Since 2013, the number of uninsured individuals in the United States decreased by nearly 13 million people. The passage and implementation of the Affordable Care Act is largely credited with this dramatic decline. In addition to the decrease in uninsured individuals, early data suggests the Affordable Care Act is helping to improve the health of certain populations, including recent college graduates.
Yet there is more work to be done. At the end of 2015, more than 28 million people were still uninsured in the United States. The nurses of the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) consider access to quality health care a basic human right. As leaders in women’s health, nurses can and should use their positions to advocate for comprehensive health care services for all, especially women and infants.
It is clear that absence of insurance contributes to lack of access to basic health care services that help keep people well. People who are uninsured are at greater risk for negative health consequences. Researchers confirm that these people are less likely to receive preventive, recommended, and follow-up care, including prescriptions. The consequences of not seeking care can be severe, especially when preventable conditions, chronic diseases, or life-threatening diseases go undetected. As a result, people without insurance are in worse health than those with insurance and they are more frequently hospitalized for preventable conditions.
AWHONN supports policy initiatives that increase access to and affordability of health insurance, but insurance is just one part of the story. Even if individuals have private insurance or if they qualify for Medicaid, there are institutional and cultural barriers that impede access to care. For example, lawfully present immigrants do not qualify for Medicaid or the Children’s Health Insurance Program. Undocumented immigrants are not able to purchase health insurance on the exchange created under the Affordable Care Act, nor do they qualify for any of the subsidies created under the law.
Further, language barriers and cultural differences can also complicate the process of receiving health care for certain populations because many health care facilities and clinicians do not accommodate individuals with translation services. Other factors that limit an individual’s access to health care include physical disabilities, lack of accommodating medical equipment, discrimination on the basis of sexual orientation and gender, mental and behavioral health issues, race, ethnicity, and living in rural or underserved areas.
To further complicate issues of access, some state-level policies restrict advanced practice registered nurses, APRNs (e.g., nurse practitioners and nurse-midwives) from practicing to the fullest extent their education and training allow. Policies regarding the scope of practice for APRNs vary widely. As a result, the extent to which APRNs are able to practice may not be related to their ability, education, or training, but rather is subject to the political decisions of the states in which they work.
Nurses should be aware of these barriers and strive to help eliminate them. Nurses can help promote access to quality health care services for all, regardless of race, socioeconomic status, or environment. The nurses of AWHONN are dedicated to raising awareness among nurses, other health care professionals, and the general public about these barriers and empowering nurses to help reduce disparities in access through advocacy work with state and federal legislators and within their communities.