Healthcare Policy Analysis Assignment
The healthcare workforce is predominantly composed of nurses who play a crucial role in strengthening health systems. Despite the apparent importance of nurses in health policymaking, various barriers such as individual, interpersonal, and systematic factors have been identified as limiting their involvement in politics and general health policy-making. This paper will examine a federal and state policy relevant to current healthcare insurance, explore the impact of these policies on patient care and healthcare delivery, and highlight how nurses can contribute to shaping policy decisions at both state and federal levels. By analyzing the role of nurses in policy-making, this study aims to shed light on the importance of enhancing nurses’ participation in health policymaking processes to ensure that policies are reflective of the needs and realities of frontline healthcare providers. Healthcare Policy Analysis Assignment
Policy Comparison
This policy comparison explores both federal and state policies. The federal health care policy is the Affordable Care Act, or Obamacare, which was implemented in 2010 with the main objectives of enhancing the quality and affordability of health insurance, broadening Medicaid eligibility, and decreasing the number of uninsured individuals in the United States. Key components of the ACA involve the creation of health insurance marketplaces for individuals and small businesses to evaluate and acquire insurance plans, financial assistance in the form of subsidies to assist low-income individuals in paying insurance premiums, an extension of Medicaid eligibility to encompass more low-income adults, and regulations that prevent insurance companies from refusing coverage or imposing higher premiums based on pre-existing conditions (Sullivan et al., 2024). The state policy for this comparison covers California. Established by the state of California in response to the ACA, Covered California serves as the health insurance marketplace for residents of the state. It functions as the state’s execution of the ACA’s regulations, providing a venue for Californians to evaluate and acquire health insurance policies. Covered California extends the opportunity for individuals and families that satisfy specific income criteria to access subsidized health insurance options.
How Each Policy Works
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The Affordable Care Act, also known as ACA, implemented the individual mandate, which required most Americans to have health insurance. Failure to comply with the mandate would result in a penalty. However, in 2019, the penalty for not having health insurance was reduced to zero, rendering it optional. Consequently, there is no longer a mechanism to force individuals to obtain health insurance (Sullivan et al., 2024). The ACA is managed by multiple federal agencies, including the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS). Despite the individual mandate no longer being enforced, Covered California still encourages individuals to obtain health insurance coverage. It provides a platform for Californians to compare and purchase various health insurance plans. Unlike ACA, Covered California does not impose any fines on individuals for not having health insurance. Instead, eligible individuals receive subsidies and financial assistance to make health insurance coverage more affordable. The state of California administers Covered California through the California Health Benefit Exchange agency. Through Covered California, California residents have access to resources and support to help them navigate the process of obtaining health insurance. Healthcare Policy Analysis Assignment
Impact on Populations
The Affordable Care Act (ACA) and Covered California were created to help those who previously had difficulty affording health insurance. This includes people with low incomes, those who are self-employed, and those with pre-existing conditions. These programs provide better access to comprehensive health insurance coverage, preventive services, and essential health benefits. Covered California offers financial assistance to eligible individuals to help them afford health insurance through subsidies and financial aid. This assistance can be used to lower the out-of-pocket costs of healthcare services. However, some people who were previously able to afford health insurance without subsidies may be negatively affected by the ACA and Covered California. Certain regulations and requirements of the ACA may result in higher premiums for them. Additionally, limited options for insurance providers may challenge some populations due to the ACA. Some people may also experience gaps in coverage for specific services under these policies. The goal of the ACA and Covered California is to reduce health disparities and promote health equity by expanding access to health insurance for underserved populations. These policies aim to address financial barriers that contribute to health disparities through subsidies and financial assistance. However, equal access to healthcare services remains a challenge.
Supporting Evidence
The Affordable Care Act (ACA) offers health insurance plans for individuals, and it is up to the buyers to make informed decisions on the quality and price of the policies available. However, purchasing health insurance can be complicated, and many things can go wrong. In 2018, more than 20% of households earning over 200% of the federal poverty level purchased an inferior silver plan, while those automatically re-enrolled were more likely to do so (Rasmussen & Anderson, 2021). The automatic enrollment and marketplace choices rules should be modified to help people select superior coverage. According to Teotia et al. (2023), one way to reduce premium growth without government mandates or price regulations is to add a public insurance option based on the county. In California, LA Care, a county-based public option, helped reduce premium growth in Los Angeles by 4.8%. The study by Teotia et al. (2023) was conducted to estimate the effect of LA Care on health insurance premiums in the Covered California exchange. County-based health plans can help reduce premium growth and provide more choices for consumers. Therefore, modifying marketplace architecture and enrollment rules is important to prevent people from being placed into dominant health insurance policies. Healthcare Policy Analysis Assignment
Nurse’s Role in Policy Development, Implementation, And Improvement
Nurses have a vital role to play in policy development. They can contribute their knowledge and expertise to develop policies that address healthcare challenges and promote patient safety and care quality. Nurses can participate in policy development by conducting research, advocating for their patients, and working with policymakers (Chiu et al., 2021). In policy administration, nurses can ensure that healthcare providers and staff understand and follow the policies in place while providing feedback and insights for policy revisions (Inayat et al., 2023). According to (Hajizadeh et al., 2021), barriers to nurse engagement in policy development, administration, and revision include limited time and resources, lack of awareness or education on policy processes, and limited representation of nurses in policy-making bodies.
Numerous obstacles hinder nurses’ involvement in policy development, with one major issue being the lack of knowledge and skills required for effective engagement. Understanding policy formulation intricacies, research methodologies, and evidence-based practices is vital but often lacking among nurses. Another significant barrier is the limited time nurses have due to heavy workloads, making it challenging to participate in policy development activities (Inayat et al., 2023). Juggling clinical duties, patient care, and policy-related tasks can be overwhelming and leave little room for policy engagement. Furthermore, nurses may face a lack of support from their employers or professional organizations when participating in policy development. Adequate resources, mentorship, and encouragement are crucial for nurses to actively engage in policy development and make a meaningful impact. Some nurses may be hesitant to take on leadership roles in policy administration due to a lack of confidence or concerns about the challenges involved in making impactful decisions that affect a larger group of people. When there is a lack of unity within healthcare organizations, the implementation of policies can be hindered. Conflicting priorities among different departments or stakeholders can create obstacles to effectively administering policies. Inadequate staffing levels can put pressure on nurses trying to enforce policies. Nurses who are overwhelmed with their workload may struggle to ensure that policies are being followed.
Nurses play a crucial role in developing healthcare policies at both the federal and state levels. They work to ensure that patient care is the center of policy development and that evidence-based practices are promoted. To influence policy, nurses engage in various activities such as research, advocacy, collaboration, and direct involvement in policy-making processes. At the federal level, nurses are actively involved in legislative processes, advisory committees, and regulatory agencies. They provide valuable insights into the potential impact of proposed policies on patient care and healthcare delivery. Nurses also help to develop and implement federal healthcare programs and initiatives. At the state level, nurses engage with state legislators, regulatory bodies, and professional organizations to advocate for healthcare reforms that address local healthcare challenges and improve access to care. Nurses shape the development of state healthcare policies through public hearings, policy briefs, and collaboration with interdisciplinary teams. They use their expertise in clinical practice, research, and education to inform policy decisions and promote evidence-based approaches to healthcare delivery.
In the future, I will continue engaging in policy development by staying informed about healthcare policy issues, especially those that pertain to nurses and related disciplines. To make a difference in policy administration and advocacy, I will join professional organizations such as the American Nurses Association and the American Psychiatric Nurses Association. Thus, I will advocate for policies that benefit patients and the nursing profession. Healthcare Policy Analysis Assignment
Conclusion
Nurses play a crucial role in utilizing health policy to enhance healthcare safety and quality. By implementing grassroots educational strategies, empowering nurses at the managerial level, and focusing on improving the social image of nursing through social mechanisms, nurses can further enhance their involvement in policymaking. By expressing my understanding of state and federal policies about health insurance, I would make a difference in my future professional, clinical, and ethical practice.
References
Chiu, P., Cummings, G. G., Thorne, S., & Schick-Makaroff, K. (2021). Policy advocacy and nursing organizations: A scoping review. Policy, Politics & Nursing Practice, 22(4), 271–291. https://doi.org/10.1177/15271544211050611
Hajizadeh, A., Zamanzadeh, V., Kakemam, E., Bahreini, R., & Khodayari-Zarnaq, R. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC Nursing, 20(1). https://doi.org/10.1186/s12912-021-00648-6
Inayat, S., Younas, A., Andleeb, S., Rasheed, S. P., & Ali, P. (2023). Enhancing nurses’ involvement in policy-making: A qualitative study of nurse leaders. International Nursing Review, 70(3), 297–306. https://doi.org/10.1111/inr.12828
Rasmussen, P. W., & Anderson, D. (2021). When all that glitters is gold: Dominated plan choice on Covered California for the 2018 plan year. The Milbank Quarterly, 99(4), 1059–1087. https://doi.org/10.1111/1468-0009.12518
Sullivan, J., Orris, A., & Lukens, G. (2024, March 25). Entering their second decade, Affordable Care Act coverage expansions have helped millions, and provide the basis for further progress. Center on Budget and Policy Priorities. https://www.cbpp.org/research/health/entering-their-second-decade-affordable-care-act-coverage-expansions-have-helped
Teotia, A., Arnold, D. R., & Scheffler, R. M. (2023a). Association between a capitated, low-cost, county-based public health insurance option and Affordable Care Act premium growth in California. JAMA Health Forum, 4(4), e230488. https://doi.org/10.1001/jamahealthforum.2023.0488
Teotia, A., Arnold, D. R., & Scheffler, R. M. (2023b). Association between a capitated, low-cost, county-based public health insurance option and Affordable Care Act premium growth in California. JAMA Health Forum, 4(4), e230488. https://doi.org/10.1001/jamahealthforum.2023.0488 Healthcare Policy Analysis Assignment
