The advent of the Patient Protection and Affordable Care Act has resulted in rapid practice changes in the United States. The goals of health care reform are to expand access and reduce the number of uninsured, reduce health insurance costs, provide a continuum of affordable insurance options, reduce the rate of increase in health care costs, and ensure patient care quality. This involves changes in insurance coverage, the delivery system, and health care financing. Each change has implications for transculrural nurses. Insurance coverage expansion is addressed through Medicaid expansion and insurance exchanges. States that have expanded Medicaid and implemented exchanges have seen a 2.5% drop in the percentage of uninsured (from 16.1% to 13.6%), whereas states that have not expanded Medicaid or implemented exchanges have seen only a 0.8% drop in the percentage of uninsured (from 18.7% to 17.9%). Only 4.9% of the population is uninsured in Massachusetts, which passed comprehensive health care reform in 2006 (Witters, 2014).
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