Running head: THE POLICY PROCESS: PART I - HEALTH CARE REFORM

The Policy Process: Part I - Health Care Reform HCS455 April 4, 2013

The Policy Process: Part I - Health Care Reform

The Policy Process: Part I - Health Care Reform At the end of 2009, 9.9% of the country's workers above the age of 16 reflect as unemployed (United States Department of Labor, 2013). More than 46 million Americans have no health insurance coverage in 2009, and 21% of working Americans receive no benefits because either they cannot afford the coverage or companies have stopped offering insurance. Additionally, 6.1 million children lacked insurance coverage in 2009 (Reinberg, 2010, para. 2,9,11). Healthcare.gov (2013) estimates 25 million Americans possess no insurance because of pre-existing conditions that prevent approval of or affordability of coverage. Seniors' concerns increase over prescription costs and many debate over which medicines not to take, or possibly reduce medications to extend the dosages. These situations represent America's economic need for improvement in the health care forum and the introduction of the Patient Protection and Affordable Care Act (PPACA), also known as Health Care Reform. However, before the country could experience the benefits of this policy, it first needed to go through the formal legislative process. FORMULATION Public opinion and demand as well as national needs set the stage for formulation of health care policies. Morone, Litman, and Robins (2008) discuss how public opinion influences governmental actions such as Congressional and executive decision-making, Supreme Court rulings and new policy changes. A new bill or legislation may begin with an increase of American concern regarding the health care industry. Any of the above situations individually or combined engages regular media attention, therefore the information is relayed to the public. People speak among themselves and as a public voice to their governmental representatives demanding action.

The Policy Process: Part I - Health Care Reform

Americans have many concerns, including stability of coverage, access to coverage and affordability. The public needs a speaker, someone in a position to enable change and initiate a proposal that becomes escalated to a political agenda. Each person or group wants their needs heard, but not all issues gain sufficient national attention or possess enough political clout to reach agenda status. Special interest groups, such as the American Medical Association (AMA) or the American Association of Retired Persons (AARP) may play a role at this point speaking for the certain groups and pushing issues to politicians and lobbyists. Because not all issues reach the government, organization, planning, and the proper support may assist in the agenda setting stage of a new legislation. The parties involved need to exchange information and begin a planning stage of the agenda. Groups of interest should establish the purpose and goals of an agenda as well as strategize short and long-term goals. Government officials can debate only so many topics, but a successful agenda with a national purpose and supporting evidence may survive this phase. After all, the purpose of a strong agenda is placement before a legislative or executive review, such as Congress, Senate, state cabinet members, or any other relevant committee. After the finalization of the agenda, begins the policy formulation. The process of policy formulation includes creating proposals, debating the information and making possibly several drafts of language for the bill. If the policy verbiage is unclear or unacceptable, the writers will make revisions to outline all necessary details. The policy should identify its goals and outcomes as well as any related activities. Additional steps may include attempting to plan for any obstacles toward the desired outcome, and identifying any progress measurements, budgetary needs, and necessary resources (Abood, 2007). After the policy formation, the document is ready for the legislative phase.

The Policy Process: Part I - Health Care Reform

LEGISLATION The first step of this process starts with the assignment of a perspective number, H.R. represents a House Bill and S. represents a Senate Bill. Once the bill is assigned the appropriate number, senators or representatives can sponsor the bill and introduce or refer it to the committee or subcommittee. These areas make debates and decisions about the verbiage and content bills, process newly introduced bills, and research new legislative needs. The subcommittees also conduct reviews and hearings to hear support and testimonies for the bill. After completion of the hearings, subcommittees hold sessions to revise the bills, making any necessary changes before presenting a revised version to the full committee (American Association of Critical-Care Nurses, 2013). The full committee receives the report and may conduct the same process as the subcommittee, performing additional hearings and investigations before voting to send the bill to the House or Senate. The committee may accept the bill as originally submitted or with the amendments. If the committee fails to report the bill, at that point it dies and no further action proceeds. The committee chairperson documents the vote and prepares a written report of the bill. The bill is next placed on the chamber calendar to appear on the floor. After legislators debate the bill on the floor, the subject is put to a vote. Once one chamber passes a vote, the bill is sent to the other for approval. If both the Senate and House pass the bill and any amendments, it goes before the president for his review (American Association of Critical-Care Nurses, 2013). After the president signs the legislation, it becomes law, and the next phase moves to implementation.

The Policy Process: Part I - Health Care Reform

IMPLEMENTATION At this stage, the law is passed and the government executes the regulations and policies. The government identifies the responsible parties, other government agencies or state departments perhaps, who will work to implement the new laws. Those parties receive any resources and authority necessary to accomplish the task of enacting the law. The implementation process may require many decisions involving staffing, procedures, and budgets. The new laws need translation to determine the need for any new processes, guidelines, or organizations. Laws may not require immediate implementation, but rather in stages, so decision makers also need to establish timelines for the various steps in the release processs (Pennsylvania State University, n.d.). Health care reform is such an example of a law that included a timeline of release rather than a single release date. President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, 2010. The legislation enacted several changes that year, including removal of pre-existing coverage for children, increasing coverage options for those with pre-existing conditions, and denying insurance companies the ability to cancel coverage based on a previous error. The next phase in 2011 would allow seniors to receive free preventative care and discounted prescriptions. PPACA also enforces medical cost ratio, stating insurance companies must spend 85% of their premiums collected on health care services and improving health care quality. In 2012, pay for performance systems become a key indicator determining how hospitals receive payment for services based on patient outcomes. Also the beginning stages of the transition to electronic medical records takes place. In 2013, the American consumers have access to the insurance exchange with more options than ever to purchase individual insurance without the risk of denial for pre-existing conditions. The government also expands the Medicaid

The Policy Process: Part I - Health Care Reform

program, increasing payments to 100% of the Medicare amount. The year 2014 brings relief for individuals with the removal of lifetime maximums from health coverage, prohibiting insurance companies from denying policies as a result of pre-existing conditions, and increasing small business tax credits to assist in providing health insurance (Healthcare.gov, 2013). Although the benefits of this plan comes in stages, one clearly can observe the phases of implementation. Public opinion and national demand may begin the process for new legislation, and health care is a topic debated among politicians throughout the years. In the past several presidents, including John. F. Kennedy, Franklin D. Roosevelt, and Harry S. Truman submitted proposals to Congress for a universal style national health insurance system. All three proposals failed because of insufficient support or a poor economy (Hoffman, 2013). In the case of health care reform, the state of the economy reflected millions of Americans unemployed and uninsured, people unable to afford coverage or not able to obtain coverage because of pre-existing conditions. These examples, along with the cost of health care premiums and services drove national demand for action and the start of the creation of the PPACA. Unlike previous failed attempts for legislation, this bill obtained the necessary support and evidence to become a law.

The Policy Process: Part I - Health Care Reform

References

Abood, S. (2007). Influencing Health Care in the Legislative Arena. The Online Journal of Issues in Nursing, 12(1). Retrieved from http://www.medscape.com/viewarticle/553404_4 American Association of Critical-Care Nurses. (2013). Introduction to the Legislative and Regulatory Process. Retrieved from http://www.aacn.org/wd/practice/content/publicpolicy/ intro.pcms?menu=practice Healthcare.gov. (2013). At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans. Retrieved from http://www.healthcare.gov/news/reports/preexisting.html Healthcare.gov. (2013). Key Features of the Affordable Care Act, By Year. Retrieved from http://www.healthcare.gov/law/timeline/full.html#2012 Hoffman, B. (2013). Health Care Reform and Social Movements in the United States. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/ Morone, J. E., Litman, T. J., & Robins, L. S. (2008). Health Politics and Policy (4th ed.). Retrieved from The University of Phoenix eBook Collection database Pennsylvania State University. (n.d.). Retrieved from https://ecampus.phoenix.edu/secure/aapd/cwe/citation_generator/web_01_01.asp PolicyProject.com. (2013). The Policy Circle. Retrieved from http://www.policyproject.com/policycircle/content.cfm?a0=4 Reinberg, S. (2010, June 20). Number of uninsured jumped by nearly 3 million in 2009. USA

The Policy Process: Part I - Health Care Reform

Today. Retrieved from http://usatoday30.usatoday.com/news/health/2010-06-20-uninsuredreform_N.htm United States Department of Labor. (2013). Bureau of labor statistics. Retrieved from http://data.bls.gov/pdq/SurveyOutputServlet