In March 2010, two federal healthcare reform acts were signed into law. The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 promise to change healthcare, as we know it. At this time last year, I made some predictions for 2010 given the heated debate about healthcare reform. Now is a good time to see how close my predictions were to what really happened.
Patients may have less disposable income for elective procedures which are not covered by health plans. They may be paying more for their health plan and an already strained economy may get worse. On the other hand, the economy might get better. (Flippin, 2009, p. 189)
Some positive things are coming soon from the healthcare reform legislation. Children of covered employees will get coverage up to 26 years of age, effective January 1, 2011. Also in 2011, lifetime limits on health insurance claims amounts are removed and all pre-existing exclusions are eliminated for children younger than 19 years. Plans must provide coverage, without cost sharing, for selected preventive services. At first glance, one would think that this would mean more disposable income in peoples' pockets. January 2011 will also bring an end to over-the-counter medications being eligible for reimbursement under the healthcare spending account unless prescribed by a physician. Effective January 1, 2013, healthcare spending account annual elections will be limited to $2,500. Employers must report the value of 2011 health benefits on W-2 statements issued in 2012. The government is not requiring employees to pay taxes on the reported value of benefits at this time, but why make the reporting requirement if not to tax it.
Although unemployment is still high, it is down to 9.6% from 10% in December 2009 (Bureau of Labor Statistics, 2010a). Real average hourly earnings fell 0.2% from June to July, whereas real average weekly earnings rose during this same period (Bureau of Labor Statistics, 2010b). From an economic indicator viewpoint, it would appear that for now we are no better or worse than we were this time last year. As for some of the other changes identified, the impact of these will be felt more in 2011.
Implementation of Healthcare Reform will either be hasty and painful or slow and painful. It will be painful. (Flippin, 2009, p. 189)
It might be too early to tell about fast or slow, but the federal government has already started reducing reimbursement and the private payers are right behind them. Layoffs have quietly begun at the health system where I work and talking points outlining the impact of healthcare reform have been published. Avoiding indiscriminate labor or budget cuts has been set as a goal. On a scale of 1-10, we are only at about a 2.
Those who thought they understood what they were getting will be surprised and probably disappointed. In a document with over 1000 pages, some surprises are bound to be buried. (Flippin, 2009, p. 189)
It is too early to tell about this one. Several years will most likely pass before its full impact is known.
Patient satisfaction may see a drop. Both supporters and opponents will not get what they envisioned. That's the beauty of compromise. (Flippin, 2009, p. 189)
Patient satisfaction does not seem to have been impacted yet. Stay tuned.
Healthcare reform may not be as bad as the opponents make it out to be, but the jury will still be out by the end of 2010. (Flippin, 2009, p. 189)
I think I can safely say that this one is true.
Physicians, nurses and others working in healthcare may question their occupational choices as stress at work reaches an all time high. This happens every time major change occurs in the field. (Flippin, 2009, p. 189)
The stress is already apparent in some of my peers, mostly from fear of the unknown. Maybe some passionate doctoral candidate will choose this as his or her area of study.
It will cost more than predicted ... a lot more. When is the last time, the government accurately predicted the cost of a program. Certainly, this has not happened in my lifetime and I am no Spring chicken. (Flippin, 2009, p. 189)
It is definitely too early to tell about this one.
There may be a large number of incumbent politicians looking for new careers after the elections. Where there is great debate, there is always fallout. The voting population tends to send messages with their votes. On the other hand, they may turn out to be heroes and heroines if reform is perceived as a great success by the majority. (Flippin, 2009, p. 189)
At the time of writing this editorial, the election outcomes were unknown. You will have to assess this one for yourselves.
There will still be uninsured. Whether by choice or circumstance, it will be impossible to cover everyone living in the USA with a healthcare plan. (Flippin, 2009, p. 189)
Here is another one that is safe to say is true, especially because the bill did not intend to insure everyone.
There will be more paperwork. It may be electronic but there will be more. (Flippin, 2009, p. 189)
Written orders for things requested during surgery procedures such as pathology, radiography, medications, and laboratory work appear to be on the horizon to ensure reimbursement.
In this reflection on 2010, very few of my predictions appear to have come true whereas it is too early to tell on others. Predicting the future is just not as easy as it looks. Maybe keeping an eye on trends while being firmly planted in the present is a better plan. Something tells me that many of us will not be able to resist the temptation to predict.
It has truly been an honor to serve as the Plastic Surgical Nursing (PSN) Editor-in-Chief. Working with the Editorial Board, peer reviewers, contributors, and PSN Board of Directors has enriched my professional life. While in the midst of work, it is not always easy to see accomplishments. However, looking back I can see implementing the online submission system and online presence of the journal as real highlights. As always, there is much more to be done. I hope you will continue to support your new Editor-in-Chief and your colleagues by continuing to share your professional expertise.
Thank you for your support and keep those manuscripts coming. Submissions are conveniently accepted online at http://www.editorialmanager.com and I am very happy to mentor authors.
Feel free to forward your comments to me and to the editorial board, by writing to us at Plastic Surgical Nursing, American Society of Plastic Surgical Nurses, 7794 Grow Drive, Pensacola, FL 32514.
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