1. Prepared by the American Association of Colleges of Nursing Updated September 22, 2014

3. Why is it Important for Nurses to Understand the New Law?  Nursing expertise is critical to health systems reform.  As the Institute of Medicine’s (IOM) Future of Nursing: Leading Change, Advancing Health report states:Future of Nursing: Leading Change, Advancing Health Nurses should be full partners with other healthcare professionals in redesigning health care in the United States. ○ Recommendation 7: Prepare and enable nurses to lead change to advance health. Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses. (IOM, Future of Nursing, Leading Change, Advancing Health: Report Recommendations, National Academies of Science, Washington, DC, p. 5).Report Recommendations  The Patient Protection and Affordable Care Act or ACA [Public Law 111- 148] is, in many ways, the redesign of healthcare in America and it is the law.[Public Law 111- 148]

4. Be A Leader for the Profession  Develop your expertise.  Make your expert opinion heard. Clearly articulate your message. ○ Include the facts and the personal experiences. 4

6. What is the Health Insurance Marketplace?  The Health Insurance Marketplace was created through the Patient Protection and Affordable Care Act or ACA [Public Law 111-148] specifically in relation to Subtitle D—Available Coverage Choices for All Americans. [Public Law 111-148] It includes the Individual Mandate and the State Exchange. Individual Mandate requires most individuals to obtain health insurance or pay a penalty in the form of a tax. Individual Mandate ○ On June 28, 2012, the United States Supreme Court upheld this provision of the ACA as constitutional in a 5-4 decision. State Exchanges allows for each state to decide if they will create their own exchange, partner with the federal government, or have a federally- facilitated exchange for individuals to gain coverage. State Exchanges Kaiser Family Foundation (2014). State Decisions For Creating Health Insurance Marketplaces, 2014 Retrieved from http://kff.org/health-reform/state-indicator/health-insurance-exchanges/

7. SOURCE: Kaiser Family Foundation analysis; Congressional Budget Office; Jonathan Gruber

8. State Structure for Health Insurance Marketplace/Exchanges This is a reprint of the NCSL interactive state map, online at http://www.ncsl.org/research/health/state- actions-to-implement-the-health-benefit.aspx (updated August 2014)http://www.ncsl.org/research/health/state- actions-to-implement-the-health-benefit.aspx

10. Please note that many of these activities require access to the Health Insurance Marketplace to complete and are therefore best for after Open Enrollment begins.

11. http://kff.org/quiz/health-reform-quiz/

12. Discussion Groups: Answering Patient Questions  Each group will investigate one of the following scenarios and report back to the class what they would tell their patient. My daughter just turned 27, and no longer can stay on my insurance. She lives in Ohio and does not have a job yet. She is really healthy, does she have to have insurance? I am a small business owner with 55 employees. Do I have to provide them with health insurance? My husband currently has insurance that covers our family, but it is not great. Can I get a new plan? I have a pre-existing condition. What are my options for coverage if I live in New Mexico?

13. Creating Your Own Resource: Considering Healthcare Literacy  Create a one-pager for the clinical population you are currently working with (i.e. children, families, adults). What information about the Marketplace is pertinent to this population? What will they need to enroll? How would you guide them? ○ Consider such things as the patient’s/family’s resources, educational level.  Then create a distribution plan. How would you distribute this information to your patient population? (i.e. text messages, office visits) What resources would be needed?

14. Understanding the State Exchanges  There are four categories of state Marketplaces/Exchanges. Breakup into four groups and investigate: What does it mean for a state to have this type of exchange? How many states have this type of exchange? Select a state that has this type of exchange and review what it is offering.  Provide a summary to the class.  Types of State Exchanges State-Run Exchange State/Federal Partnership State Running Small Business Exchange, Federally Facilitated Marketplace Federally Facilitated Marketplace

15. Discussion Groups: Learn About the Plans  There are five categories of plans that individuals can access through the Marketplace. Breakup into five groups and investigate what types of services your patient would receive. Provide a summary to the class.  Bronze  Sliver  Gold  Platinum  Catastrophic