Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX 77843, USA.
J Aging Soc Policy. 2012;24(2):206-20. doi: 10.1080/08959420.2012.660046.
Most provisions in the Affordable Care Act that affect nursing homes originated in two earlier attempts at reform, both of which failed multiple times in prior Congressional sessions: the Elder Justice Act and the Nursing Home Transparency and Improvement Act. Both of these earlier efforts focused on improving quality and reducing elder abuse in nursing homes by strengthening oversight and enforcement penalties, expanding staff training, and increasing the information on nursing home quality available to consumers and regulators. Each bill addressed problems that were serious, widespread, and had persisted for years, but each failed to pass on its own. The Affordable Care Act, with its own momentum, became the vehicle for their passage. However, the reasons the bills failed in these earlier efforts suggest implementation challenges now that they have ridden into law on the coattails of the more general effort to reform the health care sector.
平价医疗法案中大多数影响养老院的条款都源自之前两次改革尝试，这两次改革都在之前的国会会议上多次失败：《老年人司法法案》和《养老院透明度和改进法案》。这两项早期努力的重点都是通过加强监督和执法处罚、扩大员工培训以及增加养老院质量信息来提高养老院的质量并减少对老年人的虐待。每一项法案都针对严重、普遍且多年来一直存在的问题，但都没有单独通过。平价医疗法案凭借其自身的动力，成为这些法案通过的载体。然而，这些法案在之前的努力中失败的原因表明，现在它们随着更广泛的医疗保健部门改革努力而成为法律，实施起来可能会面临挑战。
