Nursing Advocacy in the Implementation of Health Policy

Advanced practice nurses have roles to play in health policies. Health policies go through stages such as development, implementation, and evaluation. Policy implementation entails change management and ensuring states expand Medicaid coverage, and individuals access the program. Nurses are closest to the patient and advocate for their patient’s quality care access and safety. This essay evaluates a healthcare policy and evaluates the roles of the advanced practice nurse in policy implementation.

The Policy Brief

The federal action to close the Medicaid coverage gap is a step that will address healthcare insurance coverage disparities and promote health among many populations. Healthcare insurance is a significant issue that affects access to quality care. Medicaid program has several restrictions, and for one to qualify for the program, the individual must be physically disabled, have chronic illnesses such as end-stage renal disease, be above 65 years of age, and those below the age of 65 must-have dependents (Lukens & Sharer, 2021). The new policy on Medicaid expansion extends Medicaid qualification to the ‘coverage gap.’ Individuals in the coverage gap are primarily African Americans who earn below the poverty line but higher than the maximum amount to qualify for Medicaid coverage. The coverage group also entails individuals below age 65 without a child.

The policy has a direct effect on primary care. Increased insurance coverage increases access to affordable care and increases the number of patients seeking primary care. Brom et al. (2018) explain that the Medicaid expansion increases the need for primary care providers at the community level. Advanced practice nurses have a significant role in increasing patients’ knowledge and access to these services. Family nurse practitioners are primary care providers, and the Medicaid expansion will directly affect the advanced professional role.

Weaknesses, Strengths, Advantages, and Disadvantages of the Issue

The policy’s major strength is that it will enjoy financial incentives from the federal government. The states that will expand Medicaid will increase their funds’ allocation from the government. However, the strength bears a weakness in that it has no stipulated funding source. The financial incentives from the government may not be enough to fund the whole program, considering the government’s roles in other sectors besides health (Lukens & Sharer, 2021). The lack of clear funding plans has been the primary source of opposition to the various states’ Medicaid expansion. The lack of a proper funding plan raises questions on the sustainability of the expansion because it lays a significant burden on the federal government. The policy has various advantages, such as increasing the number of insured individuals.

African American individuals account for more than half the population in the coverage group. The coverage group increases access to affordable care and reduces the burden of paying for healthcare services amidst caregiving responsibilities (Mazurenko et al., 2018). Many individuals with physical disabilities were previously ineligible for the program due to their income levels. According to the policy brief, the policy has increased access to healthcare insurance coverage but has not addressed the racial and ethnic disparities in care access (Lukens & Sharer, 2021).

The policy brief has noted that people of color in the coverage gap still have no healthcare access. The policy does not accommodate individuals with fluctuating income levels exposing them to poor healthcare access. The surge in healthcare access can also dilute healthcare services quality due to an increased burden on healthcare providers (Mazurenko et al., 2018). Thus, authorities must also consider care quality issues to ensure quality is maintained despite the increase in the number of individuals seeking healthcare services

Solutions/Recommendations of the Issue

The healthcare insurance coverage expansion requires various interventions. The government requires elaborate funding plans to ensure the sustainability of the program. Sustainability is the most cited reason for the resistance to Medicaid expansion in various states (Michener, 2021). In addition, the federal government should consult with states to ensure they include them in decision-making to gain their buy-in and reduce resistance. Consulting with states will ensure the decision acceptability of the decisions and their relevance, thus reducing resistance. The federal government should also create elaborate systems to ensure individuals are aware of the expansions and utilize them to improve their healthcare services access (Lukens & Sharer, 2021).

Ways to Advocate for the Policy Implementation

APN’s role in policies is indispensable. Advanced practice nurses deal with primary care patients and observe the patterns of their access to quality care depending on their income levels and insurance coverage (Côté et al., 2019). APNs can participate in research to provide data that will support the implementation of the policies in non-expansion states. Research could provide evidence of the importance of expansion in bridging the gaps in healthcare coverage.

APNs, through professional bodies, can provide advice to state governments and lawmakers to implement the policy. Professional bodies such as American Nurses Associations work with the state and federal governments to develop policies that impact population health and the nursing profession (Brom et al., 2018). Expert opinion is essential in decision-making and can help gain buy-in and promote policy implementation. Family nurse practitioners as primary care providers should inform patients and help them access these services. Thus, APNs, especially family nurse practitioners, have a significant role in this policy’s implementation.


Medicaid expansion is a new health policy that increases Medicaid eligibility. The policy has been resisted in various states due to a lack of elaborate funding systems. The federal government funds the program, but its sustainability is at stake. However, the program has seen millions of Americans access quality care. Individuals can access healthcare despite having low incomes. The policy has increased the number of primary care seekers and has increased the demand for advanced practice nurses. Advanced practice nurses should participate in the policy’s implementation to ensure it succeeds.


Brom, H. M., Salsberry, P. J., & Graham, M. C. (2018). Leveraging health care reform to accelerate nurse practitioner full practice authority. Journal of the American Association of Nurse Practitioners30(3), 120.

Côté, N., Freeman, A., Jean, E., & Denis, J. L. (2019). New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning. BMC health services research19(1), 1-10.

Lukens, G., & Sharer, B., (2021). Closing Medicaid Coverage Gap Would Help Diverse Group and Narrow Racial Disparities.

Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: a systematic review. Health Affairs37(6), 944-950.

Michener, J. D. (2021). Politics, Pandemic, and Racial Justice Through the Lens of Medicaid. American journal of public health111(4), 643-646.

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