In the State of Florida, the Affordable Care Act is used frequently by many residents as a primary source of health insurance when employer-sponsored and other alternatives are not available. However, the state did not participate in Medicaid Expansion and its lower-income populations without access to other insurance resources have not benefited from this approach (Barakat et al., 2017). For primary care nurse practitioners, it is important to evaluate the benefits of this group for many patients and to determine the best possible approaches to expand access to providers in this role. Scope of practice regulations which differ from state to state, however, affect the ability of some nurse practitioners to provide comprehensive care and treatment to all patients and to order all necessary services (Poghosyan, Boyd, & Clarke, 2016). Addressing the challenges of primary care nurse practitioners in Florida is a priority and requires an examination of the benefits and limitations of the Affordable Care Act for patients throughout the state.
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Despite the impact of the ACA on many states, Florida remains a state with a high uninsured rate, with 15.2 percent of its population without insurance as of 2015; furthermore, without the provision of Medicaid expansion, the state continues to struggle with the complications of uninsured patients and the rising costs of healthcare services (Born, 2017). The state utilizes the federal exchange program known as Healthcare.gov and has 67 separate rating areas based upon counties (Born, 2017). As of 2017, Aetna and UnitedHealthcare were no longer part of the Florida insurance exchange and in some counties, only one plan is available, Blue Cross and Blue Shield of Florida (Born, 2017). Due to these challenges, it is evident that for many people in Florida, there are limited opportunities for those who do not receive employer-sponsored health insurance to gain access to plans which address their comprehensive needs and which are affordable (Born, 2017).
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Some counties such as Gadsden and Miami-Dade have higher insurance premiums for individuals and have many health disparities; therefore, access to care may be limited for some population groups (Born, 2017). As of 2016, there were approximately 1.742 million people in Florida using the ACA exchange out of 2.068 eligible residents, including 46 percent Whites, 33 percent Latinos, and 14 percent African-Americans (Born, 2017). Throughout Florida, providers and customers share important concerns and challenges associated with the ACA that include fewer brokers available to secure coverage; limited expertise in some counties such as Gadsden county; access to relevant information; and the cost of premiums, among others (Born, 2017).
In Florida, the Latino population is growing and it is known that this group continues to experience disparities that are directly associated with ACA and access to care and treatment (Ortega, Rodriguez, & Bustamante, 2015). Within this population, chronic diseases are a common problem which require significant attention and focus; however, without access to routine care, it is often difficult for individuals to manage their health effectively which could increase healthcare costs in the future (Ortega et al., 2015). As the Latino population continues to increase in Florida, many of these residents may not have access to Medicaid insurance because expansion does not exist; furthermore, undocumented immigrants are not eligible for any type of coverage under the ACA (Ortega et al., 2015). With these challenges, children and adults in the Latino population do not always have access to care and treatment options, including those offered by primary care nurse practitioners. It is imperative that any future changes to the ACA consider these issues and that Florida lawmakers recognize the challenges the state currently faces and how to move forward in the future with a new direction and focus on improving healthcare outcomes.
The expansion of the ACA in Florida may not be a realistic choice in the future because politics often get in the way of practical solutions to common problems. However, it is important to consider that options are available for the future and that these may make an important difference for the populations in Florida which currently experience significant health disparities. Primary care services are of critical importance and will likely impact the decisions that are made in the future to improve access to care and treatment, including the availability of nurse practitioners in primary care settings. Bridging these gaps should be a primary focus of Florida lawmakers and their application of the ACA throughout the state because changes such as Medicaid expansion will make a difference for residents in the future by improving their quality of life and in reducing mortality rates.
Conclusion
The Affordable Care Act in Florida poses a variety of challenges for the consumer population to ensure that their healthcare needs are met and that providers can administer the care and treatment to patients in a timely manner. Lack of Medicaid expansion has harmed some members of the population and continues to be problematic for many residents, thereby causing greater strain on the Florida healthcare economy and the ability to serve its residents. New opportunities to expand coverage in Florida under the ACA must be considered and should align resident priorities with the services that are available, regardless of political persuasion. This remains an ongoing challenge that must be addressed in a timely manner to improve healthcare access for children and adults and to encourage the development of new ideas that will have the desired impact on those who lack access to adequate healthcare coverage under the ACA.
- Barakat, M. T., Mithal, A., Huang, R. J., Mithal, A., Sehgal, A., Banerjee, S., & Singh, G. (2017). Affordable Care Act and healthcare delivery: A comparison of California and Florida hospitals and emergency departments. PloS one, 12(8), e0182346.
- Born, P. (2017). A Study of Affordable Care Act Competitiveness in Florida.
- Ortega, A. N., Rodriguez, H. P., & Vargas Bustamante, A. (2015). Policy dilemmas in Latino health care and implementation of the Affordable Care Act. Annual review of public Health, 36, 525-544.
- Poghosyan, L., Boyd, D. R., & Clarke, S. P. (2016). Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model. Nursing outlook, 64(2), 146-155.
