Tag: Clinical-Nursing

Comparison of APRN Regulations in West Texas and North Central New Mexico

Regulation 1: Scope of Practice

West Texas: In Texas, APRNs must practice under a physician’s autonomy by requiring physician oversight for diagnosing, treating, and prescribing, particularly for controlled substances; for example, an APRN in West Texas needs a signed protocol with a collaborating physician detailing specific treatments and medications they can prescribe. The Texas Board of Nursing does not have a list of tasks that every APRN can or cannot perform (Texas Board of Nursing. 2022). The physician must regularly review a certain percentage of patient records, impeding timely care decisions.

North Central New Mexico: APRN Certified Nurse Practitioners (CNP) in New Mexico enjoy full practice authority, meaning they can independently evaluate, diagnose, interpret diagnostic tests, and initiate treatment plans without physician collaboration or oversight. For example, an APRN in North Central New Mexico can operate independently, managing patient care and making decisions in real-time. This is especially beneficial in rural settings where physician access might be limited.

Regulation 2: Prescriptive Authority

West Texas: Texas regulations require APRNs to have a prescriptive authority agreement with a physician to prescribe medications, including controlled substances. This agreement mandated a specific number of face-to-face meetings between the APRN and the physician and required documented discussions about care decisions. For instance, an APRN in West Texas prescribing a controlled medication must adhere to the stipulations of their prescription with their collaborating physician, delaying the initiation of necessary medicines.

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North Central New Mexico: In New Mexico, APRNs have independent prescriptive authority, including for controlled substances, if they have completed the required pharmacology education and meet state licensure standards. The only drugs to be included in the formulary are those relevant to the CNP’s specialty and practice setting (New Mexico Board of Nursing. 2022).  This independence allows APRNs to respond immediately to patients’ needs without consulting a supervising physician, streamlining care processes and improving patient outcomes. For instance, an APRN can adjust a patient’s medication for chronic pain management without having to schedule a consultation with a physician.

Application of Regulations to APRNs’ Practice

Texas: The collaborative and prescriptive authority agreements in Texas restrict APRNs’ ability to exercise their education and expertise fully, often requiring time-consuming meetings and physician approvals. This dependency can limit an APRN’s capacity to provide timely and comprehensive care, particularly in regions where physician availability is inconsistent. It is the position of the American Academy of Nursing (Academy) that the FPA of APRNs is essential to achieving health equity (Bosse, J, 2017). For example, an APRN with extensive experience managing chronic conditions may find their clinical decision-making delayed or altered due to the need for physician sign-off on treatment changes.

New Mexico: The full practice authority in New Mexico empowers APRNs to utilize their skills and training completely, allowing them to manage patient care from diagnosis to treatment independently. This regulatory environment maximizes APRN efficiency, particularly in underserved areas where APRNs can fill critical gaps in care. For example, an APRN running a rural health clinic in North Central, New Mexico, can independently prescribe medications and adjust treatment plans without external approvals, providing patients with immediate and continuous care.

Examples of APRNs Adhering to Selected Regulations

West Texas Examples: An APRN working in a rural clinic in West Texas adheres to state regulations by maintaining a detailed collaborative agreement with a supervising physician. This agreement outlines specific treatments and medications the APRN can manage independently and those that require physician oversight. The APRN regularly meets with the physician to discuss complex cases and prescriptive decisions, documenting these interactions as required by Texas laws Comparison of APRN Regulations in West Texas and North Central New Mexico.

North Central New Mexico Example: An APRN in North Central New Mexico operates a primary care practice independently assessing, diagnosing, and treating patients. They adhere to state regulations by ensuring all prescriptive actions are within their licensure scope and training. For example, the APRN may adjust a diabetic patient’s insulin dosage based on clinical assessment during a visit without consulting or informing a supervising physician, adhering to New Mexico’s independent practice regulations.

Conclusion

This comparison highlights state regulations’ significant impact on APRNs’ autonomy and ability to practice to the full extent of their education. While Texas APRNs faces more restrictive practices requiring physician collaboration, New Mexico APRNs benefit from full practice authority, allowing them to provide comprehensive, independent care, especially crucial in rural and underserved areas. Understanding these regulatory differences is essential for APRNs to navigate their practice environments effectively and advocate for changes that promote greater autonomy in their professional roles.

 

References:

Texas Board of Nursing. (2022). 
Advanced practice registered nurses: Rules and regulations. 
Texas Board of Nursing. Retrieved from 
https://www.bon.texas.gov
Links to an external site.

New Mexico Board of Nursing. (2022). 
Licensure and practice requirements for APRNs. 
New Mexico Board of Nursing. Retrieved from 
https://nmbon.sks.com
Links to an external site.

Bosse, J., Simmonds, K., Hanson, C., Pulcini, J., Dunphy, L., VanHook, P., & Poghosyan, L. (2017). Position statement: Full Practice authority for advanced practice register

Colorado and Montana aprn licensure comparison

Main Discussion Post Week 5

In comparing Advanced Practice Registered Nurse (APRN) Board of Nursing regulations between Colorado and Montana, key distinctions highlight differences in scope of practice, licensing, and supervision requirements (American Nurses Association, n.d.). The regulatory framework for APRNs includes seven main elements: title, license, four roles (Certified Nurse Midwife, Certified Nurse Practitioner, Certified Registered Nurse Anesthetist, and Clinical Nurse Specialist), education, national certification, independent practice, and independent prescribing (National Council of State Boards of Nursing (NCSBN), n.d.).

One regulation that stands out is the Independent Practice Authority. In Colorado, an APRN looking to adhere to independent practice authority must complete a 1,000-hour mentorship period under a physician’s or experienced APRN’s supervision before they can practice independently (Maryville University, n.d.). For example, a family nurse practitioner (FNP) who has recently graduated and obtained their APRN license must collaborate with a supervising healthcare provider during this mentorship phase. After completing these required hours, they can legally open their own practice and fully exercise their scope of practice without further supervision. In Montana, an APRN enjoys full practice authority upon licensure without any mandatory supervisory period (Maryville University, n.d.). For instance, an APRN moving to Montana from another state could immediately begin an independent practice and prescribe medications, including controlled substances, right after obtaining licensure. An example could be a psychiatric nurse practitioner (PMHNP) who can establish their own mental health practice and immediately begin providing care without the need for supervision. This system allows APRNs to fully utilize their training and skills as soon as they are licensed.

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A second regulation that stands out is the prescriptive authority. If APRNs in Colorado want to prescribe medications, they must first complete a 1,000-hour supervised practice period before gaining prescriptive authority for controlled substances, including opioids. This supervised period is a safeguard to ensure new APRNs are adequately prepared for independent practice, but it may delay full autonomy for some practitioners. Montana allows APRNs full prescriptive authority, including controlled and non-controlled substances, but with fewer restrictions. APRNs in Montana do not need to complete a mentorship or supervised practice period before gaining this authority, which provides them immediate access to prescribing rights upon licensure without a mandatory supervisory period. Following the example above, a PMHNP can immediately begin prescribing psychotropic medications without the need for supervision Colorado and Montana aprn licensure comparison.

Supervised hours should be required for all states, especially for nurses who achieved their APRN without working as a bedside RN. However, reviewing the article by Neff et al. (2018) confirms that allowing APRNs to practice immediately would have a profound effect in rural areas by decreasing drive time for patients and increasing access to care. Unfortunately, I believe bedside care is essential for any APRN’s future as an independent provider and prescriber. Providing background on bedside caregivers’ years of experience should be considered. Depending on years of experience and area of practice, an APRN should be granted full independent practice and prescriptive authority.

The key differences lie in Colorado’s requirement for a supervised practice or mentorship period for independent and prescriptive authority, whereas Montana grants these privileges to APRNs immediately upon licensure. This difference impacts how quickly APRNs in each state can exercise their full range of skills and knowledge in their professional roles. These variations reflect each state’s approach to balancing APRN autonomy with patient safety, allowing nurses in both Colorado and Montana to work within the regulations to provide comprehensive care.

References

American Nurses Association. (n.d.). 
ANA enterprise.
 http://www.nursingworld.org

Maryville University. (n.d.). 
States with full practice authority for Nurse Practitioners.
 
https://nursing.maryville.edu/blog/states-granting-np-full-practice-authority.html#:~:text=NPs%20who%20work%20in%20Colorado,a%20physician%20or%20mentoring%20NP
Links to an external site.

National Council of State Boards of Nursing (NCSBN). (n.d.). 
APRN Consensus Model.
 
https://www.ncsbn.org/nursing-regulation/practice/aprn.page
Links to an external site.

Neff, D. F., Yoon, S. H., Steiner, R. L., Bumbach, M. D., Everhart, D., & Harman J. S. (2018). The impact of nurse practitioner regulations on population access to care. 
Nursing Outlook, 66
(4), 379–385 Colorado and Montana aprn licensure comparison

NURS-6050

Week 4: Assignment –
Legislation Grid and Testimony/Advocacy Statement – Safe Staffing for nurse and Patient Safety Act of 2023 Advocacy Essay Assignment

To Prepare:

Select a bill that has been proposed (not one that has been enacted) using the congressional websites provided in the Learning Resources.

The Assignment: (1- to 2-page Legislation Grid; 1-page Legislation Testimony/Advocacy Statement)

Be sure to add a title page, an introduction, purpose statement, and a conclusion. This is an APA paper.

Part 1: Legislation Grid

Based on the health-related bill (proposed, not enacted) you selected, complete the Legislation Grid Template. Be sure to address the following:

Determine the legislative intent of the bill you have reviewed.

Identify the proponents/opponents of the bill.

Identify the target populations addressed by the bill.

Where in the process is the bill currently? Is it in hearings or committees?

Part 2: Legislation Testimony/Advocacy Statement

Based on the health-related bill you selected, develop a 1-page Legislation Testimony/Advocacy Statement that addresses the following:

Advocate a position for the bill you selected and write testimony in support of your position.

Explain how the social determinants of income, age, education, or gender affect this legislation.

Describe how you would address the opponent to your position. Be specific and provide examples.

At least 2 outside resources and 2-3 course specific resources are used.

Advocacy for the Safe Staffing for Nurse and Patient Safety Act of 2023

Part I

Legislation Grid Template

Use this document to complete Part 1 of the Module 2 Assessment
Legislation Grid and Testimony/Advocacy Statement

Health-related Bill Name

 

Safe Staffing for Nurse and Patient Safety Act of 2023 (AHRQ, 2024)

Bill Number

H.R. 2581

Description

This bill requires every healthcare facility to adopt safe nurse-to-patient staffing ratios. The bill would prevent nurses from caring for more patients than they are capable of safely handling at any given time, thus decreasing errors and the quality of care provided (American Nurses Association, 2023). It will also create good working conditions for the nurses themselves in order to prevent burnout and turnover.

Federal or State?

Federal

Legislative Intent

This bill will promote patient safety and quality care by requiring hospitals and other healthcare facilities to meet minimum standards of nurse staffing so that each nurse will be able to manage their workload in the delivery of the highest form of patient care.

Proponents/ Opponents

Proponents:
Congresswoman Jan Schakowsky; Senator Sherrod Brown.

Opponents:
Hospital administrators, some healthcare organizations citing increased costs, and concerns about operational flexibility.

Target Population

Hospital patients, particularly those in acute care settings, and nurses working in healthcare facilities.

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Status of the bill (Is it in hearings or committees?)

The bill is currently in committee, where it is being reviewed and considered before moving to a potential floor vote.
NURS-6050

Week 4: Assignment –
Legislation Grid and Testimony/Advocacy Statement – Safe Staffing for nurse and Patient Safety Act of 2023 Advocacy Essay Assignment

General Notes/Comments

 

 

This bill responds to ongoing issues of nurse burnout and patient safety concerns related to staffing levels. Supporters argue that safe staffing ratios are necessary to protect both nurses and patients, while opponents worry about the financial impact on healthcare systems.

 

PART II

Advocacy for the Safe Staffing for Nurse and Patient Safety Act of 2023

The Safe Staffing for Nurses and
Patient Safety Act of 2023
is landmark legislation that solves the growing crisis in health staffing and protects both patient outcomes and well-being. This bill will require ratios of nurse-to-patient staffing for safety that will help reduce burnout, minimize medical errors, and ultimately improve patient care. Nurses are at the very center of healthcare delivery, and it is no secret that an increasing number are overwhelmed by dangerous staffing shortages in hospitals across the nation (Tamata & Mohammadnezhad, 2022). These conditions not only put the patients in danger but also put the nurses under immense pressure that could threaten their mental and physical health.

Income, age, education, and gender make up the societal determinants that mix directly to determine the impact of this proposed legislation. Communities with lower incomes normally have hospitals that are understaffed to a crippling degree, diminishing patient care. Older patients, by nature requiring more care, become highly vulnerable in understaffed facilities.

Also, nursing is a female-dominated profession, and inequities in pay and working conditions because of gender are ongoing; hence, this staffing ensures that social justice around safe care is observed (Mwetulundila & Indongo, 2022). The bill ensures that underserved populations receive equal access to quality health care and supports nurses in caring for their patients’ needs.

Opponents of the bill argue that staffing mandates would be financially burdensome for hospitals, especially smaller and rural ones. However, this argument is far outweighed by evidence of the fact that appropriate staffing reduces costly complications and hospital readmissions, saving money in the long run (McHugh et al., 2021). Hospitals that invest in safe staffing see improved nurse retention, reducing recruitment and training costs. For example, a study in California indicated that hospitals with safe staffing ratios realized savings through costs associated with temporary staffing and turnover of nurses (Dierkes et al., 2021). Safe staffing is not only economically viable but also intrinsic to constructing a sustainable and quality healthcare system.

References

Dierkes, A., Do, D., Morin, H., Rochman, M., Sloane, D., & McHugh, M. (2021). The impact of California’s staffing mandate and the economic recession on registered nurse staffing levels: A longitudinal analysis.
Nursing Outlook
,
70
(2). https://doi.org/10.1016/j.outlook.2021.09.007

McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals.
The Lancet
,
397
(10288), 1905–1913. https://doi.org/10.1016/S0140-6736(21)00768-6

Mwetulundila, P., & Indongo, N. (2022). Gender Equity and Impedes of Career Progression in the Nursing Profession in Khomas Region of Namibia.
SAGE Open Nursing
,
8
, 237796082210746. https://doi.org/10.1177/23779608221074652

Tamata, A. T., & Mohammadnezhad, M. (2022). A Systematic Review Study on the Factors Affecting Shortage of Nursing Workforce in the Hospitals.
Nursing Open
,
10
(3), 1247–1257. https://doi.org/10.1002/nop2.1434
NURS-6050

Week 4: Assignment –
Legislation Grid and Testimony/Advocacy Statement – Safe Staffing for nurse and Patient Safety Act of 2023 Advocacy Essay Assignment

Politics and the Patient Protection and Affordable Care Act – Walden University
NURS-6050 
Week 3: Discussion

On March 23, 2010, President Barack Obama signed into law the Affordable Care Act (ACA), more often referred to as Obamacare, a federal statute passed by the 111th US Congress. Its intended purpose was to provide health insurance to millions of people who now do not have it. The law mandates that health insurance plans offer a set of core health benefits, establish a marketplace for purchasing health care, and outlaw the practice of insurance companies denying coverage based on a person’s pre-existing diseases (Investopedia.com, 2019). Republican efforts to dismantle, undermine, or replace the Affordable Care Act have been many since its passage. Legislators have voiced their want to alter Americans’ health insurance coverage in order to secure re-election, but so far, no one has been able to come up with a workable plan to either repeal or replace the act that would not impact millions of Americans.

In order to get a feel for how the cost-benefit analysis of lawmakers’ reelections impacted the ACA’s repeal and replace, it’s helpful to examine the political climate prior to and during Trump’s presidency. Even though they knew Obama would veto each time, Republicans in the House voted many times to repeal the Affordable Care Act during his presidency. The repeal of the Affordable Care Act was a rallying cry for Republicans during election campaigns, and it helped them win seats. It was within the Republican Party’s power to dismantle and replace the Affordable Care Act (ACA) when Trump became office.

According to Milstead and Short (2017), Republicans seized the chance to finally remove legislation that had long been an irritant for them. Since Republicans’ 2016 campaign platform included calls to repeal and replace the Affordable Care Act, it was thought that Republicans and lawmakers from swing states seeking reelection would gain politically by allying with the majority party. Disagreements among Republicans, some of which may have had to do with their own election campaigns, prevented them from successfully repealing the ACA.

The Affordable Care Act (ACA) had gained traction by the time Democrats ran on a platform of preserving and enhancing it in 2018. The House of Representatives was reclaimed by Democrats as a result of that campaign. The Affordable Care Act (ACA) and COVID-19 were once again the Democratic Party’s central platform issues in the 2020 election. For Democrats, that tactic was effective. Legislators have realized that the Affordable Care Act is currently highly popular and that many of them will not be re-elected if they advocate for its repeal. Everyone knows that getting reelected for another term is a legislator’s top priority. That can only occur if they maintain vigilance and are well-versed in the current political atmosphere. Mildstead and Short (2017) argue that politicians should not limit their focus to a single topic but rather should consider all relevant aspects when determining the likelihood of success or failure.

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In determining the number of votes needed to pass a bill, lawmakers must prioritize the policies that will bring them the most benefit at the lowest possible cost if they want to be re-elected. Legislators seeking reelection pay close heed to public opinion surveys whenever there is a resounding majority in favor of or against a certain proposal during an election year. Schechter (2017) argues that lawmakers have grown utterly dependent on campaign donations from wealthy individuals within the last decade. Lawmakers’ decision-making about the stance or recommendation of national policies may be influenced by the amount of money they get, rather than their constituents’.

References

Kenton, W. (2019, October 17). Affordable Care Act (ACA). 
https://www.investopedia.com/terms/a/affordable-care-act.asp
Links to an external site.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: a nurse’s guide (6th ed.).

Schechter, A. (2017, June 28). Study: Politicians Vote Against the Will of Their Constituents 35 Percent of the Time. https://promarket.org/study-politicians-vote-will-constituents-35- percent-time/ Understanding affordable care act. https://visclosky.house.gov/issues/understanding-the[1]affordable-care-act.

 

Politics and the Patient Protection and Affordable Care Act

Regardless of political affiliation, individuals often grow concerned when considering perceived competing interests of government and their impact on topics of interest to them. The realm of healthcare is no different. Some people feel that local, state, and federal policies and legislation can be either helped or hindered by interests other than the benefit to society.

Consider for example that the number one job of a legislator is to be reelected. Cost can be measured in votes as well as dollars. Thus, it is important to consider the legislator’s perspective on either promoting or not promoting a certain initiative in the political landscape.

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).

Consider who benefits the most when policy is developed and in the context of policy implementation.

By Day 3 of Week 3

Post
 an explanation for how you think the
cost-benefit analysis in terms of legislators being reelected affected efforts to repeal/replace the ACA
. Then, explain how analyses of the voters views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., Congress’ decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

By Day 6 of Week 3

Respond
 to at least 
two
 of your colleagues
* on two different days
 by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

*Note:
 Throughout this program, your fellow students are referred to as colleagues.

Politics and the Patient Protection and Affordable Care Act – Walden University
NURS-6050 
Week 3: Discussion

Politics and the Patient Protection and Affordable Care Act

Every legislature, regardless of political affiliation, plays a crucial role in shaping policies that impact the interests of the government and the public, especially in healthcare (Porter et al, 2018). Their influence is felt at local, state, and federal levels, where policies and regulations can either enhance or act as barriers to societal benefits. This underscores the importance of their role and the influence they wield.

 

Cost-benefit analysis and reelection efforts

Legislators make policies that benefit society and increase their chances of getting elected because of the cost-benefit to society. For example, the Affordable Care Act ACA is a policy that is beneficial to society in terms of health care cost because of its implication in the expansion of the insurance marketplace, resulting in an increased number of low-income earners having health insurance policies due to the reduced cost of insurance premiums (Fording & Patton, 2020). Most legislators support the ACA policies due to their impact on the general population; this is because their impact is enormous, and therefore, the decision may increase support or cause a potential backlash. A massive number of people are beneficiaries of the Affordable Care Act ACA; hence, repealing or replacing the act has a significant impact on legislators’ reelection efforts. The legislators who oppose the act may face backlash in the reelection bid.

Additionally, legislators benefit from public education campaigns when the lobby groups and influential healthcare organizations a decade’s people on policies affecting their healthcare services. When legislators want to be reelected, they align to policies that have cost benefits to the general public because they will get support for supporting such policies. For example, when healthcare professionals, organizations, insurance policy providers, and other healthcare stakeholders supporting ACA conduct public education, they will also campaign to legislators supporting it. The financial backing of the public health education campaign programs will also be pivotal for candidates supporting the policies. However, when the party policies do not support such policies, legislators aligning such policies with parties may face backlash. Thus, the legislators supporting policies that have cost benefits to the general population, such as ACA, have a chance to be reelected, unlike those opposing the policies.

 

Voters’ views and legislative decisions

Voters’ views play a critical role in shaping the decisions made by legislative leaders on national policies, such as Congress’s decision on Medicaid. Legislators’ number one goal is to get reelected; hence, they will ensure they make a decision that aligns with the majority of the voters’ views. People are aware of how certain policies affect their lives; for example, they understand the impacts of ACA policies in improving their access to healthcare services and hence will vote for any leader who supports the policy (Findley et al., 2019). Thus, legislators make legislative decisions depending on the views of voters because they want to be reelected. Hence, voters’ views have a significant impact on national policies. The campaigns and public participation in various policies in town hall meetings enlighten the legislators on the voters’ views and suggestions on which they want to be included in national policies. For example, when the voter’s views support the expansion of Medicaid programs, then legislators will be more inclined to the policies to support them for reelection. The legislators who want to be reelected will ensure that the feedback from the voters plays a central role in the national policy-making process.

 

References

Findley, P. A., Wiener, R. C., Shen, C., Dwibedi, N., & Sambamoorthi, U. (2019). Health reform under the patient protection and Affordable Care Act: characteristics of exchange-based health insurance enrollees. 
Social Work in Health Care
, 
58
(7), 685–702. https://doi.org/10.1080/00981389.2019.1619116

Fording, R. C., & Patton, D. (2020). The Affordable Care Act and the Diffusion of Policy Feedback: The Case of Medicaid Work Requirements. 
RSF: The Russell Sage Foundation Journal of the Social Sciences
, 
6
(2), 131–153. 
https://doi.org/10.7758/RSF.2020.6.2.06
Links to an external site.

Porter, K. M. P., Rutkow, L., & McGinty, E. E. (2018). The importance of policy change for addressing public health problems. 
Public Health Reports
, 
133
(1_suppl), 9S-14S. 
https://doi.org/10.1177/0033354918788880

 

Politics and the Patient Protection and Affordable Care Act – Walden University
NURS-6050 
Week 3: Discussion

Main Post

Legislators frequently consider their reelection prospects when crafting healthcare legislation, as seen by the attempts to repeal or replace the Affordable Care Act (ACA), a hot issue of discussion in U.S. healthcare policy. In this analysis, I will examine how the cost-benefit calculus of winning reelection affected attempts to repeal the Affordable Care Act and how legislative leaders’ judgments about national policies such as Medicare and Medicaid may be influenced by their grasp of voter viewpoints.

A Cost-Benefit Analysis and the ACA’s Repeal

Enacted in 2010, the ACA gave millions of Americans access to enhanced healthcare coverage. Political conflicts centered on it, particularly when Republican lawmakers attempted to repeal it. Recognizing that lawmakers must balance keeping their voting base and campaign promises—especially regarding reelection—was essential to these repeal campaigns (Brooks, 2019). Many Republicans ran their campaigns against the Affordable Care Act (ACA), seeing it as an expensive burden and an overreach of government power (Mason, 2020). Promoting repeal in these situations was political, especially with conservative audiences.

However, as public anger mounted, especially from individuals who benefitted from Medicaid expansion and ACA subsidies, it became clear how costly it was to push for repeal without a workable replacement plan (Hacker & Pierson, 2019). If lawmakers from more swing or moderate areas backed a repeal that would cause many people to lose their insurance, they would be taking political risks. For instance, Collins (2020) discovered that voters’ worries in moderate districts, where lawmakers feared electoral blowback, played a significant role in the 2017 ACA repeal effort’s failure. Legislators, therefore, had to balance their desire to keep their campaign pledges against the possibility of losing support from voters who might otherwise support the ACA as a major component of their cost-benefit analysis.

The opinions of voters and the process of making laws

Legislative leaders’ actions are greatly influenced by the electorate’s opinions, especially regarding
healthcare programs like Medicare and Medicaid. Voters often support measures that offer security regarding access to medical treatments
since healthcare is a very personal matter (Patashnik & Zelizer, 2020). Political leaders are aware of this, so they frequently encounter strong resistance, even from politicians who lean financially conservatively, to plans that threaten to cut benefits for well-liked programs like Medicare and Medicaid (Kogan & Henry, 2022).

Legislators are unlikely to press for cuts or reforms that will upset these systems, for example, if polls indicate that people want Medicaid expansion or are against major changes to Medicare (Holahan, 2021). Voters’ fear of losing their insurance was clear throughout the attempts to repeal the Affordable Care Act. Legislative leaders must thus consider the political cost of supporting unpopular measures and how public mood will affect their prospects of being reelected.

In summary

Ultimately, the cost-benefit analysis of lawmakers, especially in relation to reelection, influences their decision-making, as demonstrated by the attempts to replace or repeal the ACA. Lawmakers need to strike a balance between listening to their voters and delivering on campaign pledges when it comes to healthcare, which affects them personally. Voter choices heavily influence national policy, as legislative leaders know that staying in office depends on pleasing their voters.

References

Brooks, T. (2019). Political cost-benefit analysis and healthcare reform. 
Journal of Policy Analysis
, 48(2), 45-62.

Collins, S. R. (2020). The 2017 ACA repeal debate: Lessons for future health policy reform. 
The Commonwealth Fund
. 
https://doi.org/10.26099/n1th-yz32

Hacker, J. S., & Pierson, P. (2019). 
Let them eat tweets: How the right rules in an age of extreme inequality
. W.W. Norton & Company.

Holahan, J. (2021). Medicaid and the politics of policy reform. 
Health Affairs
, 40(8), 1234-1242.

Kogan, R., & Henry, J. (2022). The politics of Medicare reform: Balancing costs and care. 
American Political Science Review
, 116(3), 700-716.

Mason, T. M. (2020). The financial and political dynamics of ACA repeal efforts. 
Public Administration Review
, 80(4), 591-598.

Patashnik, E. M., & Zelizer, J. E. (2020). 
Unhealthy politics: The battle over healthcare in America
. Princeton University Press.

 

Reply from

Healthcare has consistently been a divisive issue in America. The Affordable Care Act is only one example of healthcare related issues that Republicans and Democrats tend to fight over. For the most part, Democrats support the ACA due to the health benefits it brings to citizens, while Republicans try to repeal or reform it in order to save money. Under the Trump Administration, the ACA was weakened by Republican legislation by reducing the annual enrollment period, removing the mandate requiring all Americans to purchase insurance, backing out of financial agreements with health insurers protected by the ACA, and allowing cheaper insurance options that did not meet ACA standards (Short, 2022, pp. 20-21). However, despite having a Republican president and Republican majority both in the House of Representatives and Senate, there was no complete repeal of the ACA. This leads me to believe, some Republicans chose to support the ACA as a representative of their constituents who may be affected negatively by an ACA repeal. Courtemanche et al. found that eighty percent of voters in 2018 ranked healthcare as “extremely/very important” and theorized that changes regarding the ACA resulted in a higher number of voters in 2018 (2020). If healthcare is important to constituents, representatives are going to make decisions that gain them more support from their constituents in hope of being re-elected.

In addition to re-election, any candidate for political office has to consider funding even while they are in office. If a candidate does not have personal funds for their own campaign, they must have contributions from organizations or constituents in order to run for office. Short explains that there are four groups in society: “the advantaged, the dependent, the contenders, and the deviants” (Short, 2022, p. 86). A representative is much more likely to listen and advocate for the advantaged and the contenders due to the benefits each group can offer, such as money or political influence. Therefore, the policies and legislation voted on by said representative, will most likely reflect the views of those two groups. For example, if a politician is voting on an issue such as lowering prescription drug prices, although they may agree with the bill, they may vote against lowering drug prices because they would risk angering pharmaceutical companies, who may have a potential impact on the politician’s campaign. On the other hand, if a legislator is running a campaign based on meeting the needs of the underrepresented and minorities, the representative will vote on policies that reflect the needs or wants of the groups classified as dependents or deviants, hoping to gain the support of those individuals.

Working in politics is a tough job because you can never make everyone happy. Politicians have to balance personal beliefs, constituents views, campaign funding, and the future of the country constantly. With every vote, bill proposed, or issue addressed, they risk losing support or gaining favor. Overall, every outcome has to be thoughtful in regards to their future campaign.

References

Short, N. (2022). 
Milstead’s health policy and politics: A nurse’s guide
. Jones & Bartlett Learning.

Courtemanche, C., Marton, J., & Yelowitz, A. (2020). The full impact of the Affordable Care Act on political participation. 
RSF the Russell Sage Foundation Journal of the Social Sciences
, 
6
(2), 179. https://doi.org/10.7758/rsf.2020.6.2.08

 

Reply from

Since the start of the Affordable care act in 2010, there have been many differing views about it. “The ultimate outcome of repealing and replacing the ACA is uncertain. However, it is clear that EHBs will continue to be a target of Republican health-reform attempts” (Willison & Singer, 2017). The cost-benefit for Americans is one that’s up for debate as well. Almost 50 million Americans have health coverage that includes pre-existing health issues and services they didn’t otherwise have access to. There was no suitable replacement for the ACA had it been repealed. For politicians, the fate of their seat lies in the positions they take on with certain topics. Parties are supported on the ideals that align with what the American people want. “Politicians across the country are pushing for laws and regulations that restrict ethical standards of care and impose politics and ideology on evidence-based clinical care” (Taylor et al., 2017).

The ACA has become a part of political strategy. For those who don’t usually vote, it brings them to the polls. “Nearly 50 million Americans have been covered through the Affordable Care Act’s health insurance marketplaces over the last decade. The marketplaces have benefitted nearly 1 in 7 Americans by expanding access to affordable coverage for Americans who could not get health insurance or had previously struggled with the cost” (US Dept. of Treasury, 2024). This appeals to a wide variety of demographics. There are those who want to keep it and/or make the system better. Politicians may not have the interests of the people at the forefront but they can bring about votes by stating that their position is with the people. It is important that nurses remain a part of developing policy that is in the best interest of the healthcare system and its patients.

References

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350.

U.S. Department of the Treasury Releases New Data Showing Nearly 50 Million Americans Have Been Covered Through Affordable Care Act Health Insurance Marketplaces Since 2014. (2024, September 10). U.S. Department of the Treasury. 
https://home.treasury.gov/news/press-releases/jy2567
Links to an external site.

Willison, C. E., & Singer, P. M. (2017). Repealing the Affordable Care Act Essential Health Benefits: Threats and Obstacles. American journal of public health, 107(8), 1225–1226. https://doi.org/10.2105/AJPH.2017.303888

Reply from 

The analysis of the benefits and costs for legislators contemplating the repeal or revision of the Affordable Care Act (ACA) was a critical factor in shaping their decisions. Lawmakers weighed the potential benefit of fulfilling a major campaign promise against the possible political risks associated with such a move. On one side, the potential benefit was significant: successfully repealing the ACA could enhance their standing with voters who were opposed to the legislation and reaffirm their commitment to the promises made during their campaigns. This could strengthen their political capital with their base and potentially solidify their position for future elections (House, 2023). On the other side, the drawbacks were substantial and potentially damaging; a considerable number of voters had gained health insurance coverage through the ACA’s provisions, and overturning the law could lead to increased rates of uninsured individuals and rising premiums. Such outcomes could provoke strong negative reactions from voters who were directly affected, jeopardizing the legislators’ chances of retaining their seats. The situation was further complicated by the Congressional Budget Office’s forecasts, which projected adverse effects from certain repeal proposals, amplifying these concerns. Legislators were acutely aware that taking a stance against the ACA could have far-reaching political consequences, especially if the repeal or modification resulted in decreased coverage and higher costs for their constituents (
Budgetary and Economic Effects of Repealing the Affordable Care Act
, 2015).

In addition to evaluating the direct impacts of policy changes, analyzing voter opinions plays a crucial role in legislative decision-making. Lawmakers are well aware that their political survival and future prospects depend heavily on how well they align with their constituents’ views and preferences (
Carnegie Endowment for International Peace
, n.d.). When public opinion strongly favors or opposes a particular policy, legislators are more likely to adjust their positions to reflect these sentiments in order to maintain electoral support and avoid losing votes. Insights gained from public opinion polls, focus groups, and feedback from advocacy groups provide valuable guidance on what voters want and how they might react to different policies. This information is essential for legislators as they navigate complex policy decisions, enabling them to strategically position themselves in a way that aligns with voter expectations. By carefully balancing their policy goals with the need to maintain favorable public perceptions, lawmakers aim to achieve their legislative objectives while also securing their reelection prospects (Ahrens, 2024).

 

REFERENCES:

Ahrens, L. (2024). Der Einfluss der öffentlichen Meinung auf Wahlverhalten and Policies. 
Zeitschrift Für Politikwissenschaft
, 
34
(1), 77–100. 
https://doi.org/10.1007/s41358-024-00366-w

Budgetary and economic effects of repealing the Affordable Care Act
. (2015, June 19). Congressional Budget Office. 
https://www.cbo.gov/publication/50252

Carnegie Endowment for International Peace
. (n.d.). Carnegie Endowment for International Peace. 
https://carnegieendowment.org/research/2023/09/polarization-democracy-and-political-violence-in-the-united-states-what-the-research-says?lang=en¢er=global

House, W. (2023, February 28). 
FACT SHEET: The Congressional Republican agenda: repealing the Affordable Care Act and slashing Medicaid
. The White House. 
https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/

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Week 3 Discussion

 

The Affordable Care Act (ACA) was intended to increase the utilization of healthcare to minimize illness in the United States (US) population at large. The expectation was that with lower barriers to healthcare access, more people would utilize healthcare, and subsequently, overall as a population our incidence of illness would decrease, thus improving the quality of life.  Proponents of the bill argue that improving life overall would be the result of such a wide sweeping novel policy (Miller, 2017).

 

Opponents of the bill however argued that allowing so many people to get free health care would ultimately overburden the health care system, and increase government expenditures to the point that it would definitely not be sustainable financially, or compatible in any way with our current infrastructure (Miller, 2017).

 

Ultimately, the Affordable Care Act (ACA) was passed and after years of being the law of the land, researchers have been able to analyze its effectiveness and any benefits associated with this act. Overall, it was determined that there were no major changes that took place as a result of the ACA, and of particularly notably interest, that there were no significant improvements from the previous status quo (Levine et al, 2022). There were no real cost savings, or even an increase in utilization by patients overall.  Patient experience and overall access noticeably improved for only the poorest of the poor groups. As the law is currently written it is probably not sustainable in the long term, or even of any true value to the American public as a whole (Levine et al, 2022).

 

At this point, policymakers do not really have anything to gain or lose other than being associated with the law, and their stand on whether it should be upheld or repealed. This law has been so famously associated with the Democratic Party that it is now a major political platform to verify if one is Republican versus Democrat. Voters really do not have much to decide with how the ACA is going to be re-written, but they use this platform to determine who they think would be a good option to help rewrite portions based on their political promises.

 

It was intended to be a step in the direction of universal healthcare for all, but at this point now it seems as though it is really just another issue to divide the American public during election season.

 

 

It appears the trend now is to move away from insurance for all, and towards focusing on specific diseases and conditions. The social determinants of health (SDOH) are something the government is focusing on to improve overall quality of life. SDOH are important to look at and help to improve the condition of people in society by making legislative changes to help people get food and housing.

 

Addressing health access for those who cannot otherwise afford healthcare coverage can overall improve the quality of life for all. Although this is a very socialist mentality, we live in a society and we need to find ways to improve the quality of everyone’s life. The pandemic showed us that we cannot isolate ourselves from others, and those with access to healthcare can catch and spread illness just as rapidly as those without. We cannot isolate ourselves in this new global society very well, so it becomes our responsibility to make sure everyone has at least their basic health needs met with regards to matters than can affect us all, such as contagious diseases, hygiene, and other social needs. Controlling an individual’s blood pressure and cholesterol is not necessarily a priority from a public health standpoint, as that is just the mortality of an individual, and does not necessarily affect those in their community directly.

Improvements in mental health care would be an example of something the public needs. Post pandemic, people have been in a rapid inflation time period, with great social stress. Policy making can improve income, and reduce stress such that people can live happier lives. Happy people vote for the people who changed policies to make them happy. They also do not engage in homicide or other crimes that scourge society. As a result, this would be something that helps improve society and quality of life for all, and can be measured through Quality Adjusted Life Years (QALY) (Brent, 2023).

 

 

 

 

References

 

Brent R. J. (2023). Cost-Benefit Analysis versus Cost-Effectiveness Analysis from a Societal Perspective in Healthcare. International journal of environmental research and public health, 20(5), 4637. 
https://doi.org/10.3390/ijerph20054637
Links to an external site.

Levine, D. M., Chalasani, R., Linder, J. A., & Landon, B. E. (2022). Association of the Patient Protection and Affordable Care Act With Ambulatory Quality, Patient Experience, Utilization, and Cost, 2014-2016. JAMA network open, 5(6), e2218167. 
https://doi.org/10.1001/jamanetworkopen.2022.18167
Links to an external site.

 

Miller, S., & Wherry, L. R. (2017). Health and Access to Care during the First 2 Years of the ACA Medicaid Expansions. 
The New England journal of medicine
, 
376
(10), 947–956. 
https://doi.org/10.1056/NEJMsa1612890
Links to an external site.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning

Taylor, D., Olshansky, E., Fugate-Woods, N., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to position statement: Political interference in sexual and reproductive health research and health professional education. Nursing Outlook, 65(2), 346–350

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Nche Mou Bayong

Sep 11, 2024 6:37pm
| 
Last reply Sep 14, 2024 7:46am

Reply from Nche Mou Bayong

Week Three Discussion

Legislators often weigh their re-election chances when drafting healthcare legislation,

a pattern evident during the repeated efforts to repeal or replace the Affordable Care Act

(ACA). ACA has continued attracting attention to healthcare policy development in the

United States of America since earlier periods and continues to cause controversy and

important law changes. This paper seeks to understand the impact of the decision-maker’s

cost-benefit assessment of the need to gain re-election in efforts to repeal the ACA. It also

explains how legislators’ perceptions of voters’ sentiments influence their choices concerning

national policies such as Medicare and Medicaid, with most legislators’ main priority being

to get re-elected.

Impact of Re-election Concerns on ACA Repeal Efforts

The cost-benefit analysis of re-election is critical in legislators’ decisions concerning

key policy issues, including attempts to repeal or replace the ACA. Thus, depending on

health care reforms, legislators must consider their political preferences and voters’ demands

(Shor, 2018). While endorsing the repeal of ACA could be in the legislator’s party’s interest,

if the outcome is adverse in the eyes of the voters, it equals political self-destruction. In this

respect, defending or enhancing healthcare insurance is a public policy issue and an election-

winning approach for politicians who want to attract voters. The possibility of losing voter

support about key legislative decisions, especially within the districts that benefited from the

ACA and where a significant number of people received insurance coverage, influences the

thought process of legislators and makes them contemplate the ramifications of certain policy

choices.

The ACA significantly expanded healthcare coverage, particularly for lower-income

individuals and those with pre-existing conditions, making healthcare reform a contentious

political issue. Lawmakers who advocated for its repeal were challenged by constituents who

sought these enlargements. For instance, repeal could lead to millions losing health coverage,

increasing healthcare costs for many families. Members of Congress whose constituents rely

heavily on ACA coverage had to factor electoral retribution into their decision-making

process when denying such provisions. Also, they learned that even in the districts that

ideologically would support the repeal, they are concerned about where they will receive their

healthcare once it’s repealed. The ACA, therefore, turned out to be an embodiment of voter-

centric policies and the enormity of legislators’ task in practicing healthcare reform, not to

mention upsetting their base to the extent they may lose their seats.

A prime example of the cost-benefit analysis was seen during the Trump

administration’s efforts to repeal the ACA. When Republican lawmakers offered the

American Health Care Act (AHCA) as a replacement, it was clear that millions of Americans

would lose their health insurance under the new plan (GovTrack, 2017). Due to the AHCA’s

age-based tax credits and failure to extend adequate coverage of pre-existing illnesses, many

United States citizens apprehended the increasing costs of healthcare services. These

consequences were outlined by the CBO, which made it unadvantageous for many

incumbents in Congress to support the bill. Senate Majority Leader Mitch McConnell found

it difficult to secure enough votes as many legislators feared backlash from voters who the

repeal would directly impact. To address these concerns, lawmakers developed the Better

Care Reconciliation Act of 2017, which tries to meet voter expectations and look for ways to

retain voters. This case shows how the desire to retain voter support, especially regarding the

changes in health care coverage, influenced the political decisions surrounding the ACA

repeal and replacement strategies.

Voters’ Views and Legislative Decision-Making

It is evident that Members of Congress, especially the House of Representatives and

the Senate, always consider the existing views of voters because this informs their chances of

being re-elected. The opinion of the masses on some of the important national policies like

Medicare and Medicaid is relevant to how legislators stand. Medicare and Medicaid are

popular federal health insurance programs, and millions of Americans, including older people

and low-income families, are grateful for these programs. Even minor adjustments or

eliminations to these programs can draw the ire of the voters early on, thus making it difficult

for the legislators to consider any unfavorable changes (Willison & Singer, 2017). This is

especially the case in the swing districts where the legislators are in a precarious position of

losing their seats if they associate themselves with destructive policies that seek to eliminate

programs that enjoy support from most citizens.

For instance, while speaking on the altering of Medicaid in the process of

implementing ACA repeal, the Republican lawmakers received backlash owing to the factor

of coverage. ACA Medicaid expansion provided newly insured healthcare for millions of

poor Americans, while it will be hard for a legislator to oppose the program without affecting

their political careers. Some conservatives called for repealing EHBs; the more profound

uncertainty and opposition came from Trump and the full ACA repeal. Due to the issues

involved in the ACA repeal and particularly influences from the Medicaid expansion, which

was popular among the citizens, the lawmakers were hesitant to eliminate the policy that

would be perceived as useful across the country to the voters. This affirms that voters have a

strong influence over the legislative leaders when deciding on policies to support at the

national level.

Conclusion

In conclusion, gains from the cost/benefit analysis of potential re-election grants

impetus to legislators’ choices regarding healthcare policies, such as attempts to repeal and

replace the Affordable Care Act (ACA). Politicians are faced with balancing the party’s

ideology and its effects on the electorate; one reason is that not addressing the voter’s

concerns could jeopardize the party’s seat in the House. The case of attempts to repeal the

ACA and coming up with the American Health Care Act made people realize that even when

politicians support legislation removing people’s health coverage, the idea of losing their

votes from millions of citizens acting in unison made them change their minds. Likewise,

regarding the national policies of Medicare and Medicaid, voter perceptions influence

legislative determinations considerably. Politicians are usually conservative to any changes

that might lead to any limitation on people’s favorite programs, as this will be

counterproductive politically. A legislator’s ultimate goal is to secure another term, and

public opinion plays a significant role in shaping the formulation, discussion, and passage of

healthcare policies in the legislature.

References

Shor, B. (2018). Ideology, Party, and Opinion: Explaining Individual Legislator ACA

Implementation Votes in the States – Boris Shor, 2018. State Politics & Policy

Quarterly. https://journals.sagepub.com/doi/full/10.1177/1532440018786734

GovTrack. (2017). American Health Care Act of 2017 (2017 – H.R. 1628). GovTrack.us.

https://www.govtrack.us/congress/bills/115/hr1628#google_vignette

Willison, C. E., & Singer, P. M. (2017). Repealing the Affordable Care Act Essential Health

Benefits: Threats and Obstacles. American Journal of Public Health, 107(8),

1225–1226. https://doi.org/10.2105/ajph.2017.303888

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Regina Candice Shaw

Sep 11, 2024 6:32pm
| 
Last reply Sep 13, 2024 12:59pm

Reply from Regina Candice Shaw

Regina Candice Shaw

September 11, 2024

NURS 3050

ACA Discussion Paper

For at least a decade, the Grand Old Party (GOP) had advocated repealing and replacing the Patient Protection and Affordable Care Act (ACA). The Affordable Care Act (ACA) was President Barack Obama’s signature healthcare achievement, providing universal healthcare coverage. Notably, this piece of legislation offered health care coverage to as many as 45 million Americans (
Affairs
 (ASPA), 2024). First, the ACA prohibits insurance the option of denying coverage to Americans with preexisting, as well as cost ceilings (Isola & Reddivari, 2024). Thus this regulation helped Americans with cancers, or lupus, for example, to still get the treatment they need and not seeing their self being deterred due to the high cost related to their condition. Additionally, the ACA, allowed children to remain on their parent’s insurance until they turn 26 years old (Isola & Reddivari, 2024). It allows numerous college students, those who cannot get coverage from their employer to remain covered and still be able to seek medical coverage. Furthermore, the ACA also promotes employer discounts that offer free preventive care, and wellness programs in the company (Isola & Reddivari, 2024). Preventive care is very important as it allows us to catch diseases at their early stage or in the example of diabetes, we can prevent prediabetics from becoming diabetics. Finally, the ACA revolutionized reimbursement programs based on outcome by obligating the hospital to coordinate follow-up care. Having those regulations will force hospitals to implement plans of care to reduce the rate of readmission. They will allocate more funds for staff education therefore will lead to better patient education.

The principal criticism made by the opposition is the cost of the program which can potentially bankrupt the country. To address the affordability part of the program the ACA had a tax penalty at the end of the year for taxpayers if they did not have healthcare coverage (Isola & Reddivari, 2024). Amid the upcoming presidential election in November 2024, the Trump Administration still struggles to come up with a coherent plan (Weixel, 2024). In addition, a politician’s main assignment is to get elected or reelected and shape their campaign messaging based on traditional poling. If the Republicans have their way and repeal the ACA approximately 29.8 million people would lose their health insurance (EPI, n.d.). Ironically those who would lose coverage would be residents residing in states comprised of predominantly Republican-controlled legislatures (e.g. Alaska, Florida, Kentucky, Louisiana, Montana, West Virginia) or battleground states (e.g. Arizona, Nevada, North Carolina). Furthermore, repealing the measure would place a further burden on private health insurance providers and ultimately would lead to less purchasing power for seniors on groceries (EPI). This reduction in economic stimulus would result in fewer jobs in the economy (EPI). Moreover, John E. McDonough (2022) finds that there are indications from some Republican senators who have conceited vis-à-vis their failed attempts to repeal the ACA (POLITICO, n.d.). For example, Senator Ron Johnson (R-Wisconsin) has yielded to the changing tides of contemporary healthcare politics by backtracking on the issue shortly after calling for its repeal. Additionally, Senator Susan Collins (R-Maine) quipped that “The Affordable Care Act is now embedded in our health care system” (McDonough). Even stark conservative Senator Chuck Grassley (R-Iowa) stated that he would vote down any repeal effort. In conclusion, one school of thought holds that in the end, politicians are policy entrepreneurs who constantly reposition themselves on public policy issues to garner electoral support while simultaneously deterring challenges from either their left or their right. Ergo, we should expect them to change course on ACA just like any other laws that have become widely popular.

 

Reference

Affairs (ASPA), A. S. for P. (2024, March 22). 
In Celebration of 10 Years of ACA Marketplaces, the Biden-Harris Administration Releases Historic Enrollment Data
 [News Release]. https://www.hhs.gov/about/news/2024/03/22/celebration-10-years-aca-marketplaces-biden-harris-administration-releases-historic-enrollment-data.html

How would repealing the Affordable Care Act affect health care and jobs in your state?
 (n.d.). Economic Policy Institute. Retrieved September 11, 2024, from https://www.epi.org/aca-obamacare-repeal-impact/

Isola, S., & Reddivari, A. K. R. (2024). Affordable Care Act. In 
StatPearls
. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK549767/

Republicans Have Stopped Trying to Kill Obamacare. Here’s What They’re Planning Instead. – POLITICO
. (n.d.). Retrieved September 11, 2024, from https://www.politico.com/news/magazine/2022/04/26/gop-obamacare-aca-health-care-00027585

Weixel, N. (2024, September 11). Trump on ObamaCare repeal: ‘I have concepts of a plan’ [Text]. 
The Hill
. https://thehill.com/policy/healthcare/4873254-trump-debate-obamacare-replacement/

 

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Jasmine Daniels
 (She/Her)

Sep 11, 2024 6:28pm
| 
Last reply Sep 14, 2024 4:58pm

Reply from Jasmine Daniels

Since its introduction in 2010, efforts have been made to repeal and replace the Affordable Care Act (McIntyre & Song, 2019).  Much of former President Trump’s campaign was centered around his promise to repeal the act. While unsuccessful in completely repealing and replacing the ACA, the individual mandate penalty was reduced from $695 per adult to $0 (Short, 2022).  The repeal bill did not implode the ACA as it initially intended.

Why wasn’t the repeal and replacement successful?

In the case of the ACA, many people gained access to quality healthcare who were not previously covered (i.e., people with preexisting conditions or people previously ineligible for Medicaid who benefitted from the expansion of Medicaid) (Short, 2022).   Due to these health equity advantages of the ACA, it was much more difficult to overturn the law, as more people would incur a perceived loss.  Midterm elections in 2018 showed an uptick in public interest in healthcare policy (McIntyre & Song, 2019).  This is not a coincidence.  With healthcare reform leading the news cycle from the mid-2010s to the present day, I would venture to say that more Americans are invested in healthcare reform and how it impacts them now more than ever.

Legislators who represent jurisdictions that lean towards benefitting more than not have noted this trend and voted to retain the ACA (Oberlander, 2020).

 

 

References

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade. PLoS Medicine, 16(2). 
https://doi.org/10.1371/journal.pmed.1002752
Links to an external site.

Oberlander, J. (2020). The Ten Years’ War: Politics, Partisanship, And The ACA: An exploration of why the Affordable Care Act has been so divisive despite the law’s considerable accomplishments. 
Health Affairs
, 
39
(3), 471-478.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed., pp. 61-69). Jones & Bartlett Learning.

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Domonique Yates

Sep 11, 2024 5pm
| 
Last reply Sep 14, 2024 9:21am

Reply from Domonique Yates

Hello colleagues,

Cost-benefit analysis (CBA) in the federal rulemaking process is the systematic examination, estimation, and comparison of the potential economic costs and benefits resulting from the promulgation of a new rule (Perkins, 2017).  The analysis for the Affordable Care Act (ACA) plays a substantial role in the decision making process when legislators are coming up for reelection especially in view of the fact that healthcare is a crucial issue for Americans. Generally, elected legislators normally want to make a good policy, make a difference or be a part of good government. Legislators use cost-benefit analysis of voters input to influence the decisions on national policies. The leaders are elected by the public and consequently have a responsibility to their constituents.  They must make sure their decisions reflect the communication, surveys and demand of the people.

Medicare and Medicaid are two government programs that provide medical and other health-related services to specific individuals in the United States. Medicaid is a social Welfare program, whereas Medicare is a social insurance program (Galan, 2024). Repealing these health systems is complex and legislators’ roles are vital in forming their policies. Without an inclusive replacement ACA plan there would have serious consequences for American families. The center of attention should be on lowering healthcare costs, improving quality and making access easier to find and understand coverage choices (Rosato, 2017).

Reference

Galan, N. (May 28,2024). Medical NewsToday. What is the difference bw=etween Medicare and Medicaid? Retrieved from 
https://www.medicalnewstoday.com/articles/what-are-medicare-and-medicaid
Links to an external site.

Perkins, D. W. (May 11, 2017). Congressional Research service. Cost-Benefit Analysis and Financial Regulator Rulemaking. Retrieved from 
https://crsreports.congress.gov
Links to an external site.

Rosato, D. (February 17, 2017). Consumer Reports. Repair, Replace, Repeal: What’s Really Happening With the ACA. Retrieved from 
https://www.consumerreports.org/healthcare-reform/repair-replace-repeal-whats-really-happening-with-the-aca/
Links to an external site.

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Nazanin Kalhor

Sep 11, 2024 4:48pm
| 
Last reply Sep 12, 2024 6:01am

Reply from Nazanin Kalhor

Main Post

The effort to repeal or replace the Affordable Care Act (ACA) offers an insightful example of how cost-benefit analysis, viewed through the lens of reelection concerns, impacts legislative decision-making. Legislators are acutely aware that their political survival is directly tied to how well their decisions align with the views of their constituents. While Republicans, particularly those from conservative districts, saw opposition to the ACA as a means to fulfill campaign promises and appeal to their voter base, the repeal attempts posed significant risks. Many constituents benefitted from the ACA, gaining access to affordable healthcare and protections for preexisting conditions, leading to potential backlash against lawmakers who supported repeal efforts (Blendon et al., 2017).

From a cost-benefit perspective, lawmakers supporting the ACA repeal had to weigh the benefit of maintaining party loyalty and satisfying a core conservative base against the potential electoral cost of alienating voters who had gained coverage. The failed attempts to repeal the ACA reflected this delicate balance; although Republicans in conservative districts may have benefited from supporting repeal, others in swing districts likely faced a different calculus. Constituents who experienced positive outcomes from the ACA, such as Medicaid expansion, would likely oppose efforts to take away these benefits, making reelection harder for those lawmakers (Oberlander, 2017).

The broader decision-making process for national policies, such as those impacting Medicare or Medicaid, similarly involves careful analysis of voter preferences. Legislative leaders are keenly aware that older adults, a group with high voter turnout, rely heavily on Medicare and are sensitive to any changes that threaten the program. Similarly, Medicaid has become essential for many low-income individuals and families, making cuts to these programs politically risky. Legislators must balance fiscal conservatism with the electoral risk of cutting healthcare benefits for a large segment of the population. As Lambrew and Pollack (2018) discuss, understanding voter sentiment on these policies is crucial for legislative leaders as they position themselves and their party on issues like healthcare reform. Voters’ reliance on Medicare and Medicaid for their healthcare needs forces legislators to prioritize policies that protect these programs, often viewing proposals for cuts as politically untenable.

In conclusion, legislators’ decisions regarding healthcare policy are heavily influenced by the potential impact on reelection. The ACA repeal efforts, Medicare, and Medicaid policies demonstrate the balancing act lawmakers must perform in aligning with party goals while keeping voter interests at the forefront. Failure to strike this balance can lead to electoral consequences, making voter views a crucial factor in the legislative decision-making process.

References

Blendon, R. J., Benson, J. M., & McMurtry, C. L. (2017). Understanding the failure of the Republican effort to repeal and replace Obamacare: Where next? 
The New England Journal of Medicine
, 377(10), 901-903. 
https://doi.org/10.1056/NEJMp1709848

Oberlander, J. (2017). The art of repeal: Republicans, ACA repeal, and the policy process. 
Journal of Health Politics, Policy and Law
, 42(5), 803-826. 
https://doi.org/10.1215/03616878-4193609

Lambrew, J. M., & Pollack, H. A. (2018). Lessons from the Affordable Care Act for a new administration. 
Journal of Health Politics, Policy and Law
, 43(5), 771-781. 
https://doi.org/10.1215/03616878-6987892

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Pawandeep Kaur Dhaliwal

Sep 11, 2024 4:20pm
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Last reply Sep 13, 2024 9:28pm

Reply from Pawandeep Kaur Dhaliwal

Main Post

Politics and the Patient Protection and Affordable Care Act

The intersection of healthcare policy and electoral politics significantly shapes legislative decisions, particularly regarding the Affordable Care Act (ACA) and government programs like Medicare and Medicaid. As healthcare reform remains a central issue for voters, legislators must carefully balance the demands of their political parties with the preferences of their constituents.

The cost-benefit analysis in terms of legislators being re-elected has significantly impacted efforts to repeal or replace the Affordable Care Act (ACA), and for many legislators, their primary objective is to ensure they remain in office, their decisions often reflecting the opinions and priorities of their voting base. In the case of the ACA, legislators had to weigh the potential backlash from millions of Americans who benefitted from the Act against the political pressure from party leaders and interest groups pushing for its repeal. The ACA has provided insurance coverage to millions of previously uninsured individuals, expanded Medicaid, and offered protections for people with pre-existing conditions. Repealing the ACA would likely lead to higher healthcare costs and a loss of coverage for millions, which could result in substantial voter dissatisfaction, particularly among vulnerable populations (The White House, 2023). Therefore, any legislator who supports the repeal of the ACA risks alienating a large portion of their constituents, which could directly jeopardize their chances of re-election.

Moreover, the legislative push to repeal the ACA often faced strong opposition not only from Democrats but also from moderate Republicans who recognized the political risks. Many voters, especially those who directly benefitted from the ACA, have a personal stake in healthcare policy. When voters feel threatened by policy changes that could harm their health and financial stability, they are more likely to mobilize against legislators supporting such changes. This is evident in the backlash seen in 2017 when the Republican-led Congress attempted to dismantle the ACA (Holahan, 2024). Public protests, town hall meetings, and widespread media coverage highlighted the potential human costs of the repeal, which contributed to the failure of those legislative efforts.

When analyzing voter views on national policies, legislative leaders are acutely aware of the electoral consequences tied to decisions on programs like Medicare and Medicaid. Medicare and Medicaid are essential programs for millions of Americans, particularly older adults, individuals with disabilities, and low-income families (Hanlon et al., 2020). Any proposed cuts or restrictions to these programs are often met with strong resistance from the public, as these programs are seen as lifelines for accessing affordable healthcare. Legislators understand that even discussing cuts to Medicare or Medicaid can trigger significant backlash from the electorate, particularly older voters who consistently turn out to vote in large numbers. Consequently, legislative leaders may choose to either maintain the status quo or propose modest reforms that do not drastically affect these programs in order to avoid voter dissatisfaction (Holahan, 2024). Protecting these programs often becomes a priority for legislators who seek to secure votes from these key constituencies.

Furthermore, legislative leaders must consider how voters view the role of government in healthcare. Public opinion polls consistently show that a significant portion of Americans believe the government should play a more active role in ensuring access to affordable healthcare (Holahan, 2024). This sentiment can influence the positioning of national policies, as leaders who want to maintain or gain voter support are more likely to propose policies that align with these views. For example, despite calls from some factions to reduce government spending on healthcare, legislative leaders may be cautious about recommending drastic cuts to Medicaid or Medicare, knowing that such actions could alienate a broad base of voters who depend on these programs.

Conclusion

The number one job of a legislator is to be re-elected, and the cost-benefit analysis surrounding healthcare policy decisions, particularly with regard to the ACA, Medicare, and Medicaid, reflects this reality. Legislators must balance the pressures from their party and interest groups with the very real concerns of their constituents. As public opinion on healthcare evolves, legislative leaders must remain attuned to voter preferences, understanding that decisions affecting access to healthcare can have profound implications for their political survival.

 

 

References

Hanlon, S., Vinelli, A., & Weller, C. (2020). 
Repealing the ACA Would Put Millions at Risk While Giving Big Tax Cuts to the Very Wealthy
. Center for American Progress. 
https://www.americanprogress.org/article/repealing-aca-put-millions-risk-giving-big-tax-cuts-wealthy/
Links to an external site.

Holahan, J. (2024). 
Repeal of the Affordable Care Act Potential Effects on Coverage, Government Spending, and Provider Revenue
. 
https://www.urban.org/sites/default/files/2024-06/Repeal%20of%20the%20Affordable%20Care%20Act.pdf
Links to an external site.

The White House. (2023). 
FACT SHEET: The Congressional Republican Agenda: Repealing the Affordable Care Act and Slashing Medicaid
. The White House. 
https://www.whitehouse.gov/briefing-room/statements-releases/2023/02/28/fact-sheet-the-congressional-republican-agenda-repealing-the-affordable-care-act-and-slashing-medicaid/
Links to an external site.

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Stella Chinelo Ukakogu

Sep 11, 2024 11:03am
| 
Last reply Sep 12, 2024 5:59am

Reply from Stella Chinelo Ukakogu

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Cost-Benefit Analysis and the ACA Repeal/Replace Efforts

The partial or complete abrogation of the ACA shows how electoral expectancies distort legislators’ cost-benefit calculations. Political actors must consider the effects of policies concerning their position in the legislature. In essence, with respect to the ACA, legislators were capable of recognizing the implications of possible change on their constituents and, ultimately, their own preservation in office.

The ACA was signed in 2010 to become a law. After being signed, it brought many reforms into the U. S health system. The reforms included the provision of health insurance and the protection of people with the pre-existing health conditions. Efforts to defund or dismantle ACA included bills to change Medicaid expansion or these essential health benefits as well as the initiatives that the public opposed. This opposition forced many legislators to change their mind regarding such measures given the possibility of losing the voters’ support and therefore the risk of not being re-elected into the office.

This is well evident from the 2017 campaigns to repeal the bills as well as various strategies mentioned above. The political implication of implementing repeal proposals made legislators also aware of the fact that passing such measures could cost them, hence making some of them adjust their stand or become outright opponents of repeal (Campbell, 2020).

Voter Views and Legislative Decision-Making

In their bid to retain power, legislators tend to focus on issues that are of concern to the voters in formulation of national policies such as Medicare and Medicaid. Voter perception and their choices of policy determine the legislation to be passed thus the need to consider the voter opinions. It is quite evident that, in an attempt to perpetuate their term in office, legislators make policies that conform to the systems’ public opinion.

Both Medicare and Medicaid are essential programs enjoying high voters’ support mainly because of the population such as senior citizens and the poor. Any legislative initiative, which may be adverse to these programs, is treated with a lot of care in order not to offend the voters (Baker, 2023). When considering voters’ interests, legislators do not only satisfy obtained requests but also increase their chances in getting re-elected (Greenberg, 2023).

References

Baker, C. (2023). 
Public Opinion and Congressional Decision-Making on Medicare and Medicaid
. Journal of Political Analysis, 14(2), 45-60.

Campbell, A. L. (2020). The Affordable Care Act and mass policy feedbacks. 
Journal of Health Politics, Policy and Law
, 
45
(4), 567-580.

Greenberg, D. (2023). 
The Influence of Voter Preferences on National Policy Formation
. American Political Science Review, 117(3), 789-803.

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Lucia Almeida

Sep 11, 2024 10:17am
| 
Last reply Sep 12, 2024 9:40pm

Reply from Lucia Almeida

Main Post

Politics and the Patient Protection and Affordable Care Act

Reelection is the primary concern of legislators, which significantly influences their actions, especially when it comes to significant bills such as the ACA. This was evident in the attempts to repeal or replace the ACA, where legislators had to satisfy voter bases while at the same time meeting the requirements of the society. A cost-benefit analysis compares the costs of losing the voters’ support with the benefits of supporting or opposing healthcare reform. Those lawmakers who aimed to repeal the ACA might have focused on the dissatisfaction of the conservative voters who saw the policy as an infringement of governmental intervention (Franz et al., 2020). On the other hand, those who were against the repeal received pressure from their voters who could benefit from the new healthcare plans. This dynamic meant that the decision to either support or reject the ACA was not based on the merits of the policy but was significantly informed by the potential electoral costs associated with voters’ preferences.

Furthermore, voters’ perceptions about health significantly shape the laws concerning health, especially Medicare and Medicaid. The legislators are fully aware of the electoral power of elderly and low-income people, and, therefore, they have to consider these constituencies’ concerns when introducing changes to these programs (Campbell & Shore-Sheppard, 2020). For instance, any policy that would involve the reduction of funding for Medicare or Medicaid is likely to be met with resistance from these groups, which would mean that the politicians would stand to lose their votes from the said groups. Thus, legislative leaders must analyze voters’ attitudes to realize that many policies regulating such vital services could impact the election. Politicians need to ensure that any changes are packaged in a manner that will not attract opposition while at the same time being politically feasible.

However, the relationship between voters’ opinions and policies is not only applicable to the ACA. Members of Congress constantly weigh the implications of their actions on healthcare policies on their constituents, especially in marginal districts where the difference between an incumbent and a challenger is very slim. Thus, by identifying voters’ preferences on legislative issues, legislators seek to maintain voters’ electoral support in the future (Ju et al., 2023). This alignment, however, can result in policies geared toward the political gains of the parties in power at the expense of society, as seen with the ACA. Finally, the cost-benefit analysis in the context of healthcare legislation is not only the financial cost but also the political cost of remaining in office.

References

Campbell, A. L., & Shore-Sheppard, L. (2020). The social, political, and economic effects of the Affordable Care Act: Introduction to the issue. 
RSF: The Russell Sage Foundation Journal of the Social Sciences
, 
6
(2), 1–40. 
https://doi.org/10.7758/rsf.2020.6.2.01
Links to an external site.

Franz, B., N. Milner, A., & Brown, R. K. (2020). Opposition to the Affordable Care Act has Little to do with Health Care. 
Race and Social Problems
. 
https://doi.org/10.1007/s12552-020-09306-z
Links to an external site.

Ju Yeon Park. (2023). Electoral rewards for political grandstanding. 
Proceedings of the National Academy of Sciences of the United States of America
, 
120
(17). 
https://doi.org/10.1073/pnas.2214697120
Links to an external site.

 

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Tiffany Peron

Sep 11, 2024 9:52am
| 
Last reply Sep 14, 2024 2:05pm

Reply from Tiffany Peron

Main Post

Tiffany Peron

Week 3 Discussion

 

When lawmakers think about repealing or replacing policies such as the Affordable Care Act (ACA) their main focus is often on their chances of being re-elected. “Nearly nine years after its passage, the Affordable Care Act (ACA) remains at the forefront of public policy debate” (McIntyre, A., 2019, February 26). Political leaders will weigh the potential political risks and the rewards of each decision. If they decide to change or eliminate the ACA it could potentially upset many voters who have this as their health care coverage. Many lawmakers might be concerned about the loss of votes this could cause. According to Brooks, 2019 lawmakers must balance keeping their voting base and campaign promises especially when looking at reelection to repeal campaigns.

Reelection Concerns:

The Cost:
 Legislators must weigh the potential political costs of repealing or significantly altering the ACA. For instance, repealing the ACA could mean disrupting millions of Americans’ health coverage which could cause anger in those who benefit from the ACA, including those with pre-existing conditions, low-income individuals, and young adults on their family’s insurance plan.

Benefit of Reelection:
 Legislators may face pressure from their political party leaders who advocate for repeal, viewing it as a significant achievement. If this group is large and influential enough, supporting a repeal might be beneficial for securing campaign support as well as endorsements for that politician.

   Voter Views and Legislation Decisions

Influence of Voters:

Policy Decisions:
 Legislators closely monitor voter’s feelings and preferences, especially on major issues like Medicare and Medicaid. If voters show a strong support for these programs, legislators may be more inclined to protect or expand them rather than cut funding or make significant changes.

Polling and Feedback:
 Regular polling, town halls, and constituent feedback are crucial in shaping legislative strategies. If polls show a time for change legislators will work on making a change for their party.

Strategic Positioning:

Campaign Messaging:
 How legislators show themselves on national policies can be strategic. If they emphasize their commitment to preserving Medicare benefits or improving Medicaid services in their campaign messaging it could attract and retain voters who prioritize these issues.

Legislative Actions:
 Legislators might also engage in symbolic actions or push for incremental reforms that line up with their voter preferences. This approach allows them to demonstrate responsiveness to people’s concerns while navigating the complex realities of national policy-making.

In summary, health care is still a top priority among voters, legislators must prioritize actions that will align with their voter’s needs (Johnson, 2024). A legislator’s primary goal of reelection drives their decisions on high-stakes issues like healthcare. According to Short, N.M., 2022, a winning election can be very costly and legislators face tough reelection campaigns. With this they must develop the public’s trust to ensure the popular vote. The potential political costs and benefits of repealing or replacing the ACA, or altering Medicare and Medicaid, are central to their decision-making processes. Legislators need to balance the demands of their political base, party leadership, and the broader public sentiment to secure their positions and maintain their electoral support. Their actions are often a reflection of extensive cost-benefit analyses, aiming to align with voter preferences and mitigate risks to their reelection prospects.

 

References

Brooks, T. (2019). Political cost-benefit analysis and healthcare reform. 
Journal of Policy Analysis
, 48(2),           45-62.

Johnson, R. (2024). Electoral Pressures and Health Policy: Understanding Legislative         Decisions.
 Journal of Political Analysis, 
45(2), 123–135.

McIntyre, A., & Song, Z. (2019, February 26). 
The US Affordable Care Act: Reflections and directions at               the close of a decade
. PLoS medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6390990/

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones   & 
Bartlett Learning.

       Chapter 5, “Policy Enactment: Legislation and Politics” (pp. 97–117) 

       Chapter 10, “Financing Health Care” (pp. 239–249)

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Alicia Prentler

Sep 11, 2024 9:31am
| 
Last reply Sep 12, 2024 6:28am

Reply from Alicia Prentler

Initial Discussion Post:

The saying, “as clear as mud” has never been so applicable then when it comes to my understanding of politics. I personally struggle with this, as I cannot fathom agreeing or disagreeing with a topic purely based on what my “political affiliation” tells me to. When discussing cost benefit analysis, one must first understand what this means. A cost benefit analysis is when a company or person evaluates whether the cost or cutting of a specific item or in this case agenda item and compare this change in the economy to the benefit of the company or country (Stobierski, T., 2019). In this definition the cost is referring to monies, however, when we are talking about politics and agenda the cost benefit analysis is measured in votes. Participating in elections is expensive, candidate participation can be funded by special interest groups or lobbyists (Short, 2022; pp 108). These funded parties expect a follow through on bills, and legislation that will benefit their interests, hence this leads many to believe that election seats are bought not earned, (Short, 2022; pp108).

When discussing something such as big and recent as the Affordable Care Act, one can say that it was met with substantial backlash by the Republican Party. During the Trump administration there were several items that were passed in order to reduce the efficacy of the Affordable Care Act (ACA), with no re-establishing of the ACA criteria under the Biden Administration due to Senate Minority Leader Mitch McConnell (R) blocking most attempts (Short, 2022; pp 21). When we have special interest groups controlling how our politicians vote instead of our popular vote, we get agenda items that are bought, and when one accompanies this with cost of participating in elections, a legislator is going to take a stand with their special interest group not necessarily their constituents. Looking at the ACA, if I am a republican legislator running for office, but I have a special interest group who is offering my campaign $100,000 but I only get this money if I vote to remove the mandated fee associated with not having insurance under the ACA, I have now participated in “chipping away the ACA,” (Short, 2022; pp21), though this may not be the want of my constituents. Having this differential makes it my job as the politician to paint a picture that attempts to make my constituents agree with my special interest group who is funding my campaign.

 

 

Resources:

Short, N.M., (2022). Milstead’s Health Policy and Politics A Nurse’s Guide (7th ed.) Jones and Bartlett Learning.

Stobierski, Tim. (2019). How to do a cost benefit analysis and why it’s important. Harvard Business School. Retrieved on September 10th, 2024. https://online.hbs.edu/blog/post/cost-benefit-analysis

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Lovepreet Kaur
 (She/Her)

Sep 11, 2024 12:04am
| 
Last reply Sep 13, 2024 10:16pm

Reply from Lovepreet Kaur

Main post

The analysis of the costs and benefits affected 
the 
legislative process of 
repealing or replacing
 the ACA mainly due to the political concern for 
reelection
. First, lawmakers balanced the political risk of losing 
the 
support of the voters who 
had previously been supported by the ACA, such as
having pre-existing conditions or affordable coverage through the expansion of Medicaid
 (
Courtemanche
 et al., 2021). 
Second, they looked at the cost 
to
 their constituents
,
 pointing out that repealing the ACA could result in increased insurance and lower coverage, which would not help them in the polls. Third, legislators evaluated the 
proposed alternatives’ effectiveness, while some saw them as less persuasive in terms of the benefits 
compared to the ACA. Fourth, threats of advocacy group backlash 
and
 backlash from the constituents who supported the ACA put additional pressure, thus making the political risk of repeal too risky for many
 
(Courtemanche et al., 2021). Therefore, constraints that stem from the need to gain votes and do so without encountering public opposition significantly influenced the legislative approach towards ACA.

It is seen that legislative leaders tend to take the voters’ perceptions 
into account when
 recommending policies, as their 
primary
 focus is on power retention. 
Suppose many constituents belong to the category that receives social services such as Medicare or Medicaid (
Butler & Vis,
 
2023). 
In that case,
 the legislators 
will
 fight 
for
 the programs to be preserved or improved 
to
 retain the voters’ support. On the other hand, lobbying for measures that are potential risks to such programs may draw 
the public’s anger
, thus reducing the possibility of a legislator being 
reelected
. For example, 
suppose research indicates that voters are against a reduction in Medicaid 
(Butler & Vis, 2023)
. In that case, politicians will refrain from proposing such changes or look for other ways of handling the problem not to anger the electorate
. Also, the leaders might support policies that the constituents approve of, be it the accessibility to health or the 
program’s efficiency,
to enhance their popularity and authority
 (
Baum
 et al., 2022). 
Thus, bearing policy choices in tune with voters’ preferences, legislators 
also increase their chances of being re-elected and having further backing from their constituents.

References

Baum, F., Townsend, B., Fisher, M., Browne-Yung, K., Freeman, T., Ziersch, A., … & Friel, S. (2022). Creating political will for action on health equity: practical lessons for public health policy actors. 
International Journal of Health Policy and Management
, 
11
(7), 947.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9808180/
Links to an external site.

Butler, C., & Vis, B. (2023). Heuristics and policy responsiveness: a research agenda. 
European Political Science
, 
22
(2), 202–227. 
https://doi.org/10.1057/s41304-022-00394-6
Links to an external site.

Courtemanche, C., Fazlul, I., Marton, J., 
Ukert
, B., 
Yelowitz
, A., & Zapata, D. (2021). The Affordable Care Act’s Coverage Impacts in the Trump Era. 
Inquiry :
 a journal of medical care organization, provision and financing
, 
58
, 469580211042973. 
https://doi.org/10.1177/00469580211042973
Links to an external site.

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Cody Ross Newton

Sep 10, 2024 6:34pm
| 
Last reply Sep 12, 2024 2:37pm

Reply from Cody Ross Newton

Main Post

In the context of efforts to repeal or replace the Affordable Care Act (ACA), the cost-benefit analysis for legislators revolves heavily around their chances of reelection. When trying to repeal or replace the Affordable Care Act (ACA), legislators had to think about how their decision would impact their constituents. Their main goal is to stay in office, so they had to weigh the benefits and risks of their choices. If a lot of people in their district liked the ACA, trying to get rid of it could make them lose votes. On the other hand, if the people in their district didn’t like the ACA, supporting a repeal might help them get re-elected. Voters’ opinions play a huge role in shaping what lawmakers do. If voters really like certain parts of the ACA, like protections for pre-existing conditions, lawmakers might avoid fully getting rid of it. Instead, they might suggest smaller changes so they don’t upset voters too much. A finding in an issue brief of The Commonwealth Fund found that if a full repeal had gone through there would have been
 “a $140 billion loss in federal funding for health care in 2019, leading to the loss of 2.6 million jobs (mostly in the private sector) that year across all states” (Ku et al., 2017). 
Party leaders also guide lawmakers based on what voters want. If polls show that most people like or dislike the ACA, leaders will recommend policies that match what voters want. They know that pushing for something voters don’t like could hurt their chances in future elections. Assessing the future of the ACA requires factoring in the COVID-19 pandemic. As the pandemic continued, the demand for health insurance increased, affecting not only those who were uninsured before, but also individuals who lost their employer-provided insurance due to job losses. Estimates suggested that between 12 to 35 million people lost workplace coverage because of layoffs during the pandemic. (Neiman et al., 2021). Legislators and lawmakers have to take these kinds of things into consideration when thinking about their constituents and how the ACA affects their lives. According to an article from the Harvard School of Public Health, “the most significant change since the implementation of the ACA has not been the increase in public approval of the ACA, which has gone from 44% in 2012 to 49% at the time of the recent debate in 2017, but rather the rise in overall support for universal coverage” (2017). The Affordable Care Act will likely be a debate issue between parties for years to come which means it will be at the forefront of most politicians platforms that are running reelection campaigns.

References

Ku, L., Steinmetz, E., Brantley, E., & Bruen, B. (2017). Repealing federal health reform: Economic and employment consequences for states. 
The Commonwealth Fund.

https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_jan_ku_aca_repeal_job_loss_1924_ku_repealing_federal_hlt_reform_ib.pdf

Neiman, P. U., Tsai, T. C., Bergmark, R. W., Ibrahim, A., Nathan, H., & Scott, J. W. (2021). The Affordable Care Act at 10 years: Evaluating the evidence and navigating an uncertain future. 
Journal of Surgical Research
, 
263
, 102–109. https://doi.org/10.1016/j.jss.2020.12.056

Poll analysis finds failure of Senate ACA replacement bill related to huge divisions among republicans and between parties. (2017). 
Harvard School of Public Health
. https://www.hsph.harvard.edu/news/press-releases/poll-aca-political-divisions/

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Rebecca Carico

Sep 10, 2024 3:30pm
| 
Last reply Sep 12, 2024 6:43pm

Reply from Rebecca Carico

Cost-benefit analysis has been a requirement in legislation since the 1970s. It involves monetizing and quantifying the expected costs and benefits of regulations that may have a heavy impact on the economy (Carey, 2022). Cost-benefit analyses weigh the pros and cons of proposed regulations to ensure that the benefit will be worth the risk and ensures that resources are directed to initiatives that yield the highest returns (Nguyen et al., 2024). The Affordable Care Act (ACA) was put in place by Former President Obama in 2010, which mandated every U.S. resident to carry a health insurance plan or pay a penalty for not being insured. The penalty for being uninsured was $695 per adult, $347 per child under 18, and the maximum penalty was $2,085 or 2.5% of household income, whichever was greater (Short, 2022). These penalties were paid when taxes were filed, and citizens had the option of paying out of pocket or having the penalty deducted from their tax returns, if applicable. Legislation reduced the penalty to $0 in December 2017, while keeping the lower-cost and subsidized healthcare plans an option for those who qualified.

When legislators are seeking reelection, their biggest concern is “how can I get the most votes to secure my seat?”. In 2017, the U.S. House of Representatives passed the American Health Care Act (ACHA) which partially repealed and replaced the ACA. However, the ACA is still very much active and is set to expire in 2025 unless it is voted to be renewed. How the ACA, Medicaid expansion, and Medicare changes have impacted the lives of voters combined with the views of the specific candidate(s) seeking reelection will have a heavy hand in reelection status and overall votes. While legislation has met and debated for hours upon hours to come to a decision on whether to repeal and replace the ACA all together, I feel as though many of their intentions could arguably be biased and be geared more toward what electoral college voters and heavy-hitter sponsors want instead of what is best for the U.S. overall. Short (2022) mentions that it is arguable that legislators can be bought via votes, which is unfortunate for those affected by these great decisions.

I think that the cost-benefit analysis for legislators being reelected heavily impacted the efforts that were made to repeal and/or replace the ACA due to outside influencers that could make or break a bill, in a financially aspect. Many sponsors and electoral college voters have serious influence when it comes to financial support and resources. Most issues that legislation faces when voting on a bill ultimately come down to money and resources, both of which the high rolling voters and heavy-hitting sponsors have influence on. The voters’ views on repealing and replacing the ACA and the Medicaid expansion affects decisions made by legislative leaders simply because legislative leaders depend on these voters for reelection. If the voters do not agree with the policies that this leader has put in place, then voters will find another leader that better suits them according to their own beliefs and needs for their families.

For instance, when the Medicaid expansion was first recommended within the ACA, it was projected that the expansion would be associated with an increase in health disparities and outcomes, would provide easier access to health care for low income families, and also would increase the revenue of hospitals and specialties overall due to the influx of people seeking care that are able to provide payment (Tarazi, 2020). Voters’ views play a large role in how legislative leaders recommend policies because voters are the reason these legislators are in office. If these policies are negatively affecting most voters, then that will heavily impact the number of votes that specific leader could get next go around. I have learned that by being a legislative leader, you have to be somewhat of a people pleaser. Which is unfortunate, because people pleasing doesn’t always produce positive change. Nurses can play a large role in influencing policies on a legislative level because we are the frontline in health care. As nurses, we bring an excellent and unique perspective for policy deliberations because of our training, ethics, values, and experiences (Short, 2022). We see the positives and the negatives firsthand regarding how the changes affect our patients, such as the Medicaid expansion and the passing of the ACHA. We are our patients’ biggest advocates, which is why we play a vital role in influencing policies and bringing positive change.

References

Carey, M. (2022, March 8). 
Cost-Benefit Analysis in Federal Agency Rulemaking
. CRS Reports. https://www.adobe.com/acrobat/pdf-viewer-extension.html

Nguyen KH, Comans T, Nguyen TT, Simpson D, Woods L, Wright C, Green D, McNeil K, & Sullivan C. (2024). Cashing in: cost-benefit analysis framework for digital hospitals. 
BMC Health Services Research
, 
24
(1), 694. 
https://doi.org/10.1186/s12913-024-11132-7
Links to an external site.

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
 (7th ed.). Jones & Bartlett Learning.

Tarazi, W. W. (2020). Associations between Medicaid expansion and nurse staffing ratios and hospital readmissions. 
Health Services Research
, 
55
(3), 375–382. https://doi.org/10.1111/1475-6773.13273

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Irynne Grace Canencia Obmerga

Sep 10, 2024 8:55am
| 
Last reply Sep 12, 2024 1:15pm

Reply from Irynne Grace Canencia Obmerga

Main Post:

Government exists to govern, protect, and advance the interest of the people as described by Short, N.M. 2022. The government should protect and look for its people’s welfare. The contents and stipulations in the Affordable Care Act (ACA) have been challenged many times in the judicial court, (Short, N.M. 2022). It remains an ongoing debate from legislators whether to repeal or replace the ACA. According to congress.gov, 2023, Affordable Care Act (ACA) completed the enrollment period with over 16 million Americans signed up for health coverage under the Affordable Care Act. A 100% increase from the first year’s enrollment in 2014. It shows that the constituents agree with ACA. Repealing the ACA might affect the winning stance of the legislators based on the response of the people. As per congress.gov, 2023, the ACA plays a leading role in healthcare as it decreases uninsured Americans, increase accessibility to healthcare to everyone. Moreso, under President Biden’s administration, he supported and expanded the benefits of the ACA under his Inflation Reduction Act. All these outputs from ACA could influence the cost-benefit analysis in legislators seeking reelection based on their stand and efforts to support or repeal the Affordable Care Act (ACA).

Legislators are individuals elected by voters in a geographic region to represent the constituents at U.S. congress, Short, N.M., 2022. Since legislators seek reelections, analyses of voters’ views matter as legislative leaders pay attention to polls and surveys on any issues. Like congress’ decisions impacting Medicare or Medicaid, legislators are open and understanding of the voters’ plight especially if the policy is being dealt with in real time events. As part of their electoral agenda, legislators usually align their policies with the voters’ preferences especially if the policies are congruent to the needs of their constituents. According to Short, N.M., 2022, winning an election can be costly and legislators face tough reelection campaigns. Therefore, prioritizing the voters’ analyses plays a crucial part for them to develop public trust and get reelected.

References:

Congress.govLinks to an external site.
Links to an external site.
. (n.d.). Retrieved September 20, 2018, from 
https://www.congress.gov/
Links to an external site.

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & 
Bartlett Learning.

       Chapter 5, “Policy Enactment: Legislation and Politics” (pp. 97–117)

       Chapter 10, “Financing Health Care” (pp. 239–249)

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Erica Danielle De Los Santos

Sep 10, 2024 5:12am
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Last reply Sep 10, 2024 7:47pm

Reply from Erica Danielle De Los Santos

Analyzing the cost and benefits of repealing the Affordable Care Act.

Lawmakers choices to revoke the Affordable Care Act (ACA) were shaped by an assessment of the political advantages and disadvantages. “Many Republicans viewed the repeal of the ACA as a means to uphold their campaign commitments and bolster party backing in accordance, with their aspirations (Cohen et al., 2016).”

The ACAs broadened coverage underlines the potential for a voter backlash if it is repealed—a risk exacerbated if the alternative plans are seen as insufficient or detrimental (Jacobs & Mettler 2018). The possible adverse effects on healthcare providers and insurers could lead to backlash, from the public and media outlets. This could shape choices according to Gollust et al. In 2017.

 

The Influence of Voter Opinions on Decision Making in Policies

Lawmakers also consider voter opinions when creating policies such, as Medicare and Medicaid. Politicians frequently change their positions to reflect the views of the people they represent as per Ansolabehere & Jones (2010). When there is public backing or backlash, on certain issues and policies legislators may adjust their proposals to better match voter concerns. Strategizing for elections involves considering how policies related to Medicare and Medicaid can impact the votes of demographic groups, like seniors and low-income families (Jones & Hillygud). Lawmakers use methods, like surveys and community meetings to understand the views of the public. This helps them make informed choices and steer clear of policies that could result in losing elections.

 

References:

Ansolabehere, S., & Jones, B. (2010). 
The Policy Preferences of Congress, 1971-2002
. The Journal of Politics, 72(3), 762-776. doi:10.1017/S0022381610000445

Cohen, J. E. (2016). 
The Political Economy of Health Reform
. Policy Studies Journal, 44(2), 143-167. doi:10.1111/psj.12152

Gollust, S. E., Nagler, R. H., & Fowler, E. F. (2017). 
The Role of Public Opinion in Health Policy Decisions
. Health Affairs, 36(5), 898-905. doi:10.1377/hlthaff.2016.1148

Jacobs, L. R., & Mettler, S. (2018). 
How the ACA Became a Political Target
. Journal of Health Politics, Policy and Law, 43(6), 949-969. doi:10.1215/03616878-6923550

Jones, B. D., & Hillygus, D. S. (2018). 
Electoral Behavior and Policy Preferences
. American Political Science Review, 112(3), 543-561. doi:10.1017/S000305541800017X

Stimson, J. A. (2004). 
Tides of Consent: How Public Opinion Shapes American Politics
. Cambridge University Press.

 

 

The cost-benefit analysis regarding legislators’ re-election prospects influenced efforts to repeal and replace the Affordable Care Act (ACA). Legislators had to weigh the potential benefits of repealing the ACA against the risks of losing voter support. For many, the ACA provided health coverage to a large segment of their constituents, particularly in lower-income groups and those with pre-existing conditions. Repealing it could alienate these voters, potentially resulting in a loss of trust and votes. On the other hand, failing to repeal it might upset the conservative base, which supported dismantling the ACA as a critical political objective. Ultimately, legislators faced a political tightrope: aligning with party goals while ensuring their re-election by not disenfranchising significant voter blocs. The failure of repeated repeal efforts can be attributed to this calculation. In districts where many benefited from the ACA, the political cost of repeal would outweigh any gains from fulfilling partisan promises.

Regarding broader national policies like Medicare and Medicaid, voter views are central in shaping legislative decisions. Legislators rely on voter analyses to determine what policies will keep them in office. For example, Medicare and Medicaid are trendy programs, especially among older adults and low-income populations—key voting groups. Legislative leaders know that any proposal to cut or privatize these programs significantly could trigger a negative backlash among these constituencies, jeopardizing their re-election chances. As a result, even if a party’s platform calls for reducing federal spending on such programs, legislative leaders may hesitate to push for cuts or reforms that are unpopular with their voters. Instead, they may position policies to appear as improvements or cost-saving measures rather than outright cuts, framing decisions in ways that align with public sentiment to ensure they maintain voter support and secure their political futures.

 

References

Brady, D. W., & Han, H. C. (2018). The congressional partisan balance and the ACA. The Journal of Health Politics, Policy, and Law, 43(4), 567-591. 
https://doi.org/10.1215/03616878-6608646
Links to an external site.

Campbell, A. L., & Morgan, K. J. (2019). Federalism and the politics of old-age care in the United States. The Gerontologist, 59(1), 42-51. 
https://doi.org/10.1093/geront/gny155
Links to an external site.

Mayhew, D. R. (2004). Congress: The electoral connection (2nd ed.). Yale University Press.

Oberlander, J. (2017). The political life of Medicare and Medicaid: Reconsidering the sources of program resilience. Journal of Health Politics, Policy and Law, 42(5), 851-878. 
https://doi.org/10.1215/03616878-4193617
Links to an external site.

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Agenda Comparison Grid and Fact Sheet Sample 1

Healthcare Insurance Access for Underserved Adults

I selected healthcare insurance access for underserved adults because many adults with low incomes depend on Medicaid or ACA Marketplace plans for basic and long-term care. Policy changes can alter coverage quickly, which affects health outcomes and access to needed treatment. This paper compares two presidential agendas, analyzes agency roles, and presents a fact sheet for legislative communication.

Part 1: Agenda Comparison Grid

Identify the Population Health concern you selected.

Healthcare insurance access for underserved adults is a serious population concern, Many adults have low incomes, limited employer insurance, and rely on Medicaid or ACA Marketplace subsidies.

Describe the Population Health concern you selected.

Underserved adults, who often rely on Medicaid or Marketplace plans for routine care and treatment of chronic illness are strongly affected by policy changes in Medicaid, and by changes in the ACA subsidies, which can increase or reduce their access to healthcare with life or death repercussions. That is why this issue is so important for national and state leaders.

Administration (President Name)

Biden administration

Trump administration

Explain how each of the two presidential administrations approached the issue.

The Biden administration approached this issue by increasing federal support for ACA enrollment and expanding subsidies. The administration restored full Navigator funding, reopened enrollment periods, and removed barriers created by the previous administration (White House, 2025). It also enhanced premium tax credits through the American Rescue Plan Act and later extended them. These actions made insurance more affordable and easier to access. Medicaid work requirements were withdrawn or blocked, and enrollment systems were improved. The administration also increased outreach to underserved communities. These steps supported record ACA enrollment in 2025 and improved access for adults who have low incomes (White House, 2025).

The Trump administration approached this issue by reducing federal support for ACA enrollment and by adding new rules that made enrollment harder for adults with low incomes. The administration cut Navigator funding by ninety percent, shortened the enrollment period, and removed automatic re-enrollment (Pifer, 2025). The administration also supported Medicaid work requirements and encouraged states to increase eligibility checks. These policies reduced outreach, increased confusion, and raised the risk of coverage loss for underserved adults. The House Republican bill, the One Big Beautiful Bill Act, continued this direction (McIntyre et al., 2025). It included large cuts to Medicaid and ACA subsidies. It created new work requirements, new income verification rules, and shorter enrollment periods. It also raised out-of-pocket costs for many families. The intent of the bill was to reduce federal health spending, but the effect was a sharp reduction in coverage.

Identify the allocations of resources that the current and previous presidents dedicated to this issue.

Increased Navigator funding. Expanded subsidy funding through ARPA and IRA (White House, 2025). Strengthened CMS staffing. Increased federal investment in outreach and enrollment support.

Navigator funding reduced from $98 million to $10 million  (Pifer, 2025). Reduced federal spending for outreach. Supported legislation cutting $800 billion from Medicaid and ACA subsidies over ten years. The Congressional Budget Office estimates that proposed legislation would reduce Medicaid enrollment by approximately 10 million people and increase the uninsured population by 7.6 million (McIntyre et al., 2025). Federal Medicaid expenditure reductions under consideration range from $625 billion to $880 billion over ten years, with significant impacts on coverage for underserved adults (Gaffney et al., 2025).

General Notes/Comments

As a result of this administration’s policies, people had improved access and lower premiums (White House, 2025). This resulted in stronger protection for adults with low incomes and chronic conditions.

The policy changes instituted by the Trump administration resulted in an increased risk of coverage and higher costs for those who remain insured. Research suggests that proposed Medicaid funding reductions could lead to substantial coverage losses among low-income adults, with an estimated 10.3 million people losing Medicaid enrollment and large increases in preventable mortality (Gaffney et al., 2025).

Part 2: Agenda Comparison Grid Analysis

Administration

Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency the most helpful?

Healthcare insurance access for underserved adults is shaped by federal agencies that create rules, guide the states, and manage these huge programs. The agency that would help me address this issue is the Department of Health and Human Services (HHS), especially the Centers for Medicare & Medicaid Services (CMS). HHS and CMS manage Medicaid and the ACA Marketplace, so they have the authority to create enrollment rules, guide outreach work, and monitor state actions. CMS also gives states technical support when they try to improve enrollment systems. This makes CMS the most helpful agency for my issue, because the agency already manages the programs that underserved adults depend on.

How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?

This issue would get on the presidential agenda when national leaders see large coverage losses, rising costs for families, and major changes in political support for their party. A president usually pays attention when many people lose access to care or when advocacy groups and professional groups share strong evidence of harm. When I see the steady rise in the number of adults who need help paying for insurance, I understand why leaders continue to focus on this topic. Strong media coverage and moving stories from people who lose insurance also help keep the issue in the public eye and affect public opinion and voting behavior.

Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected? An example is Michael J. Fox a champion for Parkinson’s disease.

A policy issue like this one needs a champion who understands health equity and who can speak directly to lawmakers. My choice for champion is Ernest Grant, PhD, RN, FAAN, the former president of the American Nurses Association. Dr. Grant has a long history of advocating for improved access to care and supporting underserved communities. He understands the daily challenges faced by adults who cannot pay for insurance and often miss care for chronic illness. He also knows how federal policy affects the practice environment for nurses. Dr. Grant meets often with federal leaders, and he uses evidence and strong communication skills to work for health equity. These qualities make him an effective champion for expanding insurance access and reducing barriers that keep many people from getting care.

Analysis

Research demonstrates that nurse-led care models can advance whole-person health and health equity within Medicaid programs serving underserved populations (Johnson et al., 2024). The ACA Medicaid expansion reduced racial and ethnic disparities in healthcare access, though significant inequities persist in non-expansion states (Osmani, 2025). Long-term studies show that adults who gained coverage through ACA expansions experienced improved health outcomes and reduced costs when entering Medicare (Tipirneni et al., 2025).

 

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Part 3: Fact Sheet

HEALTHCARE INSURANCE ACCESS FOR UNDERSERVED ADULTS

THE ISSUE

Millions of low-income adults depend on Medicaid and ACA Marketplace subsidies for essential healthcare coverage

Policy changes can rapidly alter coverage access, directly impacting health outcomes and survival

Gaining coverage is linked to improved long-term health outcomes and reduced costs upon entering Medicare, making this a fiscally responsible long-term investment (Tipirneni et al., 2025).

KEY FACTS FROM PRESIDENTIAL ADMINISTRATIONS

Biden Administration:

Restored Navigator funding and expanded premium subsidies through ARPA and IRA (White House, 2025)

Achieved record ACA enrollment in 2025 with improved access and lower premiums (White House, 2025)

Strengthened CMS staffing and increased federal investment in enrollment support (White House, 2025)

Trump Administration

Reduced Navigator funding from $98 million to $10 million (90% cut) (Pifer, 2025)

Congressional Budget Office projections indicate that recent legislative proposals would reduce Medicaid spending by hundreds of billions of dollars and result in 7.6 million additional uninsured Americans (McIntyre et al., 2025).

Created administrative barriers including work requirements and shortened enrollment periods (McIntyre et al., 2025)

FEDERAL AGENCY RESPONSIBILITY

The Centers for Medicare & Medicaid Services (CMS) within HHS manages Medicaid and ACA Marketplace programs

CMS creates enrollment rules, guides states, and provides technical support for enrollment systems

WHY NURSES MUST BE INVOLVED

Nurses are the largest healthcare workforce and witness firsthand how insurance gaps affect patient outcomes

Nurses possess clinical evidence and patient stories that can inform effective policy decisions

Professional nursing organizations have direct access to federal policymakers and can champion health equity

Nurses must actively counter political interference in health policy decisions to protect evidence-based care for vulnerable populations (Taylor et al., 2017)

CALL TO ACTION

Maintain and expand Navigator funding to ensure enrollment support

Protect premium subsidies and Medicaid eligibility for underserved adults

Engage nurses in policy discussions to bring clinical evidence to legislative decisions

Conclusion

Access to affordable healthcare insurance is essential to protect people’s lives and improve health outcomes for underserved adults. The comparison of presidential agendas shows large differences in support and funding priorities. CMS is a key player in this issue, but it is dependent upon funding at the congressional level, and nurse leaders must keep this issue active in the political arena in order to support health equity.

 

References

Gaffney, A., Himmelstein, D. U., & Woolhandler, S. (2025). Projected effects of proposed cuts in federal Medicaid expenditures on Medicaid enrollment, uninsurance, health care, and health.
Annals of Internal Medicine, 178
(9). https://doi.org/10.7326/ANNALS-25-00716

Johnson, C., Ingraham, M. K., Stafford, S. R., & Guilamo-Ramos, V. (2024). Adopting a nurse-led model of care to advance whole-person health and health equity within Medicaid.
Nursing Outlook, 72
(4), https://doi.org/10.1016/j.outlook.2024.102191

McIntyre, A., Kim, J., & Sommers, B. D. (2025). New Medicaid enrollment barriers and lessons from unwinding.
JAMA Health Forum, 6
(9), e254849. https://doi.org/10.1001/jamahealthforum.2025.4849

Osmani, A. R. (2025). Unequal gains? A literature review on the Affordable Care Act’s effects on healthcare utilization across racial and ethnic groups.
International Journal of Environmental Research and Public Health, 22
(7), 1059. https://doi.org/10.3390/ijerph22071059

Pifer, R. (2025, February 18).
Trump administration slashes funding for ACA navigators.
Healthcare Dive. https://www.healthcaredive.com/news/trump-slashes-aca-navigator-funding-cms/740180/

Taylor, D., Olshansky, E. F., Woods, N. F., Johnson-Mallard, V., Safriet, B. J., & Hagan, T. (2017). Corrigendum to: Political interference in sexual and reproductive health research and health professional education. [
Nursing Outlook, 65
(2), 242–245].
Nursing Outlook, 65
(3), 346–350. https://www.nursingoutlook.org/action/showPdf?pii=S0029-6554(17)30262-2

The White House. (2025, January 8). Fact sheet: Biden-Harris administration announces record-breaking 2025 open enrollment period under the Affordable Care Act.
https://bidenwhitehouse.archives.gov/briefing-room/statements-releases/2025/01/08/fact-sheet-biden-harris-administration-announces-record-breaking-2025-open-enrollment-period-under-the-affordable-care-act/

Tipirneni, R., Roberts, E. T., Levy, H. G., et al. (2025). Health care utilization and costs for older adults aging into Medicare after the Affordable Care Act.
JAMA Health Forum, 6
(1), e245025. https://doi.org/10.1001/jamahealthforum.2024.5025

 

Agenda Comparison Grid and Fact Sheet Sample 2

Agenda Comparison Grid and Fact Sheet – Walden University
NURS-6050
Week 2: Assignment

Introduction

One ongoing public health crises affecting countries across the globe is opioid. It is characterized by a high incidence of opioid addiction, fatal overdoses, and skyrocketing costs in terms of health care and social implications. It is even worse in rural and low-income areas to the point where health care and police services are overstretched. Several presidential terms have developed measures to resolve the crisis, and each has its strategies. This paper contrasts the Biden and Trump administrations and underscores the necessity for representing and eradicating this issue through legislation and public health campaigns.

Part 1: Agenda Comparison Grid

Identify the Population Health concern you selected.

Opioid Crisis

Describe the Population Health concern you selected.

Opioid refers prescription of heroin and other synthetic opioids, for example, fentanyl. It has resulted in alcoholism, instances of deaths through substance overdose, and high expenses on health as well as other social services. It has tremendously affected health care, especially in rural areas, and is still a burden to medical and the police (Centers for Disease Control and Prevention, 2022).

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Administration (President Name)

Biden Administration

Trump Administration

Explain how each of the two presidential administrations approached the issue.

The administration of Biden has put more focus  on the pro-health aspect of the opioid epidemic treatment rather than increasing access to services for addiction treatment, as well as making naloxone more available. President Biden has advocated for funding in the American Rescue Plan and other statutes to address substance use and overdose and has especially emphasized race and socioeconomic justice in treatment.

Prevention and treatment measures were in the balance, but primarily, the Trump administration opted for a law enforcement approach concerning Illegal drug trafficking. In 2017, Trump as the President by then called the opioid crisis a public health emergency and worked for legislative approaches. The approaches were meant Support for Patients and Communities Act aimed at strengthening opioid treatment programs and increasing access to addiction services Agenda Comparison Grid and Fact Sheet.

Identify the allocations of resources dedicated to this issue by the current and previous presidents.

The administration of Biden provided $4 billion in the American Rescue Plan for substance use and mental health care. The resources included grants to states and local governments for opioid use disorder treatment. Some of the agencies such as Disease Control (CDC),the Health and Human Services (HHS), and the Substance Abuse and Mental Health Service Administration, have received substantial funding Agenda Comparison Grid and Fact Sheet.

 

During the administration of Trump s $6 billion were set aside for two years to fight the opioid crisis, with the intended funding for states and communities for treatment and recovery and other programs. In the past, the Support Act gave healthcare professionals and law enforcement tools to deal with substance use disorders Agenda Comparison Grid and Fact Sheet – Walden University
NURS-6050
Week 2: Assignment

 

Part 2: Agenda Comparison Grid Analysis

 

Administration

 

Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency the most helpful?

 

The agencies that would most respond to the opioid problem are the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention. HHS has main regulatory authority over public health activities, health insurance accessibility, and substance use treatment programs through sister agencies such as the SAMHSA. The CDC has to track data and monitor the success or otherwise of its interventions concerning opioid overdoses.

These agencies are the most helpful because they address both the public health and medical sides of the disaster. The U.S. Department of Health & Human Services (HHS) facilitates the expansion of medication-assisted treatments (MAT), while the CDC is important for research and monitoring of overdoses to inform policy changes.

How might your selected healthcare issue get on the presidential agenda? How does it stay there?

The opioid crisis can thus get to the presidential agenda through public pressure, the media and statistics. The opioid overdose death rate, which has crossed a hundred thousand in the U. S, remains an area of interest in the current social trends as it continues to attract the attention of the citizens as well as the policymakers.

Facing Addiction and MAPDA are other important players who constantly push for the realization that the opioid crisis exists through engaging Congress as well as the public. These approaches seem to be likely to remain on the presidential agenda as long as the rates of addiction and overdoses are relatively high and there is a new increasing bipartisan interest in the development of integrated drug policies. As a result, public health and safety may remain a concern in the future, which will sustain the issue focused on in the discussion of the nation (White House 2019).

Who would you choose to be the entrepreneur/ champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected? An example is Michael J. Fox, a champion for Parkinson’s disease.

One more vigorous supporter of the opioid crisis is Senator Rob Portman. As argued by White House. (2019) Senator Rob Portman has supported more affordable holistic opioid addiction treatment programs; he has also pushed for and worked on both sides of the CARA or Comprehensive Addiction and Recovery Act Agenda Comparison Grid and Fact Sheet – Walden University
NURS-6050
Week 2: Assignment

In addition, Macklemore musician, who has talked about his opioid use disorder, can become an advocate. That is why his participation in programs dedicated to addiction recovery and campaigns for young people will be effective and helpful in removing the stigma of seeking assistance.

Part 3: Fact Sheet

Title:
Addressing the Opioid Crisis: A National Priority

Overview:

The opioid crisis is one of the unprecedented incidents which developed into a significant threat to the public health system of the U. S., claiming at least one hundred thousand overdose fatalities per year. It has affected the health care delivery systems especially in the rural regions and has put much pressure in the public health and law enforcement organs. Infection continued to rise during both the Biden and Trump administrations; efforts have been made to address the lack of treatment, further the prevention, and maintain the nation’s health infrastructure.

Why it Matters:

Opioid affects a large population of people in the United States and has suppressed their lives by raising the number of deaths, healthcare costs, and social services expenditures.

If left unaddressed, the crisis will persistently worsen and stretched public health care and Sunday families and communities.

Agenda Comparison Grid and Fact Sheet – Walden University
NURS-6050
Week 2: Assignment

It is crucial to act in order to make addiction treatment, overdose prevention as well as care for affected individuals accessible to everyone.

Nurse’s Role in Policy Setting:

Nurses have a particular duty of promoting health reforms in the population and supporting the patients diagnosed with SUDs.

Thus, there is nothing as strategic as empowering nurses as they turn out to have the right outlook that is required in making policies concerning the treatment of opioid addition and the prevention of opioid overdose.

Advocacy can be done by the nurses through educating other people, working with policymakers, and see to it that these policies reflect patient’s needs.

Summary/Conclusion

Opioid crisis is involving numerous overdose deaths per year and continues to strain healthcare facilities. Both the Biden as well as Trump governments have previously taken the measures. The Biden administration has been active in increasing access to addiction treatment and access to naloxone coupled with the promotion of health care equity. On the other hand, the current Trump’s administration prefers the law enforcement approach by enacting the Support Act needed for further expansion of treatment and recovery initiatives. Major governmental entities including HHS and CDC are involved in the identification of emerging overdose patterns and the coordination of treatment interventions. Both Democratic and Republic politicians and advocates have been able to keep the crisis as one of the main priorities in the country. This profession play a very important role in formulation of the healthcare policies based on their experience and observations of different programs and patients needs in order to come up with the correct policies that are workable and respected by patients.

 
References

White House. (2019).
Trump administration’s efforts to combat the opioid crisis
. Office of National Drug Control Policy.
https://www.whitehouse.gov/ondcp/presidential-efforts

Centers for Disease Control and Prevention. (2022, March).
Understanding the epidemic
. CDC.
https://www.cdc.gov/drugoverdose/epidemic/index.html

To Prepare:

Review the agenda priorities of the current/sitting U.S. president and at least one previous presidential administration.

Tip: 
You can locate presidential agenda information by searching Google for your health topic and the president. For example,
 mental health Obama presidential agenda
.

Select an issue related to healthcare that was addressed by two U.S. presidential administrations (current and previous).

Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.

Use your Week 1 Discussion post to help with this assignment
.

The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page narrative) with a title page. This is an APA paper. Use 2-3 course resources and at least 2 outside resources.

Part 1: Agenda Comparison Grid

Use the
Agenda Comparison Grid Template
found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the previous president, and their agendas related to the population health concern you selected. Be sure to address the following:

Identify and provide a brief description of the population health concern you selected.

Explain how each of the presidential administrations approached the issue.

Identify the allocation of resources that the presidents dedicated to this issue.

Part 2: Agenda Comparison Grid Analysis

Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:

Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected and why is this agency the most helpful for the issue?

How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?

An entrepreneur/champion/sponsor helps to move the issue forward. Who would you choose to be the entrepreneur/champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected and why would this person be a good entrepreneur/ champion/sponsor? An example is Michael J. Fox is champion for Parkinson’s disease.

Part 3: Fact Sheet

Using the information recorded on the template in Parts 1 and 2, develop a 1-page fact sheet that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:

Summarize why this
healthcare issue
is important and should be included in the agenda for legislation.

Justify the role of the nurse in agenda setting for healthcare issues.

Assignment document should include:

Title page

Introductory paragraph

Agenda comparison grid and analysis

Fact sheet

Summary/conclusions

References

NURS 6050 Week 1 Discussion Answers

Mental Health in Healthcare Policy and Presidential Agendas

The rising importance of mental health to both the general population’s well-being and the nation’s economic growth has propelled it to the forefront of the presidential agenda in recent years. Recent worldwide occurrences, such the COVID-19 epidemic, have intensified mental health illnesses, which impact millions of Americans. Federal policymaking and health problem priority can be illuminated by examining how past and present presidents have dealt with mental health.

Policy on Mental Health at the Presidential Level

The importance of mental health as a public health issue has been recognized by both the Trump and Biden administrations. As part of their larger approach to the opioid problem, President Trump’s administration prioritized mental health. Provisions to enhance mental health services were a part of the 21st Century Cures Act, which was signed into law in December 2016. These included measures to increase access to treatment for those with severe mental illness and to integrate mental health care with primary care. Certified Community Behavioral Health Clinics (CCBHCs) receive more money from the Trump administration so they may treat substance abuse and mental health issues more comprehensively (U.S. Department of Health and Human Services, 2020).

The effects of the COVID-19 epidemic on mental health have not diminished President Joe Biden’s commitment to improving people’s mental health. Increasing availability of mental health treatments, decreasing stigma, and incorporating mental health into general health care are all areas that the Biden administration has prioritized as part of its public health strategy. Mental health services, especially in areas hit hard by the epidemic, received substantial financing under the American Rescue Plan Act of 2021. Substance Abuse and Mental Health Services Administration [SAMHSA], 2021, states that among Biden’s mental health agenda items are more mental health experts, more telehealth services, and funding for community-based mental health programs.

Possible Policy Changes and Suggestions

Although there have been some positive developments in mental health policy throughout both regimes, there is still need for improvement in a number of key areas. To begin, improving people’s mental health must be the first step in achieving better health for all Americans. This can only be achieved by a more thorough and coordinated national approach. Treatment, early intervention, and prevention should be the pillars of this approach. Reducing the strain on specialized mental health services might be achieved by increasing the availability of mental health services within primary care settings. This would encourage the early identification and treatment of mental health issues (Patel et al., 2021).

A second piece of advice for policymakers is to zero in on issues like poverty, housing instability, and educational opportunities as they relate to people’s mental health. To tackle these antecedent issues, we need a multi-sectoral strategy that brings together health, education, housing, and social services to build communities that are mentally healthy (Marmot, 2020). Increased funding for mental health research is also necessary to provide new, effective therapies and interventions that can reach a wide range of people.

Addressing complicated public health concerns, such as mental health, requires federal agenda-setting. The Trump and Biden administrations’ strategies show how important it is to include mental health in larger social and health programs. To enhance mental health outcomes, future policy initiatives should center on preventing mental health problems, intervening early, and tackling socioeconomic factors. All Americans’ mental health needs can be better met if the federal government takes a more holistic and integrated approach.

References

Marmot, M. (2020). Social determinants of health inequalities. 
The Lancet, 365
(9464), 1099-1104. 
https://doi.org/10.1016/S0140-6736(05)74234-3
Links to an external site.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., … & UnÜtzer, J. (2021). The Lancet Commission on global mental health and sustainable development. 
The Lancet, 392
(10157), 1553-1598. 
https://doi.org/10.1016/S0140-6736(18)31612-X
Links to an external site.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Biden-Harris administration’s investments in behavioral health and substance use disorder services in the American Rescue Plan. Retrieved from 
https://www.samhsa.gov/newsroom/press-announcements/20210329
Links to an external site.

U.S. Department of Health and Human Services. (2020). 21st Century Cures Act. Retrieved from 
https://www.hhs.gov/about/news/2020/12/01/hhs-announces-grants-200-million-expand-mental-health-substance-abuse-treatment.html
Links to an external site.

 

Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?

Reference:

New York State Department of Health. (n.d.). 
Making New York the healthiest state: Achieving the triple aim
. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf

Resources

 

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To Prepare:

Review the Resources and reflect on the importance of agenda setting.

Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

By Day 3 of Week 1

Post
 your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. Which social determinant most affects this health issue? How did two recent presidents handle the problem? What would you do differently?

By Day 6 of Week 1

Respond
 to at least 
two
 of your colleagues
* on two different days
 by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

*Note:
 Throughout this program, your fellow students are referred to as colleagues.

nurs 6050 week 1 discussion answers

Mental Health in Healthcare Policy and Presidential Agendas

The rising importance of mental health to both the general population’s well-being and the nation’s economic growth has propelled it to the forefront of the presidential agenda in recent years. Recent worldwide occurrences, such the COVID-19 epidemic, have intensified mental health illnesses, which impact millions of Americans. Federal policymaking and health problem priority can be illuminated by examining how past and present presidents have dealt with mental health.

Policy on Mental Health at the Presidential Level

The importance of mental health as a public health issue has been recognized by both the Trump and Biden administrations. As part of their larger approach to the opioid problem, President Trump’s administration prioritized mental health. Provisions to enhance mental health services were a part of the 21st Century Cures Act, which was signed into law in December 2016. These included measures to increase access to treatment for those with severe mental illness and to integrate mental health care with primary care. Certified Community Behavioral Health Clinics (CCBHCs) receive more money from the Trump administration so they may treat substance abuse and mental health issues more comprehensively (U.S. Department of Health and Human Services, 2020).

The effects of the COVID-19 epidemic on mental health have not diminished President Joe Biden’s commitment to improving people’s mental health. Increasing availability of mental health treatments, decreasing stigma, and incorporating mental health into general health care are all areas that the Biden administration has prioritized as part of its public health strategy. Mental health services, especially in areas hit hard by the epidemic, received substantial financing under the American Rescue Plan Act of 2021. Substance Abuse and Mental Health Services Administration [SAMHSA], 2021, states that among Biden’s mental health agenda items are more mental health experts, more telehealth services, and funding for community-based mental health programs.

Possible Policy Changes and Suggestions

Although there have been some positive developments in mental health policy throughout both regimes, there is still need for improvement in a number of key areas. To begin, improving people’s mental health must be the first step in achieving better health for all Americans. This can only be achieved by a more thorough and coordinated national approach. Treatment, early intervention, and prevention should be the pillars of this approach. Reducing the strain on specialized mental health services might be achieved by increasing the availability of mental health services within primary care settings. This would encourage the early identification and treatment of mental health issues (Patel et al., 2021).

A second piece of advice for policymakers is to zero in on issues like poverty, housing instability, and educational opportunities as they relate to people’s mental health. To tackle these antecedent issues, we need a multi-sectoral strategy that brings together health, education, housing, and social services to build communities that are mentally healthy (Marmot, 2020). Increased funding for mental health research is also necessary to provide new, effective therapies and interventions that can reach a wide range of people.

Addressing complicated public health concerns, such as mental health, requires federal agenda-setting. The Trump and Biden administrations’ strategies show how important it is to include mental health in larger social and health programs. To enhance mental health outcomes, future policy initiatives should center on preventing mental health problems, intervening early, and tackling socioeconomic factors. All Americans’ mental health needs can be better met if the federal government takes a more holistic and integrated approach.

What would you do differently?

 

Since I’m a nurse, I know how important it is for people with mental illnesses to have good health insurance. Many people I know who have mental illnesses have had a hard time. To make sure that everyone has access to mental health care, I would make changes. I would also push states to build more treatment centers for mental illness and drug abuse so that this doesn’t happen again. Increasing funding for healthcare workers is also needed to make sure that people get good care in a comfortable setting. Supporting mental health programs is very important for the overall health of Americans.

References

Marmot, M. (2020). Social determinants of health inequalities. 
The Lancet, 365
(9464), 1099-1104. 
https://doi.org/10.1016/S0140-6736(05)74234-3
Links to an external site.
Links to an external site.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., … & UnÜtzer, J. (2021). The Lancet Commission on global mental health and sustainable development. 
The Lancet, 392
(10157), 1553-1598. 
https://doi.org/10.1016/S0140-6736(18)31612-X
Links to an external site.
Links to an external site.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Biden-Harris administration’s investments in behavioral health and substance use disorder services in the American Rescue Plan. Retrieved from 
https://www.samhsa.gov/newsroom/press-announcements/20210329
Links to an external site.
Links to an external site.

U.S. Department of Health and Human Services. (2020). 21st Century Cures Act. Retrieved from 
https://www.hhs.gov/about/news/2020/12/01/hhs-announces-grants-200-million-expand-mental-health-substance-abuse-treatment.html
Links to an external site.
Links to an external site.

nurs 6050 week 1 discussion answers Reply from Lovepreet Kaur

​
One population health topic that remain
s 
relevant to 
the 
presidential agenda 
currently 
is 
healthcare
 access and 
healthcare
 costs
,
 with 
an 
emphasis on mental health. This brings us to the final stage of the social determinants of health model, which is access to healthcare services
. Mental
 Health care is still a concern to millions of Americans
,
 especially those in rural and other under-served areas
 (
Crowley
 et al., 2020). 
President Joe Biden’s administration attempted to address mental health by investing in formal 
behavioural
health services using 
COVID-19
 relief programs and signing the American Rescue Program
,
 which increases mental health and substance utilization funding. The administration also played a role in 
expanding
 telehealth services
, which also benefitted the delivery of mental health services to 
vulnerable populations
 (
McBain
 et al., 2023).

​
President Donald Trump also paid a lot of attention to this area of health
,
 
primarily
 through his attention to the opioid crisis. His administration also introduced the Opioid Initiative
, which involved augmenting the funds for
 treatment services. Furthermore, in 2018, Trump enacted the 
Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT)
 for Patients and Communities Act
,
seeking to enhance mental health in the frame of substance use prevention and treatment
 (
Fishbein & Sloboda,
 
2023). 
Despite these efforts, a significant barrier remains: many Americans still lack easy and cost-effective access to professional, timely, and extensive psychiatric services.

​
I would address the challenge differently by advocating for mental health benefits to be included under 
the 
health insurance regime to the same extent as primary health 
benefits
. 
In addition
, I will propose to expand the care providers in mental health professions through measures like offering student loan forgiveness to practitioners in the mental health field. Further, I would encourage the provision of mental health services not only in the schools, the workplace and other 
community-based
 services but also 
in 
taking preventive measures to ensure that individuals do not reach the point where they require this service. Telehealth 
will 
also continue to be expanded, particularly for rural patients, and these will have to be made available at an 
affordable cost to the patient under insurance schemes
 
(McBain et al., 2023).

References

Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. 
Annals of internal medicine
, 
172
(2_Supplement), S7-S32.
https://www.acpjournals.org/doi/full/10.7326/M19-2415
Links to an external site.

Fishbein, D. H., & Sloboda, Z. (2023). A national strategy for preventing substance and opioid use disorders through evidence-based prevention programming that fosters healthy outcomes in our youth. 
Clinical 
Child 
And
Family Psychology Review
, 
26
(1), 1-16.
https://link.springer.com/article/10.1007/s10567-022-00420-5
Links to an external site.

McBain, R. K., Schuler, M. S., Qureshi, N., Matthews, S., 
Kofner
, A., Breslau, J., & Cantor, J. H. (2023). Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022. 
JAMA 
Network Open
, 
6
(6), e2318045. 
https://doi.org/10.1001/jamanetworkopen.2023.18045
Links to an external site.

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April Simon

Aug 28, 2024 11:18pm
| 
Last reply Sep 1, 2024 7:41am

Reply from April Simon

Mental health has been a recurring issue in presidential agendas for years, due to rising rates of suicides and shootings in the U.S. There has been a growing demand from Americans for improved mental health services, and we believe that current resources are not enough or available for those in need. “The social determinants of mental health such as income inequality and poor education are understood as being underpinned by unequal distribution of opportunity and more deeply by public policies” (Trump White House 2020). Raising awareness is crucial because many people lack proper education about mental health. Financial stress can be significant for families with the increasing inflation and insufficient income to support their needs can contribute to depression.

The last two Presidents have each emphasized mental health and made significant contributions to support it. President Biden allocated “nearly $300 million in September for new and existing certified community behavioral health clinics, with an additional $15 million in grants to be awarded early next year.” (SAMHSA, 2022). This funding is vital for providing the resources necessary to make an impact for this patient population. During his term, President Trump signed an executive order aimed at mitigating the negative effects of prolonged shutdowns on mental and behavioral health, and at enhancing suicide prevention efforts” (Trump White House, 2020). The pandemic had a major effect on the mental health of millions of Americans, including children, who experienced depression due to lack of social interaction and the struggle with adapting to return to social settings. These children require support to help them adapt and learn to lead normal lives.

I believe both Presidents have made great efforts in addressing mental health by discussing it and implementing supportive policies. However, I would advocate for ensuring that a portion of the funding is also directed toward educating healthcare providers on the treatment and detection of mental illness. Especially in the inpatient setting where doctors fail to continue the patients home medications, specifically for mental health. Far too often, I’ve seen that providers are focusing on one issue and don’t address continued mental health needs in the acute setting.

Patients can also feel or overtly be judged by their healthcare providers, which can discourage them from seeking help. Although there are beliefs that mental illness still has a stigma, I feel as if the oversharing nature of social media has somewhat caused cracks in the barriers. There is more information being shared for the people who have access that could potentially be of assistance to others. Utilizing the social platforms has given access to information we didn’t otherwise have prior. It’s essential for healthcare professionals to improve their understanding and approach to mental health to better support and care for these individuals.

 

References

Compton, M & Shim, R (2015) The Social Determinants of Mental Health. Psychiatry Online. 
https://focus.psychiatryonline.org/doi/pdf/10.1176/appi.focus.20150017Links to an external site.
Links to an external site.

 

SAMHSA. (2022) Biden-Harris Administration Announces Millions of Dollars in New Funds for States to Tackle Mental Health Crisis. 
https://www.samhsa.gov/newsroom/press-announcements/20221018/biden-harris-administration-announces-funding-states-tackle-mental-health-crisisLinks to an external site.
Links to an external site.

President Donald J. Trump Is Safeguarding Americans’ Mental Health and Preventing The Tragedy of Suicide – The White House. (2020, October 5). The White House. 
https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/
Links to an external site.

 

 

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Mehak Ishaq

Aug 28, 2024 10:27pm
| 
Last reply Aug 31, 2024 9:20pm

Reply from Mehak Ishaq

 

Obesity is a chronic condition in which there is an excessive amount of fat in the body, and is considered when an individual’s BMI is greater than 30 (
Body Mass Index, BMI Calculator, Healthy BMI
, n.d.). This chronic condition is able to be prevented by changing one’s lifestyle and managing their weight through diet and exercise. The recent data indicates that 39.6% of the people in the United States of America are obese. Rates of obesity prevalence was the highest in African American and hispanic populations (
Obesity in the U.S. – Food Research &Amp; Action Center
, 2019). Obesity increases the risk for patients to experience various heart diseases, diabetes, sleep apnea, and high blood pressure (
Obesity – Symptoms and Causes – Mayo Clinic
, 2023). All this can be prevented if the population has better and affordable options to eat and exercise regularly. Social determinants that are associated with obesity include education, income, and occupation (Pcna, 2023). Populations that come from low economic areas are at the highest risk for obesity.

President Biden has issued an Executive order to renew the President’s Council on  Sports, Fitness, and Nutrition until 2025 (
President’s Council | Health.gov
, n.d.). This allows various populations to become aware of healthy eating and benefits of physical activity. This council motivates and brings awareness to the less economical areas about how increasing physical activity and healthy eating will prevent diseases such as heart disease, diabetes and also helps alleviate anxiety.Also, this council promotes youth sports participation,which is vital for the youth to get outside and become active (
President’s Council | Health.gov
, n.d.). This council will also educate the public about what exactly is healthy eating, and the affordable option they have in their surroundings. NURS 6050 Week 1 Discussion Answers

The Obama administration acknowledged the growing rates of obesity, and routed the problem to processed foods and a sedentary lifestyle. In order to do something about this, the Obama administration has drastically improved the standards for school meals in 2012. They released a program called, “The Healthy, Hunger-Free Kids Act”, which required schools to increase the proportions for fruits, vegetables, whole grains, and low fat milk (
Obama-era School Nutrition Policy Led to Better Diets for Students but Faces Changes | UW School of Public Health
, 2020). This was very different from the previous lunches that the schools would provide for the children which included foods high in sodium and fat (
Obama-era School Nutrition Policy Led to Better Diets for Students but Faces Changes | UW School of Public Health
, 2020). This shift from unhealthy lunches to much more healthier lunches have displayed positive changes in the health of children since 2012.

If I was in a position of power, after realizing the massive population of obesity that is prevalent in the United States, I would do various actions. I would start off by screening populations that are at the greatest risk for obesity, and after screening them I would educate the population about how obesity puts them at a higher risk for various chronic conditions. Then I would educate those populations about how they will be able to conquer obesity, I would suggest they exercise 30 minutes every day even if it’s just walking. I would also tell them various recipes that they are able to make with the vegetables and fruits that are already in their homes, to make them realize that healthy eating is not always expensive. I would also do something about how expensive healthy options are, and make sure to have affordable options surrounding the community.

 

 

References:

Body Mass Index, BMI Calculator, Healthy BMI
. (n.d.). 
https://www.nhlbi.nih.gov/health/educational/lose_wt/bmitools.htm#:~:text=This%20ratio%20of%20weight%20to,in%20relation%20to%20their%20height.

Obama-era school nutrition policy led to better diets for students but faces changes | UW School of Public Health
. (2020, July 28). 
https://sph.washington.edu/news-events/news/obama-era-school-nutrition-policy-led-better-diets-students-faces-changes

Obesity – Symptoms and causes – Mayo Clinic
. (2023, July 22). Mayo Clinic. 
https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742#:~:text=Obesity%20isn’t%20just%20a,sleep%20apnea%20and%20certain%20cancers.

Obesity in the U.S. – Food Research & Action Center
. (2019, October 3). Food Research & Action Center. 
https://frac.org/obesity-health/obesity-u-s-2

Pcna. (2023, July 19). 
Social Determinants of Health and Obesity – PCNA
. PCNA. 
https://pcna.net/social-determinants-of-health-and-obesity/

President’s Council | Health.gov
. (n.d.). 
https://health.gov/pcsfn

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Thabasum Abraham

Aug 28, 2024 9:07pm
| 
Last reply Aug 31, 2024 11:36am

Reply from Thabasum Abraham

Week 1 Discussion Post – Policy & Advocacy for Pop Health-Fall 2024 – 6050N

 

Post
 your response to the discussion question: Consider a population health topic that rises to the presidential agenda level.

As health care workers, the COVID-19 pandemic is something we still going through in 2024, even though the lock down and media coverage has died down. We are still seeing surges and new strains all the time, and with long-COVID, there are just so many unknowns.

In my opinion, this is a good discussion topic since this was worldwide issue for extended period of time, and continues to be a topic of debate and discussion worldwide. We are not sure if the virus is causing complications or the vaccine itself, or some combination?  One thing we do know is that there is still ongoing research to clarify the long term effects. Huge amounts of national funding was dedicated to stopping the spread, and now additional funds are being spend on root cause analysis type studies to determine if what was done was correct, and what we can expect to be long term effects, if any.

 

Which social determinant most affects this health issue?

Social determinants of health (SDOH) “are organized into 5 place-based domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context (Social Determinants of Health Workgroup, 2024).” Most commonly we consider this homelessness, food insecurity, healthcare insecurity, drug and alcohol abuse and other negatively mitigating factors for health issues. All of these 5 played some role in the COVID-19 pandemic issues in the US and across the world.  The poorer people had less access to supplies, medications and vaccinations. Less educated people had a poorer understanding and comprehension of hygiene and universal precautions. Limited healthcare access needed to be overcome to provide care to these groups, especially in impoverished areas of the US, and even more so in  underdeveloped nations. It cannot be said that there was any one SDOH that had no impact on the spread and management of the COVID-19 pandemic.

 

How did two recent presidents handle the problem?

During COVID, the world had to start from scratch to figure out the type of illness, methods of contagion, prevention, and cure. Each day we had new health care policies and recommended implementation as research was updated day to day, often with just anecdotal evidence. In the early stages of the pandemic, partisan politics were a major deciding factor in how policies were implemented, and it does not appear in retrospect that much of what was mandated was rooted in scientific evidence, but more politics and mass hysteria (Gadarian et al., 2021).  We still have not eradiated this pandemic, as they are identifying more viruses like alpha, delta, omicron and sub variants which continue to create more suffering in our society. These new variants are not effective with previous vaccines approved by FDA, and it appears as this is no longer a headlining news topic, science is once again the determining factor for policy rather than politics.  This contagious virus forced us to shut down schools, businesses and even many doctors’ offices that were both good and harmful to the community at the same time. In initial months, we observed many hospitalizations, and deaths, but eventually the world was able to unite and develop new policies to overcome rising COVID numbers. As this was nothing we had even seen before in our lifetimes, this was something we were ill-equipped to manage (Glied, 2020).

During last two presidential terms, President Trump and President Biden were forced to establish many new policies and implement them in the public health emergency.

During the Trump administration is when COVID initially was identified, and the Trump administration initiated travel restrictions, and lock downs which helped us to stop further spread both domestically and internationally. The COVID 19 rapid tests were developed, and the CDC approved guidelines to treat patients. Hand hygiene, masking, and social distancing became the norm for those few years. Those policies were based the best evidences of the time on infection control specifically to protect the most vulnerable populations. Vaccinations were a controversial topic, but were developed in record time, and the health emergency allowed populations to get minimally tested drugs during that time in hopes of serving the greater good. President Trump’s team was able to provide free vaccinations, free testing centers, and even free at- home tests to everyone. The research, development and manufacturing of multiple different types of vaccines started during Trump administration world-wide.

During the Biden administration, the COVID public health emergency officially ended. As of May 11
th
 2023, the administration was still giving significant importance to the pandemic by continuation of the development of new variant vaccinations, and continuing free at home test accessible to the general public (Jaffe, 2021). Although the pandemic has officially ended, it is safe to say COVID has become endemic to the world.

During the Biden-Harris administration, the largest adult vaccination program in U.S history was developed. Tele-health availabilities are still in place, which offered access to healthcare to those in the most remote and rural areas, typically underserved by healthcare. At this time the Centers for Disease Control (CDC) also launched the National Wastewater Surveillance System (NWSS) to track SARS-COV-2 in sewage across the country. The administration has also successfully built a robust emergency response infrastructure. Our surge response – led by the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) – developed over 100 federal mass vaccination sites and surge testing sites and the capability to distribute essential supplies to those in need.  Since July 2021, the federal government deployed over 4,000 military and non-military personnel including doctors, nurses, and paramedics; sent over 3,400 ventilators, ambulances, and other critical supplies; and shipped over 115 million pieces of PPE. And over the last year, FEMA has invested $300 million in state hospital preparedness to expand hospital capacity in 38 states (National COVID-19 Preparedness Plan, 2024).

 

What would you do differently?

What I would do differently would be educating our society that illness still exists, continuing masking, and that hand hygiene is still needed. Increasing awareness about at home tests, rather than emergency room visits with minor symptoms is another thing I would advocate. As an ER nurse, I see still hoards of people just coming to the ER to just test for COVID, which creates a crowded ER, and less resources available to those who present with truly severe and acute illnesses. Another recommendation I have would be opening more COVID one stop test and vaccine clinics, open free to the public, which help people to seek help as they need it. Advertising those services on TV and social media would be a great way to spread information. Creating websites where the public can get status updates and find local areas at risk, or even text alerts when travelling to higher risk areas. I also recommend helping people with disabilities and the elderly to get prompt care, as well as offering paid sick leave to care your loved ones who contracted serious illness or complications as a result of COVID. All of these help reduce the SDOH that are limiting our fight against COVID.

 

References:

Gadarian, S. K., Goodman, S. W., & Pepinsky, T. B. (2021). Partisanship, health behavior, and policy attitudes in the early stages of the COVID-19 pandemic. 
PloS one
, 
16
(4), e0249596. 
https://doi.org/10.1371/journal.pone.0249596
Links to an external site.

Glied S. (2020). Health Policy in a Biden Administration. 
The New England journal of medicine
, 
383
(16), 1501–1503. https://doi.org/10.1056/NEJMp2029546

Greer, S. L., Dubin, K. A., Falkenbach, M., Jarman, H., & Trump, B. D. (2023). Alignment and authority: Federalism, social policy, and COVID-19 response. 
Health policy (Amsterdam, Netherlands)
, 
127
, 12–18. 
https://doi.org/10.1016/j.healthpol.2022.11.007
Links to an external site.

Jaffe S. (2021). Legal challenges threaten Biden’s COVID-19 vaccine rule. 
Lancet (London, England)
, 
398
(10314), 1863–1864. 
https://doi.org/10.1016/S0140-6736(21)02537-X
Links to an external site.

National COVID-19 Preparedness Plan
. (2024, 8). Retrieved 8 2024, from The White House: https://www.whitehouse.gov/covidplan/

Office of Disease Prevention and Health Promotion. Explore Resources Related to the Social Determinants of Health. Retrieved from 
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources
Links to an external site.

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
(7th ed.). Jones & Bartlett Learning (pg 12)

Social Determinants of Health Workgroup. (2024). Retrieved 8 2024, from Healthy People 2030: https://health.gov/healthypeople/about/workgroups/social-determinants-health-workgroup#cit5

O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). 
Political efficacy and participation of nurse practitioners
Links to an external site.
. 
Policy, Politics, and Nursing Practice, 18
(3), 135–148.

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
(7th ed.). Jones & Bartlett Learning

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Tiffany Peron

Aug 28, 2024 8:09pm
| 
Last reply Aug 31, 2024 8:53pm

Reply from Tiffany Peron

                                                                         WEEK 1 Discussion

Nursing 6050N-27

Tiffany R. Peron

August 27
th
, 2024

 

Mental health is so often talked about and noted to have such a huge need but we are still leaps and bounds behind where we should be in 2024. Many are now suffering from anxiety and depression, Post-traumatic stress disorder, and a rising instance of self-harm and suicide. There is still such a huge stigma around mental health. Many are afraid to seek help as they fear they will be labeled as something is wrong with them. Post COVID-19 many youths have been noted to be struggling with these issues being stuck in homes where they were not nurtured or exposed to more violence, drug use, and neglect. Many governments are working to adopt new laws and regulations, working with organizations to get new policies in place but the demand is still so high.

 

                                   Current and Previous President’s Approaches to Mental Health

President Joe Biden and former President Donald J Trump called to action and noted the need for more! There is a need for more educated doctors, nurses, and counselors to provide care to many of these individuals. A need to reduce the Stigma around mental health. A need for insurance providers to open up their networking and allow more services to be provided. According to Mezuk (October 2022) “Among the multiple factors that contribute to poor availability of mental health care, the White House plan did not address inadequate reimbursement by private health insurance and public payers, including Medicaid.” This is such a huge issue even in the school setting when a child has private insurance they are often placed on a sliding scale fee which is way too steep or practical or are told to find an outside therapist for services. We are failing our youth by telling them we cannot help with their needs and this is leading to more and more children falling through the cracks.

President Joe Biden

According to the fact sheet in 2023, President Joe Biden and his administration planned to increase new resources for school-based health services which would include an increase in school counselors, psychologists, as well as social workers. They also plan to expand peer support where someone who has lived with mental health issues could become a person to talk to others. Increasing crisis response such as Mobile Response Services and the use of 988 as a crisis line to assist youth and adults in need of crisis are getting rapid response to their needs. There are so many areas that still need to be covered and is a work in progress to incorporate all of these initiatives.

President Donald J. Trump

After the COVID-19 pandemic, Donald J. Trump noted that “40.9% of Americans reported at least one adverse mental health condition and 10.7% reported seriously considering suicide”. He also signed legislation to put in place more services for mental health as well as substance abuse. We need to focus on vulnerable populations who have been affected the most children, veterans, elderly and so many more.

As of now, both presidents have not succeeded in assisting with the mental health crisis. So many people are suffering and need reliable care that is affordable and easily accessible. Ensuring that there is a team of qualified mental health experts to assist with developing more care and reducing the stigma would allow more advancements in research. Nurses need to become more aware of current legislation and active in political issues by ensuring that their knowledge is heard and seen by political leaders (
Milstead’s health policy and politics). As nurses, we need to advocate for the care of our patients and ensure that there are receiving all the care that they need. When there is a shortage of services or insurance denies patient care they are not receiving the best care possible.

What Would I Do Differently

More services:

Looking into providing more counselors, therapists, and social workers in a school-based setting and underserved areas. Adding a mental health provider to all primary care settings such as pediatric offices, family practices, and even OBGYN offices. Offering counseling services for anyone interested the more it is seen and talked about the more willing people would be.

Reducing the Stigma:

The biggest way to make this happen is education for those with mental health disorders and for those who do not understand mental health issues. If someone is worried about what their friends and family might think if they open up to them or a provider oftentimes they go untreated. Often people describe mental health as living with a secret feeling of decreased self-worth (Strategies to Reduce Mental Illness Stigma).

Technology

Since COVID-19 telehealth has made such huge strides and has become a huge industry offering more and more opportunities for convenience as well as a sense of private counseling to build relationships for those who need that confidentiality.

.                                                                         References

Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice,      Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). 
Nursing health, & environment
Links to an external site.
Links to an external site.
:
 Strengthening the relationship to improve the public’s health.

Mezuk, B., Maust, D., & Zivin, K. (2022, October). 
A response to the president’s call to support Public Mental Health
. American journal of preventive medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9516693/?scrlybrkr=e6c8d9d3

National Archives and Records Administration. (n.d.). National Archives and Records Administration. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

Shahwan, S., Goh, C. M. J., Tan, G. T. H., Ong, W. J., Chong, S. A., & Subramaniam, M. (2022, January 31). 
Strategies to reduce mental illness stigma: Perspectives of people with lived experience and caregivers
. International journal of environmental research and public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835394/

Short, N. M. (2022). 
Milstead’s health policy and politics: A nurse’s guide
 (7th ed.). Jones & Bartlett Learning.

Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 2–23 only)

The United States Government. (2023, May 18). 
Fact sheet: Biden-Harris Administration announces new actions to tackle nation’s mental health crisis
. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/

 

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Alicia Prentler

Aug 28, 2024 8:05pm
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Last reply Aug 31, 2024 10:01am

Reply from Alicia Prentler

                  Mental health is a topic of health that routinely makes it to the Political Agenda and is often a discussion point in presidential debates. There are many detriments as it pertains to mental health, with access to mental health care being the most substantial. Nurses often can play a key role in policy making as they bring power in numbers, not only through individual numbers, but also through professional organizations that so many nurses affiliate themselves with (Short, Nancy, 2022 pp17). The following will provide an overview of the last two presidents and their policy on mental health and access to much needed care.

Biden Administration

President Joe Biden has served as president of the United States from 2020-2024, and prior to this he served as vice president under the Obama Administration who was most famous for his Affordable Care Act. The Biden Administration believes that mental health is healthcare and has thus set forth a list of requirements that insurers and providers must adhere to (The White House, 2023). One of the first conditions is that insurances must conduct an analysis of their care and costs compared to other insurances, along with in network and out of network pricing to ensure care is equal and in accordance with the Mental Health Parity and Addiction Equity Act; which was put into law in 2020 (The White House, 2023). The Biden administration also put forth more strict policies on what insurance companies can and cannot do, as it pertains to prior authorizations and care; in short, they must make the same effort to cover mental health care as they do physical health care (The White House, 2023). The last major change that the Biden Administration did thus far was “closing the loophole” making state and private insurances abide by the MHPAEA, which previously was only enforced in federal insurances (The White House, 2023).  There are three other areas of focus as well, and these include mental health care in schools, enhancing crisis response resources, and allowing more expanded payment for mental health with those who have Medicare (The White House, 2023).

Trump Administration

President Donald J. Trump served as president of the United States from 2016-2020. The former president’s policy on mental health focused on three major areas: Improving Mental Health, Protecting Americans, and Promoting Physical and Mental Health (Trump White House Archives, 2020). The biggest impact that former Pres. Trump had was Improving Mental Health policies, regarding access, as during COVID, previously video access for mental health was not covered under insurances, this policy made it so video was an acceptable form of delivery of care mandating insurances to cover video appointments (Trump White House Archives, 2020). This change in policy opened a door allowing millions of people to continue access to mental health care during COVID, of which many in person appointments were not being had. Former Pres. Trump’s administration recognized that during COVID there was a negative impact on mental health through isolation and shutdowns that were mandated, this prompted the administration to produce $425 million dollars in emergency mental health resources (Trump White House Archives, 2020).

What Would I Change?

The single most important thing I would change if possible, would be to put providers and patients back in the driver’s seat for care.  I cannot fathom how a physician can say that a certain medication is needed, or treatment is needed, but an insurance company can deny coverage until other avenues are tried. Especially when the companies who are directing this approval and denial often do not hold medical degrees themselves. I struggle with the thought process of allowing a company who has never met a patient to override the care plan that a provider believes is best for the patient, creating ultimately a delay in care, and this delay in mental health can often cause someone their life.

The other thing I would change is that I would mandate mental health professionals in all schools, or medical organizations, with the requirement that routine suicide and depressions screenings be conducted in order to provide preventive therapy and care, decreasing inpatient hospitalizations and hence health care spending.

 

 

 

 

Resources:

Short, Nancy M. (2022). Health Policy and Politics A Nurse’s Guide. (7th Edition).

Jones and Bartlett Learning.

The White House. (2023). FACT SHEET: Biden- Harris Administration Takes Action to Access

In-Network Mental Health Care. Retrieved on Aug 27th, 2024. 
https://www.whitehouse.gov/briefing-room/statements-releases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network-mental-health-care/
Links to an external site.

Trump White House Archives. (2020). President Donald J. Trump is safeguarding American’s Mental Health and Preventing the Tragedy of Suicide. Retrieved on Aug 28th, 2024. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

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Cecile Bowen

Aug 28, 2024 6:26pm
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Last reply Aug 30, 2024 7:52pm

Reply from Cecile Bowen

Prescription drug prices have been a major topic of conversation and will continue to be until the U.S. is able to find a solution to the insane prices we are subject to. Based on the amount of drug research and healthcare intuition in the U.S., one would expect the U.S. to compete fairly well in prescription drug pricing ranges with other countries. However, in 2019, per capita, the United States spent $1,126 on prescription medications while other countries in similar economic and social statuses only spent $552 (Kurani et al., 2022). In truth, there are many factors that play in to this and there is not a simple solution. Additionally, both the Republican and Democratic Parties have different views on what it takes to solve this financial problem which means fighting each other tooth and nail until one side finally cracks the code.

During Trump’s time in office, he worked with the U.S. Department of Health and Human Services (HHS) to create “The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.” By identifyingseveral factors that caused the increase in prescription drug prices such as the 1990s business model, Medicare and Medicaid evolutions, ACA taxes and rebates, international price controls, and lack of pharmaceutical competition, a plan was created to enforce lower drug prices (The U.S. Department of Health & Human Services [HHS], 2018). Trump’s plan included four main sectors: increasing competition, better negotiation, creating incentives to lower list prices, and reducing patient out-of-pocket spending (HHS, 2018). Each section had an immediate action that HHS may take and a second phase that HHS could consider and still give and receive feedback on. From my understanding, the blueprint did not make it far legally.

Biden’s administration recently announced that agreements have been made to lower prices for 10 select prescription drugs. These drugs are some of the most common medications in the Medicare program, with the savings estimated at $3.7 billion in the first year (HHS biden). CMS states that by February 1, 2025, 15 more drugs will be selected for negotiation in the coming years (HHS, 2024). While this is great progress, these savings only apply to Medicare Part D prescription coverage.

Overall, I think I would want to combine efforts from both former presidents so that negotiation can be used when competition cannot. Additionally, I think the U.S. should be allowed to cap prices on certain medications. Many European countries regulate the price of medications. And as much as I hate to say it, the economy has to change. The rate of inflation simply does not match the rising cost of living, including the cost of prescription drugs. Rate of inflation on average from January 2022 to January 2023 was 6.6%, while the average increase for drugs was 15.2% (U.S. Bureau of Labor Statistics, 2023; Bosworth et al., 2023). This is a seriously complicated problem we have gotten ourselves into, and I will not pretend to know all the answers, but I think these ideas would move us in the right direction.

References

Bosworth, A., Sheingold, S., Finegold, K., Sayed, B. A., De Lew, N., & Sommers, B. D. (2023, October 6). 
Changes in the List Prices of Prescription Drugs, 2017-2023.
 U.S. Department of Health and Human Services. 
https://aspe.hhs.gov/reports/changes-list-prices-prescription-drugs
Links to an external site.

Kurani, N., Cotliar, D., & Cox, C. (2022, February 8). 
How Do Prescription Drug Costs in the United States Compare to Other Countries?
 Peterson-KFF Health System Tracker. 

How do prescription drug costs in the United States compare to other countries?

Links to an external site.

U.S Bureau of Labor Statistics. (2023). 
Chained Consumer Price Index for All Urban Consumers 
[Table]. 
https://www.bls.gov/cpi/tables/supplemental-files/c-cpi-u-202301.xlsx
Links to an external site.

The U.S. Department of Health & Human Services. (2018, May). 
American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-pocket Costs
. 
https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf
Links to an external site.

The U.S. Department of Health & Human Services. (2024, August 150. 
Negotiation for Lower Drug Prices Works, Saves Billions.
 
https://www.hhs.gov/about/news/2024/08/15/historic-first-biden-harris-administration-successfully-negotiates-medicare-drug-prices-delivers-promise-lower-prescription-drug-costs-american-seniors.html
Links to an external site.

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Nazanin Kalhor

Aug 28, 2024 5:28pm
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Last reply Aug 31, 2024 10:17am

Reply from Nazanin Kalhor

Main Question Post

Discussion Response

The opioid crisis is a major public health issue that has made its way onto the presidential agenda. The opioid crisis has become a major public health concern in the United States, resulting in severe morbidity, mortality, and societal implications. One of the most important social variables influencing this health concern is socioeconomic position, which includes income, employment, education, and the local environment. These variables significantly influence healthcare access, mental health services, and drug abuse risk (Dasgupta et al., 2018).

Social Determinant Impact: Socioeconomic Status

Socioeconomic status (SES) is a crucial socioeconomic factor that contributes to the opioid problem. People from lower socioeconomic backgrounds are more likely to be stressed, have restricted access to healthcare and mental health services, and participate in more drug-related occurrences. Opioids are more likely to be prescribed to people with chronic pain who are also at a higher risk of abuse and addiction (Dasgupta et al., 2018). Compounding the problem is the fact that regions with high rates of unemployment and poverty typically lack the funding necessary to establish all-encompassing addiction treatment programs (Kolodny et al., 2015).

Presidential Approaches: Obama and Trump Administrations

After declaring the opioid problem, a public health emergency, both the Obama and Trump administrations took action to address it. After the Affordable Care Act (ACA) was established, the Obama administration prioritized making treatment more accessible. The ACA makes substance use disorder therapy a mandatory health benefit. This made it possible for more people to get addiction treatment. To enhance pain management and lower the number of opioid prescriptions written, the administration also introduced the National Pain Strategy (Davis et al., 2017).

In 2017, the Trump administration designated the opioid crisis as a public health emergency, allowing for some leeway in the distribution of government funding for the fight against the epidemic. Apart from encouraging the creation of non-addictive substitutes for approved drugs, the government placed emphasis on employing law enforcement techniques to limit the availability of illicit substances. However, some experts in public health have expressed disapproval of the focus on punitive measures as opposed to all-encompassing solutions for public health (Gollust et al., 2020).

Alternative Approaches

If I were taking a different stance on this matter, I would support a more holistic strategy that prioritizes the basic socioeconomic determinants of health, such extending educational possibilities, preserving the status quo in the economy, and enhancing access to mental health treatments. By enlarging community-based initiatives, drug use problems would be supported, educated, and prevented. In addition, I would place a higher priority on funding research into non-opioid drugs and the creation of easily accessible, reasonably priced, and well-thought-out addiction treatment programs for certain groups of individuals. In addition, I will prioritize funding for research into non-opioid pain management and the creation of addiction treatment options that are accessible, inexpensive, and customized to the needs of various groups. My approach would also include a focus on harm reduction methods such as increased access to naloxone and safe injection places. This holistic policy intends to address not only opioid usage and overdose mortality, but also the underlying socioeconomic problems that contribute to the crisis.

References

Davis, C. S., Green, T. C., & Case, P. (2017). Availability of naloxone in the United States: A new era in opioid overdose prevention? 
Drug and Alcohol Dependence, 182,
 379-381. https://doi.org/10.1016/j.drugalcdep.2017.01.018

Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: No easy fix to its social and economic determinants. 
American Journal of Public Health, 108
(2), 182-186. https://doi.org/10.2105/AJPH.2017.304187

Gollust, S. E., Barry, C. L., & Niederdeppe, J. (2020). Partisan responses to public health messages: Motivated reasoning and sugar-sweetened beverage taxes. 
Journal of Health Politics, Policy and Law, 45
(1), 37-74. https://doi.org/10.1215/03616878-7952151

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. 
Annual Review of Public Health, 36,
 559-574. https://doi.org/10.1146/annurev-publhealth-031914-122957

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Pawandeep Kaur Dhaliwal

Aug 28, 2024 4:58pm
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Last reply Aug 30, 2024 7:57pm

Reply from Pawandeep Kaur Dhaliwal

Main Post

Presidential Agendas

Access to medical care is a fundamental component of public health, yet it remains a persistent challenge in the United States, particularly for individuals with lower socioeconomic status (SES) (McMaughan et al., 2020). This issue has consistently risen to the forefront of the presidential agenda, with recent administrations taking varied approaches to address it.

One of the most important social determinants influencing this issue is socioeconomic status (SES). SES includes income, education, and job, and it is an important factor in influencing an individual’s ability to obtain healthcare services. Individuals with lower socioeconomic status frequently face difficulties such as a lack of health insurance, limited access to healthcare facilities, and financial restraints, preventing them from receiving timely and effective medical care. These barriers exacerbate health disparities, resulting in lower health outcomes for economically disadvantaged people (McMaughan et al., 2020).

In recent years, two US presidents have approached the subject of medical access in different ways, reflecting their administrations’ divergent objectives and political beliefs. The Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, marked a significant step forward. The Affordable Care Act aims to improve access to healthcare by extending Medicaid, establishing health insurance exchanges, and mandating that individuals purchase health insurance. It also provided subsidies to help low- and middle-income people purchase insurance and barred insurance companies from refusing coverage because of pre-existing diseases (Healthcare.gov, 2022). These measures were particularly beneficial for people with low socioeconomic status, and as a result, millions of previously uninsured Americans got access to health insurance, leading to an increase in preventative care and early treatment, which critical in managing chronic conditions and improving overall health outcomes.

President Joe Biden’s administration has also made a good contribution to healthcare access in recent years by expanding and enhancing the Affordable Care Act. In March 2021, Biden signed the American Rescue Plan Act, which included provisions to increase health insurance premium subsidies, making coverage more accessible for millions of Americans (The White House, 2024). These increased subsidies considerably reduced the cost of insurance for low- and middle-income individuals and families, especially during the COVID-19 pandemic, when healthcare access was vital. Biden’s administration also worked to increase membership in the ACA marketplaces by extending open enrollment periods and investing in outreach and education programs, which benefited more individuals. Additionally, Biden’s efforts to persuade states to extend Medicaid along with financial incentives provided in the American Rescue Plan, aimed to increase coverage for low-income individuals who had previously fallen into the coverage gap (Corallo, 2021).

If I were to address the issue of medical access differently, I would prioritize strengthening and expanding the existing healthcare framework to ensure that it better addresses the needs of those most affected by socioeconomic disparities. One critical step would be to advocate for the implementation of a public option, which would provide a government-run health insurance plan that competes with private insurers. This could help lower premiums and increase coverage options for individuals who do not qualify for Medicaid but still struggle to afford private insurance.

In addition, I would emphasize the importance of addressing the root causes of SES-related disparities, such as education and employment opportunities. By investing in education and job training programs, we could help lift individuals out of poverty, thereby reducing the long-term need for government-funded healthcare (Saputra, 2024).

Conclusion

Access to healthcare remains a critical public health issue influenced heavily by socioeconomic status, necessitating targeted interventions at the federal level. While recent presidents like Barack Obama and Joe Biden have made significant strides through the Affordable Care Act and the American Rescue Plan, continued efforts are essential to address the persistent disparities faced by lower SES populations. By expanding existing frameworks and addressing root causes, a more equitable healthcare system can be achieved, ensuring better access for all Americans.

 

 

References

Corallo, B. (2021). New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending. KFF. 

New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending

Links to an external site.

Healthcare.gov. (2022). 
Affordable care act (ACA) 
. Healthcare.gov; U.S. Centers for Medicare & Medicaid Services. 
https://www.healthcare.gov/glossary/affordable-care-act/
Links to an external site.

McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Frontiers in public health, 8, 231. 
https://doi.org/10.3389/fpubh.2020.00231
Links to an external site.

Saputra, G. R. (2024). Analyzing the Impact of Government Policy on Poverty Alleviation: Evaluating Social Protection Programs, Healthcare Access, and Economic Reforms. 
Inspirasi & Strategi (INSPIRAT): Jurnal Kebijakan Publik & Bisnis
, 
15
(1), 27-36. 
https://ejournal.isha.or.id/index.php/Inspirat/article/view/339
Links to an external site.

The White House. (2024). FACT SHEET: President Biden Takes New Steps to Lower Prescription Drug and Health Care Costs, Expand Access to Health Care, and Protect Consumers. The White House. 
https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/06/fact-sheet-president-biden-takes-new-steps-to-lower-prescription-drug-and-health-care-costs-expand-access-to-health-care-and-protect-consumers/
Links to an external site.

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Henrietta Mensah

Aug 28, 2024 3:55pm
| 
Last reply Aug 29, 2024 7:31pm

Reply from Henrietta Mensah

Presidential Agendas

It is beneficial to create policies that influence population health by emphasizing prevention and wellness. The government makes various policies regarding the reduction and elimination of waste eradication of health disparities based on various factors such as ethnicity, language, income, gender disability, race and sexual orientation. Good policies enhance public health, improving the community health status as a whole, not just an individual. Therefore, regardless of political affiliation or the president in power, every citizen has to enjoy the benefits of a good healthcare policy. Healthcare is part of every president’s agenda; therefore, each president must fulfill the agenda by creating healthcare policies that benefit the citizens.

One of the critical aspects that require effective policy-making is mental health, which continues to affect society. Depression, anxiety and stress, among other mental health challenges, affect millions of American citizens and result in other healthcare challenges; therefore, it is paramount to ensure adequate policies on the social location to enhance mental health treatment to improve productivity, quality of life and overall health status (World Health Organization, 2022). Mental health has a critical adverse impact on the economy, as the mentally ill population cannot increase productivity, which negatively affects GDP. Effective measures to ensure access to mental health treatment for timely and quality psychiatrist services such as telepsychiatry resulting in improved mental health and increased productivity. The mental health policy also includes discrimination and stigmatization reduction policies, including diversity and inclusivity policies that ensure all people, regardless of their race or ethnicity, have access to quality life. The president must read in allocating resources to implement comprehensive strategies and create long-term health outcomes.

During the President Obama era, he created the Affordable Care Act (ACA), (Obamacare), which ensured that mental health and behavioral services were incorporated into insurance coverage to ensure mental health treatment for all. Obamacare included mental health insurance in private insurance plans and tele-visits are available to everyone and covered by employer insurance coverage. Mental health was incorporated into essential health benefits that the Affordable Care Act ensured citizens could receive quality treatment services. Mental health and behavioral health services, are incorporated in Medicaid programs that ensure the low premium insurance coverage policies cover effective behavioral health treatment such as counseling, mental health and behavioral health inpatient services, and substance use disorder treatment (Stewart et al., 2018). Therefore, the inclusion of mental health as an essential health benefit means health insurance plans cover mental health treatment, enhancing access to quality care. The expanded Medicaid that was issued to most of the low-income earners who were uninsured and insurance policies were critical to ensuring mental health access to most of the poor people who are vulnerable to mental health challenges. The inclusion of telehealth under the support of ACA ensured increased access to mental health treatment processes for people living remotely. Therefore, President Obama made significant policies, including the Affordable Care Act that ensured mental health treatment services were available to Americans, thus increasing the quality of life and overall health care.

Under President Trump, the ACA was not successful, but there were critical improvements in telehealth policies that improved health treatment virtually due to covid-19 pandemic that limited inpatient treatment. Under the current administration, President Biden introduced the American Rescue Plan, which increased funding for mental health treatment plans and telehealth, improving access to mental health treatment. The funding has also been allocated to education and awareness campaigns that will ensure healthcare professionals educate the public on the dangers of mental challenges and substance use (Randi, 2021). The policy to increase budgeted allocation to the mental health statement process is timely and critical after the coronavirus, which increases mental health challenges. There has been increased access to healthcare treatment services for both in-person and virtual services. Therefore, each president has been critical in highlighting the Presidential agenda, with each increasing access to mental health treatment through creating quality policies.

On what I would do differently, I would ensure mental health policies are well developed under universal mental health coverage that will ensure individuals with mental health challenges have mental health access regardless of the type of insurance coverage they have. This policy, building on Obama care and the American rescue plan act by the Biden administration, will significantly reduce mental health challenges. All insurance policies, including Medicaid and private programs, will cover mental health treatment. I would prioritize the increased budget allocation to infrastructure development and telehealth services, which ensure mental health services, are accessible to every part of the country, even in rural areas where resources are limited. Infrastructure development in rural areas to ensure there is an adequate network is critical to support virtual health care and mental medication apps that increase mental health access. The funding was also largely awareness campaigns to reduce factors that increase mental health challenges such as stigmatization. This will be critical in addressing the gaps left by the policies of the two presidents.

 

References

Randi, O. (2021, August 2). 
American Rescue Plan Act Presents Opportunities for States to Support School Mental Health Systems
. NASHP. https://nashp.org/american-rescue-plan-act-presents-opportunities-for-states-to-support-school-mental-health-systems/

Stewart, M. T., Horgan, C. M., Hodgkin, D., Creedon, T. B., Quinn, A., Garito, L., Reif, S., & Garnick, D. W. (2018). Behavioral Health Coverage Under the Affordable Care Act: What Can We Learn From Marketplace Products? 
Psychiatric Services
, 
69
(3), 315–321. https://doi.org/10.1176/appi.ps.201700098

World Health Organization. (2022, June 17). 
Mental health
. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

 

 

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Erica Danielle De Los Santos

Aug 28, 2024 2:06pm
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Last reply Aug 30, 2024 7:34am

Reply from Erica Danielle De Los Santos

Access to health services plays a vital role in shaping mental health outcomes within our society; factors like the availability of mental health professionals and the financial accessibility of services are key elements in this determinant alongside the presence of a supportive infrastructure to uphold these services effectively and efficiently for individuals in need (referencing Pincu et al., 2007). Various obstacles that hinder access to health services—such as limited insurance coverage and societal stigma attached to seeking help for mental health concerns along, with challenges related to geographical distance—significantly affect individuals’ mental well-being and holistic wellness.

President Obama’s administration implemented measures to tackle mental health concerns through laws and policy actions. His Affordable Care Act (ACA) broadened health coverage by incorporating mental health and substance abuse treatment services as crucial health benefits to bridge the gap in healthcare accessibility (Obama 2010). This extension played a role in enhancing the provision of mental health support, for numerous Americans. During his time in office the Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted. This law mandated that mental health services should receive the coverage as physical health services in order, for treatment fairness (accordingly stated by Bachbach & Sacks in 2014).

Throughout Donald Trump’s time as President of the United States, mental health received attention through various legislative initiatives and responses to the opioid crisis. His administration endorsed the 21st Century Cures Act; which aimed to secure funding for bolstering mental health services and enhancing the coordination of mental health care within broader healthcare frameworks (Trump 2016). Nevertheless, there were apprehensions regarding suggested reductions, in Medicaid funding and other programs that could potentially weaken health services (Lavis and Robles 2019). Although the steps taken by the government to tackle the crisis were commendable, some critics believe that these actions did not adequately target the underlying problems related to mental health care accessibility.

When it comes to taking care of mental well-being, in advance I’d put these plans into action;

Support the development of care models that bring together mental health services and primary care in a unified approach to enhance accessibility and reduce stigma, around mental health treatment while making it a regular part of overall healthcare management (as discussed by Pincus and colleagues in 2007). Let’s allocate resources to community-based initiatives by funding mental health programs in areas that lack adequate services and by enhancing support for community mental health centers and projects targeting factors, like housing and job assistance that contribute to mental well-being (source. Jorm 2014). Let’s improve health education and training by introducing training programs, for primary care providers and first responders to better recognize and address mental health conditions early on while also spreading awareness and reducing stigma through public education initiatives (Corrigan & Watson).

By implementing these tactics, we can establish a health care system that is more inclusive and efficient, in catering to both accessibility and quality of services.

 

References:

Bachrach, L. L., & Sacks, V. (2014). 
The Affordable Care Act and Mental Health Parity: A Health Policy Perspective
. 
Health Affairs
, 33(5), 836-843.

Corrigan, P. W., & Watson, A. C. (2007). 
The Stigma of Psychiatric Disorders and the Role of Mental Health Literacy
. 
Journal of Social Work Education
, 43(1), 29-40.

Jorm, A. F. (2014). 
Mental Health Literacy: Empowering the Community to Take Action for Better Mental Health
. 
American Psychologist
, 69(7), 481-491.

Lavis, N., & Robles, R. (2019). 
Evaluating the Impact of the Trump Administration’s Policies on Mental Health Services
. 
Journal of Policy Analysis and Management
, 38(4), 944-959.

Obama, B. (2010). 
Remarks on the Affordable Care Act
.

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Rebecca Carico

Aug 28, 2024 11:48am
| 
Last reply Aug 31, 2024 8:06pm

Reply from Rebecca Carico

Opioid Epidemic

Between 2002 and 2022, deaths caused by opioid overdoses have skyrocketed. According to the latest data available from the CDC, in 2022 synthetic opioids had the highest rate of drug overdose deaths compared to heroin, methadone, and natural/semisynthetic opioids combined (Spencer et al., 2024). The total deaths in 2002 for males and females combined topped out at 23,518, while the total deaths for males and females combined in 2022 topped out at 107,941 (Spencer et al., 2024, data table for figure 4 PDF). This is almost a five-fold increase in deaths since 2002. While easier accessibility to healthcare has been on the rise and our more rural areas are seeing the benefits of having easier access to healthcare in their community, this also could have inadvertently contributed to the rising opioid epidemic that we are currently battling in our country. Lack of continuing education, experience, knowledge of pain management using best practice standards, and poor staff ratios also could be considered contributing factors for the growing opioid crisis.

Obama Administration

In 2010, Former President Obama released his first National Drug Control Strategy that stressed the importance to address the opioid crisis while also ensuring patients received adequate and effective treatment for pain management (Office of the Press Secretary, 2015). During his first term, he placed more than $300 million in funding for drug abuse prevention, improving prescribers’ education regarding opioids and adequate pain relief, increasing treatment access, and offering support for recovery and rehabilitation.

In 2015, Former President Obama announced federal, state, local, and private sector efforts aimed at addressing the prescription drug abuse and heroin epidemic (Office of the Press Secretary, 2015). This effort stresses the importance of proper training for prescribers and educators (such as doctors, dentists, advanced practice registered nurses, physician assistants, etc.), improving access to treatment of drug abuse for patients, and providing easier access to opioid reversal agents such as naloxone.

Trump Administration

In 2018, Former President Trump approved more than $1 billion in funding to state and local entities for prevention, treatment, recovery, and education for opioid addiction and secured $6 billion in new funding over two years to fight the opioid crisis (National Archives and Records Administration, 2018). Former President Trump also implemented a Safer Prescribing Plan that reduced the demand for over-the-counter prescriptions, helped states transition to Prescription Drug Monitoring Programs, and helped healthcare providers adopt best practices for opioid prescribing (National Archives and Records Administration, 2018)

Biden Administration

In 2018, President Biden signed the Mainstreaming Addiction Treatment (MAT) Act of 2023 that eliminated the “X-waiver” that prescribing providers needed to prescribe buprenorphine, a medication that curbs opioid cravings, reduces drug use, and prevents opioid related deaths (The United States Government, 2023). In 2023, President Biden made Naloxone (Narcan) more accessible by working with the U.S. Food and Drug Administration (FDA) to approve the use of Naloxone as an over-the-counter nasal spray, eliminating the need for a prescription. President Biden also deemed August 25
th
 – 31
st
 as national Overdose Awareness Week in an attempt to acknowledge the numerous lives that have been negatively affected by the opioid crisis.

What I Would Do Differently

While I understand the limitations our policymakers face in the big picture, whether it be time constraints, lack of knowledge, or lack of resources, I do believe there are things that can be done to improve the opioid epidemic at a local and state level. I would continue to dive deeper into promoting continuing education for prescribing providers, specifically those who prescribe medications in a hospital, surgical, pain management, and psychiatric settings. In my experience after talking to patients about their personal experience with opioids, those healthcare settings mentioned are some of the most common places that my patients have stated “that’s where my addiction started”. Promoting alternative methods of pain relief can also be an option for decreasing the overall opioids prescribed, such as (but not limited to) homeopathic approaches, non-addictive pain relievers, physical therapy, guided imagery, gentle exercises, and nutritional supplementation.

Another area I would focus on would be to put in place stricter guidelines, rules, and regulations for our rehabilitation centers and “halfway homes”. Unfortunately, many of these facilities are not properly regulated due to lack of education, funding, and poor staffing ratios. Staffing and funding are two big areas that, on a local and state level, need to be reviewed and addressed for overall efficiency. While many financial representatives try and cut costs where they can to increase profit for their company, I do not believe healthcare is an area where “corners can be cut” to save a dime. Too often facilities are understaffed due to budgeting issues or “census issues”, which results in little to no time that proper education can be provided. I personally believe that this is a major contributor to the lack of education and resources for opioid rehabilitation in our rural areas. I would do my best to ensure that the budget is not an issue so in return, staffing needs can be properly met.

 

References

Spencer, M., Garnett, M., & Minino, A. (2024, March 21). 
Drug Overdose Deaths in the United States, 2002-2022
. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db491.htm#ref1

Office of the Press Secretary. (2015, October 21). 
Fact sheet: Obama Administration announces public and private sector efforts to address prescription drug abuse and heroin use
. Obama White House Archives. https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector

National Archives and Records Administration. (2018, October 24). 
President Donald J. Trump’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand
. Trump White House Archives. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand-2/

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Nche Mou Bayong

Aug 28, 2024 10:54am

Reply from Nche Mou Bayong

Presidential Agendas

The opioid crisis has developed into one of the most acute social problems affecting the population in the United States, causing thousands of deaths every year and putting pressure on the healthcare industry and society in general. Like all the other previous administrations, both the Trump and Biden administrations have realized the severity of the epidemic and have adopted multiple measures towards it. These approaches encompass their overall health care philosophies, but they are methodologically and aims distinct; Trump twists in Public health emergency declarations and funding endeavours, while Biden put in public health-centered approach. This essay will analyze the measures taken by these administrations and identify the other measures that could help to increase the impact of the federal response to this on-going problem.

Donald Trump’s Approach

Trump’s strategy on the opioid problem was characterized by tremendous early steps such as declaring the opioid use a public health emergency in October 2017. This was aimed at centralizing the federal response to the epidemic and coordinate the flow of resources at the national level; the epidemic was strongly affecting the country and 2017 alone recorded over 42, 000 opioid related deaths (Mann, 2020). It also ensured massive funding to address the crisis with $6 billion on two years on the initiative to Stop Opioid Abuse. This include half billion U.S dollars in 2017 and another five billion U.S dollars in 2018 dedicated to improve prevention, treatment and recovery (Wen & Sadeghi, 2020). The Trump administration was also keen on medication-assisted treatment (MAT) and formed the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which offered more guidelines on how to progress. Such activities were demonstrative of severe efforts toward the management of the crisis despite an evident lack of coordination and continuity.

Despite the Trump administration’s initiatives, its approach faced criticism for being inconsistent and insufficiently coordinated. Although the provision of the public health emergency and the allocation of considerable funds for this purpose were quite relevant and meaningful steps, the overall approach was seen as uncoordinated. The Office of National Drug Control Policy (ONDCP) suffered from Budget reductions at first, which were then restored; however, the absence of a coherent leadership system led to the poor organization of the opioid response (Mann, 2020). Moreover, conserving law enforcement also became the goal of the administration, such as increasing the penalties for drug traffickers and other types of criminals, where some critics said that the administration could care less about the development of appropriate public health strategies. This is because after having recorded a modest improvement in the number of overdose deaths in 2018, there was a spike in the number of deaths in the following years, thereby pointing to the partial nature of the Trump administration’s approach to the problem, indicating that much more ambitious and long-term interventions were in order.

Joe Biden’s Approach

The Biden administration has taken a more comprehensive and public health-focused approach to addressing the opioid crisis. Acknowledging the fact that the epidemic is severe, the administration has focused on increasing funding for and supporting efforts undertaken by states and communities. In 2022, President Biden unveiled $1.5 billion in funding to improve treatment and recovery programs; the president also stressed eliminating silos to other public health solutions and increasing the availability of treatment services (The White House, 2022). He has also ensured adequate funding for the drug control programs in his administration through advocacy for appropriate funding to address substance use disorders instead of punishing the individuals. This strategy comprises activities such as the promotion of recovery-oriented workplaces, the promotion of harm reduction programs, and the use of financial tools against international drug trafficking, especially networks involved in the supply of synthetic opioids, particularly fentanyl. In this way, the Biden administration proposed a comprehensive approach to tackle the opioid crisis in order to change the current punitive and oppressive model, helping the thousands of people struggling with opioid addiction.

Biden’s approach also reflects a broader shift towards a more holistic understanding of addiction and its impact on individuals and communities. Such an approach contrasts sharply with previous governments’ efforts to combat drug problems and aims to address them as a public health issue rather than a law enforcement one, using compassionate and treatment-based methods. Biden reported actions to weaken sources of synthetic opioids by rimming international cooperation and leveraging the Finances of the affected nations together with the practice of educational campaigns and increasing the availability of naloxone, an antidote to opioid overdose (The White House, 2022). The administration has also supported an expansion of such programs as the provision of syringes to drug users as well as the elimination of prejudice when it comes to addiction. The Biden administration is incorporating these various components as one comprehensive approach to respond to the opioid crisis in the short term as well as the long term in order to help as many people as possible in recovery and to decrease the social cost of addiction.

What You Would Do Differently

To strengthen the federal response to the opioid crisis more, I would concentrate on enhancing the national approach to response with the efforts of Federal, State, and local governments. This strategy entails charging a direct management team in the ONDCP with the responsibility of coordinating all the opioid initiatives so as to avoid duplication and hence guarantee efficient use of the available resources. Also, I would promote embracing long-term funding models rather than short-term grants to offer proper funding strategies by the treatment centers and the community programs in the long run. Another appropriate component of this approach would also be to create a unique register containing information on trends in opioid use in members, for example, overdose rates and treatment outcomes. In this way, it would be possible to identify the necessary measures as soon as possible, given the rapid increase in the newly arising needs of members.

Another essential component would be the extension of efforts in preventive and early action, more specifically in schools and neighborhoods. Increased availability of educational programs that would help the youthful population learn about the potential dangers of consumption of opioids and encouraging organizations to find strategies that can help manage the country’s pain without resorting to opioids would be another effective way of preventing the problem before it actually starts. I would also aim to increase the engagement of the community in ity involvement in developing and implementing opioid response strategies that should reflect the specific cultures of the needy cultures. Also, I would enhance collaboration with medical facilities to increase enrollment in medication-assisted treatment (MAT) and obtain the availability of harm-reduction resources like naloxone and syringes. When these prevention-centered strategies are integrated with thorough treatment and recovery services, this is the kind of federal response that could tackle the complex causes of the opioid epidemic and promote recovery for people affected.

References

The White House. (2022, September 23). 
FACT SHEET:  Biden-Harris Administration Announces New Actions and Funding to Address the Overdose Epidemic and Support Recovery | The White House
. The White House; The White House. 
https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/23/fact-sheet-biden-harris-administration-announces-new-actions-and-funding-to-address-the-overdose-epidemic-and-support-recovery/
Links to an external site.

Mann, B. (2020, October 29). 
Opioid Crisis: Critics Say Trump Fumbled Response To Another Deadly Epidemic
. NPR. 
https://www.npr.org/2020/10/29/927859091/opioid-crisis-critics-say-trump-fumbled-response-to-another-deadly-epidemic
Links to an external site.

Wen, L. S., & Sadeghi, N. B. (2020). The opioid crisis and the 2020 US election: crossroads for a national epidemic. 
The Lancet
, 
396
(10259), 1316–1318. 
https://doi.org/10.1016/s0140-6736(20)32113-9
Links to an external site.

‌

 

‌

 

‌

 

 

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Lucia Almeida

Aug 28, 2024 9:48am
| 
Last reply Aug 31, 2024 2:49pm

Reply from Lucia Almeida

The opioid crisis is still a significant problem in the public health sector, and it has become a national concern because of its prevalence. Economic disparities, lack of access to healthcare, and scarcity of mental health services are still driving this problem, especially among marginalized communities. These factors have been focal in presidential agendas over the past years, though with different strategies in terms of coverage and efficiency.

During the Trump administration, the opioid crisis was declared a public health emergency, which saw an increase in federal funding and efforts in the prevention and treatment of the disease. The administration focused on law enforcement measures, tighter prescription policies, and the availability of treatment methods like MAT (Phillips et al., 2020). However, the approach was often criticized for adopting a punitive approach rather than a public health approach, with insufficient focus on addressing the causes associated with social determinants. Despite the increased funding, unequal distribution of resources across the different states, especially in rural and hard-to-reach areas, hampered the implementation of these interventions.

The Biden administration moved the focus to a more comprehensive approach to a public health crisis, focusing on prevention and access to fair treatment. Biden’s American Rescue Plan plan focuses on increasing funding for harm reduction services and mental health services and addressing the racial and economic disparities that worsen the crisis(Affairs (ASPA), 2022). For instance, Biden has advocated for community-based interventions and treatment services for populations that have limited access to such services, acknowledging that social factors such as poverty, homelessness, and literacy levels are critical drivers of SUD.

Therefore, a more effective response would entail improving the implementation of social determinants in policymaking. Instead of relying mainly on the police to solve the problem, I would recommend policies that address the root causes of the opioid epidemic. For example, enhanced funding for community-based initiatives that encompass preventive education and socioeconomic services can help decrease substance abuse rates. Also, the policies should address the issue of parity for mental health and treatment in different communities, especially in minority groups.

In conclusion, although the recent administrations have made some efforts to counter the opioid epidemic, there is a dire need to enact policies that directly address the social determinants that fuel the epidemic. A combined approach of population-level interventions and targeted approaches aimed at addressing economic and racial inequalities would lead to more sustainable impacts, providing the basis for the community to protect itself against substance misuse in the long term.

References

Affairs (ASPA), A. S. for P. (2022, January 20). 
Biden-Harris Administration Awards $103 Million in American Rescue Plan Funds to Reduce Burnout and Promote Mental Health and Wellness Among Health Care Workforce
. HHS.gov. 
https://www.hhs.gov/about/news/2022/01/20/biden-harris-administration-awards-103-million-american-rescue-plan-funds-reduce-burnout-promote-mental-health-wellness-among-health-care-workforce.html
Links to an external site.

Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2020). 
Evidence on Strategies for Addressing the Opioid Epidemic
. Nih.gov; National Academies Press (US). 
https://www.ncbi.nlm.nih.gov/books/NBK458653/
Links to an external site.

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Brianna Renee Cole

Aug 28, 2024 7:08am
| 
Last reply Aug 31, 2024 12:52am

Reply from Brianna Renee Cole

Discussion 1
 

NURS 6050
 

Brianna Cole
 

August 28, 2024
 

 

Reproductive Rights

Abortion, one of the biggest topics that is on the forefront of every presidential agenda, has caused a major uproar across the country over the past two years. Women’s reproductive rights in general has been a sensitive political topic for decades. With the recent overturn of Roe vs Wade in 2022, millions of women are struggling to get the care that they need. This can be dangerous to many and cause bigger issues like before “Roe” won in 1973 when women who were desperate enough were finding ways to have an illegal abortion which ended up taking some of their lives. (Roe V. Wade: Behind the Case That Established the Legal Right to Abortion, n.d.)
 

As a nurse who is extremely passionate about women’s health and currently working in that area there have already been moments since the overturn of Roe where doctors have been needed but scared to perform the medically necessary abortions with all the possible legal trouble. It has caused a prominent level of uncertainty to many providers and nurses caring for them.
 

From the overturn of Roe vs Wade, there are many states with restrictions all the way to full bans on abortions, leaving women in unimaginable dilemmas. One of the main social determinants of health affecting this topic is economic stability. (Girardi et al., 2023) Those who are in trouble financially now must find the finances and resources to get to another state where abortions are still legal, and it is not that easy for a lot of women.
 

 

Trump Administration

Title X funding- Title X funding was created to help lower income families gain access to contraceptive services, supplies, and information about family planning. Former president Trump created a rule that barred providers that were in the Title X network from discussing abortion care to patients, even if they mentioned it first. It forced providers to drop out of the network if they wanted to continue to counsel patients on the topic.
 

Teen Pregnancy Prevention- Trump cut more than $200 million in programs that were made to help prevent teen pregnancy.
 

Global Gag Rule- Shortly after coming into office Trump reinstated and expanded on the global gag rule which prevents recipients of U.S. foreign aid from offering any information, referrals, services, or advocacy regarding abortion care.
 

Abortion Coverage- Trump passed a bill that denies abortion coverage on private insurance.
 

Supreme Court Justice- Trump appointed three new justices that replaced longstanding policymakers causing a dramatic change and contributed to the overturn of Roe vs Wade. (Short, 2021)
 

Biden Administration

Title X Funding- In 2021, President Biden reversed the rule created by Donald Trump which allowed providers to continue to counsel their patients as needed and refer them to abortion clinics. 
 

Right To Travel- President Biden reaffirmed the right to travel to another state to have a legal abortion performed without penalty.
 

Contraception Coverage- Proposed a rule that will help women have access to contraception at no cost. 

Reproductive Healthcare Privacy HIPAA- Biden issued a new rule to protect any reproductive health sought by an individual regardless of where you receive it. (House, 2023)
 

 

What I Would Do Differently

I would continue to expand on the changes taken place during the Biden-Harris Administration. The nation needs more funding to help with reproductive rights now more than ever. Giving funding back to teen pregnancy programs and Planned Parenthood is so vital. I would continue to work to make sure contraception is something that is more easily assessable to all who acquire it without it being a struggle. I would also work hard to have Roe vs Wade reinstated, as it is one’s personal right to make decisions about their bodies. Doing so, I would continue to make sure the privacy of one’s personal decisions remains private. 
 

 

References

Girardi, G., Longo, M., & Bremer, A. A. (2023). Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. International journal for equity in health, 22(1), 186. 
https://doi.org/10.1186/s12939-023-01963-x
Links to an external site.
 

Roe v. Wade: Behind the Case That Established the Legal Right to Abortion. (n.d.). Www.plannedparenthoodaction.org. 
https://www.plannedparenthoodaction.org/issues/abortion/roe-v-wade/roe-v-wade-behind-case-established-legal-right-abortion#:~:text=Road%20to%20Roe-
Links to an external site.
 

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed.). Jones & Bartlett Learning
 

The White House. (2023, June 23). FACT SHEET: President Biden Issues Executive Order on Strengthening Access to Contraception. The White House. 
https://www.whitehouse.gov/briefing-room/statements-releases/2023/06/23/fact-sheet-president-biden-issues-executive-order-on-strengthening-access-to-contraception/
Links to an external site.
 

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Regina Candice Shaw

Aug 28, 2024 12:03am
| 
Last reply Aug 31, 2024 3:56pm

Reply from Regina Candice Shaw

Prescription Drug Cost Reforms

 

Healthcare costs in the United States of America are growing exponentially, and lifesaving medications are still unaffordable for many Americans.
The Republican Party and the Democratic Party
have both different approaches to solving the issues. One side believes allowing competition will bring the price down. The other side argues that capping the cost of prescription drugs will make them less accessible to more Americans. Unfortunately, in the post-COVID-19 era, we have seen a rise in the cost of living, and some citizens had to choose between groceries and medication.

The Trump Administration has been successful at speeding up the Food and Drug Administration (FDA) approval rate for processing new drugs, which led to the early introduction of generic drugs (Dabbous et al., 2019). Normally, the FDA review process takes 6-8 years for a generic drug, shortening the time allows more competition and drives the cost down. During, the pandemic, for example, the fast approval of the vaccine and other competitors allowed more people to get vaccinated and helped prevent more deaths. In addition, former President Donald J. Trump’s executive order promoted healthcare and competition across the state lines. This action was estimated to save $200 billion towards the federal deficit in 10 years (Dabbous et al., 2019). Admittedly, competition alone cannot solve the issue of prescription costs rising, the government should have more regulatory power to considerably drive the cost.

The Biden Administration reached an agreement with drug manufacturers to lower the price of life-saving medication used in the treatment of chronic diseases such as Farxiga, Entresto, insulin, and others for the treatment of diabetes, heart failure, and chronic kidney disease. Moreover, crucial medication for stroke prevention and the treatment of blood clots Medicare enrolled almost 4 million Americans who used the medication they were able to negotiate the price down to 56% (House, 2024). Working as a nurse on the cardiac floor we hear anecdotes about seniors not being able to afford their medication and going months without it because they are not able to afford it or take less than was prescribed to make their supply last longer (i.e. rationing). Finally, the Biden Administration is planning to expand the list of medications they will plan on negotiating the price which will help beneficiaries of Part D Medicare recipients at least $400 yearly (House, 2024).

Among other industrialized nations, the US prices persistently remain high despite progress to reduce the cost. What I would do is have the government implement policies to further lower the cost of prescription drugs, because in the senior community, for example, there are seniors that have multiple comorbidities. Some of my patients have to deal with diabetes, hypertension, heart failure, coronary artery disease, COPD, and others. Most of them have 10-plus medications to take daily, which can easily go over $500 monthly (Kesselheim et al., 2016). I will advocate for affordable prescription drugs for all not just a specific population. Neglecting to care for the younger population will lead to a sicker senior population. For example, in France Lantus costs $46.6 compared to $186 which is almost 4 times less (Kesselheim et al., 2016). Lastly, promoting a healthy lifestyle needs to be incorporated at every level. Some solutions like portion reduction, better choices of ingredients, and an active lifestyle.

In summation, there is still a long way to address the healthcare crisis in this country, from health coverage to prescription affordability. Politician have to set their differences apart and work to serve their citizen. Management of chronic disease should be accessible to all because complications, frequent hospitalization, and worst death can happen prematurely. Undoing progress from the previous administration is not a solution but building on and ameliorating what is not working will set the nation forward rather than going back.

 

 

 

References

Dabbous, M., François, C., Chachoua, L., & Toumi, M. (2019). President Trump’s prescription to reduce drug prices: From the campaign trail to American Patients First. 
Journal of Market Access & Health Policy
, 
7
(1), 1579597. https://doi.org/10.1080/20016689.2019.1579597

House, T. W. (2024, August 15). 
FACT SHEET: Biden-Harris Administration Announces New, Lower Prices for First Ten Drugs Selected for Medicare Price Negotiation to Lower Costs for Millions of Americans
. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2024/08/15/fact-sheet-biden-harris-administration-announces-new-lower-prices-for-first-ten-drugs-selected-for-medicare-price-negotiation-to-lower-costs-for-millions-of-americans/

Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform. 
JAMA
, 
316
(8), 858. https://doi.org/10.1001/jama.2016.11237

 

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Stella Chinelo Ukakogu

Aug 27, 2024 10:12pm
| 
Last reply Aug 31, 2024 2am

Reply from Stella Chinelo Ukakogu

Week1 Discussion

Main Post

 

The opioid crisis is still a significant health problem in the United States of America, affecting the lives of many individuals, communities, and business entities. Fighting this crisis has become one of the major concerns of the recent presidential terms. According to Lombardi et al. (2023), Obama and Trump, and the recently elected Biden, had their policies regarding the opioid crisis, although the strategies differed and the effectiveness was also different.

Obama’s administration began concentrating on increasing the availability of treatment, as seen through the Comprehensive Addiction and Recovery Act (CARA) of 2016, which sought to help improve prevention, treatment, and recovery support. However, even when these programs were in place, opioid deaths persisted, which was an indication that there was a need for more elaborate action (Roberts, 2024). The Obama Administration released the opioid declaration in 2017 and expanded funding of programs and policing to arrest the supply and demand of illicit substances. Nevertheless, it was considered to be neglected in identifying the fundamental issues of addiction. The Biden administration has moved to the Health and Well Being approach, where the administration highlights the need to meet the Quadruple Aim of healthcare, improve physical and mental health, decrease health disparities, improve the healthcare practitioner experience, and reduce the cost of healthcare. These are what the American Rescue Plan covers, which are significant in such areas, recognizing that substance use disorders are also multidimensional with social and economic determinants (Chhatwal et al., 2023).

What I would have done differently

To continue and strengthen these changes, I would continue to further the preventable measures by continuing education that targets substance abuse among students and enhancing the availability of mental health services in communities. In the same regard, the application of informational technology, like applications of artificial intelligence, could promptly improve the patterns of mitigating incidences among high-risk individuals. A lifespan, prevention-oriented approach should be used to address the deadly consequences of the opioid cris

References

Roberts, D. L. (2024). Reframing the response to the opioid crisis: The critical role of resilience in public health. 
Open Health
, 
5
(1), 20230006.

Chhatwal, J., Mueller, P. P., Chen, Q., Kulkarni, N., Adee, M., Zarkin, G., … & Barbosa, C. (2023). Estimated reductions in opioid overdose deaths with sustainment of public health interventions in 4 US States. 
JAMA network open
, 
6
(6), e2314925-e2314925.

Lombardi, A. R., Arya, R., Rosen, J. G., Thompson, E., Welwean, R., Tardif, J., … & Park, J. N. (2023). Overdose detection technologies to reduce solitary overdose deaths: a literature review. 
International journal of environmental research and public health
, 
20
(2), 1230.

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Uzunma Nkama

Aug 27, 2024 9:59pm
| 
Last reply Aug 30, 2024 8:52pm

Reply from Uzunma Nkama

Past presidents have approached the important problem of marginalized people’s access to healthcare in different ways. Former President Barack Obama enacted the Affordable Care Act (ACA) in an effort to provide millions of Americans with greater access to healthcare, but it has since encountered difficulties and undergone modifications (Obama, 2010). Opponents argue that President Trump’s administration’s policies and attempts to dismantle the Affordable Care Act have exacerbated disparities in healthcare access. A more thorough and diverse approach is required to solve this problem.

Increasing funding for community health centers, enacting laws to combat systematic racism and discrimination, funding initiatives to combat poverty and increase access to opportunities for education and employment, fortifying Medicaid and other public health insurance programs, and endorsing community-based projects to improve health outcomes and tackle social determinants of health are a few potential solutions (CDC, 2020).

In conclusion, resolving health disparities and guaranteeing underprivileged populations’ access to healthcare necessitates an all-encompassing strategy that tackles the underlying causes of these problems.

                                                                                   References

Centers for Disease Control and Prevention. (2020). Social determinants of health

Obama, B. (2010). The Affordable Care Act. Retrieved from

https://www.healthcare.gov/about-the-aca/
Links to an external site.

 

 

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Jasmine Daniels
 (She/Her)

Aug 27, 2024 9:49pm
| 
Last reply Sep 1, 2024 8:15am

Reply from Jasmine Daniels

Jasmine Daniels

August 27, 2024

 

Reproductive Rights: A Nurse’s Approach

Reproductive rights have been one of the hottest topics on the ballot for the last several election terms.  From contraception to abortion to sex education, the topic of reproductive rights—or lack thereof—has created an immense amount of discourse, both on and off the podium.  Legislation began in the 1970s with Title X, a program established to provide accessible and affordable family planning and reproductive health resources for low-income families within the United States (Department of Health and Human Services, 2022).  The 
Roe v. Wade 
decision would follow, creating a landscape for discourse on sexual health, sex education, abortion, and reproductive rights as a whole.

The Roe v. Wade
 decision of 1973 set a precedent for the right to choose whether to have children.   By extension, abortion was considered a fundamental right (Wilson, 2020).  From the time of the ruling to today, many bills have been introduced to amend parts or all of the 
Roe v. Wade
 decision, threatening access to reproductive care and women’s health resources across the United States (Baden et al., 2024).

The last three presidential administrations have had vastly different approaches to the topic of reproductive rights.

 

Obama Administration

2010 – 
Affordable Care Act 
– 
Prevented insurance companies from denying coverage based on gender and pre-existing conditions. Expanded access to preventative care, including contraceptives (
Fact sheet: Obama administration record for women and girls
 2014).

Defended Title X (2014).

2015 – 
Budgeted for funding
 
programs geared at sex education and teen pregnancy prevention (2014).

 

Trump Administration

2018 – 
Trump administration announces plan to cut funding for Title X.

2019 – 
Domestic Gag Rule – revisions to Title X imposing restrictions on abortion providers and facilities. (Hasstedt & Dawson, 2022)

 

Biden Administration

2021- 
Proposal to restore Title X provisions cut by domestic gag rule during Trump Administration (
Title X program handbook (July 2022)
.

2022
 – Executive Order 14076 – Protecting Access to Reproductive Health Services. Provided guidance to healthcare providers and allied health professionals regarding roles, responsibilities, and legal coverage when providing abortion-related services through the Emergency Medical Treatment and Labor Act (EMTLA) (2022).

2022
 – Clarification on Affordable Care Act coverage of contraceptives (2024).

 

What would I have done differently?

The topic of reproductive rights is very nuanced and tends to incite enthusiastic discourse. Regardless of personal beliefs or opinions, we must advocate for our patients.  That said, I do believe more funding needs to be allocated to real sex education.   Access to quality healthcare for preventative care and family planning is also critical. As a healthcare provider in a rural area, I have seen the negative impact that limited access to reproductive health resources and education can create.  I certainly don’t have all of the answers, but I am eager to learn how to better advocate for my patients beyond the bedside.

 

Reference
s

Baden, K., Dreweke, J., & Gibson, C. (2024, August 22). 
Clear and growing evidence that Dobbs is harming reproductive health and freedom
. Guttmacher Institute. https://www.guttmacher.org/2024/05/clear-and-growing-evidence-dobbs-harming-reproductive-health-and-freedom

Department of Health and Human Services : Office of population affairs. (2022, July). 
Title X program handbook (July 2022)
. Title X Program Handbook. https://opa.hhs.gov/sites/default/files/2022-08/title-x-program-handbook-july-2022-508-updated.pdf

Hasstedt, K., & Dawson, R. (2022, August 30). 
Title X under attack-our comprehensive guide
. Guttmacher Institute. https://www.guttmacher.org/article/2019/03/title-x-under-attack-our-comprehensive-guide

National Archives and Records Administration. (2014, August 26). 
Fact sheet: Obama administration record for women and girls
. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/2014/08/26/fact-sheet-obama-administration-record-women-and-girls

The United States Government. (2022, August 5). 
Executive order on securing access to reproductive and other healthcare services
. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/08/03/executive-order-on-securing-access-to-reproductive-and-other-healthcare-services/

The United States Government. (2024, March 7). 
Fact sheet: Biden-Harris Administration continues the fight for Reproductive Freedom
. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/07/fact-sheet-biden-harris-administration-continues-the-fight-for-reproductive-freedom/

Wilson, J. C. (2020). Striving to rollback or protect Roe: State legislation and the trump-era politics of abortion. 
Publius: The Journal of Federalism
, 
50
(3), 370–397. https://doi.org/10.1093/publius/pjaa015 NURS 6050 Week 1 Discussion Answers

NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

Patient 1:
 A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

The Assignment

Answer the following questions using the patient examples described above.

Patient 1

What are the concerns of the patient remaining on the opioid medication and clonazepam?

How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

How would you instruct the patient to taper off clonazepam?

What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.

How would you start the new recommended psychotropic medication for the patient?

Discuss one legal, ethical, or social consideration with the treatment plan.

Patient 1: NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

The case of the 36-year-old male patient who presented to the clinic with a prescription for an opioid analgesic medication from a work accident presented to be a complex challenge in medication management. The primary risk in this medication regimen is the risk of respiratory depression, which can be a significant side effect after taking opioids, such as benzodiazepine. In their study, Boon et al. (2020) identified that when benzodiazepines are prescribed together with opioids, it can have potential harm to taking medication alone. Benzodiazepine and opioids both cause respiration depression, which increases the patient’s risk for potentially lethal apnea.

Educating this patient regarding the identified risks is also essential to approaching the conversation with empathy and emphasizing the importance of safety. Therefore, ongoing patient education should be keen on the synergistic impacts of medications on the central nervous system and how it is likely to result in excessive sedation, cognitive impairment, and an increased risk of falls and injuries. During patient education, explaining that while each medication may benefit the individual, taking them concurrently increases their risks for other related health conditions is critical.

BUY A PLAGIARISM-FREE PAPER HERE

Following the patient’s position to discontinue clonazepam, it is important to recommend a carefully structured tapering plan. Abrupt discontinuation of benzodiazepine is likely to contribute to severe withdrawal symptoms such as rebound anxiety, insomnia, and, in some cases, seizures (Brandt et al., 2024). The gradual tapering plan entails the reduction of the dose by 5-10% every 2-4 weeks. The nurse should monitor the patient closely for any withdrawal symptoms or exacerbation of anxiety.

To address the patient’s concern regarding panic attacks, the alternative medication that should be considered should not interact with opioids. Selective Serotonin Reuptake Inhibitors (SSRIs) have been described as a first-line choice for panic disorder and with a more favorable safety profile when combined with opioids (Garakani et al., 2020). A medication in that class is sertraline, which has been shown to have efficacy in the treatment of panic disorder and has no significant interactions with opioid medications. When starting the new psychotropic medication, it is essential to initiate a low dose and titrate slowly (Baldacci et al., 2023). Sertraline’s initial dose is 25 mg daily for the first week, which will be increased to 50 mg daily in the subsequent week. Other adjustments may be made based on response and tolerability, and patients may be instructed to follow up with their regular NPs or MDs every 2-3 weeks.

A significant level of ethical consideration is the need to provide the best for the patient and achieve a balance between pain management and the risk of medication addiction. The prescriber has a legal obligation to manage the patient’s chronic pain and, at the same time, safeguard from a possible opioid addiction.

De-Prescribing

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note:
 APA style format guidelines will apply.

Patient Examples:

Patient 1:
 A 36-year-old male presents to your office being prescribed by his primary care physician (PCP) for the past 3 years an opioid analgesic medication for a work accident. He has chronic pain and is attending a pain clinic. It is determined the best course of treatment for pain is to remain on opioid medication. The patient is also being prescribed clonazepam 1mg BID for “relaxation” and panic attacks.

Patient 2:
 
A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects.
She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects
.

Patient 3:
 
A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

Patient 4:
 
A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

Resources

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare for this Assignment:

Review the assigned Learning Resources for this week.

Review the definitions presented in your text and resources for de-prescribing and tapering.

Consider the importance of de-prescribing.

Based on the example(s) provided, consider how you might de-prescribe a patient.

The Assignment

Answer the following questions using the patient examples described above.

Patient 1

What are the concerns of the patient remaining on the opioid medication and clonazepam?

How might you educate the patient about these risks and concerns?

The patient agrees that he should not continue both medications in combination. He would like to “get off” the clonazepam but worries about “bad withdrawals” that he’s heard about from stopping clonazepam “cold turkey” and is concerned about re-occurring panic attacks. How might you respond to the following:

How would you instruct the patient to taper off clonazepam?

What other medication would you recommend for the patient for the treatment of his panic attacks? Keep in mind, he will continue the opioid medication for pain relief.

How would you start the new recommended psychotropic medication for the patient?

Discuss one legal, ethical, or social consideration with the treatment plan.

Patient 2

The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?

Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.

Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?

What is the dose you would prescribe and how would you taper off the medication?

Patient 3

Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.

Review other alternative medications to treat generalized anxiety disorder.
Include risks, benefits, and potential side effects to both the patient and the developing fetus
. Keep in mind, the patient is looking to breast feed for 6 months postpartum.

The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.

The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 4

Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?

How would you evaluate the patient for these side effects?

The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?

Review with the patient and daughter potential side effects
of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

Reminder:
 The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The 
Walden Writing Center Sample Paper
Links to an external site.
 provides an example of those required elements.

By Day 7

Submit
 your Assignment by 
Day 7 of Week 5
.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the 
Turnitin Drafts
 from the 
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 area.

To submit your completed assignment, save your Assignment as 
WK5Assgn_LastName_Firstinitial

Then, click on 
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 near the top of the page.

Next, click on 
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 and select 
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 for review.

Rubric

NURS_6630_Week5_Assignment_Rubric

NURS_6630_Week5_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Patient 1: Describes concerns for patient remaining on the medication and how these risks and concerns will be addressed to the patients. Describes how to assist Patient 1 in tapering medication, as well as what other medication might be prescribed with considerations of legal, ethical, or social considerations to the plan.

20
 
to >
18.0
 pts
Excellent
The response comprehensively describes medication risks and concerns. The response comprehensively and clearly explains how the patient will be educated. The response comprehensively and clearly explains considerations for medication tapering. The response comprehensively and clearly reflects on legal, ethical, or social considerations of the plan.

18
 
to >
15.0
 pts
Good
The response clearly describes medication risks and concerns. The response clearly explains how the patient will be educated. The response clearly explains considerations for medication tapering. The response clearly reflects on the legal, ethical, or social considerations of the plan.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes medication risks and concerns. The response inaccurately or vaguely explains how the patient will be educated. The response inaccurately or vaguely explains considerations for medication tapering. The response inaccurately or vaguely reflects on legal, ethical, or social considerations of the plan.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes medication risks and concerns, or it is missing. The response includes inaccurate and vague examples that does not explain how the patient will be educated, or it is missing. The response vaguely or inaccurately explains considerations for medication tapering, or it is missing. The response includes inaccurate and vague examples that does not reflect on legal, ethical, or social considerations of the plan, or it is missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 2: Describes common withdrawal symptoms and patient education information. Describes which benzodiazepine might be prescribed to convert the patient, as well as the specific dosing and tapering information.

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly explains withdrawal symptoms. The response comprehensively and clearly provides patient education information. The response comprehensively and clearly identifies a benzodiazepine for the patient. The response comprehensively and clearly details dosing and tapering information.

18
 
to >
15.0
 pts
Good
The response clearly explains withdrawal symptoms. The response clearly provides patient education information. The response clearly identifies a benzodiazepine for the patient. The response clearly details dosing and tapering information.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely explains withdrawal symptoms. The response inaccurately or vaguely provides patient education information. The response inaccurately or vaguely identifies a benzodiazepine for the patient. The response inaccurately or vaguely details dosing and tapering information.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately explains withdrawal symptoms, or it is missing. The response includes inaccurate and vague examples that does not provide patient education information, or it is missing. The response vaguely or inaccurately identifies a benzodiazepine for the patient, or it is missing. The response includes inaccurate and vague examples that does not detail dosing and tapering information, or it is missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 3: Describes potential risks, benefits and side effects of lorazepam, as well as alternative medications that might be prescribed for the patient. Describes how the patient might discontinue lorazepam, with necessary patient education regarding discontinuing medication and patient/fetus needs.

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly describes risks, benefits and side effects of lorazepam. The response comprehensively and clearly identifies potential alternative medications. The response comprehensively and clearly describes how the patient might discontinue the medication. The response comprehensively and clearly provides necessary education for discontinuing the medication for patient and fetus.

18
 
to >
15.0
 pts
Good
The response clearly describes risks, benefits and side effects of lorazepam. The response clearly identifies potential alternative medications. The response clearly describes how the patient might discontinue the medication. The response clearly provides necessary education for discontinuing the medication for patient and fetus.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes risks, benefits and side effects of lorazepam. The response inaccurately or vaguely identifies potential alternative medications. The response inaccurately or vaguely describes how the patient might discontinue the medication. The response inaccurately or vaguely provides necessary education for discontinuing the medication for patient and fetus.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes risks, benefits and side effects of lorazepam, or it is missing. The response includes inaccurate and vague examples that does not identify potential alternative medications, or some or all are missing. The response vaguely or inaccurately describes how the patient might discontinue the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary education for discontinuing the medication for patient and fetus, or some or all are missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education regarding the tapering NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly describes potential side effects and risks. The response comprehensively and clearly describes how to taper the medication. The response comprehensively and clearly provides necessary patient education for tapering.

18
 
to >
15.0
 pts
Good
The response clearly describes potential side effects and risks. The response clearly describes how to taper the medication. The response clearly provides necessary patient education for tapering.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes potential side effects and risks. The response inaccurately or vaguely describes how to taper the medication. The response inaccurately or vaguely provides necessary patient education for tapering.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes potential side effects and risks, or it is missing. The response vaguely or inaccurately describes how to taper the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary patient education for tapering, or some or all are missing.

20
 pts

This criterion is linked to a Learning Outcome
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references

5
 
to >
4.0
 pts
Excellent
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references outside of course resources.

4
 
to >
3.0
 pts
Good
Paper demonstrates some critical thinking and/or vague synthesis of literature with four (4) evidence-based, peer reviewed scholarly references outside of course resources.

3
 
to >
1.0
 pts
Fair
Paper demonstrates vague critical thinking and/or little synthesis of literature with three (3) evidence-based, peer reviewed scholarly references.

1
 
to >
0
 pts
Poor
Paper demonstrates no critical thinking and/or synthesis of literature with two (2) or less evidence-based, peer reviewed scholarly references.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4
 
to >
3.0
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the Assignment is stated yet is brief and not descriptive.

3
 
to >
1.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the Assignment is vague or off topic NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

1
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5
 
to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.0
 pts
Good
Contains one or two grammar, spelling, and punctuation errors.

3
 
to >
1.0
 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors.

1
 
to >
0
 pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.0
 pts
Good
Contains one or two APA format errors.

3
 
to >
1.0
 pts
Fair
Contains three or four APA format errors.

1
 
to >
0
 pts
Poor
Contains many (five or more) APA format errors.

5
 pts

Total Points: 
100 NURS-6630 Week 5: Assignment De-Prescribing – Anxiolytics and Anxiety – A 36-year-old male prescribed opioid analgesic medication and clonazepam 1mg BID

NURS-6630 Week 5: Assignment De-Prescribing – A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia

Patient 4:
 A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia. He is forgetful and seems to be tripping on things or walking into walls, although he has lived in the same home for the past 35 years. The patient does not agree with his daughter but does admit he has had a “few stumbles and falls” lately. Medication reconciliation shows the following medications: metoprolol ER 50mg q day, omeprazole 20mg q day, clonazepam 1mg TID, levothyroxine 75mcg q am. His daughter is wondering if he should be started on a “dementia medication.”

Patient 4

Review potential side effects for elderly on benzodiazepines providing education to both the patient and the patient’s daughter. What are the risks of continuing the benzodiazepine for this patient?

How would you evaluate the patient for these side effects?

The patient and daughter agree he will need to taper off the clonazepam given the risks of continuing this medication. How would you recommend tapering off this medication?

Review with the patient and daughter potential side effects of tapering off the medication. Review with them common side effects to more serious side effects and when to seek medical attention.

Patient 4 Solved

The case involving a 71-year-old male with potential cognitive decline and a history of falls presents a critical change for a medication review and de-prescribing. The use of benzodiazepines among the elderly population has been associated with significant risks that may be contributing to the patient’s current symptoms. Benzodiazepines have been known to contribute to significant risks for elderly patients, such as fall risk and sedation. Benzodiazepines have also been shown to contribute to an increased risk of addiction and cognitive decline, including a decline in memory, attention, and executive function (Horowitz et al., 2021). In their study by Edinoff et al. (2021), the risk of falls contributes to injuries among elderly patients. Other notable side effects include paradoxical reactions, such as increased agitation or confusion and increased risk of motor vehicle accidents.

ORDER OWN PAPER HERE

Evaluating the patient for side effects will require the use of a comprehensive geriatric assessment will be used. This will include a cognitive assessment tool called a mini-mental state examination. In their study by Su et al. (2021), MMSE is an instrument used to evaluate cognitive functioning. It measures aspects including orientation to time, orientation to place, registration, attention and calculation, recall, and language. The balance and gait assessment will use the Time Up and Go (TUG) test, a reliable, cost-effective, safe, and efficient to assess overall functional mobility (Klotzbier et al., 2021). The patient’s fall history will be reviewed to understand the scenarios and frequency of falls. The assessment will also include a medication review to identify potential drug interactions or other medications that may contribute to increased fall risk or cognitive impairment.

Based on the patient’s risk and current symptoms, it is important to taper off clonazepam. Among elderly patients, a gradual taper of the clonazepam medication is recommended due to their heightened sensitivity to withdrawal symptoms (Edinoff et al., 2021). The plan will include using a slow taper of a 5% reduction every two weeks. The slow taper process will be vital in reducing withdrawal symptoms and the risk of symptom recurrence.

References

Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. 
Journal of addiction medicine
, 
12
(1), 4-10. https://doi.org/10.1097/ADM.0000000000000350

Baldacci, A., Saguin, E., Balcerac, A., Mouchabac, S., Ferreri, F., Gaillard, R., … & Bourla, A. (2023). Pharmacogenetic Guidelines for Psychotropic Drugs: Optimizing Prescriptions in Clinical Practice. 
Pharmaceutics
, 
15
(11), 2540. https://doi.org/10.3390/pharmaceutics15112540

Boon, M., van Dorp, E., Broens, S., & Overdyk, F. (2020). Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events. 
Annals of Palliative Medicine
, 
9
(2), 54257-54557. https://doi.org/10.21037/apm.2019.12.09

Brandt, J., Bressi, J., Lê, M. L., Neal, D., Cadogan, C., Witt-Doerring, J., … & Wright, S. (2024). Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review. 
Clinical medicine
, 
70
. 10.1016/j.eclinm.2024.102507

Chang, Y., Xie, X., Liu, Y., Liu, M., & Zhang, H. (2024). Exploring clinical applications and long-term effectiveness of benzodiazepines: An integrated perspective on mechanisms, imaging, and personalized medicine. 
Biomedicine & Pharmacotherapy
, p.
173
, 116329. https://doi.org/10.1016/j.biopha.2024.116329

Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., … & Kaye, A. D. (2021). Benzodiazepines: uses dangers and clinical considerations. 
Neurology International
, 
13
(4), 594-607. https://doi.org/10.3390/neurolint13040059

Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of anxiety disorders: current and emerging treatment options. 
Frontiers in psychiatry
, p.
11
, 595584. https://doi.org/10.3389/fpsyt.2020.595584

Horowitz, M. A., Wright, J. M., & Taylor, D. (2021). Risks and benefits of benzodiazepines. 
Jama
, 
325
(21), 2208-2209. https://doi.org/10.1001/jama.2021.4513

Klotzbier, T. J., Korbus, H., Johnen, B., & Schott, N. (2021). Evaluation of the instrumented Timed Up and test as a tool to measure exercise intervention effects in nursing home residents: results from a PROCARE substudy.
Ger J Exerc Sport Res
51, 430–442 (2021). https://doi.org/10.1007/s12662-021-00764-0

Maust, D. T., Petzold, K., Strominger, J., Kim, H. M., & Bohnert, A. S. (2023). Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy. 
JAMA network open
, 
6
(12), e2348557-e2348557. https://doi.org/10.1001/jamanetworkopen.2023.48557

Reid Finlayson, A. J., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. 
Therapeutic advances in psychopharmacology
, p.
12
, 20451253221082386. https://doi.org/10.1177/20451253221082386

Su, Y., Dong, J., Sun, J., Zhang, Y., Ma, S., Li, M., … & Zhu, P. (2021). Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study. 
BMC geriatrics
, 
21
, 1–10. https://doi.org/10.1186/s12877-021-02471-9

Wang, X., Zhang, T., Ekheden, I., Chang, Z., Hellner, C., Hasselström, J., … & Sidorchuk, A. (2022). Prenatal exposure to benzodiazepines and Z-drugs in humans and risk of adverse neurodevelopmental outcomes in offspring: A systematic review. 
Neuroscience & Biobehavioral Reviews
, 
137
, 104647. https://doi.org/10.1016/j.neubiorev.2022.104647

NURS_6630_Week5_Assignment_Rubric

NURS_6630_Week5_Assignment_Rubric

Criteria

Ratings

Pts

This criterion is linked to a Learning Outcome
Patient 1: Describes concerns for patient remaining on the medication and how these risks and concerns will be addressed to the patients. Describes how to assist Patient 1 in tapering medication, as well as what other medication might be prescribed with considerations of legal, ethical, or social considerations to the plan NURS-6630 Week 5: Assignment De-Prescribing – A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia.

20
 
to >
18.0
 pts
Excellent
The response comprehensively describes medication risks and concerns. The response comprehensively and clearly explains how the patient will be educated. The response comprehensively and clearly explains considerations for medication tapering. The response comprehensively and clearly reflects on legal, ethical, or social considerations of the plan.

18
 
to >
15.0
 pts
Good
The response clearly describes medication risks and concerns. The response clearly explains how the patient will be educated. The response clearly explains considerations for medication tapering. The response clearly reflects on the legal, ethical, or social considerations of the plan.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes medication risks and concerns. The response inaccurately or vaguely explains how the patient will be educated. The response inaccurately or vaguely explains considerations for medication tapering. The response inaccurately or vaguely reflects on legal, ethical, or social considerations of the plan.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes medication risks and concerns, or it is missing. The response includes inaccurate and vague examples that does not explain how the patient will be educated, or it is missing. The response vaguely or inaccurately explains considerations for medication tapering, or it is missing. The response includes inaccurate and vague examples that does not reflect on legal, ethical, or social considerations of the plan, or it is missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 2: Describes common withdrawal symptoms and patient education information. Describes which benzodiazepine might be prescribed to convert the patient, as well as the specific dosing and tapering information.

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly explains withdrawal symptoms. The response comprehensively and clearly provides patient education information. The response comprehensively and clearly identifies a benzodiazepine for the patient. The response comprehensively and clearly details dosing and tapering information.

18
 
to >
15.0
 pts
Good
The response clearly explains withdrawal symptoms. The response clearly provides patient education information. The response clearly identifies a benzodiazepine for the patient. The response clearly details dosing and tapering information.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely explains withdrawal symptoms. The response inaccurately or vaguely provides patient education information. The response inaccurately or vaguely identifies a benzodiazepine for the patient. The response inaccurately or vaguely details dosing and tapering information.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately explains withdrawal symptoms, or it is missing. The response includes inaccurate and vague examples that does not provide patient education information, or it is missing. The response vaguely or inaccurately identifies a benzodiazepine for the patient, or it is missing. The response includes inaccurate and vague examples that does not detail dosing and tapering information, or it is missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 3: Describes potential risks, benefits and side effects of lorazepam, as well as alternative medications that might be prescribed for the patient. Describes how the patient might discontinue lorazepam, with necessary patient education regarding discontinuing medication and patient/fetus needs.

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly describes risks, benefits and side effects of lorazepam. The response comprehensively and clearly identifies potential alternative medications. The response comprehensively and clearly describes how the patient might discontinue the medication. The response comprehensively and clearly provides necessary education for discontinuing the medication for patient and fetus.

18
 
to >
15.0
 pts
Good
The response clearly describes risks, benefits and side effects of lorazepam. The response clearly identifies potential alternative medications. The response clearly describes how the patient might discontinue the medication. The response clearly provides necessary education for discontinuing the medication for patient and fetus.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes risks, benefits and side effects of lorazepam. The response inaccurately or vaguely identifies potential alternative medications. The response inaccurately or vaguely describes how the patient might discontinue the medication. The response inaccurately or vaguely provides necessary education for discontinuing the medication for patient and fetus.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes risks, benefits and side effects of lorazepam, or it is missing. The response includes inaccurate and vague examples that does not identify potential alternative medications, or some or all are missing. The response vaguely or inaccurately describes how the patient might discontinue the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary education for discontinuing the medication for patient and fetus, or some or all are missing.

20
 pts

This criterion is linked to a Learning Outcome
Patient 4: Describes potential risks and side effects of continuing benzodiazepine. Describes how to taper the medication and education regarding the tapering NURS-6630 Week 5: Assignment De-Prescribing – A 71-year-old-male who comes to see you at the insistence of his daughter. His daughter expresses concern of memory loss and is wondering if he has the beginning stages of dementia.

20
 
to >
18.0
 pts
Excellent
The response comprehensively and clearly describes potential side effects and risks. The response comprehensively and clearly describes how to taper the medication. The response comprehensively and clearly provides necessary patient education for tapering.

18
 
to >
15.0
 pts
Good
The response clearly describes potential side effects and risks. The response clearly describes how to taper the medication. The response clearly provides necessary patient education for tapering.

15
 
to >
10.0
 pts
Fair
The response inaccurately or vaguely describes potential side effects and risks. The response inaccurately or vaguely describes how to taper the medication. The response inaccurately or vaguely provides necessary patient education for tapering.

10
 
to >
0
 pts
Poor
The response vaguely or inaccurately describes potential side effects and risks, or it is missing. The response vaguely or inaccurately describes how to taper the medication, or it is missing. The response includes inaccurate and vague examples that does not provide necessary patient education for tapering, or some or all are missing.

20
 pts

This criterion is linked to a Learning Outcome
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references

5
 
to >
4.0
 pts
Excellent
Paper demonstrates critical thinking and synthesis of literature with five (5) evidence-based, peer reviewed scholarly references outside of course resources.

4
 
to >
3.0
 pts
Good
Paper demonstrates some critical thinking and/or vague synthesis of literature with four (4) evidence-based, peer reviewed scholarly references outside of course resources.

3
 
to >
1.0
 pts
Fair
Paper demonstrates vague critical thinking and/or little synthesis of literature with three (3) evidence-based, peer reviewed scholarly references.

1
 
to >
0
 pts
Poor
Paper demonstrates no critical thinking and/or synthesis of literature with two (2) or less evidence-based, peer reviewed scholarly references.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction is provided, which delineates all required criteria.

5
 
to >
4.0
 pts
Excellent
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion is provided which delineates all required criteria.

4
 
to >
3.0
 pts
Good
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the Assignment is stated yet is brief and not descriptive.

3
 
to >
1.0
 pts
Fair
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the Assignment is vague or off topic.

1
 
to >
0
 pts
Poor
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. No purpose statement, introduction, or conclusion was provided.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation

5
 
to >
4.0
 pts
Excellent
Uses correct grammar, spelling, and punctuation with no errors.

4
 
to >
3.0
 pts
Good
Contains one or two grammar, spelling, and punctuation errors.

3
 
to >
1.0
 pts
Fair
Contains several (three or four) grammar, spelling, and punctuation errors.

1
 
to >
0
 pts
Poor
Contains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

5
 pts

This criterion is linked to a Learning Outcome
Written Expression and Formatting: The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.

5
 
to >
4.0
 pts
Excellent
Uses correct APA format with no errors.

4
 
to >
3.0
 pts
Good
Contains one or two APA format errors.

3
 
to >
1.0
 pts
Fair
Contains three or four APA format errors.

1
 
to >
0
 pts
Poor
Contains many (five or more) APA format errors.

5
 pts

Total Points: 
100

NURS-6630 Week 5: Assignment De-Prescribing – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

What is the importance of de-prescribing? How might you assist a patient to taper from a medication safely or transition to a new medication?

In this Assignment, you will use the following patient examples to write a 5- to 6-page paper on considerations you have for how you might de-prescribe. Support your answers with five (5) evidence-based, peer-reviewed scholarly literature resources outside of Required Learning Resources in this course.

Note:
 APA style format guidelines will apply.

Patient Example:

Patient 3:
 A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder. She recently found out she is pregnant (9 weeks gestation). She was referred to you by her OB-GYN to discuss this medication for her current situation. The patient is wondering if she can stay on the lorazepam through her pregnancy and postpartum, as it is an effective medication for anxiety symptoms. She plans to exclusively breastfeed for the first 6 months postpartum. She has not had any other trials of medication to treat anxiety as lorazepam has been effective.

The Assignment – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

Answer the following questions using the patient example described above.

Patient 3 

Review the potential risks, benefits, and side effects of continuing lorazepam throughout the pregnancy and postpartum for both the patient and fetus.

Review other alternative medications to treat generalized anxiety disorder. Include risks, benefits, and potential side effects to both the patient and the developing fetus. Keep in mind, the patient is looking to breast feed for 6 months postpartum.

The patient agrees that it would be safest for her pregnancy and fetus to discontinue the lorazepam. How would you recommend she discontinue lorazepam? Provide education on potential side effects from tapering off the medication, including common side effects to more serious side effects and when to seek medical attention.

The patient would like to forgo medications at this time, given she is early in her pregnancy and is concerned about “damage” to the fetus if she were to continue medications. Provide education to the patient about the risks of untreated anxiety symptoms during pregnancy for both the patient and the fetus.

Patient 3 – SOLVED – A 24-year-old female prescribed lorazepam 1mg TID for generalized anxiety disorder

The case of the 24-year-old pregnant woman prescribed Lorazepam for generalized anxiety disorder presents a complex clinical scenario that needs careful outweigh for the risks and benefits of the mother and her fetus. In their study, Wang et al. (2022) prescribing BZDs and z-drugs during pregnancy needs a careful balance of potential benefits against the risks of adverse obstetric and neonatal outcomes and extensive long-term consequences for the child’s growth and development. To reduce the risk associated with abrupt Lorazepam withdrawal, it is essential to utilize a gradual tapering to discontinue Lorazepam or lower the dosage slowly. In their study, Reid Finlayson et al. (2022) noted that lorazepam treatment should be discontinued gradually and with a reduction of about 0.125 mg BID every three days until the drug becomes wholly withdrawn.

ORDER YOUR PAPER HERE

As part of patient education, it is essential to emphasize the benefits of gradual reduction and not abrupt stopping. The patient will be educated on the impact of abrupt withdrawal of lorazepam, including withdrawal reactions such as blurred vision, insomnia, sweating, and seizures. It is essential to educate the patient that the cessation of treatment using benzodiazepines may make the patient distressed physiologically due to the physical dependence and potential for withdrawal, such as seizures (Maust et al., 2023). It is essential to consider the risks associated with untreated anxiety during pregnancy. Having untreated anxiety during pregnancy is a significant risk factor for postpartum depression and may affect the child’s development and the maternal-infant bonding. Severe maternal anxiety has been associated with adverse outcomes such as preterm birth, low birth weight, and possible outcomes to fetal neurodevelopment.

References

Maust, D. T., Petzold, K., Strominger, J., Kim, H. M., & Bohnert, A. S. (2023). Benzodiazepine Discontinuation and Mortality Among Patients Receiving Long-Term Benzodiazepine Therapy. 
JAMA network open
, 
6
(12), e2348557-e2348557. https://doi.org/10.1001/jamanetworkopen.2023.48557

Reid Finlayson, A. J., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. 
Therapeutic advances in psychopharmacology
, p.
12
, 20451253221082386. https://doi.org/10.1177/20451253221082386

Su, Y., Dong, J., Sun, J., Zhang, Y., Ma, S., Li, M., … & Zhu, P. (2021). Cognitive function assessed by Mini-mental state examination and risk of all-cause mortality: a community-based prospective cohort study. 
BMC geriatrics
, 
21
, 1–10. https://doi.org/10.1186/s12877-021-02471-9

Wang, X., Zhang, T., Ekheden, I., Chang, Z., Hellner, C., Hasselström, J., … & Sidorchuk, A. (2022). Prenatal exposure to benzodiazepines and Z-drugs in humans and risk of adverse neurodevelopmental outcomes in offspring: A systematic review. 
Neuroscience & Biobehavioral Reviews
, 
137
, 104647. https://doi.org/10.1016/j.neubiorev.2022.104647

Patient 2:
 A 42-year-old female on alprazolam 1mg BID for panic attacks. Panic attacks have been in remission and the patient wants to taper off the medication. But, every time she has attempted to do so in the past, she experienced withdrawal effects. She is wondering how to safely taper off the benzodiazepine medication without having withdrawal effects.

Patient 2

The patient reports withdrawal symptoms when previously tapering off the alprazolam. What symptoms are common withdrawal symptoms from this medication?

Provide the patient education of withdrawal symptoms that range from common and less serious to withdrawal symptoms that are a cause for concern and that should prompt patient should seek medical attention.

Given the patient’s history of having withdrawal effects from attempting to taper off alprazolam, what longer-acting benzodiazepine would you choose to convert the patient to?

What is the dose you would prescribe and how would you taper off the medication?

Patient 2

This case involves a 42-year-old female who is on Alprazolam for panic attacks and is seeking to withdraw but is concerned about the withdrawal effects. The common withdrawal symptoms associated with Alprazolam, taken together with other benzodiazepines, include anxiety, insomnia, tremors, nausea, sweating, and irritability (Ait-Daoud et al., 2019). It is essential to educate the patient about these possible symptoms to help her understand the expected outcome and possible signs that need immediate medical attention. The providers should also emphasize to patients that while experiencing withdrawal symptoms that may be uncomfortable, there is a possibility of adequately managing them. It is essential to educate the patient to understand that when a patient tapers off benzodiazepines, symptoms may continue over for some time (Reid Finlayson et al., 2022). It is also essential to educate the patient on the possible symptoms and appropriate responses that may be needed to assist in alleviating the withdrawal process.

GET A HUMAN-WRITTEN PAPER HERE

Based on the patient’s history of withdrawal, shifting to a longer-acting benzodiazepine may assist in having a smoother tapering process. Diazepam has been considered a preferred choice based on its long half-life and is available in various doses (Chang et al., 2024). A gradual tapering process will be essential to minimize the withdrawal symptoms. In this case, the 0.5 mg of Alprazolam is equivalence to 10 mg of Diazepam, and therefore, based on the patient’s Alprazolam daily dose, an initial conversion to 20 mg of Diazepam daily (10 mg twice daily) will be appropriate. The tapering off of the Alprazolam will be done gradually, with an estimated reduction of 5-10% every two weeks, and then the dosage will be adjusted based on her response. In their study, Ait-Daoud et al. (2018), Alprazolam’s recommended plan is for the taper not to extend 0.5 mg every three days. The pace of the tapering process will be adjusted based on the patient’s tolerance and symptoms.

 

References

Ait-Daoud, N., Hamby, A. S., Sharma, S., & Blevins, D. (2018). A review of alprazolam use, misuse, and withdrawal. 
Journal of addiction medicine
, 
12
(1), 4-10. https://doi.org/10.1097/ADM.0000000000000350

Chang, Y., Xie, X., Liu, Y., Liu, M., & Zhang, H. (2024). Exploring clinical applications and long-term effectiveness of benzodiazepines: An integrated perspective on mechanisms, imaging, and personalized medicine. 
Biomedicine & Pharmacotherapy
, p.
173
, 116329. https://doi.org/10.1016/j.biopha.2024.116329

Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., … & Kaye, A. D. (2021). Benzodiazepines: uses dangers and clinical considerations. 
Neurology International
, 
13
(4), 594-607. https://doi.org/10.3390/neurolint13040059

Reid Finlayson, A. J., Macoubrie, J., Huff, C., Foster, D. E., & Martin, P. R. (2022). Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. 
Therapeutic advances in psychopharmacology
, p.
12
, 20451253221082386. https://doi.org/10.1177/20451253221082386