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                            The Accountability and Affordable Care Act of 2010
            A public policy that is impacting my workplace along with the rest of the nation’s healthcare is the Accountability and Affordable Care Act of 2010 (ACA).  Overall, this policy expanded eligibility for Medicaid to millions of Americans (Frank, Beronio, & Glied, 2014).  Before the ACA, the mentally ill was a population who struggled to gain access to care.  Fortunately, now the mentally ill can get insurance coverage which has impacted the facility in which I work.  We are always full with a waiting list of patients trying to get admitted.  
The ACA was designed to improve access, cost, and quality to care for all Americans.  According to the Substance Abuse and Mental Health Services Administration (2018), it has dramatically impacted the number of Americans who have access to mental health care.  According to Laureate Education (2012a), 32 million Americans who did not have coverage before this act will have coverage.  In conjunction with the Mental Health Parity and Addictions Equity Act, about 60 million Americans will have access to mental health services (Frank et al., 2014).  Also, the ACA was designed to help the cost of healthcare.  Unfortunately, this cost was initially expensive for our nation (Laureate Education, 2012a).  However, in the long run, the Affordable Care Act will hopefully save the nation money (Laureate Education, 2012a).  Lastly, quality was a goal of the ACA.  The ACA prompted changing payment models so that facilities are held accountable for quality care, and value of delivered care effects reimbursement rates (Knickman & Kovner, 2015).  Overall, the ACA is still a work in progress to improve access, cost, and quality of care.
As a nurse in a psychiatric facility, the ACA has impacted my daily life.  Due to the increase in access to care, my facility is always busy.  We are continuously full, and there are always patients waiting to get in.  Next week, our new building will be opening which will more than double our beds.  The ACA has also affected the quality of care given in my facility.  High importance is placed on care coordination to make sure the patient has follow-up care to avoid readmission.  Also, leadership is focused on monitoring incidences and near misses to avoid errors as errors are expensive.  The ACA has, unfortunately, added much stress to the daily lives of healthcare professionals in my facility.
Staffing in Healthcare
An enormous struggle we are facing in our facility, and one I would like to see change through public policy, is staffing of nurses and patient care techs.  This issue seems to come up in every conversation among nurses no matter where they work.  Soon, my facility will have the supply of rooms along with the demand of patients, but we do not have the staff.  This staffing crisis makes me nervous.
Kingdon’s model identifies four influential factors to get issues on the public agenda (Milstead, 2019).  First, the problem stream is the staffing crisis that hospitals and agencies face all over our nation (Milstead, 2019).  In my 11 years of nursing in three different hospitals, staffing ratios have only worsened.  Second, the policy stream attaches a solution to the problem (Milstead, 2019).  The answer to the staffing crisis may be to implement policy not allowing hospitals to admit patients if they can’t maintain a specific staffing ratio of nurses to patients.  Third, the political stream includes getting the problem and solution government attention (Milstead, 2019).  As nurses, we could set up a campaign to get the word out regarding staffing and could notify our local representatives.  The fourth factor that influences getting issues on the public agenda is the window of opportunity (Milstead, 2019).  This concept is about the timing of introducing a problem.  A good time may be close to an election year when it is vital for local representatives to get votes from their constituents (Laureate Education, 2012b).  
Due to the ACA, millions of Americans, especially the mental health population, were given access to more affordable and quality healthcare.  Unfortunately, the healthcare industry is not ready.  Staffing is the next problem needing to be addressed by our government.   
References
Frank, R.G., Beronio, K., & Glied, S.A. (2014). Behavioral health parity and the affordable care act. J Soc Work Disabil Rehabil, 13, 31-43. doi: 10.1080/1536710X.2013.870512
Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.
Laureate Education (Producer). (2012a). Introduction to healthcare delivery, part II: Healthcare reform. Baltimore, MD: Author.
Laureate Education (Producer). (2012b). Health policy and politics. Baltimore, MD: Author.
Milstead, J. A. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones and Bartlett Publishers.
Substance Abuse and Mental Health Services Administration. (2018). Laws and Regulations. Retrieved from https://www.samhsa.gov/about-us/who-we-are/laws-regulations