US Health Care Delivery System Transformation

Health Care Improvement Act of 2021

Since the fundamental shift toward patient-oriented and preventive health care introduced by the Affordable Care Act (ACA) of 2010, legislators have put substantial effort into defining the ways to extrapolate government-supported health care across the country. Hence, currently, more than 30% of the US population is covered by Medicaid or Medicare health insurance (Kaiser Family Foundation, 2019). These programs are aimed at providing health security for the population with low income and senior communities. The rest of the population is also accounted for under the Obamacare laws, as the Employer Mandate expects the employers who have more than fifty full-time employees to cover the insurance of nearly 95% of their staff (Internal Revenue Service, 2021). For this reason, the majority of emerging federal regulations are focused on the promotion of health insurance coverage for the US population.

A prime example of such a federal regulation is the Health Improvement Act of 2021, issued in February 2021 by the US Senate. In terms of the present legislative initiative, the state health departments are encouraged to expand their Medicaid, Medicare, and public insurance networks in order to receive financial assistance from the government (US Senate, 2021). In essence, this legislation tends to promote the idea of health insurance being an integral right of a US citizen rather than a privilege for white-collar workers (Bauchner et al., 2021). After a continuous debate by Joe Biden’s administration, the Health Care Improvement Act of 2021 manifests the continuation of the ACA through the expansion of government insurance support and the initiation of public insurance options (Cutler, 2021). Besides these provisions, the US Senate (2021) also plans to:

  • expand the premium tax credit to lower the insurance costs for individuals receiving insurance from private marketplaces;
  • increase the salaries of rural health care providers;
  • establish guidelines for employers to inform workers on potential insurance deals and premium tax returns.

Hence, it may be concluded that the Health Improvement Act of 2021 is a promising instrument in the context of access to quality care. The latter, for its part, has long been associated with a fundamental objective of nursing. Indeed, according to Cleveland et al. (2019):

Nurses are integral in sustaining the financing of healthcare concerns through integrated activities with policymakers, legislators, and administrators because of the need to close the increased gap between funding the Medicare Trust, health-related expenditures, and insurance plan instability

For this reason, with the government’s intention to expand Medicaid and Medicare coverage, the primary responsibility of insurance promotion and guidance lies with the nurses. In this context, the role of the nurse is to serve as a mediator between the public incentives and their implementation within the population, as nurses need to make sure the patient is aware of their insurance options and sources of financial aid. Undeniably, such community work is a supplement to professional medical care.

Pay for Performance and Patient Outcomes

The realm of health care is fundamentally a socially justifiable endeavor of helping and saving humanity. However, while nurses and other medical professionals may be internally motivated by providing quality care for the patients, the efforts put into professional assistance should be reimbursed. According to Baljoon et al. (2018), there are various factors that contribute to the nurses’ motivation in the workplace, namely, age, experience, autonomy, work environment, empowerment, peer support, and financial reward for the work. Hence, it is reasonable to assume that pay for performance is a crucial aspect in terms of patient outcomes and the average quality of services provided.

As far as the Health Care Improvement Act of 2021 is concerned, the issue of nurse payment has become rather complicated. According to one of the studies, the dissonance lies in the fact that while higher Medicare and Medicaid enrollment rates secure more employment and profit opportunities for nurses, the profits have a decreasing tendency compared to private insurance plans (Bisco et al., 2017). Moreover, although currently, Medicaid and Medicare plan secure more autonomy for the nurses, they receive their payments through medical establishments and physicians and not directly (Bisco et al., 2017). The payment patterns for physicians and nurses are different both within the Medicaid and Medicare frameworks, as nurses frequently receive only up to 85% of what a physician’s benefit from the Medicare/Medicaid service provided (American Nurses Association, 2017). The situation sometimes differs according to the state, but the tendency of lower payments for nurses is prevalent in the country.

On the contrary, the quality measures introduced by the public initiatives, such as the expansion of the Medicaid coverage, are of significant benefit to the community. Hence, the adoption of better exposure to medical insurance should be pursued by the government and medical professionals, as in the long term, access to insured primary care may result in less workload, shorter length of stay, and better patient outcomes. Hence, there is currently a demand for equalizing payment for nurses and physicians who work under Medicare and Medicaid programs, as the amount of work performed by nurses should be financially motivated.

Nursing Leadership in Primary Care

The widespread introduction of Medicaid, Medicare, and public insurance is primarily aimed at the encouragement of primary care as a means of improving community health and saving health costs. Thus, in this scenario, nurses play a critical role in reaching out to people and educating them on health prevention and promotion. According to Nieuwboer et al. (2019), the idea of leadership training in nursing is an important step towards the development of an integrated primary care system that focuses on a proactive approach to treatment. Hence, nowadays, the roles of the nurse have elevated beyond clinical management of the patient, encompassing advocacy for community health, communication with providers, education, and holistic support of the patients.

Emerging Trends in Nursing

When anticipating the prospects of nursing, it is reasonable to assume that the first developmental trend will concern the autonomy of nurses. Indeed, over the past years, many states have adopted legislation to permit nurses to perform a series of tasks without a physician’s supervision. First, autonomy increases the nurses’ motivation and job satisfaction. Second, the ability to avoid excessive communication with physicians increases the productivity of both professionals. Finally, the autonomy of nurses presents better access to health care for the population, as the patients will be able to receive quality and justified treatment directly from the nurses, whereas the number of physicians is more limited in certain areas.

The second significant trend in nursing is the extensive use of telehealth. Since the pandemic outbreak in 2020, much attention has been drawn to the application of technology to patient monitoring and communication (Purdue University Global, 2021). Hence, the nurses should be aware of the new challenges of embracing social media and digital platforms in health care, including ethics and data security guidelines.


American Nurses Association. (2017). Medicare payment for registered nurse services and care coordination [PDF document]. Web.

Baljoon, R. A., Banjar, H. E., & Banakhar, M. A. (2018). Nurses’ work motivation and the factors affecting it: A scoping review. International Journal of Nursing & Clinical Practices, 5(1). Web.

Bauchner, H., Fontanarosa, P. B., & Maddox, K. J. (2021). Health care is a right, not a privilege: A new series on US health care and health policy. JAMA, 325(3), 227-228. Web.

Bisco, J. M., Cole, C., & Karl, J. B. (2017). The effect of government-run healthcare on the salaries of nursing professionals in the US. Journal of Insurance Issues, 215-246.

Cleveland, K., Motter, T., & Smith, Y. (2019). Affordable care: Harnessing the power of nurses. Online Journal of Issues in Nursing, 24(2). Web.

Cutler, D. M. (2021). Which way will Biden go on health care? JAMA Health Forum, 2(5). Web.

Internal Revenue Service. (2021). Employer shared responsibility provisions. Web.

Kaiser Family Foundation. (2019). Health insurance coverage of the total population. Web.

Nieuwboer, M. S., van der Sande, R., van der Marck, M. A., Olde Rikkert, M. G., & Perry, M. (2019). Clinical leadership and integrated primary care: A systematic literature review. European Journal of General Practice, 25(1), 7-18. Web.

Purdue University Global. Top 10 nursing trends for 2021. Web.

US Senate. S.352 – Health Care Improvement Act of 2021. Web.

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