Answer for NUR 550 Identify two major policy issues that affect the current state of health care delivery and population health equity in the United States (may be state or federal) Re: Topic 7 DQ 1

One of the major health policy reforms that made an impact on health equity and disparity in the US is the Affordable Care Act (ACA). ACA is a comprehensive reform law that was enacted in 2010, which aimed to increase health insurance coverage for the uninsured and implement reform in the insurance market. Patients who may have been uninsured due to preexisting conditions or limited finances can secure affordable health plans through the health insurance marketplace in their state (AMA, n.d.). In 2017, the Tax cut and Jobs removed the penalty for individuals not having insurance which scaled back the outreach program to help Americans sign up for ACA, and caused the number of Americans covered by ACA to drop by almost 5 million the next year. In 2021, President Biden signed an executive order to focus on rules and policies that limit Americans’ access to health care. The American rescue plan act (ARPA) extended the eligibility of ACA health insurance subsidies to those buying healthcare coverage in the marketplace with incomes over 400% of poverty.

In California, Assembly Bill 890 (AB 890) Nurse Practitioner, the scope of practice is one of the more recent bills passed. This was initially proposed during the pandemic when there was a shortage of physicians. With the passage of AB 890, Nurse Practitioners may be able to practice independently once certain provisions have been met. A nurse practitioner must first complete the transition to practice by practicing under one or more physicians for 3 full-time equivalent years of practice or 4600 hours. For nurse practitioners to expand their practice outside of those settings, they must practice within the limits of their knowledge, experience, and certification in good standing for at least another 3 years after completion of the initial 3 years of transition to practice. The CA Board of Nursing is expected to implement AB 890 by January 1, 2023 (California Board of Nursing, 2022).

Another related bill is SB 1375 which will increase access to affordable, quality abortion care and reproductive health services in California. It clarifies existing laws so that trained and experienced nurse practitioners can provide this critically needed care without physician supervision. With the shortage of primary care physicians in California, especially in the Latino, Black, and Native American communities, over 40% of the counties do not have clinics that provide abortion (California Association for Nurse Practitioners, 2022).

References:

American Medical Association (AMA). (n.d.) Understanding the affordable care act. https://www.ama-assn.org/delivering-care/patient-support-advocacy/understanding-affordable-care-act

California Board of Nursing. (2022). Assembly bill 890. https://www.rn.ca.gov/practice/ab890.shtml

California Association for Nurse Practitioners. (2022). 2022 Legislation status: The legislative and regulatory process. https://canpweb.org/advocacy/ab-890-implementation/2022-legislation-status/