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(SOLVED)DNP-840A – Advanced Nursing Practice Leadership

(SOLVED)DNP-840A – Advanced Nursing Practice Leadership

DNP-840A – Advanced Nursing Practice Leadership

Question: Describe a healthcare delivery impediment caused by state or federal policy or legislation. What modifications to the policy/law would you suggest, and what positive or negative effect do you foresee on patient care?

The introduction of the Affordable Care Act (ACA) was a major benefit to the American people; nevertheless, despite numerous advantages, impediments remain. The passing of the ACA allowed those with pre-existing diseases to get health care at a fair price and also allowed those previously ineligible to purchase insurance (Harvard, 2017). Buying or acquiring a health plan via employment helped middle-class Americans keep their children on their plan until the age of 26 to pay reduced medical premiums (Harvard, 2017). Medicaid benefits were also considerably extended as part of this scheme, although they vary based on where you reside. For example, Medicaid coverage was increased in most states; nevertheless, twelve states chose not to expand coverage (Alio et al., 2022; Harvard, 2017). Several of these states do not allow Medicaid benefits unless you are well below the poverty level; for example, Texas does not allow Medicaid coverage until a single parent earns less than $6,000 per year, and individuals without children are not eligible for Medicaid unless they are disabled (Harvard, 2017). This demonstrates that healthcare may be inequitable depending on where you reside and how many gaps exist due to racial stigmatization of Medicaid since their health systems are heavily political and do not push for health equality (Alio et al., 2022; Harvard, 2017).
Moreover, Medicaid reimburses providers at a lower rate than Medicare, reducing the number of doctors participating in the program (Alio et al., 2022). This contributes to the persistence of health inequalities in poor and minority communities, perpetuating a cycle of health disparities based on structural racism. Alio and colleagues, 2022).


As a doctorate leader, I would lobby for higher Medicaid reimbursement, so clinicians do not have to pick between Medicare and Medicaid. Greater reimbursements or incentives to accept Medicaid clients would enable minorities and people with lesser socioeconomic means to be treated similarly, regardless of geography. Another intervention would be to urge medical facilities to embrace the Street Nurse Program, which would allow nurses to go into the community and treat persons who are homeless. The Street Nurse Program in California assists persons experiencing housing and food insecurity by deploying a nurse to homeless encampments to provide basic medical treatment (American Organization for Nursing Leadership, 2021). This initiative is consistent with my philosophy of ensuring equal health access for all people regardless of capacity to pay for care.


A. P. Alio, M. J. Wharton, & K. Fiscella (2022). Access to Medicaid-Funded Excellent Cancer Care in the United States: Systemic Racism and Inequities. 5(7), e2222220-e2222220.

The AON is the American Association for Nursing Leadership (Host). (2021, May). [Audio podcast episode] Street nurse program providing care to match patient needs. Leadership in Nursing Today. SoundCloud.

Harvard College. (October 6, 2017). It depends on your state: Part 1: Policy and Politics of the American Health Care System [Video]. YouTube.

DNP-840A - Advanced Nursing Practice Leadership


There are several hurdles to healthcare delivery due to state and federal regulations. One such impediment is the failure of certain states to expand Medicaid. While the Affordable Care Act was designed to provide healthcare insurance coverage for all Americans, a 2012 Supreme Court ruling allowed states to opt out of the Medicaid expansion (Singer & Rozier, 2020). Due to this ruling, several states elected not to extend Medicaid coverage, leaving millions of individuals uninsured. Many low-income Americans and immigrants cannot get health treatment due to financial constraints. This problem is causing poor health outcomes and raising healthcare expenses by causing chronic illness and adverse events that may be avoided with adequate basic care. The failure to expand Medicaid may create a vicious cycle of poverty. Recent research (Baicker et al., 2023) highlighted several methods for the nation to attain universal health care. Based on the health benefits created by a service, these tactics involve assessing how much insurance and healthcare access society wants. It should also include payment structures for the types of services, with the authors using Medicare Advantage Plans and social insurance in the Netherlands and Switzerland as examples. The writers then discussed cost-sharing possibilities. Doctor of Nursing Practice (DNP) trained nurses are well positioned as leaders and educators to fight for Medicaid expansion in all states as advanced practice registered nurses. The learner might collaborate with national and local authorized nursing authorities to initiate conversations about the tactics presented in the initial research. Another policy reform the learner may advocate is making Medicaid expansion obligatory in all states. This would guarantee everyone, regardless of income or geography, access to affordable health care. It would also lower the number of uninsured people, easing the strain on hospitals and healthcare professionals caring for uninsured patients. Medicaid expansion for all states was debated throughout the epidemic. The economic element of this problem was thoroughly explored in a study (Blumberg & Mann, 2020). This is a difficult undertaking, but the learner may advocate, educate the public, establish novel healthcare models, and further study the subject to make policymakers aware. The mandated Medicaid expansion’s possible benefit is increased patient care with easy access to primary care concentrating on preventive care, lower hospitalization, and ER visit rate.

K. Baicker, A. Chandra, & M. Shepard (2023). A different paradigm is used in the United States to attain universal coverage. 4th Annual Meeting of the American Medical Association (2).

L. Blumberg & C. Mann (2020, March). During the COVID-19 pandemic, Medicaid expansion would have a greater effect than ever before. 3.pdf

Singer, P. M., and M. D. Rozier (2020). Changing threats and rhetoric: Republican governors’ perspectives on Medicaid expansion. 496-508 in Health Economics, Policy, and Law, 15(4).

DNP-840A - Advanced Nursing Practice Leadership


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