In prior columns, we have discussed how necessary it is for patients, and even more important, for ambulatory care nurses, to understand major provisions of the health care reform law as they affect access to care and care options for their patients. As major reference persons for ambulatory care patients, nurses can provide assistance to patients so that they can seek and access opportunities for insurance and care. Lack of understanding and confusion regarding provisions in the health care reform law, the implementation timeline, and ways to access insurance on the part of health care consumers persists.

"Health reform is a year old and the latest Kaiser Health Tracking Poll finds a basic division (regarding support for the health reform law) has changed little during the last 12 months" (Henry J. Kaiser Family Foundation Health Reform Source, 2011). Conducted in March 2011, the poll found 42 percent of Americans viewed the law favorably, while 46 percent view it unfavorably. In addition, beliefs about the health care reform law represented partisan views, with 71 percent of Democrats in favor of the law and 82 percent of Republicans opposed. Presumably, some of the lack of support is also related to lack of understanding of benefits of the law.

Not only do consumers not understand how to access health care insurance coverage, but enrollment in high-risk pools has also been much slower and lower than expected. In addition, once they become involved in comparisons of health insurance plans available, consumers are confused regarding the cost-sharing provisions in plans.

The Commonwealth Fund and the California HealthCare Foundation collaborated with the Consumers Union to develop and implement surveys of consumers' initial reactions to the "Summary of Benefits and Coverage" health disclosure form which allows consumers to compare health insurance plans and understand terms of coverage. Insurance companies will be required to use this form for their enrollees in 2012. According to the study, "consumers were able to use the forms to make hypothetical choices among health plans...however, the study also found deep-seated confusion and lack of confidence with respect to health plan cost-sharing" (Quincy, 2011). The Web site Healthcare.gov offers a succinct outline of preventive care services available under the health care reform law and discusses cost-sharing.

Online Resources

American Nurses Association Health Care Reform
www.nursingworld.org/MainMenuCategories/ HealthcareandPolicyIssues/Health-Care-Law.aspx

Health Care and You
www.healthcareandyou.org

Kaiser Family Foundation Health Reform Quiz
https://www.kff.org/quiz/health-reform-quiz/

The other point regarding the law that is poorly understood is the expectation that providing access not only to acute care, but also to health promotion and disease prevention, should decrease the cost of care for individuals as well as state and federal governments. The most recent estimates of the cost of health care compiled by the Centers for Medicare and Medicaid Services (2011) show that Americans are spending more money on health care - 17.6% of the U.S. economy in 2009 compared to 7.2% in 1970. Such growth in health care costs is unsustainable and makes the U.S. products less competitive on the world market where health care costs less than half that of U.S. health care; other countries also have better health care outcomes for each dollar spent.

There is an excellent new Web site (see "Health Care and You" in sidebar) that can be used by nurses and consumers to better understand the health reform law. A collaboration of AARP, the American Academy of Family Physicians, the American College of Physicians, the American Medical Association, the Catholic Health Association, the National Community Pharmacists Association, the American Cancer Society, and the American Nurses Association, this consumer-focused site aims to explain how the new law will affect consumers. The site includes easily accessible information about health care by state as well as a glossary of terms.

As an ambulatory care nurse accepts the challenge of learning more and better understanding the implications of the health care reform law, you may be interested in accessing a new online quiz about the health care reform law. This quiz was developed by the Kaiser Family Foundation and is available online (see sidebar). You may also wish to get more involved professionally at a local or national level. The American Nurses Association (ANA) Web site (see sidebar) offers news, resources, and opportunities to share stories about how the law has affected your patients. You may also connect with colleagues at N-STAT, the Nurses Strategic Action Team, on the ANA site. AAACN is also planning to enhance opportunities for members and launch initiatives aligned with health care reform legislation, so stay tuned.


Sheila A. Haas, PhD, RN, FAAN, is a Professor, Niehoff School of Nursing, Loyola University of Chicago, Chicago, IL. She can be reached at shaas@luc.edu

References
Centers for Medicare and Medicaid Services. (CMS). (2011). National health expenditure data. Retrieved from www.cms.gov/NationalHealthExpendData 

The Henry J. Kaiser Family Foundation Health Reform Source. (2011). KFF March health tracking poll: One year later, views on health reform remain divided. Retrieved from http://www.kff.org/kaiserpolls/8166.cfm

Quincy, L. (2011). Making health insurance cost-sharing clear to consumers: Challenges in implementing health reform’s insurance disclosure requirements. The Commonwealth Fund, 2(February 2011). Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Feb/1480_Quincy_making_hlt_ins_costsharing_clear_consumers_ib.pdf