Topic 7 DQ 1 Identify two major policy issues that affect the current state of health care delivery and population health equity in the United States (may be state or federal). What impact do these population health policies and initiatives have on advanced nursing practice? Re: Topic 7 DQ 1

Maternal morbidity and mortality is often caused by factors such as cardiovascular disease and hypertension requiring care longer than two months postpartum. One-third of pregnancy related deaths occur between one week and one year after delivery, and almost 12% occur after the regular six-week postpartum visit. This had led to an increased recognition that postpartum women need comprehensive care beyond two months—therefore also need the insurance coverage to ensure continuity of services.

Women who qualify for Medicaid on the basis of pregnancy receive a variety of services including prenatal care, and labor and delivery services. Under current law, states must provide Medicaid coverage to all pregnant women who earn up to 138% of the federal poverty level (FPL) through two months postpartum and provide Medicaid coverage for the infant for the first year of birth. Extending Medicaid coverage beyond two months postpartum ensures access to services both during and after pregnancy (Association of State and Territory Health Officials, 2021).

Since 2015, legislators in at least seven states, as well as Congress, have introduced 15 bills to finance substance use disorder prevention and treatment activities by imposing a surcharge, tax, or fee on prescription opioids. Although none of these bills have been enacted, it is a new approach that states are exploring to combat the opioid epidemic. Proponents of the measures claim that as the opioid epidemic is driven, in part, by the over-marketing and over-prescribing of opioid painkillers, raising dedicated revenue from those drugs to address substance abuse prevention and treatment is necessary (Kramer, 2017)

Nursing care is a central component in key programs and strategies to promote maternal and infant outcomes. Example are evidence-based home-visiting programs, such as Nurse Family Partnership (NFP) which deploys RNs to visit first-time mothers in their homes for prenatal and postnatal care. NFP in particular has been found to have positive impacts on families, as well as positive cost outcomes. Incorporation of advanced registered nurses would help achieve the essence of the medicare coverage and reduce maternal mortality.

As educators and patient advocates, nurses are in a unique position to help patients with non-opioid pain management including other medication modalities, regional anesthetic interventions, surgery, psychological therapies, rehabilitative/physical therapy, and complementary and alternative medicine (CAM) (ANA, 2018)

Reference

ANA (2018). The Opioid Epidemic: The Evolving Role of Nursing Retrieved from https://www.ncsbn.org/2018_ANA_Opioid_Epidemic.pdf