It is estimated that since the passing of the Affordable Care Act (ACA) an additional 11 million citizens of the United States have gained access to health insurance coverage (Carthon, Barnes, & Sarik, 2015). Primary care visits are expected to increase to 15-24 million annually over the next five years (Carthon, Barnes, & Sarik, 2015).

It is estimated that since the passing of the Affordable Care Act (ACA) an additional 11 million citizens of the United States have gained access to health insurance coverage (Carthon, Barnes, & Sarik, 2015). Primary care visits are expected to increase to 15-24 million annually over the next five years (Carthon, Barnes, & Sarik, 2015).

There are 51 million Americans who reside in rural communities (Douthit, 2015). The Affordable Care Act (ACA) was designed to make health care available to all citizens. In its efforts to improve the quality of care, access to care, disease prevention and to create a healthy community, rural health care disparities exist.
Problem definition
There are many barriers that remain in rural healthcare today. According to the Health and Human Resources Administration (HHS, 2015), rural communities in the United States are disproportionate in services of primary care practitioners. There are higher levels of chronic disease, poor health outcomes as well as a lack of health care practitioners.
Rural populations suffer because there are not enough health care practitioners to meet the demands (Davidson, 2012). Rural communities in the United States continue to struggle to retain and attract qualified health care practitioners (Cohn & Hastings, 2013). Attracting health care practitioners to rural areas involves many dynamics of recruitment for example exposing students to the unique needs of rural populations in such way to attract candidates to live and work within these communities.
How addressed by the ACA
According to the National Rural Health Association (NRHA), there are twenty-one key provisions that directly impact the rural community (Smalley & Warren, 2014). Provisions such as: Physician training grants that assist colleges to develop programs to recruit within rural areas so they may return to live and practice in these communities (Smalley & Warren, 2014). Rural health clinics such as federal qualified health care centers. National Health Service Corps to assist with educational funding to bring practitioners to work and assist with student loan repayment.
The Institute of Medicine (IOM), report The Future of Nursing Leading Change, Advancing Health recommends that the practice barriers among advanced practice nurses be removed. These barriers inhibit the implementation of care that the rural community needs. APNs should be full partners with physicians to provide a collaborative care model. Unfortunately, many states lag behind on the IOM recommendations in relation to the ACA (Bear, 2012). Much of the opposition in unfounded about the safety of the community. Legislators, hospitals and physician organizations have made claim to the potential harm that can occur by lifting practice barriers. Although there is no evidence based research to support their claims, current research supports the opposite. APN’s increase patient safety and quality, increase continuity of care and increase productivity (Bear, 2012).
Personal view / Pros and Cons
It is the personal view of this graduate student that without removing practice barriers for APN’s these rural based disparities will remain. Even with the expansion of the ACA, the health of the citizens will further deteriorate in the rural communities, while the urban communities will have access to care. Leaving our smaller based communities at further risk for chronic diseases to be left untreated, thus having poorer health outcomes.
The good the bad and the ugly. We all have heard this saying before, while the ACA has good intentions it is not a means to an end without major changes in this fractionated health care system. The realization and the identification of the problem is the first step in the success. Implementing change and removing the old practice barriers is a vital step in the right direction. Much work needs to be done.
Conclusion

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