The Affordable Care Act is the federal policy that facilitates the Americans with the security for better health by upholding the insurance reforms of comprehensive health that act to expand the coverage, makes the accountability to the insurance companies, more choices are guaranteed and the quality of care gets enhanced for the Americans. This act joins the two separate legislation pieces that conjugate the Patient Protection and Affordable Care Act with the Healthcare and Education Reconciliation Act. These two acts come together for expanding the Medicaid coverage to the Americans who belong to the category of low-income groups. The act came into existence on March 23, 2010 and represented the regulatory overhaul that is most significant to the healthcare system of the US (Huesch, Ostbye & Michener, 2016). The primary physicians and the hospitals would be able to transform their practices clinically, technologically and financially for improving their methods of accessibility and distribution, lower costs and better outcomes of health. It was enacted to enhance the affordability and quality of health insurance, expand the private and public insurance coverage and thereby lowering the uninsured rate and decrease the healthcare costs for the government and the individuals (HealthCare.gov).
In the health insurance marketplace, the plans are exhibited in four different categories termed as Metals. The four metal categories include Platinum, Gold, Silver and Bronze. These metals are formulated based on the splitting of the healthcare costs of the respective plans and are not associated with the quality of care. For the Bronze plan the insurance company and the beneficiary share the care costs in the ratio 60%: 40%. In the Silver plan, the share is 70% : 30%, for Gold it is 80% : 20 % and for Platinum it is 90% : 10%. From the above splitting format, it can be said that the Platinum plan gives the maximum benefit to the beneficiary and the Bronze plan offers the minimum benefits. In the Bronze Plan, the beneficiary pays the 40% of their share of total cost in the form of deductibles, coinsurance and copayments and facilitates them with low monthly premiums (Blumenthal & Collins, 2014). The silver plan is a bit expensive than the Bronze plan and comes with the subsidies of cost sharing, that significantly reduces the coinsurance, copays and deductibles. While choosing the Gold plan, the beneficiary needs to pay higher premiums and the greater portion of the healthcare expenses are borne by the health insurer. Platinum plan the most expensive one with and for using the health insurance every time, the beneficiary needs to pay the cost sharing factors (HHS.gov).
The Affordable Care Act aims to provide greater access to the coverage of healthcare, improve the service quality delivered and decrease the rate of spending on health. It helps the senior Americans in several ways that have been summarized below (Medicaid.gov).
- Lowering the cost of the prescription drugs
- Annual wellness visit and preventive services
- Lower premiums for Medicare Part B
- Improvements for the members of the Medicare Advantage plans
- Prevention of Medicare abuse, waste and fraud
- Improving the payment reforms and delivery system of Medicare
- Helping the senior Americans with various functionalities
Evidence Based Nursing Practice
Table 1: List of referred journals
Oral care in nursing practice: A pragmatic representation
Croy?re et al. (2012)
Translating evidence into nursing practice: Oral hygiene for care dependent adults: Translating evidence into oral care practices
Chan et al. (2011)
Oral care practices for orally intubated critically ill adults
Feider, Mitchell & Bridges (2010)
Oral hygiene care in the pediatric intensive care unit: practice recommendations
Johnstone, Spence & Koziol-McClain (2010)
Association between pneumonia and oral care in nursing home residents
The research work carried out by Chan et al. (2011) with the title ‘Translating evidence into nursing practice: Oral hygiene for care dependent adults: Translating evidence into oral care practices’ as found to be the best article for the nursing intervention for oral care practice. The article aimed at translating the available evidence for improving the oral care practices. This is very important from the point of view of nursing intervention as it is very important for the nurses to translate the theoretical knowledge into practice without which, the treatment and care remain ineffective or incomplete. Oral hygiene is very much necessary for the maintaining the well-being and health of the hospitalized patients. From the previous studies, the authors noted that the nurses lacked the knowledge that is evidence based for delivering proper oral care. Therefore, the authors carried out an extensive survey of the nurses who are working in the high dependency or intensive care units and found that a protocol for oral care is necessary to bridge the gap between the knowledge and practice. Hence, the authors successfully heightened the knowledge and awareness of the nurses on oral care and helped to provide the best intervention for the oral health of the patients.The other four articles support the findings of the research articles in different methods. The study conducted by Croy?re et al. (2012) with the title ‘Oral care in nursing practice: A pragmatic representation’ was an exploration of the social representation of the oral care by the nurses along with the healthcare assistants engaged in palliative care. Feider, Mitchell & Bridges (2010) carried out a research work on the title ‘Oral care practices for orally intubated critically ill adults’ was a descriptive and cross-sectional study for describing the practices of oral care that are performed by the critical care nurses for the patients who are critically ill and are intubated. Johnstone, Spence & Koziol-McClain (2010) conducted a research study titled ‘Oral hygiene care in the pediatric intensive care unit: practice recommendations’ where fourteen articles were critically appraised for the development of a PICU guideline in oral hygiene. El-Solh (2011) performed a research work on the title ‘Association between pneumonia and oral care in nursing home residents’ where a review of various articles were carried out to establish the fact that there is a need for the implementation of a program for using oral hygiene as a daily routine for the settings of long-term care.The article that developed the best research design was ‘Oral hygiene care in the pediatric intensive care unit: practice recommendations’ that was authored by Johnstone, Spence & Koziol-McClain (2010). In this article, fourteen articles have been identified to be relevant to the oral care for the pediatric patients in the Pediatric Intensive Care Unit or PICU. The research articles were critically appraised and a PICU guideline based oral hygiene was developed. The research successfully highlighted the relationship between the poor condition of oral hygiene in the ICU with an increase in the accumulation of the dental plaque, oropharyngeal bacterial colonization and increased rates of nosocomial infection that is associated with ventilator-based pneumonia. The research design included an extensive search of literature from the various academic databases like Medline, CINAHL, Cochrane Database of Systematic Reviews and The Cochrane Library. The Iowa Model was employed for gathering expert opinion, theories and case reports for permitting the protocols to be based on the best available evidence. The collected articles included randomized controlled trials, systematic reviews, comparative trial, non-randomized trials and expert opinions. Six different levels were used for rating the strength and quality
Croy?re et al. (2012) conducted a research study titled ‘Oral care in nursing practice: A pragmatic representation’ that most clearly developed the purpose and problem statement of the study among the five referred journals. The problem statement of the study stated that the oral care for the patients who are receiving the palliative care that is non-specialist lacked in several aspects. Therefore, the authors explored the social representation of the oral care by the nurses along with the healthcare assistants providing the palliative care. The purpose of the study was to describe a training program on a large scale that intended to the modification of the shared attitudes in oral care. The social representation of the healthcare assistants and the nurses was to be shared in the study that is concerned with the oral care of the patients in a palliative care setting that is non-specialist. The practices, beliefs, ideas and values of the nurses are to be shared in the study to address the problem statement and the study will enroll two groups for attaining the purpose of the study. The two groups are control and test groups that are aimed to evaluate the change in the practice and approach of oral care to solve the associated problem in palliative care.The research work carried out by El-Solh (2011) titled ‘Association between pneumonia and oral care in nursing home residents’ had the best sample size for their research problem. Pneumonia happens to be leading death cause among the residents of nursing homes. Dentures and oral surface colonization with the respiratory pathogens and the dental plaque accumulation act as reservoirs for the recurrent problem of the infections of the lower respiratory tract. For highlighting this research problem, the author conducted a systematic review of several research articles where a large number of hospital residents served as the study sample from different settings. This large variety of the sample size gave a deeper understanding of the problem as the patients were from different demographics and was selected from different study designs. The sample size of this study with its extensive variety stated that the problem of recurrent pneumonia due to poor oral
Feider, Mitchell & Bridges (2010) carried out a research work titled ‘Oral care practices for orally intubated critically ill adults’ that made the best and most accurate conclusion from the study findings. The objective of the study was to describe the practices of oral care performed by the nurses working in the critical care facilities for the patients who are critically ill and are orally intubated. These practices are compared with the recommendations for the oral care in the manual for
The five reviewed journal articles directed at one common point of improving the oral health and hygiene of the patients with the nursing intervention procedures. CDC or Centers for Disease Control and Prevention aims at similar practices through its recommendations and guidelines for promotion of the oral health, being a national guideline. It lays down the guidelines for practices of infection control in the oral cavity and lays down the federal government’s objectives for improved oral health. Both the research articles and the national guidelines are synchronous and aim at a better world with improved oral health and hygiene.
Affordable Care Act | Medicaid.gov. (2016). Medicaid.gov. Retrieved 10 June 2016, from
Blumenthal, D., & Collins, S. R. (2014). Health care coverage under the Affordable Care Act—a progress report. New England Journal of Medicine,371(3), 275-281.
Chan, E. Y., Lee, Y. K., Poh, T. H., Ng, I. H. L., & Prabhakaran, L. (2011). Translating evidence into nursing practice: Oral hygiene for care dependent adults: Translating evidence into oral care practices. International Journal of Evidence-Based Healthcare, 9(2), 172-183.
Croy?re, N., Belloir, M., Chantler, L., & McEwan, L. (2012). Oral care in nursing practice: A pragmatic representation.International Journal of Palliative Nursing, 18(9), 435-440.
El-Solh, A. A. (2011). Association between pneumonia and oral care in nursing home residents. Lung, 189(3), 173-180.
Feider, L. L., Mitchell, P., & Bridges, E. (2010). Oral care practices for orally intubated critically ill adults. American Journal of Critical Care, 19(2), 175-183.
Huesch, M., Ostbye, T., & Michener, J. L. (2016). The Affordable Care Act, State Policies and Demand for Primary Care Physicians. CESR-Schaeffer Working Paper, (2016-010).
Johnstone, L., Spence, D., & Koziol-McClain, J. (2010). Oral hygiene care in the pediatric intensive care unit: practice recommendations. Pediatric nursing, 36(2), 85.
Read the Law. (2015). HHS.gov. Retrieved 10 June 2016, from
Understanding Marketplace health insurance categories. (2016). HealthCare.gov. Retrieved 10 June 2016, from