relatively low incomes is likely to remain uninsured. It is only when this state will make more efficient reforms that it will continue expanding eligibility and restructuring delivery systems. Based on the current state of health care in California, building on these reforms would ensure efficient, high-quality care to many residents in Georgia. This paper provides the similarities and variations between the health care landscape in California and Georgia.
Health Insurance
During the initial ACA open enrollment period, Georgia residents were allowed to purchase health plans through the federal Health Insurance Marketplace. The ACA contains provisions that allow states to develop a state-based Marketplace, establish a Marketplace in partnership with the federal government, or use the existing Marketplace, which is usually facilitated by the federal government (Giaimo, 2016). Georgia opted against establishing its own stated-based Marketplace. Thus, the federal government has put in place and is facilitating the Health Insurance Marketplace in this state. Currently, five insurance companies offer Qualified Health Plans (QHPs) in the Georgia personal Marketplace. However, it is only one of these insurers that provide plans on a state-wide basis (Bauchner and Fontanarosa, 2016). The $250 monthly premium for a Benchmark QHP in Atlanta is considered to be well below the average amount for all the great cities in the United States. Considering the trend in premium changes, there is a 6% drop in 2016 as compared to 2015.
While Georgia relies on the federally facilitated insurance Marketplace, California has one that is state-based, called Covered California (Giaimo, 2016). Through this Marketplace, individuals who do not have access to alternative affordable health insurance are eligible to buy individual coverage directly from insurance providers. California currently has ten insurers that provide Qualified Health Plans (QHPs) in the individual Marketplace, with all of them offering plans on a state-wide basis. The average cost of monthly premiums in this state is $219, which is also considerably cheaper compared to many other states (Bauchner and Fontanarosa, 2016). However, this figure represents an 8% increase between 2015 and 2016. It follows that, while premium rates are decreasing in Georgia, purchasing health coverage in California is becoming more expensive.
General Health Statistics and Health Ranking
On the overall health measures, California is ranked 16th among all states in the United Health Foundations Report, America’s Health Rankings 2016, with the state also ranking above the national average on the majority of population health measures. The health challenges facing California are mainly as a result of the environmental conditions. For instance, the state registers a relatively higher degree of air pollution and lengthy periods of severe and unprecedented droughts (United Health Foundation, 2016). Such conditions only serve to pose incessant public health problems to the state. Nonetheless, California has considerably low rates of obesity, physical inactivity, and smoking.
Georgia falls below the national averages on many measures of population health. As a result, the state manages to be above only twelve states in the rankings of the overall health standards (United Health Foundation, 2016). Like California, Georgia registers comparatively low rates of alcohol consumption and other forms of drug abuse (Bauchner and Fontanarosa, 2016). The major health concerns of this state tend to be the high mortality rate from diabetes, heart disease and HIV, which are well above the national averages. Also, the state has one of the highest rates of teenage pregnancies in the country.
Disparities in Health Care Access
In both states, the measures of health status vary by ethnicity. A larger fraction of the white population in both states smoke, as compared to African-Americans and Hispanics. Additionally, whites are more likely than African-Americans, Hispanics, and Asians to report having a usual source of health care (Bauchner and Fontanarosa, 2016). Nonetheless, it is the white people who are more likely to have diabetes or be overweight.
Health Care Reform
The primary objective of the Affordable Care Act was to extend health coverage to millions of the non-elderly uninsured people across the country. By the time this Act was fully implemented, the number of non-elderly uninsured individuals in California and Georgia was 5.8 million and 1.8 million respectively (Bauchner and Fontanarosa, 2016). In both states, the ACA accomplishes this goal through insurance reforms and by introducing new coverage plans, such as the expansion of Medicaid to cater for almost all non-elderly individuals up to 138% Federal Poverty Level. Furthermore, both states currently provide premium subsidies to most non-elderly adults earning up to 400% FPL to buy coverage on the Health Insurance Marketplace. It is important to note that California has already established its own
Medicaid Expansion
The decision of the Supreme Court concerning the Affordable Care Act accordingly made the Medicaid expansion to non-elderly adults optional for any state, and Georgia decided against executing the expansion. If the state supported this expansion, more than 600,000 low-income adults would have received Medicaid coverage. California, unlike Georgia, implemented the Medicaid program expansion (Giaimo, 2016). Notably, the state undertook an early expansion of the program under its half a decade “Bride to Reform” Medicaid Demonstration Waiver, which was accepted by the federal government in the year 2010. The waiver had additional provisions, in that, it allowed for federal matching financial support for the establishment of a coverage program that is useful on a county level, referred to as the Low-Income Health Program (LIHP). The LIHP covers low-income non-elderly adults who fail to meet Medi-Cal eligibility. Almost every county in California participates in LIHP, and more than 700,000 are currently members of the program (Bauchner and Fontanarosa, 2016).
The Influence of Reform on Professional Nursing Practice
In 2012, the United States Supreme Court upheld nearly every provision of the Affordable Care Act, such as the “shared responsibility” to buy health insurance (Giaimo, 2016). Through such initiatives, there have been considerable developments both for individual nurses and the nursing profession in the United States. The impacts of health care reform on nurses and the nursing profession are quite similar for both California and Georgia, except for a few variations.
Health care professionals, including nurses, have been awarded scholarships and loan repayments through the ACA, the American Recovery and Reinvestment Act (ARRA) and annual appropriations (Bauchner and Fontanarosa, 2016). For instance, millions of dollars were provided to primary health professionals to improve the access and quality of healthcare for the underserved areas of Georgia in 2015. During the same period, in both states, the American Nursing Association (ANA) was working with the Nursing Community and the American Academy of Colleges of Nursing (AACN) to effectively increase financial aid for the Nursing Workforce Development programs.
Staffing Laws
There are fourteen states, including California, that have staffing committees whose duty is planning and establishing proper staffing policies. To date, California is the only state that defines a required minimum nurse to patient ratio to be maintained by any health care unit in the state (Giaimo, 2016). In this case, the state can maintain a high ratio of nurses to patients. On the other hand, Georgia, which does not have such legislation, has a very low nurse to patient ratio. Furthermore, Georgia, unlike California, has regulations that hinder autonomy among nurse practitioners. As a result, for patients suffering from acute myocardial infarction mainly, more RN hours per patient day in California result in lower mortality rates as compared to Georgia. It follows that such a reform in health care is likely to produce desirable outcomes.
Conclusions
While Georgia declined to implement the voluntary Medicaid expansion, California undertook an early expansion of the program 2010. As a result, there was a greater increase in the number of covered non-elderly individuals in California than Georgia between 2010 and 2016. Notably, the state undertook an early expansion of the program under its half a decade “Bride to Reform” Medicaid Demonstration Waiver, which was accepted by the federal government in the year 2010.
The various health care reforms that have taken place in the United States over the past several years are likely to have considerable effects on the nursing profession and individual nurses. The effects of new staffing policies, or the absence of such policies, in many states, are a demonstration of the significance of health care reforms to professional nursing practice.
References
Bauchner, H., & Fontanarosa, P. B. (2016). The Future of US Health Care Policy. JAMA, 315(13), 1339-1340.
Giaimo, S. (2016). The Intersection of Health and Politics. In Reforming Health Care in the United States, Germany, and South Africa (pp. 1-34). Palgrave Macmillan US.
United Health Foundation. (2016). America’s Health Rankings. Retrieved from http://www.americashealthrankings.org
