Florida and the Patient Protection and Affordable Care Act

FNA Position Paper

Florida and the Patient Protection and Affordable Care Act

Medicaid Expansion

The Florida Nurses Association supports the expansion of Medicaid under the Patient Protection and Affordable Care Act (PPACA) and believes nurses will play a vital role in new and emerging health care delivery models. It is important that nurses are able to contribute all their skills and knowledge to the care of patients and play key roles patient-centered and preventive health care.

Background:

The Florida Legislature must decide whether to expand Medicaid coverage to individual who are at 138% (133% plus a 5% differential) of the federal poverty level. Florida currently provides no Medicaid coverage to childless adults and covers only those parents with incomes at or below 20% FPL — $3,813 for a family of three. This expansion could bring up to 1.3 million individuals into the Medicaid system, many of them children (Georgetown University, Center for Children and Families, 2012).

The federal government will pay the full costs of adding these individuals to the Medicaid program, but will phase down to 90% by 2020. However, cost savings can be achieved in several areas, including a drop in uncompensated care provided by hospitals to uninsured patients.

Key points:

• Nearly 20% of Floridians are uninsured (
• Expanding Medicaid will provide insurance coverage to more working families, children, the elderly in nursing homes and others who will have access to basic health care services;
• These individuals will be more likely to get primary care services that can prevent more costly and complex health conditions;
• Nurses, particularly Advanced Registered Nurse Practitioners (ARNPs), are available to meet the increased demand for primary health care practitioners at a time when Florida faces a shortage of physicians;
• Registered nurses are fundamental to the success of emerging patient-centered care delivery models;
• Registered nurses should be allowed to work o the full extent of the education and experience in order to meet the needs of the increased patient demand while providing high-quality, cost-effective health care services. This includes the ability for ARNPs to prescribed controlled substances under a protocol agreement with a physician.

PPACA directs renewed attention and substantially more resources and incentives to promote those elements of care which are also the backbone of nursing practice -- patient-centered or “holistic” care, including family and community; care continuity; coordination and integration across settings and providers; chronic disease management; patient education; prevention and wellness care; and information management (American Nurses Association, 2010).

PPACA recognizes the advance ARNP as a valuable provider of primary care services, as well as a potential leader in new integrated care systems.