Nurses and Other Stakeholders’ Involvement in the Development and Implementation of Healthcare Policy in the District of Columbia: Case Scenario the Affordable Care Act, Essay Example


The argument that every American citizen should have a guaranteed healthcare cover takes two dimensions (Grover, 2007). Is it that all citizens should have access to the same level of healthcare? Or should they have a right to some minimum healthcare cover? The U.S government has selected the second option in relation to the policies it creates directed to healthcare. There are quite a number of policies that have been put in place to realize this goal since there is no single healthcare policy that can cater for all of this demands. The government has made a move to provide access to medical services. In the past, particular groups of people have been selected based on their economic status or their distinctive social circumstances. The policies include Medicaid (for poor children), Medicare (for the elderly), Veterans’ Administration (for veterans), Indian Health Services (for Native Americans) and renal failure security (for transplants and kidney dialysis).

The purpose of this study

The research’s main focus is to investigate the how government and nurses are involved in the development and implementation of healthcare related policies. The District of Columbia will be the highlight of this paper. Accordingly, the paper will put more emphasis on one of the most recent health care policies in the Obama governance i.e. The Affordable Care Act.

Significance of this study

The research will try and examine the current and previous efforts directed at ensuring that basic health care is available to every American citizen, thus providing knowledge to all of the stakeholders. In the process, the research will bring out any loopholes in the whole process of medical care and suggest any improvement that needs to be done where possible. At the same time, it will also highlight the role of nurses in the healthcare sector and recommend ways of ensuring that their services becomes more effective in the wake of a high demand for their services.

The role of Nursing

Nurses have an important role to play in the development and implementation of healthcare policy both as professionals and as individuals. It is very true that nurses can be considered as the true heart of the healthcare system. They are able to take on different roles in their everyday life, serving as great helpers to both the doctors and the patients. Nurses play a very critical role when it comes to dealing with the problem of accessing better medical services within the Primary Health Care system (PHC). The scope of the nurses in PHC continually evolves as a result of the challenges and changes in the health requirements of American communities (Stanhope & Lancaster, 2012). Nurses act as servants following the orders of the doctors in taking care of the patients. Nurses help doctors while they perform specific procedures as well as undertaking medications and treatments as directed by the doctors. Nurses examine the patients in hospital at certain interval during their shifts, checking their general health while making note of nay changes that might have occurred. They keep records of the patients and report to the doctors for any measures. Another vital role of the nurses is to act as the advocate of the patient. Many nurses have fought for the rights of the patients wherever they observe that the patients are treated in an improper manner. This role can even take the direction of activism, where nurses mobilize the support for improved health conditions in hospitals. Most importantly, nurses are crucial players in the implementation any healthcare policies. Consequently, any hospital’s pursuit of a high quality care for patient is largely dependent on their ability to engage the nursing resources as effective as possible (Griffith, 1999).

The current state of health in Washington DC

Notwithstanding the encouraging results that many residents of D.C have access to health insurance; a big challenge still underlies the access to medical care by the pediatric population in Washington D.C. One of the reasons for this is that having a chance of seeing a specialist in D.C is more problematic than any part of America as findings have shown (8% nationally vs. 12% in D.C). The access to dental and developmental assessment is a challenge to both parents and children. In the years 2004 through 2008, ambulatory care has worsened in this part of the country since there have been increased cases of the hospitalization of patients related to the care. For the last two decades, it has increasingly become difficult for a number of people in D.C to pay for premiums that health insurance require them to. The situation has even been made more desperate because of the soaring amounts premiums each year, not forgetting that health care cost has also heightened thus most of the burden has  been shifted to the  consumers themselves. The citizens have had to deal with increased deductions whereas the covered services have been cut accordingly. The middle and low-income families deserve a relief from this ever-increasing cost of health care. The Affordable Care Act (otherwise better known as the Obama Care) has come at a time when it is needed more than ever. If fully implemented, it will bring a big relief to Many Marylanders.

Response of the governing body to the Affordable Care Act

The Affordable Care Act has given many hard working families in Washington D.C a reason to smile. Under this law, the federal government set ten early reforms for markets that touched health insurers that are private and both large and small group markets for the District of Columbia and the rest of the fifty states.  The District of Columbia made it regulatory for all the health insurers to comply with at least one of the ten early market reforms. D.C also increased the dependent coverage to the age 26 and at the same time prohibited insurers from withdrawing the coverage (excluding a few circumstances).  This came as a result of the ability of the states to exercise authority for the implementation of the law so as to protect the consumers i.e. the residents of that state. This healthcare law demands that all insurance companies play by the set rules thus barring them from dropping any coverage for an individual despite their pre-existing conditions. As provided in this new law, if any state decides to not-to-enforce the reforms, the federal government will take over and do that for that particular state. Nevertheless, the District of Columbia has shown a positive gesture as far as the implementation of this new healthcare reform is concerned.

Issues of funding

The District of Columbia has benefited from quite a number of funds provided through this new law.  Since its inception in the year 2010, over $23 million have been awarded to Washington as grants for under the prevention fund and through various organizations under the following platforms: Community Prevention ($3,298,000), Clinical Prevention ($8,465,000), Public Health Infrastructure and Training ($9,508,000), Research and Data Collection ($1,824,000).  The Affordable Care Act has provided for a lot of funds with the aim of expanding community health centers and ensuring they operate smoothly. The national assembly on school-based health care has received $90,000 while the Center for Health Policy Development got $45,972. The District of Columbia Primary Care Association has also received $75,000.  These and many other grants really show that the law has gone a long way in enabling the funding of a number of services that are intended at ensuring better health care to many residents of Washington D.C. However, this new law has reduced the budgetary options for reimbursing of the Sustainable Growth Rate (SGR). In its bid to cover many more citizens, the law promises to increase the Medicaid spending to $16 million. These rates of reimbursement are generally lower compared those gotten by doctors from patients who are insured privately. This will become a challenge in the future since the number for covered citizens continues to soar.

 Arising Concerns

While it remains that all the rest of the stakeholders in the Affordable Care Act such as the citizens, nurses and the government officials such as the state governors are very much excited about this new law, the doctors seems to have put on a somber face (Kronenfeld & Kronenfeld, 2004). The physicians are very worried that the new law tends to shift the authority of decision-making from doctors to the various government officials, thus interfering with best practices. This is known as the uniformity of practice. On the other hand, a number of provisions in the Affordable Care Law promises realization of a community based medicine. It seems that these new law will have far-reaching effects for physicians and patients. Nevertheless there is still time to address the predictable outcomes foreseen in the future.


The supply of doctors should be increased since the demand for more and efficient services is eminent as a result of the increased number of patient cover expected. There should also be an amendment to the law in relation to doctor reimbursement increase so as to act as a morale booster to them since without them the law will be of no use. Another thing that should be closely guarded is the funds that are meant to implement the new law. Measures should be put in place to protect against misappropriation of these funds by the concerned parties. Severe penalties should be imposed on those found to squander the resources. The citizens also have a role to play in acting as the watchdogs in the implementation exercise of this law by reporting any foul play they discover during this transition period.


Griffith, J. R. (1999). The well-managed healthcare organization (4th ed.). Chicago, Ill.: Health Administration Press.

Grover, J. (2007). Healthcare. Detroit: Green haven Press.

Kronenfeld, J. J., & Kronenfeld, M. R. (2004). Healthcare reform in America: a reference handbook. Santa Barbara, Calif.: ABC-CLIO.

Stanhope, M., & Lancaster, J. (2012). Public health nursing: population-centered health care in the community (8th ed.). Maryland Heights, Mo.: Elsevier Mosby.

Department of Health and Human Services. (n.d.). The Affordable Care Act’s Prevention and Public Health Fund in Your State: Washington, D.C. | Center for Consumer Information and Insurance Oversight | Retrieved February 10, 2013, from