HEalth Policy and Politics

Abigail Collins, Megan Baril, Emily Learn, Kacey

Sturgeon
 Policies Vs. Politics
Politics is part of the government system, and a policy can be called a plan.
● Policy: a course or principle of action adopted or proposed by a government, party, business,
or individual.
○ Policy is a set of rules or principles that guide decisions
○ A commitment or statement of intent
● Politics: Science or art of governing or government, especially governing a political entity like
a nation.
○ Politics refers to the theory and practice of governance
○ It refers to authority and refers to public life. Politics generally revolves around government
and its activities. Politics is a term that refers to the organizational process.

https://www.youtube.com/watch?v=MEInmLnlmTc
Role of Legislative level:
● The legislative branch is made up of the House and Senate, known collectively as the
Congress. Among other powers, the legislative branch makes all laws, regulates interstate and
foreign commerce and controls taxing and spending policies.
● Established by Article I of the Constitution, Congress is granted the sole authority to enact
legislation and declare war, the right to confirm or reject many Presidential appointments,
and substantial investigative powers.
○ The House of Representatives: made up of 435 elected members, divided among the 50
states in proportion to their sum population. There are also 6 non-voting members,
representing the District of Columbia, the Commonwealth of Puerto Rico, and four other
territories of the United States. The Speaker of the House presides over the chamber and
is elected by the Representatives. This member is also third in line for the succession of
the presidency. The house specifically holds the power to initiate revenue bills, impeach
federal officials, and elect the President in the case of an electoral college tie.
Legislative cont.
● Senate: composed of 100 Senators, 2 for each state. Members are elected to six-year terms by
the people of each state. The President of the Senate is the Vice President of the United states
and may cast the decisive vote in the event of a tie in the Senate.
○ The Senate has the authority to confirm those of the President’s appointments that
require consent, and to ratify treaties. They try impeachment cases for federal officials
referred to it by the House. But, there are some exceptions including; the House must
also approve any foreign trade treaty and appointments to the Vice Presidency.
● All legislative power in the government is in Congress, meaning that it is the only
part of the government that can make new laws or change existing laws
● In order to pass legislation and send it to the President for his signature, both the House and
the Senate must pass the same bill by majority vote. If the President vetoes a bill, they have
the opportunity to override his veto by passing the bill again in each chamber with at least 2/3
of each body voting in favor.
Role of Administrative level:
● The Administrative level carries out and enforces laws. It includes the president, vice
president, the Cabinet, executive departments, independent agencies, and other boards,
commissions, and committees.
○ Much of the work in the executive branch is done by federal agencies, departments,
committees, and other groups. Such as the Executive Office of the president, which
communicates the president's message and deals with the federal budget, security, and
other high priorities.
Administrative cont: Key roles
There are some key roles in the administrative level of government, including;

● President:
○ Presides over the United States, and acts as the head of state, leader of the federal
government, and Commander in Chief of the United States Armed Forces.
● Vice President:
○ Supports the president and becomes the president if the the current president is unable
to continue to serve. The vice president also serves as the president of the Senate.
● The Cabinet:
○ The members of the cabinet serve as advisors to the president. They include the vice
president, heads of executive departments, and other high-ranking government officials.
Members are nominated by the president and are voted in by the members of the senate
by a popular vote.
Role of Judicial level:
The judicial branch interprets the meaning of laws, applies laws to individual cases, and
decides if laws violate the Constitution. It is made up of the Supreme court and other federal
courts.

● Supreme court:
○ The highest court in the country
○ Nine members make up the Supreme Court including a Chief Justice and eight Associate
Justices. There must be a minimum of six Justices to decide a case.
○ If there is an even number of Justices and a case results in a tie, the lower court's
decision stands.
● Federal Courts – The Constitution gives Congress the authority to establish other federal
courts to handle cases that involve federal laws including tax and bankruptcy, lawsuits
involving U.S. and state governments or the Constitution.
Health Care Policy
● Health care policy is a set course of actions undertaken by government or health care organizations to obtain a
desired outcome.
○ Private health policy is made by health care organizations, such as hospitals, and includes those policies
instituted to govern innumerable employer/ employee practices and processes in the delivery of the
health care services provided within the organization.
○ Public health policy refers to local, state, and federal legislation, regulations, and resource allocation
related to health, health care service delivery, coverage, workforce, and reimbursement.
■ The mandatory requirement for licensure to practice professional nursing is an example of public
health policy.
● Health policies can be developed and implemented at the local, state, or federal level, and they apply to all
residents within the jurisdiction of the respective governmental authority.
● Local health policy applies to people who are residents of that local community, whereas health policy at the
federal level applies to all residents in the United States.
Local Health policy
● Many cities or counties offer a variety of health care services to meet the needs of their
residents.
○ Examples of different local health policies are free or reduced rate immunizations offered
to all children in the community, allocating funds to employ RNs as school nurses in public
schools, and the requirement for tobacco-free public areas such as restaurants and
buildings
● Local health policy varies across the United States, with some communities funding an extensive
variety of health programs and others offering limited health services or none at all.
● Even the smallest communities are involved to extend health policies through partnerships with
their state government to provide public health programs.
○ Such as safe drinking water, enforcement for seat belt and child restraint laws, and
emergency medical systems
State health Policy
● Health policy at the state level has an influence on the health and safety of each state’s residents.
○ Lead role in governing nursing and other health professions scope, practice, and
performance through the state’s professional practice acts
○ Some smaller policies include maintaining a safe meat supply through livestock
inspections, ensuring safe food storage, preparation, and serving in restaurants, and
ensuring that healthcare facilities provide safe, quality care through regulatory compliance.
● State health policy also involves paying for some individual health care services
○ The Medicaid program is funded through a mix of state and federal funds, and is a health
insurance program for health care services for people at a specific income level
○ Most states have a Children’s Health Insurance Program that provides health insurance
coverage to uninsured children who do not qualify for the state Medicaid program. CHIP is
funded through a partnership between federal and state governments.
State Health Policy Cont.
● State governments are also the source of funding for mental health, health care services for
prisoners, and substance abuse services
● The state wants the implementation of State Health Insurance Exchanges (SHIEs), which is a set
of state regulated and standardized health care plans from which individuals may purchase
health insurance eligible for federal subsidies
● The role the state is playing in accepting or rejecting the Medicaid Expansion provisions is a
significant health policy issue of the decade
Federal Health Policy
● The federal government plays an important role in leadership in the health of Americans,
including passage of the PPACA by the 11th Congress
● Their role in health care includes funding for health and disease prevention and research,
supplemental funding for education for health professions, including nurses and physicians, and
paying for individual health care services through Medicare, Medicaid, CHIP, Veterans
Administration, and Indian Health Services care system
● Federal also plays a role in shaping nursing practice
○ The first federal policy to provide funding to nursing services was the Sheppard- Towner
Act of 1921.
■ This act provided states with matching funds to establish prenatal and child health
centers staffed by public health nurses. The goal of the act was to reduce maternal
and infant mortality rates by teaching women about infant care and hygiene.
■ The program was discontinued, but later reinstated within Title V of the Social
Security Act
Federal Health Policy Cont.
● Other examples of Health Policies that have influenced Nursing Practice include:
○ Hill- Burton Act of 1950
■ It provided funding to local communities that resulted in construction of hospitals. As
the number of hospitals increased, so did the need for nurses to staff them.
○ Medicare and Medicaid
■ They led to an increased number of hospitalized older adults and an increased need
for nurses in care settings
○ Nurse Training Act (1964)
■ Expanded university education for nurses and provided funding to the programs
○ Balanced Budget Amendment (1997)
■ Expanded the practice opportunities for advanced practice registered nurses (APRNs)
and removed barriers to APRN practice such as medical supervision
Health Policy Issues
Policy issues come and go each year as societal,
health care, public needs,and demands ebb and flow.
The critical importance of these topics will keep
them on the policy agenda for many years.

Policy topics include:

➢ Health Care Reform

➢ Health care workforce enhancement
➢ Health care safety and quality
 Health Care Reform
We use health care reform as the general term to refer to health policy
initiatives to effect significant changes and to promote health care.

➢ Many health organizations such as the ANA support comprehensive reforms that address
critical health problems that our nation is facing. These issues include: growing
uninsuraned population, rapidly rising costs, and health professional shortage.
➢ It has been decades of trying to fix the U.S health care reform and eventually they
placed the Patient Protection and Affordable Care Act (PPACA). If this policy was not
implemented then over half of the country would continue to be uninsured.
➢ Uninsured people are less likely to seek treatment causing less patients for health
providers and fewer jobs.
➢ Those uninsured are more likely to use emergency services instead of preventive care
services which is neither cost nor clinically effective.
➢ Uninsured populations generate uncompensated costs and bad debt for health providers.

Health care reforms like the PPACA are essential for reshaping the health system.
Since this has taken place the number of uninsured people has decrease and the
reimbursement for primary health care providers has increased, but there are still
ongoing problems and health care reforms will always be needed.
 Health Care Workforce Enhancement
The Institute of Medicine (IOM) issued a A nursing workforce with the needed
report that set four major recommendations knowledge, skills, and authority has
that will help develop a better and more tremendous effects on health care
effective workforce. quality, costs, and values which creates
effective policy interventions to be
1) Nurses should practice to the full extent developed and implemented to promote
of their education and training. such an environment for professional
2) Nurses should achieve higher levels of nursing.
education and training through
improved education systems.
3) Nurses should be full partners with
physicians and other health care
professionals, in redesigning health
care in the United States.
4) Effective workforce planning and
policymaking require better data
collection and information infrastructure.
Health Care Safety and Quality
The ANA works with other national nursing organizations to set principles and
recommendations as references for federal policymakers This topic is essential for
nursing health professions to keep the quality of care the best it can be. The principles and
recommendations address the following:

➢ The supply of RNs, APRNs, and nursing facilities.

➢ The full utilization of advanced practice nurses to provide comprehensive, cost-effective,
and high-quality care.
➢ The use of care coordination models and reimbursement to improve quality outcomes and
reduce costs for patients and the overall health enterprise.
➢ Increase emphasis on wellness and overall health promotions strategies.
➢ Implementation of a nationwide information system.

Nurses should be informed about initiatives so they can advocate for their profession
and the safety, quality, and nursing care for all Americans. Nurses can be used to
identify any underlying problems and this continues to be done to create a difference
in patients outcomes.
 Safety and quality cont.
There are several websites nurses can use and review updated amendments and
legislation that will affect nursing care. An example would be Library of Congress’s
“Thomas” website (www.thomas.gov)
All you have to do is enter key words from the bill and then the bills progress can be
tracked.

When nurses are involved and actively working on legislation and being an
advocate they are helping improve access to health care, improve nursing
workforces, patient safety, and the quality of care.

https://www.youtube.com/watch?v=NvFrAta7_6I
Grassroot Political Strategies
❖ Actions taken at the local level to influence
policymakers
➢ This includes lobbying
■ Can be done by nurses
❖ Local organizations use their influence to effect changes
at all levels of government, even the international level
❖ Often called the bottom of the political pyramid
➢ Opposite of the establishment that controls the top
■ But can also be the same
❖ Most important thing to remember is grassroot members
cannot be managed, manipulated, governed, directed or
exploited
ABC’s of Lobbying?
❖ What
➢ Communicating views on local, state or national policies to an
elected official in a timeley and effective anner
❖ Who
➢ Anyone who has called, written, e-mailed, or visited a member of
congress
➢ Can be a professional job
Communicating with Politicians
❖ How
➢ Several methods
■ Letters, E-mail, fax, telephone, face-to-face
➢ Limit agenda to no more than 3 separate topics
➢ More personal = more effective
➢ Be persistant
➢ May be more effective to get to know staff than the actual politician
How to be an effective political player
❖ Register to vote
❖ Join a nursing organization
❖ Attend meetings and keeping up to date on political
policies
❖ Communicating with relevant politicians

https://www.youtube.com/watch?v=RP_YQwiFNys
Getting Involved
❖ Working in a campaign
➢ Educates political candidates about healthcare issues
➢ Jobs within campaign
■ Writing healthcare position statements
■ Working in campaign offices
■ Attending local debates
■ Displaying political ads, stickers, and buttons
■ Fundraising events
➢ Having nurse friendly candidates wim = nurse-friendly policies
❖ Participating in town hall meetings
➢ Before the meeting, become familiar with what is to be discussed,
what will be voted on, or how a candidate usually votes
Joining a nursing organization
❖ Easier to make a change with many voices than just one
❖ Can put together knowledge and make a plan for change
❖ Major source of reliable information for policy issues
and policymakers
❖ If has a political action committee, an organization can
help a nurse gain skills in order to participate and
understand political issues and elections
❖ Can increase access to politicians
The ANA
❖ Represent the entire RN population
❖ Composed of about 3.1 million RN’s
➢ Associated with American Nurses Credentialing Center, American
Academy of Nurses, American Nurses Foundation, and many more
corporate entities
❖ Taken firm and visible positions on variety of health
policies
➢ Include medicare and medicaid passage
➢ Policies about patient’s rights, safe workplace, safe needles and
other health practices, whistle blower protection, safe health
practices, patient handling, and many more
➢ Most recent is health care reform
❖ Nurses Strategic Action Team (N-STAT
N-STAT
❖ ANA program
❖ Unifies nurses’ political views into one voice
❖ Composed of thousands of nurses
➢ They are always current on all issues
➢ Always have contact to their legislature
➢ Informed of a bill at every step of legislative process
❖ Makes political process seem less intimidating and easier
for nurses to get their opinion out
References
https://www.whitehouse.gov/about-th
e-white-house/the-legislative-branc
h/
http://www.renewamerica.com/grassro
ots.htm
https://www.aaacn.org/abcs-lobbying
https://www.usa.gov/branches-of-gov
ernment
http://www.differencebetween.net/mi
scellaneous/politics/difference-bet
ween-policy-and-politics/
The book