Tag: Clinical-Nursing

Evidence Base in Design

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

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 Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.

Review the health policy you identified and reflect on the background and development of this health policy.

By Day 3 of Week 7

Post
 a d
escription of the health policy you selected and a brief background for the problem or issue being addressed
. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

By Day 6 of Week 7

Respond
 to at least 
two
 of your colleagues
* on two different days
 by either supporting or respectfully challenging their explanation on whether there is an evidence base to support the proposed health policy they described.

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

This topic is closed for comments.

RS

Regina Candice Shaw

Oct 12, 2024 4:01pm

Reply from Regina Candice Shaw

Regina Candice Shaw

October 12, 2024

The Kidney Patient Act is a bipartisan bill introduced in the House of Representatives last year on the 28
th
 of July by Representative Carter Earl L. from Georgia. This bill targets Medicare recipients with end-stage renal disease (ESRD) to have access to oral-only therapy. This bill will prevent the Center for Medicare and Medicaid Services from moving oral therapy into the Medicare Part B payment system. The change will, unfortunately, restrict access to medication and subsequently increase the cost of dialysis treatment (
Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee
, 2024). In addition, this bill will prevent phosphate binder-lowering drugs, for example, from being restricted (
The Kidney PATIENT Act of 2023 [H.R. 5074] | American Nephrology Nurses Association
, n.d.).

Uncontrolled diabetes and hypertension contribute to the prevalence of kidney disease in the U.S. Due to the lack of access to care and the unaffordability of healthcare costs more and more Americans are progressing to ESRD. Notably, socioeconomic status plays a detrimental role as economically weak people have limited access to healthcare, cannot afford the cost of medication, and have poor nutrition habits. Patients with kidney disease have to follow a strict nutritional regimen as electrolyte imbalance is pretty frequent and can lead to fatal complications. Regulating the phosphate level is essential for individuals with ESRD because it increases the mortality rate. Complications associated with unbalanced levels of phosphate include cardiovascular disease and mineral and bone disorders such as hyperparathyroidism (Chen L et al., 2018). According to Chen L. et al., intensifying phosphate level management reduces the risk of developing secondary hyperparathyroidism, improving the health and patient quality of life. Finally, a restricted diet, nutritional counseling, and phosphate binders reduce the risk of developing hyperphosphatemia and increase regimen adherence (Moroșan E et al., 2023).

To conclude, pushing for the Kidney Patient Act of 2023 will preserve access to oral medication for end-stage renal disease, according to the American Nephrology Nurse Association. Access to health care and education is important as it empowers patients to make informed decisions regarding their health management. Restricting access to health is a setback and can negatively affect the patient’s health outcome. Preventing the prevalence of another chronic disease that can shorten life expectancy should receive support. As nurses, we should be more involved in politics and advocate for our patients as we are the ones who spend more time with them and are aware of the struggles they encounter.

 

Works Cited

Chen L, He JX, Chen YY, Ling YS, Lin CH, & Guan TJ. (2018). Intensified treatment of hyperphosphatemia associated with a reduction in parathyroid hormone in patients on maintenance hemodialysis. 
Renal Failure
, 
40
(1), 15–21. https://doi.org/10.1080/0886022X.2017.1419966

H.R.5074—118th Congress (2023-2024): Kidney PATIENT Act of 2023 | Congress.gov | Library of Congress
. (n.d.). Retrieved October 12, 2024, from https://www.congress.gov/bill/118th-congress/house-bill/5074

Moroșan E, Popovici V, Elian V, Dărăban AM, Rusu AI, Licu M, Mititelu M, & Karampelas O. (2023). The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series. 
International Journal of Environmental Research and Public Health
, 
20
(6). https://doi.org/10.3390/ijerph20065049

Rep. Sewell’s Kidney PATIENT Act Passes Out of the House Ways and Means Committee
. (2024, March 12). U.S. Congresswoman Terri Sewell. https://sewell.house.gov/2024/3/rep-sewell-s-kidney-patient-act-passes-out-of-the-house-ways-and-means-committee

The Kidney PATIENT Act of 2023 (H.R. 5074) | American Nephrology Nurses Association
. (n.d.). Retrieved October 12, 2024, from https://www.annanurse.org/kidney-patient-act-2023-hr-5074

 

Mark as Unread
Mark as Unread

AS

April Simon

Oct 11, 2024 3:40pm
| 
Last reply Oct 12, 2024 6:47pm

Reply from April Simon

H.Res.27 — 118th Congress (2023-2024) Condemning attacks on health care facilities, health care personnel, and patients.

Introduced to the House 1/11/2023, this bill was introduced to judge acts of violence and attacks on healthcare facilities, more specifically for women’s reproductive health centers. This requests that the Biden-Harris administration implement and uphold safety protocols for staff and patients. The emergency department is a primary area in the frontline of chaos. While I am not an ER nurse, during times of being floated to the ER I have witnessed workplace violence from patients and their family members. I have seen hospital staff spat at, punched, kicked, slapped and shootings verbally threatened.

“Between 1977 and 2015, nearly 7,000 violent acts were reported against providers at health centers for women, including bombings, arsons, death threats, kidnappings, and assaults; and between 1993 and 2015, there were 11 murders, numerous attempted murders, 42 bombings, and 186 arsons targeted at individuals and facilities associated with care provided at health centers for women (congress.gov, 2023).

Workplace violence hinders the providers from caring for the patients. It has an effect on the emotional wellbeing of the staff, therefore directly affecting the population. As healthcare workers are exiting the field due to the hazards of the job, social determinants of health are directly affected for all involved. SDH include occupation, job status, workplace safety, level of income, opportunities for education, job and place of work protection, inequity between men and women (Chelak, K. & Chakole, S.,2023).

According to the ANA, the likelihood of health care workers being exposed to violence is higher than prison guards or police offi­cers (ANA, 2018). With the shortage in healthcare workers, longer wait times are a result. Patients and family members become increasingly angry with what they perceive as a lack of attention or care. This leads to more incidence of aggression in the acute care setting. One’s personal beliefs about choice for women’s healthcare have led to outside attacks, therefore making it more difficult for women to want to seek care. Too often healthcare workers are assaulted and it goes without punishment. This federal law is important to uphold attackers in a facility to a criminal standard as it would with law enforcement, paramedics and other outside EMS services.

 

References

Chelak, K., & Chakole, S. (2023). The Role of Social Determinants of Health in Promoting Health Equality: A Narrative Review. 
Cureus
, 
15
(1), e33425. 
https://doi.org/10.7759/cureus.33425
Links to an external site.

 

H.Res.27 – 118th Congress (2023-2024): Condemning attacks on health care facilities, health care personnel, and patients. (2023, January 11). 
https://www.congress.gov/bill/118th-congress/house-resolution/27
Links to an external site.

 

Workplace violence/end nurse abuse
. ANA. (2018, December 13). https://www.nursingworld.org/practice-policy/work-environment/end-nurse-abuse/

Expand discussion thread from April Simon

5 Replies, 5 Unread

5 Replies, 5 Unread

Mark as Unread
Mark as Unread

NK

Nazanin Kalhor

Oct 9, 2024 9:36pm
| 
Last reply Oct 12, 2024 2:19pm

Reply from Nazanin Kalhor

Main Post

Title: Proposed Health Policy: Background, Development, and Impact

In recent years, the Congress has been actively proposing various health policies to address pressing issues in healthcare. One such policy is the Medicare for All Act of 2023, introduced to expand access to comprehensive healthcare coverage across the United States (Congress.gov, 2023). This policy aims to address the longstanding issue of healthcare affordability and accessibility, particularly for uninsured and underinsured populations.

The Medicare for All Act originates from concerns over the rising costs of healthcare services, which have contributed to financial barriers preventing many Americans from receiving necessary medical care (Congress.gov, 2023). This legislation proposes a single-payer system that would consolidate and streamline healthcare financing, potentially reducing administrative costs and ensuring universal coverage for all residents. The primary social determinant influencing this policy is socioeconomic status, as financial constraints often dictate individuals’ ability to access healthcare services (CDC, 2020).

Evidence supporting the Medicare for All Act stems from various studies indicating that countries with universal healthcare systems often achieve better health outcomes at lower costs compared to the fragmented system currently in place in the United States (Smith et al., 2021). For instance, a study by Smith et al. (2021) demonstrated that countries with single-payer systems spend less per capita on healthcare while achieving higher life expectancy and lower infant mortality rates.

In conclusion, the Medicare for All Act represents a significant step toward addressing healthcare disparities in the United States by proposing a comprehensive, single-payer system. The evidence base supporting this policy suggests potential benefits in terms of cost-effectiveness and improved health outcomes, aligning with global trends observed in countries with similar healthcare models.

References

Centers for Disease Control and Prevention (CDC). (2020). 
Social Determinants of Health.
 Retrieved from 
https://www.cdc.gov/socialdeterminants/index.htm
Links to an external site.

Congress.gov. (2023). 
Medicare for All Act of 2023, H.R. 1234, 117th Cong.
 Retrieved from 
https://www.congress.gov/bill/117th-congress/house-bill/1234

Smith, J., Johnson, M., & Brown, L. (2021). Comparative analysis of healthcare systems: Lessons from global experiences. 
Journal of Health Policy and Management, 34
(2), 123-135. 
https://doi.org/10.1177/13558196211012345

Expand discussion thread from Nazanin Kalhor

5 Replies, 5 Unread

5 Replies, 5 Unread

Mark as Unread
Mark as Unread

NB

Nche Mou Bayong

Oct 9, 2024 9:12pm
| 
Last reply Oct 10, 2024 9:06pm

Reply from Nche Mou Bayong

Evidence Base in Design- The American Rescue Plan Act (ARPA)

Background of the Policy

The American Rescue Plan Act (ARPA), enacted in March 2021, represents a significant federal initiative aimed at addressing the mental health crisis exacerbated by the COVID-19 pandemic. This $1.9 trillion legislation expect a lot of dollars for improving mental health services, including $1.5 billion for community mental health and substance abuse treatment by block grant to states (Johnson-Staub & Weerasinghe, 2022). The ARPA also encourages exploration of fresh solutions like mobile crisis response units – specially equipped cars that help in cases of mental health episodes and minimize police presence. To this effect, the ARPA aims to reduce the impacts of the pandemic by focusing on the economic conditions and economic access as two of the social determinants of health. This policy has a robust evidence base, which found an increase in demand for mental health services, and that integrated care models actually do work improving patient outcomes.

Social Determinants Affecting the Policy

Economic stability is the primary social determinant shaping the American Rescue Plan Act (ARPA). With COVID-19 causing massive job losses and financial insecurity, the links between this and declines in mental health is strong. Research reveals that people who suffer from economic hardship usually face an increased rate of suffer from mental ill health; including anxiety and depression, as a result of factors like unemployment, poverty and debt. For instance, evidence shows that economic downturn increases prevalence of minor mental diseases and alcohol dependence with case higher in dropouts experiencing discriminated labeling social stress and trauma (Occhipinti et al., 2024). Mental health policy should therefore address these material roots of economic marginalization because better economic circumstances are associated with better mental health for the whole population. That is why increasing attention to the mental health service development is the significant constituent to the minimization of the negative influence of economic instability on mental health by the ARPA.

Evidence Base Supporting the Policy

The American Rescue Plan Act (ARPA) is underpinned by a robust evidence base that highlights the urgent need for enhanced mental health services. Research also shows that some 40 percent of adults reported having anxiety or depressive symptoms during the COVID-19 pandemic (Brookings, 2021). This is an alarming trend, and we need immediate mitigation, as untreated mental health situations often result in one of direst consequences, such as exponentially more frequent trips to ERs and more engagement with law enforcement. To tackle these issues, the ARPA allocates $1.5 billion each to Mental Health and Substance Abuse Block grants allowing states with the resources to expand the reach of necessary services and more greatly impact community health (tcmhcc, 2021).

Moreover, the introduction of mobile crisis intervention teams is a pivotal aspect of ARPA’s strategy to address mental health emergencies effectively. Studies based on different programs including the CAHOOTS model in Eugene, Oregon show that these teams can greatly minimize use of police officers in psychiatric emergencies, which could easily lead to shootings or other fatalities. Published research also reveals that in those places, where mobile crisis intervention has been introduced, approximately 69% of calls were referred from EMS to the proper mental health intervention, proving that these kinds of interference are rather helpful in managing crisis situations and providing help to people in need (Brookings, 2021). This model not only improves individual outcomes but also alleviates pressure on emergency services and law enforcement.

Finally, ARPA’s funding provisions also extend to schools, recognizing the critical need for mental health support among children and adolescents. From the Elementary and Secondary School Emergency Relief Fund, states received more than $122 billion to support programs that address students’ social, emotional and mental health needs. The current literature reveals the fact that raising the availability of school-based mental health services enhances academic outcomes as well as life satisfaction of students (Randi, 2021). Through engaging and developing successful relationships with community organizations and incorporating evidence-based practice schools can ensure that their environment is more mentally healthy and a person will not feel ashamed to seek help. Therefore, the ARPA helps to solve present mental health issues while beginning the process of constructing permanent reformations in public health legislation.

Conclusion

In conclusion, the American Rescue Plan Act (ARPA) provides just the right response to the COVID-19 induced mental health crisis. Recognizing the high social determinants of economic stability as a key driver, the ARPA addresses the urgent need to improve access to care and help vulnerable populations, by focusing on improving current mental health services, that are already available. This evidence supports the wisdom of taking immediate action and developed helpful innovations like mobile crisis teams and school programs. Ultimately, ARPA not only seeks to alleviate immediate mental health challenges but also lays the groundwork for long-term improvements in public health outcomes.

References

Brookings. (2021). 
How the American Rescue Plan Act will help cities replace police with trained crisis teams for mental health emergencies
. Brookings. https://www.brookings.edu/articles/how-the-american-rescue-plan-act-will-help-cities-replace-police-with-trained-crisis-teams-for-mental-health-emergencies/

Johnson-Staub , C., & Weerasinghe, I. (2022, April 10). 
Supporting Mental Health Policies and Practices through the American Rescue Plan | CLASP
. CLASP. https://www.clasp.org/publications/report/brief/supporting-mental-health-policies-and-practices-through-american-rescue/

Occhipinti, J.-A., Skinner, A., P Murali Doraiswamy, Saxena, S., Eyre, H., Hynes, W., Geli, P., Dilip Jeste, Graham, C., Song, C., Prodan, A., Goran Ujdur, Buchanan, J., Rosenberg, S., Crosland, P., & Hickie, I. (2024). The influence of economic policies on social environments and mental health. 
Bulletin of the World Health Organization
, 
102
(5), 323–329. https://doi.org/10.2471/blt.23.290286

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/

tcmhcc. (2021). 
American Rescue Plan Act (ARPA) Funding for Consortium Initiatives – TCMHCC
. Utsystem.edu. https://tcmhcc.utsystem.edu/arpa/

Expand discussion thread from Nche Mou Bayong

3 Replies, 3 Unread

3 Replies, 3 Unread

Mark as Unread
Mark as Unread

BC

Brianna Renee Cole

Oct 9, 2024 8:25pm
| 
Last reply Oct 11, 2024 9:56pm

Reply from Brianna Renee Cole

Discussion 4

NURS 6050

Brianna Cole

October 9, 2024

Sickle Cell Care Expansion Act of 2023

H.R. 3100 and S. 1423 are the same bill proposed by both the House of Representatives and the Senate that supports the Sickle Cell Care Expansion Act of 2023. Sickle Cell disease also known as sickle cell anemia, is a lifelong disease that affect hemoglobin, a protein in the red blood cells that carries and oxygen. (National Heart, Lung, and Blood Institute, 2023) With sickle cell disease the hemoglobin shape is not the normal round disc shape, it shapes like crescent making it harder to move in cells, blocking blood flow to vital organs, then causing major pain. (National Heart, Lung, and Blood Institute, 2023)

H.R. 3100 and S. 1423 were introduced for numerous reasons, to incentivize physicians to specialize in treating patients with sickle cell disease by offering them scholarships and loan repayments, providing community-based grants to offer resources to those affected by sickle cell disease, and provide grants to make sure patients have smooth transitions from pediatric care to adult care. (Congress, 2023)

Social Determinants of Health Affecting the Policy

Sickle cell disease affects approximately 100,000 individuals in the United States. Even though there are cases of sickle cell seen in many races, more than 90% are non-Hispanic African American. (CDC, 2024) Many different social determinants of health can affect the care received by patients with sickle cell disease including low socioeconomic status, lack of education and insurance, and neighborhoods and physical environments. (Mendez et al., 2024) On top of the social determinants of health affecting the care, racial discrimination plays a huge role as pain in African American patients have been known to be mistreated. (Robinson-Lane & Booker, 2017) In my opinion, all the social determinants of health mentioned equally affect the treatment of those suffering from sickle cell disease.

Evidence Based Research

I believe there is evidence-based research available that supports the proposal of bill H.R. 3100 and S. 1423. We need more providers to specialize in caring for patients with sickle cell disease. Having more compassionate and understand providers would help patients get the proper pain management regimens when going into a sickle cell crisis. (Macey-Stewart & Louie, 2023) Having community-based grants to help bring education and awareness to communities is vital in helping improve the access to the treatment needed. (Congress, 2023) Also, making sure there is a solid transfer of care from a patient’s pediatrics provider to their adult provider is very important as life expectancy for a patient with sickle cell disease is about 20 years shorter than the average healthy person. (CDC, 2024) From all the evidence-based research available on this topic, I believe these proposals will successfully pass into bills opening doors the doors to better care for patients with sickle cell disease.

 

References

CDC (2024, May 6). 
Data and Statistics on Sickle Cell Disease
. Sickle Cell Disease (SCD). 
https://www.cdc.gov/sickle-cell/data/index.html
Links to an external site.

Congress (2023) 
H.R.3100 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023
. Congress.gov.
https://www.congress.gov/bill/118th-congress/house-bill/3100/text?s=5&r=41&q=%7B%22search%22%3A%22health+care%22%7D
Links to an external site.

Congress (2023) 
S.1423 – 118th Congress (2023-2024): Sickle Cell Care Expansion Act of 2023
. (2023). Congress.gov. 
https://www.congress.gov/bill/118th-congress/senate-bill/1423?s=1&r=18&q=%7B%22search%22%3A%22sickle+cell%22%7D
Links to an external site.

Macey-Stewart, K. V., & Louie, K. (2023). Using an individualized pain management plan for African American adults with sickle cell disease. 
Journal of the American Association of Nurse Practitioners
, 
35
(7), 434–440. 
https://doi.org/10.1097/jxx.0000000000000885
Links to an external site.

Mendez GG, Nocek JM, Brambilla DJ, Jacobs S, Cole O, Kanter J, Glassberg J, Saving KL, Melvin CL, Gibson RW, Treadwell M, Jackson GL, King AA, Gordeuk VR, Kroner B, & Hsu LL. (2024). Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry. BMC Health Services Research, 24(1), 291. 
https://doi.org/10.1186/s12913-024-10717-6
Links to an external site.

National Heart, Lung, and Blood Institute. (2023, August 30). 
Sickle Cell Disease – What is Sickle Cell Disease?
 Www.nhlbi.nih.gov. 
https://www.nhlbi.nih.gov/health/sickle-cell-disease
Links to an external site.

Robinson-Lane, S. G., & Booker, S. Q. (2017). Culturally Responsive Pain Management for Black Older Adults. 
Journal of gerontological nursing
, 1–8. Advance online publication. 
https://doi.org/10.3928/00989134-20170224-03
Links to an external site.

Expand discussion thread from Brianna Renee Cole

1 Reply, 1 Unread

1 Reply, 1 Unread

Mark as Unread
Mark as Unread

Alicia Prentler

Oct 9, 2024 8:19pm
| 
Last reply Oct 10, 2024 7:45am

Reply from Alicia Prentler

Recently Congress has passed bill S.670 the IMPACTT on Human Trafficking Act, which improves resources, and care for immigrants who have been victimized by human trafficking (118th Congress, 2024). This bill has a direct impact on our public health policy because not only does in increase resources available to immigrant victims but also training and education for Homeland Security Investigators (HSI).  The introduction of this bill came from the Polaris Project in which studies showed that in 2019 there were upwards of 15,000 reported cases of Human Trafficking through the Human Trafficking hotline, but it is predicted that this number is far greater due to this crime being vastly under reported (Severans, S., 2022). This act is meant to stem off the Secure our Skies Act also led by congresswoman Titus, who is passionate regarding the topic of Human Trafficking and the battles our law enforcement fight to rid our society of this heinous act, (Severans, S., 2022). This bill directly effects the social determinants revolving around immigration and the law enforcement meant to work with this population. Recognizing human trafficking victims in immigration has become vital, as these individuals are already scared of law enforcement, and their trafficker may be holding their passport hostage, or limiting funds for the victim to get out of their current situation.

The Enhanced Collaboration Model (ECM) was initiated in 2010 in order to collectively as a government identify and combat human trafficking (National Institute of Justice, 2022),  This ECM initiative is the sole reason why we have so many nationally funded human trafficking entities, as the overall goal from this study is to get a task force in each area of government where human trafficking has been identified to be a high risk situation and immigration is high on this list, leading to the IMPACTT on Human Trafficking Act. Human trafficking as a whole poses a severe threat to our nation’s health hence why many state board of nursing entities have made CEU’s of human trafficking a requirement to renew licensure. This is a topic that I feel very much falls into the category of, “the more you know,” as in the more as we as a society know and are educated on this subject the more we as a society will be able to recognize a possible victim of human trafficking.

 

Resources:

118th Congress. (October 01,2024). Public Law 118-96 Retrieved on October 9th, 2024. 
https://www.congress.gov/118/plaws/publ96/PLAW-118publ96.pdf
Links to an external site.

National Institute of Justice. (2022). Federally Backed Human Trafficking Task Force Model Yields Progress, and Opportunities for Continued Growth. Retrieved on October 9th, 2024. https://nij.ojp.gov/topics/articles/federally-backed-human-trafficking-task-force-model-yields-progress#1-0

Severans, S., (2022). Titus, Joyce Introduce Bipartisan IMPACTT Human Trafficking Act. Retrieved on October 9th, 2024.  https://titus.house.gov/news/documentsingle.aspx?DocumentID=3371

 

Expand discussion thread from Alicia Prentler

1 Reply, 1 Unread

1 Reply, 1 Unread

Mark as Unread
Mark as Unread

MI

Mehak Ishaq

Oct 9, 2024 6:11pm
| 
Last reply Oct 12, 2024 7:54pm

Reply from Mehak Ishaq

The Treat and Reduce Obesity Act of 2021, aims to enhance accessibility to obesity treatment within Medicare and Medicaid by expanding the variety of covered services, including counseling, medications, and surgical procedures (
Does Medicare Cover Weight Loss Treatments?
, 2024). This law addresses the growing obesity problem in the United States, where more adults are affected, significantly contributing to chronic health conditions like diabetes and heart disease (
Obesity – Symptoms and Causes
, n.d.). A major social factor influencing this legislation is financial status, as individuals with lower incomes often encounter difficulties in obtaining healthy food and medical care.Obesity disproportionately affects underserved communities, leading to significant health disparities. The evidence supporting this legislation is strong; research indicates that comprehensive obesity management approaches can result in meaningful weight loss and improved health outcomes. For example, the Look AHEAD study demonstrated that lifestyle changes could effectively lower diabetes incidence among participants. Expanding treatment options under Medicare and Medicaid is likely to improve access for vulnerable populations (
How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?
, 2024), thus addressing these disparities.Furthermore, incorporating obesity treatment into standard healthcare can reduce long-term medical expenses associated with obesity-related diseases. By emphasizing preventive and treatment measures, S.596 aims to promote healthier communities and mitigate the overall effects of obesity in the United States.

 

References:

Does Medicare cover weight loss treatments?
 (2024, February 27). https://www.ncoa.org/article/obesity-treatment-and-medicare-a-guide-to-understanding-coverage/

How would authorizing Medicare to cover Anti-Obesity medications affect the federal budget?
 (2024, October 1). Congressional Budget Office. https://www.cbo.gov/publication/60816

Obesity – Symptoms and causes
. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obesity/symptoms-causes/syc-20375742#:~:text=Obesity%20makes%20you%20more%20likely,of%20insulin%20resistance%20and%20diabetes.

Expand discussion thread from Mehak Ishaq

3 Replies, 3 Unread

3 Replies, 3 Unread

Mark as Unread
Mark as Unread

TA

Thabasum Abraham

Oct 9, 2024 5:11pm
| 
Last reply Oct 10, 2024 12:30pm

Reply from Thabasum Abraham

Health Policy and Brief Background

S.Res.769 — 118th Congress (2023-2024)

A resolution recognizing the importance of mental health for youth in the United States, and expressing the pressing need for awareness and support for mental health care for children and adolescents.

Sen.Padilla,Alex introduced this health policy on July,2024.and agreed to in senate without amendment and with a preamble by Unanimous Consent.

 

Over the past decade the incidence of mental health diagnoses have increased tremendously, particularly since the COVID pandemic, and more markedly in our younger age groups. Suicide is the third leading cause of death among children from 14 to 18 years old in the United States. Increased mental health related emergency department visits are an important indicator of unmet mental health needs, which are rarely solved outpatient. As an ER nurse, I have witnessed firsthand, numerous mental health conditions presenting to my ED, and an increased incidence of suicides among children at my facility. Studies show all types of mental health related visits significantly increased, and suicide related visits showed the greatest increase from 0.9% to 4.2% of all pediatric ED visits (Bommersbach et al, 2023). According to Congress, over 20% of high school students seriously consider attempting suicide and 10 percent attempted to take their lives (S.Res.769, 2024).

Social Determinants

Identifying risk factors associated with mental health problems and providing adequate support and care are the most important parts of this health policy. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available (Hua et al,2024). Focusing on schools in particularly vulnerable areas with higher statistical rates of mental illness and suicide would be the places to focus on. There are several social determinants that influence these issues such as homelessness, drug use, physical and sexual abuse, food insecurity, poverty, etc.

S.Res.769 health policy encourages state, local educational agencies, schools, and community organizations to support children, youth, and students experiencing mental health challenges at all grade levels by supporting students well-being through evidence-based prevention strategies, and identifying signs and symptoms of mental health disorders among students whom educators have direct contact.

Evidence Base

There is evidence to support the proposed policy to recognize the importance of mental health awareness among youth. This can be accomplished by providing adequate resources to the community, identifying early signs and easily accessible treatment options, addressing the stigma associated with mental health challenges in schools and colleges where youth get more information, recognizing that young children are often  misdiagnosed or undiagnosed, and providing them adequate services and support (S.Res.769, 2024). When children in at risk populations are removed from those environments, there tends to be improvements in their outcomes as a result of the removal of those risk factors. I assert that implementing these policies to screen and treat at risk individuals will result in overall improvements to their health outcomes.

 

 

References:

 

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., Hwang, I., Kessler, R. C., Liu, H., Mortier, P., Nock, M. K., Pinder-Amaker, S., Sampson, N. A., Aguilar-Gaxiola, S., Al-Hamzawi, A., Andrade, L. H., Benjet, C., Caldas-de-Almeida, J. M., Demyttenaere, K., Florescu, S., … Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization World Mental Health Surveys. 
Psychological medicine
, 
46
(14), 2955–2970. 
https://doi.org/10.1017/S0033291716001665
Links to an external site.

 

Bommersbach, T. J., McKean, A. J., Olfson, M., & Rhee, T. G. (2023). National Trends in Mental Health-Related Emergency Department Visits Among Youth, 2011-2020. 
JAMA
, 
329
(17), 1469–1477. 
https://doi.org/10.1001/jama.2023.4809
Links to an external site.

 

Hua, L. L., Lee, J., Rahmandar, M. H., Sigel, E. J., COMMITTEE ON ADOLESCENCE, & COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION (2024). Suicide and Suicide Risk in Adolescents. 
Pediatrics
, 
153
(1), e2023064800. 
https://doi.org/10.1542/peds.2023-064800
Links to an external site.

 

S.Res.769
. (2024, 7 24). Retrieved 10 2024, from Congress.gov: https://www.congress.gov/bill/118th-congress/senate-resolution/769?s=2&r=1

Expand discussion thread from Thabasum Abraham

2 Replies, 2 Unread

2 Replies, 2 Unread

Mark as Unread
Mark as Unread

CN

Cody Ross Newton

Oct 9, 2024 4:18pm
| 
Last reply Oct 12, 2024 6:49am

Reply from Cody Ross Newton

Initial Post

S.4079 – Rural Obstetrics Readiness Act

The Rural Obstetrics Readiness Act (S.4079) aims to enhance maternal healthcare access in rural areas by providing support for rural hospitals to improve their obstetric services. This includes funding for necessary infrastructure, training for healthcare providers, and resources to ensure that hospitals are equipped to handle obstetric emergencies. The legislation also emphasizes workforce retention and recruitment, recognizing that many rural areas struggle to maintain adequate staffing levels for maternal care.

Background of the Policy

Maternal health outcomes in the U.S. have been declining, particularly in rural areas where access to comprehensive healthcare is often limited. Rural communities frequently face challenges such as hospital closures, shortages of qualified healthcare professionals, and longer travel times for expectant mothers. Maternal mortality rates are significantly higher in rural regions compared to urban areas (Merkt et al., 2021). These disparities are worsened by social determinants of health such as socioeconomic status, access to transportation, and educational resources.

Key Social Determinant Affecting the Policy

One of the most significant social determinants affecting this policy is geographic location. Rural areas often lack access to comprehensive healthcare services, which can lead to inadequate prenatal care, increased complications during childbirth, and higher rates of maternal mortality. Transportation barriers further complicate access, as unreliable transportation can delay necessary medical attention, increasing risks for both mothers and infants. Additionally, rural areas typically experience workforce shortages, with fewer healthcare providers available, which can result in inadequate care during emergencies. Geographic isolation also affects the availability of emergency services, making it critical for rural hospitals to be prepared for obstetric emergencies (Holcomb et al., 2021).

Evidence Base for the Policy

There is evidence to support the proposed Rural Obstetrics Readiness Act. Research consistently shows that improved access to maternal healthcare services significantly enhances health outcomes for mothers and infants, particularly in rural areas where disparities are most pronounced. Timely prenatal care reduces the risks of complications during pregnancy and childbirth and regions with better access to skilled birth attendants and emergency obstetric services experience lower maternal and infant mortality rates. Also, successful interventions, such as telehealth programs, have proven effective in bridging the gap in care access for rural populations, ensuring that expectant mothers receive necessary support and monitoring. Workforce development and training initiatives, like advanced certifications for nurses and advanced practice providers, targeted at rural healthcare providers have been shown to improve the quality of care and increase retention rates that are needed to care for these patients (Vivek, 2020).

References

Holcomb, D., Pengetnze, Y., Steele, A., Karam, A., Spong, C., & Nelson, D. (2021). Geographic barriers to prenatal care access and their consequences. 
American Journal of Obstetrics & Gynecology MFM
, 
3
(5), 100442. 
https://doi.org/10.1016/j.ajogmf.2021.100442
Links to an external site.

Merkt, P., Kramer, M., Goodman, D., Brantley, M., Barrera, C., Eckhaus, L., & Petersen, E. (2021). Urban-rural differences in pregnancy-related deaths, United States, 2011–2016. 
American Journal of Obstetrics and Gynecology
, 
225
(2), 183.e1-183.e16. https://doi.org/10.1016/j.ajog.2021.02.028

Vivek, M. (2020). 
Strategies and actions: Improving maternal health and reducing maternal mortality and morbitiy
. The Surgeon General’s Call to Action to Improve Maternal Health – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/sites/books/NBK568218/

Expand discussion thread from Cody Ross Newton

3 Replies, 3 Unread

3 Replies, 3 Unread

Mark as Unread
Mark as Unread

EF

Elizabeth Rachel Fofanah

Oct 9, 2024 1:18pm
| 
Last reply Oct 12, 2024 1:09am

Reply from Elizabeth Rachel Fofanah

Main Discussion Post

H.R.4066: Save Rural Hospitals Act of 2021

On June 22, 2021, the House received this legislation, which aims to promote equity in Medicare reimbursements and safeguard healthcare accessibility in rural regions. The H.R. 4066—117th Congress (2021) articulates that this legislation creates a foundational wage modification threshold for Medicare hospital payments in states that do not qualify as frontier states, while also exempting these modifications from specific budget independence regulations.

It is believed hospitals in rural areas are experiencing a concerning trend, with over 130 such facilities having ceased operations across the nation since 2010 (Warner et al. 2021). Regrettably, the pace of rural hospital closures reached unprecedented heights during the COVID-19 pandemic, with over 20 rural hospitals ceasing operations in 2020. The predominant reasons for the closures of these rural hospitals are frequently attributed to diminished patient volumes and considerable financial pressures. In numerous instances, the financial challenges faced by hospital systems in rural areas are exacerbated by the inadequacies of the Medicare Area Wage Index, which leads to diminished billing rates for these institutions.

This legislation aims to facilitate equitable reimbursement rates for hospitals, thereby enhancing the sustainability of rural healthcare facilities across the country. Warner et al. (2021) clarify that the proposed legislation aims to institute a suitable national requisite to represent the Medicare Area Wage Index, thereby ensuring equitable compensation for rural hospitals in relation to the services they deliver while concurrently maintaining the current reimbursement levels for urban healthcare facilities.

 

Social Determinants

According to Healthy People 2030 (n.d.), social determinants of health (SDOH) encompass the various conditions present in the settings where individuals are born, reside, engage in education, pursue careers, partake in leisure activities, practice their faith, and grow older, all of which significantly influence a broad spectrum of physical and mental wellness and life satisfaction results and associated risks. The five categories encompass financial stability, accessibility to and quality of higher education, access to and quality of healthcare, the surrounding area and physical setting, as well as social and community context. The social determinant that exerts the greatest influence on this legislation is the accessibility and quality of healthcare. The absence of rural healthcare significantly undermines patients’ capacity to obtain care for emerging, critical, and habitual needs. Individuals residing in rural regions often find themselves several hours distant from the nearest level one or level two trauma center. The restricted access significantly impacts their overall health, as various other constraints may hinder their ability to travel to more distant locations for essential, routine healthcare services. Furthermore, in instances where individuals residing in rural areas experience a traumatic event or face a health condition that necessitates immediate intervention to preserve life, there is a significant escalation in their mortality rate. This legislation serves to ensure the continued operation of rural healthcare facilities.

 

Subjective Outlook

I am fully convinced that this bill has the potential to help maintain the operational status of rural hospitals; however, I remain uncertain about the sufficiency of evidence backing the proposed policy. The proposal was presented to the House in 2021 and remains unpassed to this day. The available literature on the Congress website concerning this bill is quite sparse. Nevertheless, a substantial body of evidence exists to substantiate the argument for advancing and enacting this bill, as detailed in the preceding paragraphs. An illustrative case is the closure of numerous rural hospitals as a consequence of the COVID-19 pandemic. However, one must consider the mechanisms by which existing rural hospitals are sustaining their financial viability in the absence of this legislation.

 

Fostering Agreement for Transformation Among Stakeholders

Establishing a unified agreement for transformation necessitates meticulous preparation. Fostering trust and cultivating strong relationships with individuals capable of actualizing concepts is essential. When one perceives that their voice is acknowledged, it becomes crucial to comprehend the mechanisms behind decision-making. This enables us to engage proactively and contribute thoughtfully to the process. Rather than concentrating solely on the issues that require rectification, it is more beneficial to contemplate the proactive measures one can undertake to address them. The Save Rural Hospitals Act of 2021 has been presented to the House; however, it is evident that it has become mired in inactivity on the legislative agenda. Although it has ascended through the legislative process, we remain in anticipation of advancing toward the enactment of this bill. Reaching out to your state representatives and presenting well-substantiated evidence to advocate for the bill would serve as an excellent initial step in revitalizing this legislative proposal.

 

Reference

Healthy People 2030. (n.d.). Social Determinants of Health. Retrieved January 10, 2023, from 
https://health.gov/healthypeople/priority-areas/social-determinants-health
Links to an external site.

H.R. 4066 – 117th Congress. (2021, June 22). H.R.4066 – Save rural hospitals act of 2021. Retrieved January 11, 2023, from 
https://www.congress.gov/bill/117th-congress/house-
Links to an external site.
 bill/4066

Warner, M. R., Cornyn, J., Blackburn, M., & Warnock, R. (2021). Save Rural Hospitals Act of 2021. Mark R. Warner: US senator from the commonwealth of Virginia. Retrieved January 11, 2023, from 
https://www.warner.senate.gov/public/index.cfm/
Links to an external site.
   

Expand discussion thread from Elizabeth Rachel Fofanah

1 Reply, 1 Unread

1 Reply, 1 Unread

Mark as Unread
Mark as Unread

HM

Henrietta Mensah

Oct 9, 2024 10:48am

Reply from Henrietta Mensah

American Rescue Plan Act of 2021

The American Rescue Plan Act of 2021, signed by Joe Biden, stands as a beacon of hope, providing critical healthcare policies and legislative proposals that have significantly enhanced economic relief and public health measures after the COVID-19 pandemic.
 Its provisions offer a sense of reassurance in these challenging times.

Background and development 

Millions of Americans, most of whom are low-income earners and immigrants, were affected by the COVID-19 pandemic, resulting in an economic crisis that al
so undermined healthcare services. Over 4 million workers were out of work for more than 6 months and over 9.5 million lost their job due to covid-19 pandemic. The Act was significant in providing direct payment to individuals, extending unemployment benef
its and enhancing funding for small businesses. Notably, the
  American
 Rescue Plan Act of 2021 played a significant role in helping workers who lost their jobs pay health insurance premiums
(Congressional Research Service, 2021)
. It ensures there is seriou
s investment in the public health sector, including paying for vaccine manufacturing testing and enrollment to curb increased COVID-19 contamination that has had significant economic and healthcare challenges. The American Rescue Plan Act of 2021 also has 
a significant impact on expanding the Affordable Care Act through subsidizing help insurance purchased via the Affordable Care Act marketplace
(Congressional Research Service, 2021)
. The move was significant in ensuring an increased number of low-income ea
rners could afford the insurance policies.

Social determinant impacting the policy 

The social determinants of health were significantly impacted by the policy due to increased healthcare access and economic stability. The policy has been impactful in actually providing 
economic stability through providing employment to unemployed individuals after COVID-19 pandemic, and offering financial support enabling most of the people to access quality healthcare services. It has also established subsidies to health insurance purchased through ACA, enabling most of the low income e
arners to access quality healthcare services improving their health wellbeing.

Evidence-based 

 According to 
O’Mahen & Petersen (2021), the American Rescue Plan Act provided $1.9 trillion to combat the COVID-19 pandemic. It was impactful in broadening the Affordable Care Act policies, including extending health insurance 
policies to the uninsured, resulting in increased Medicaid expansion. U.S. Department of Labor, 2021) indicated that the American Rescue Plan Act, significant in assisting with health insurance premiums to healthcare workers who had lost their jobs or had 
been there, was reduced during the pandemic pay for health insurance by subsidizing the healthcare insurance premium program. The subsidies resulted in a significant decrease in premiums by an average of 40%, significantly increasing healthcare access by m
ost low-income earners and people who had lost their jobs. The funding also supported healthcare workers by ensuring there was adequate financial support to enhance healthcare worker recruitment, training, and retention to offer healthcare services during 
the pandemic, resulting in an increased number of healthcare workers, thus increasing patient safety, quality of care and overall healthcare outcome. Congressional Research Service (2021), the American Rescue Plan Act ensured there was money for vaccine ma
nufacturing, testing, and campaigns. The money was also used in the COVID-19 testing and contact tracing process, ensuring there was a reduction in COVID-19 spreading. The money was also used to enhance healthcare 
infrastructure and provide resources for t
he COVID-19 treatment process, including purchasing personal protective equipment and PPEs for healthcare workers critical in treating process.

Conclusion 

The American Rescue Plan Act significantly resulted in economic and healthcare policies helping wit
h the recovery process after the COVID-19 pandemic. It is an evidence-based policy that has offered critical support to American citizens hugely affected by the pandemic. The Act has been critical in making decisions on expanding healthcare services throug
h enhancing economic support, such as subsidized health insurance policies. The evidence shows the importance of the American Rescue Plan Act in reducing healthier costs and improving economic stability.

References

Congressional Research Service.
 (2021). 
American Rescue Plan Act of 2021 (P.L. 117-2): Public Health, Medical Supply Chain, Health Services, and Related Provisions
.

O’Mahen
, P. N., & Petersen, L. A. (2021).
 Will the American Rescue Plan Overcome Opposition to Medicaid Expansion? 
Journal of General Internal Medicine
, 
36
(11).
https://doi.org/10.1007/s11606-021-07084-x

U.S. Department of Labor.
 (2021). 
The
 American Rescue Plan Act | U.S. Department of Labor
. Www.dol.gov. https://www.dol.gov/general/american-rescue-plan

Mark as Unread
Mark as Unread

TP

Tiffany Peron

Oct 9, 2024 8:53am
| 
Last reply Oct 11, 2024 2:56pm

Reply from Tiffany Peron

Main Discussion

Tiffany Peron

 

H.R.3548, which is known as the Pursuing Equity in Mental Health Act, this act aims to address disparities in mental health care access and treatment among diverse populations. This legislation seeks to enhance funding for mental health programs that serve underserved and marginalized communities, promote workforce diversity in mental health professions, and improve data collection on mental health outcomes to better identify and address these disparities (S.1700 – 118th Congress 2023-2024).

Background of the problem:

Mental health disparities are well-documented, especially among racial and ethnic minorities, LGBTQ+ communities, and individuals with low incomes. These groups frequently encounter barriers to accessing care, such as stigma, cultural insensitivity in treatment, lack of insurance, and socioeconomic challenges. The COVID-19 pandemic has intensified these issues, underscoring the urgent need for focused interventions to promote equitable mental health care.

Social Determinant:

The most significant social determinant affecting this policy is socioeconomic status. Individuals from lower socioeconomic backgrounds are more likely to experience mental health issues due to factors like financial stress, unstable housing, and lack of access to quality healthcare. As well as worrying about the stigma around mental health and how others will perceive them. Addressing these socioeconomic disparities is crucial for improving mental health outcomes and ensuring equitable access to care (Kirkbride, J. B. et al., 2024, February).

Evidence Base:

I think there is significant evidence highlighting the necessity for policies such as the Pursuing Equity in Mental Health Act. Research indicates that culturally competent care can enhance treatment outcomes for minority populations. In the article Culturally tailored interventions for ethnic minorities it revealed that minority patients receiving culturally tailored interventions demonstrated greater engagement and adherence to treatment (Joo, J. Y., & Liu, M. F. 2021, September). Also data shows that increasing diversity within the mental health workforce can foster better patient-provider relationships and enhance care experiences. I found the article The importance of diversity and inclusion in health care very interesting. This article pointed out that patients from diverse backgrounds often prefer providers who understand their cultural contexts and unique challenges (Stanford, F. C. 2020, June). This would be another way to reduce the stigma around mental health.

Conclusion

H.R.3548 tackles significant disparities in mental health care by implementing evidence-based strategies that emphasize socioeconomic factors and workforce diversity. Considering the documented gaps in access and outcomes, this legislation is an essential move toward achieving equity in mental health care for all individuals, especially those from underserved communities. In my community alone there are no mental health providers and just recently a doctor’s office in the school setting has started and they are already completely full.

 

References

Joo, J. Y., & Liu, M. F. (2021, September). 
Culturally tailored interventions for ethnic minorities: A scoping review
. Nursing open. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363345/

Kirkbride, J. B., Anglin, D. M., Colman, I., Dykxhoorn, J., Jones, P. B., Patalay, P., Pitman, A., Soneson, E., Steare, T., Wright, T., & Griffiths, S. L. (2024, February). 
The social determinants of mental health and disorder: Evidence, prevention and recommendations
. World psychiatry : official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10786006/?scrlybrkr=e6c8d9d3

S.1700 – 118th Congress (2023-2024): Pursuing equity in mental health act | congress.gov | library of Congress. (n.d.). https://www.congress.gov/bill/118th-congress/senate-bill/1700

Stanford, F. C. (2020, June). 
The importance of diversity and inclusion in the healthcare workforce
. Journal of the National Medical Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387183/

Expand discussion thread from Tiffany Peron

3 Replies, 3 Unread

3 Replies, 3 Unread

Mark as Unread
Mark as Unread

Cecile Bowen

Oct 8, 2024 11:02pm
| 
Last reply Oct 11, 2024 2:49pm

Reply from Cecile Bowen

Initial Response

On March 3 of 2023, Senator Grassley introduced the bill S. 645 which discusses the need for post-traumatic stress disorder [PTSD] and acute stress disorder [ASD] treatment to be available to public safety officers. This bill would require the General Attorney to form a report stating the necessary funds, resources, and actions to create a program providing PTSD and ASD treatment and support for United States public safety officers. Public safety officers include but are not limited to police, firefighters, and telecommunicators.

Public safety personnel are exposed to a much higher frequency of traumatic incidents than the average citizen (Jaeger, 2023; Edgelow et al., 2023). Because of this the risk of developing a mental health disorder such as PTSD is 25.6 times higher for public safety personnel as well (Los Angeles Airport Peace Officers Association, 2024). Per Kiederer and associates, mental health assistance is commonly found only while onboarding (2024). Long term support is much harder to obtain. Not only is this affecting public safety personnels wellbeing and quality of life, it also affects how they perform their jobs and interact with other citizens. For example, if police officers make decisions based off prior experience, they may have a more forceful or brute response due to PTSD or traumatic events they have been through. Not only would encouraging mental health increase personal outcomes for these public servants, it could also have a major impact on the way these individuals interact with citizens.

The National Occupation Research Agenda [NORA] held a meeting in February of 2024 as a continuation of their Agenda for Public Safety (Kiederer et al., 2024). In this council, the mental health programs already in place for public health personnel were discussed and analyzed. The challenges as well as further needs to provide better care were identified. While additional studies need to be had to prove the link between trauma and the impact it has on decision-making, it is undeniable that there is a major increased risk of traumatic events, PTSD, or other mental health disorders for individuals who work in public safety. Passing a bill like this, either on a state or federal level could have a major impact on society. We need to be taking care of the individuals such as police, firefighters, first-responders, and telecommunicators as they have a large impact on emergency response.

 

References

Edgelow, M., Fecica, A., Kohlen, C., & Tandal, K. (2023). Mental health of public safety personnel: Developing a model of operational, organizational, and personal factors in public safety organizations. 
Front Public Health, 11.
 
https://doi.org/10.3389%2Ffpubh.2023.1140983
Links to an external site.

Fighting Post-Traumatic Stress Disorder Act of 2023, S. 645, 118
th
 Congress. (2023). 
https://www.congress.gov/bill/118th-congress/senate-bill/645/text?s=7&r=6&q=%7B%22search%22%3A%22telehealth%22%7D
Links to an external site.

Jaeger, S. (2023). 
The Impact of life experiences on police officers.
 United States Federal Bureau of Investigation. 
https://leb.fbi.gov/articles/perspective/perspective-the-impact-of-life-experiences-on-police-officers
Links to an external site.

Kiederer, M., Tiesman, H., Gerard, D., Hofer, M., Wheldon, K., Neitlich, D., Shapiro, D., Attwood, W., D’Alessandro, M., & Marsh, S. (2024). 
Tackling mental health challenges in the public safety sector: Implementing and evaluating mental health programs
. Centers for Disease Control and Prevention. 
https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/
Links to an external site.

Los Angeles Airport Peace Officers Association. (2024). 
Suffering in silence no more: Shedding light on PTSD among peace officers
. 
https://blogs.cdc.gov/niosh-science-blog/2024/05/09/mental-health-public-safety-sector/
Links to an external site.

Expand discussion thread from Cecile Bowen

5 Replies, 5 Unread

5 Replies, 5 Unread

Mark as Unread
Mark as Unread

PD

Pawandeep Kaur Dhaliwal

Oct 8, 2024 9:57pm
| 
Last reply Oct 11, 2024 9:57pm

Reply from Pawandeep Kaur Dhaliwal

Main Post

The Childhood Cancer STAR Reauthorization Act

The Childhood Cancer STAR Reauthorization Act is one of the vital health policies that focus on the needs of children and other young persons with cancer. As reauthorized in 2023, the STAR Act expands cancer research, supports biobanking activities, and the quality of survivorship care (Congress, 2023). This legislation enables the National Cancer Institute (NCI) and the National Institutes of Health (NIH) to enhance paediatric oncology investigation and broaden scrutiny by state cancer registries, improve on treatments of other rare cancer types, address survivorship issues and offer long-term care for childhood cancer survivors (NCI, 2023).

The STAR Act addresses several key concerns in pediatric oncology, namely the weak efficacy of current therapies in some rare cancer subtypes, a paucity of biospecimens to support research, and lack of focus on survivorship. One of the key elements of this policy focuses on biospecimen acquisition from children and AYAs to expand existing biobanks (NCI, 2023). By targeting only subtypes, which respond poorly to treatment, the STAR Act provides for more intensive research into novel treatments, especially for cancers that show high recurrence rates and low survival rates. Further, it fosters analysis of the late effects of cancer therapies since many young patients suffer from chronic health conditions. Survivorship study entails the assessment of the late complications or effects of treatment, for instance the second cancers or other chronic diseases that can occur after cancer relapse. Continued research and support through fiscal year 2028 helps sustain the programs’ progress, which is why reauthorization of this policy is important (Chris Van Hollen, 2023)

The specific social determinant that has most impact on Childhood Cancer STAR Reauthorization Act is the unequal health care access and inequalities in outcomes amongst the cancer affected children from different strata of society (Maria e al., 2022). Lack of follow-up care and disparities in survival rates are not rare problems, and these elements depend on income, education, and race. For instance, because most low income families cannot afford quality healthcare, their children may not receive adequate cancer treatment or survivorship programs because those services may be unavailable in their neighborhoods or may be too expensive. The STAR Act makes a point of encouraging the assessment of and seeking ways to mitigate these factors, and in that respect, this language directly contributes to combating social determinants that may affect cancer outcomes.

I firmly believe that there is a substantial evidence base supporting the Childhood Cancer STAR Reauthorization Act. For example, NCI’s ongoing efforts to enhance biobanking and biospecimen research have already resulted in the initiation of new projects aimed at improving treatments for rare cancer subtypes and reducing treatment failures. The collection of tumor specimens, particularly at relapse, has enabled researchers to explore biological changes that occur between diagnosis and relapse, which is crucial for developing targeted therapies (Lone et al., 2022). Additionally, the expansion of biobanking efforts, including rapid autopsy programs, ensures that researchers have access to valuable biospecimens needed to advance pediatric cancer research. The policy’s focus on survivorship research is also grounded in evidence. Research has shown that childhood cancer survivors are at higher risk for secondary cancers and chronic health conditions, reinforcing the need for policies that promote long-term survivorship care and monitoring (Abrahaoet al., 2020).

Conclusion

The Childhood Cancer STAR Reauthorization Act is a well-supported and impactful policy that addresses the complex needs of pediatric and AYA cancer patients. By emphasizing cancer research, biobanking, and survivorship care, the policy seeks to improve both immediate and long-term outcomes for these populations. It also acknowledges and aims to reduce disparities in access to care and survivorship outcomes, particularly for those affected by social determinants such as income. With a evidence base supporting its provisions, the STAR Act remains a critical piece of legislation for advancing childhood cancer treatment and improving survivorship care.

 

 

References

Abrahão, R., Ribeiro, R. C., Brunson, A., & Keegan, T. H. (2020). The burden of second primary cancers among childhood cancer survivors. 
Annals of Cancer Epidemiology
, 
4
. 
https://doi.org/10.21037/ace-2020-01
Links to an external site.

Chris Van Hollen Page. (2023). 
Childhood Cancer STAR Reauthorization Act Signed into Law 
. Www.vanhollen.senate.gov. 
https://www.vanhollen.senate.gov/news/press-releases/childhood-cancer-star-reauthorization-act-signed-into-law
Links to an external site.

Congress. (2021). 
Text – S.4120 – 117th Congress (2021-2022): Childhood Cancer STAR Reauthorization Act
. Congress.gov. 
https://www.congress.gov/bill/117th-congress/senate-bill/4120/
Links to an external site.

Lone, S. N., Nisar, S., Masoodi, T., Singh, M., Rizwan, A., Hashem, S., … & Macha, M. A. (2022). Liquid biopsy: a step closer to transform diagnosis, prognosis and future of cancer treatments. 
Molecular cancer
, 
21
(1), 79. 
https://doi.org/10.1186/s12943-022-01543-7
Links to an external site.

María, J. U. Á., Mario, C. F., Mauricio, H. C., Gisset, G. P. A., Alirio, H. R. J., Guillermo, P. P., & Alejandro, B. C. (2022). A cross-sectional study of the socio-demographic and epidemiological factors associated with childhood cancer in Cali, Colombia. 
Heliyon
, 
8
(5). 
https://www.cell.com/heliyon/fulltext/S2405-8440(22)00698-3
Links to an external site.

National Cancer Institute. (2023). 
Childhood Cancer STAR (Survivorship, Treatment, Access, Research) Act (Public Law No: 115-180)
. Cancer.gov. 
https://www.cancer.gov/about-nci/legislative/recent-public-laws/star-act#top
Links to an external site.

Expand discussion thread from Pawandeep Kaur Dhaliwal

2 Replies, 2 Unread

2 Replies, 2 Unread

Mark as Unread
Mark as Unread

JD

Jasmine Daniels
 (She/Her)

Oct 8, 2024 7:34pm
| 
Last reply Oct 12, 2024 6:39pm

Reply from Jasmine Daniels

 

H.R.3548 – the Pursuing Equity in Mental Health Act is aimed at dismantling the inequities surrounding access to mental health care for people of color.   This bill enlists the Department of Health and Human Services (HHS) to champion mental and behavioral health promotion with a focus on the destigmatization of substance use disorder and mental illness to communities considered to be “racial or ethnic minority groups.”   This bill also calls for additional research on mental health disparities relative to these minority groups (Pursuing Equity in Mental Health act, 2023).

The Pursuing Equity in Mental Health Act was initially introduced in the House of Representatives in 2020 as H.R. 5469 and sent to the Senate for their vote (govtrak.us, 2024). This bill died in the 116
th
 Congress but was reintroduced in 2021 to the 117th Congress as H.R. 1475 in part as a response to the growing mental health epidemic resulting from the increased isolation due to the COVID-19 pandemic (American Psychological Association, 2021).   H.R. 1475 passed unanimously in the House but was not passed by the Senate.  In 2023, the Pursuing Equity in Mental Health Act was again introduced to the 118th Congress as H.R. 3548.

Research on suicide prevention, the loneliness epidemic, and the impact of COVID-19 on America’s youth shows a startling trend for people of color.  Indigenous and Black adolescents are twice as likely to die from a suicide attempt than white adolescents (Gordon, 2020).  The number of self-injury attempts in young Black men increased by 122% between 1991 and 2017 (The Congressional Black Caucus Emergency Taskforce, 2018).   Black and Latinx children with autism are less likely to be diagnosed during childhood than their white peers, foiling opportunities for intervention that could be pivotal to their education (Gordon, 2020). Additionally, 2018 data from the Substance Abuse and Mental Health Services Administration show that fewer than 35% of Black and Latinx adults with mental illness accessed treatment for their mental health concerns.  Less than 20% of the same population polled received treatment for substance use disorder, citing cost as the major factor for not initiating treatment (Shim, 2021).

Inequitable access to health care resources, particularly access to mental health resources, can be tied back to systemic racism.  From eugenics to residential segregation, the impact of the disenfranchisement of people of color has led to poverty, unemployment, food insecurity, and other social determinants of health that directly impact mental health (Shim, 2021).   Additionally, the research gap on mental health has led to bias –whether intentional or unintentional—in treatment of mental illness in people of color.  The consequence of this bias could be far-reaching, up to and including the possibility of misdiagnosis or even death (Mongelli et al., 2020).

So, what is a viable solution?  Further research on mental health in people of color, community resources, culturally competent care, and a change in policy.  The Pursuing Equity in Mental Health Act has a goal of bridging these gaps.  This bill aims to fund more research on mental health in minority communities and allows funding from the Minority Fellowship Program to be used to educate behavioral health and psychology students on best practices related to culturally competent care and funding for minorities pursuing higher degrees in mental and behavioral health fields. Additionally, if passed, this bill will provide grants for healthcare facilities serving underserved communities (Pursuing Equity in Mental Health act, 2023).

The need for a change in policy is apparent.  Many bills have been proposed to address the inequities in access to quality mental health care.  I hope that this legislation will pass as it could be a meaningful start to bridging the mental healthcare gap.

 

 

 

References

American Psychological Association. (2021, May 11). 
Advancing Mental Health Equity and youth suicide prevention legislation
. https://www.apaservices.org. https://www.apaservices.org/advocacy/news/mental-health-suicide-prevention

Gordon, J. (2020, January 29). 
Addressing Disparities: Advancing Mental Health Care for All Americans
. Retrieved October 8, 2024, from https://www.nimh.nih.gov/about/director/messages/2020/addressing-disparities-advancing-mental-health-care-for-all-americans#:~:text=Mental%20health%20disparities%20are%20significant%20and%20easily

GovTrack.us. (2024). H.R. 3548 — 118th Congress: Pursuing Equity in Mental Health Act. Retrieved from https://www.govtrack.us/congress/bills/118/hr3548

H.R.3548 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act. (2024, April 16). https://www.congress.gov/bill/118th-congress/house-bill/3548

Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the United States. 
Focus
, 18(1), 16-24.

The Congressional Black Caucus Emergency Taskforce. (2018). Ring The Alarm: The crisis of Black youth suicide in America. In 
A Report to Congress
 (p. 1). https://theactionalliance.org/sites/default/files/ring_the_alarm-_the_crisis_of_black_youth_suicide_in_america_copy.pdf

Shim, R. S. (2021). Dismantling Structural Racism in Psychiatry: A Path to Mental Health Equity. 
American Journal of Psychiatry
, 178(7), 592–598. https://doi.org/10.1176/appi.ajp.2021.21060558

Expand discussion thread from Jasmine Daniels

3 Replies, 3 Unread

3 Replies, 3 Unread

Mark as Unread
Mark as Unread

DY

Domonique Yates

Oct 8, 2024 5:25pm
| 
Last reply Oct 12, 2024 2:08pm

Reply from Domonique Yates

Hello colleagues,

The health policy I have selected is H.R.5413 – Prevent Youth Suicide Act. This bill will fund suicide prevention initiatives, promise health care providers gain training to prevent intentional harm, and create an internal hub to furnish safety facts to at risk youth and their support networks (Zadrozny, 2017). Suicide and suicidal behavior among adolescents is a critical public health situation. Suicide is the second leading cause of death among young people 10-24 years of age in the United States, and the rate has been rates increasing for decades. Among the youth in the US who has died, over 25% died from suicide. The proportion of mental health–related emergency department visits for suicide attempts in early 2021 among adolescents 12–17 years of age increased 31% compared with the same period in 2019 (CDC, 2021).

Social determinants of health (SDOH) are the conditions in which people are born, live, work, and age.  These aspects have an important impact on mental health outcomes for youths. Some of the aspects come from depression,  anxiety, low educational achievement, poor living conditions, bad family relationships, violence, bullying, negative childhood, discrimination, and lack of stable housing.  Still in all, certain individuals are at greater risk of suicide, it can be difficult to know who will act upon their thoughts and feelings.

I believe there is evidence base to support the proposed policy for the prevention of teen suicide. This can be accomplished by educating youth on despair and fatal behavior in schools considering it is the commonplace environment for adolescents.  Among the different intervention methods, school-based involvement for adolescent suicide have shown possible results in detering and addressing youth suicide (Liu &Wang, 2024). Learning suggests a call to knowledge and guidance related to school postvention. Postvention provides support for the grieving family, friends, professionals or peers which aids in the possibility of copycat suicide. When a exposed youth can relate with a suicide victim, he/she might choose the same destiny, thinking it maybe a way out for them (Zadrozny, 2017). Schools, communities and organizations should be ready to react to suicide and include postvention as a element for youth suicide prevention since it supports healing and comforting to loss survivors.

Reference

(June 11,2021). CDC. Emergency Department Visits for Suspected Suicide Attempts Among Persons Aged 12–25 Years Before and During the COVID-19 Pandemic — United States, January 2019–May 2021. Retrieved from 
https://www.cdc.gov/mmwr/volumes/70/wr/mm7024e1.htm
Links to an external site.

Liu, X. Q., & Wang, X. (2024). Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs. 
World journal of psychiatry
, 
14
(4), 494–506. 
https://doi.org/10.5498/wjp.v14.i4.494
Links to an external site.

Zadrozny B. (April 28,2017). Daily Beast. Teen Copycat Suicides Are A Real Phenomenon. Retrieved from 
https://www.thedailybeast.com/teen-copycat-suicides-are-a-real-phenomenon
Links to an external site.

Expand discussion thread from Domonique Yates

5 Replies, 5 Unread

5 Replies, 5 Unread

Mark as Unread
Mark as Unread

ES

Erica Danielle De Los Santos

Oct 8, 2024 3pm
| 
Last reply Oct 9, 2024 6:49am

Reply from Erica Danielle De Los Santos

A new health policy called the “Improving Access to Vaccines for Children Act,
“
 has been put forward to boost vaccination rates in children from underserved areas specifically to tackle the decline in immunization rates that have been associated with outbreaks of diseases like measles and whooping cough (Salmon et al., 2020). This act seeks to improve access to vaccines by providing funding for health programs and mobile vaccination services, while implementing targeted efforts to educate families on the significance of getting vaccinated.

The drop in vaccination rates is influenced by reasons such as misinformation on vaccine safety and limited access to healthcare services, alongside challenges that hinder families from receiving the required vaccinations (McKee & Bohannon – 2016). The strategy aims to address these concerns by offering support to health agencies and community groups for raising awareness and improving vaccine accessibility conveniently.

Factors that shape our environment.

The main factor influencing this policy is the socioeconomic status (SES) of individuals. People in SES categories often encounter difficulties in obtaining healthcare services because of limitations and a lack of transportation options and healthcare providers in their areas (as mentioned by Marmot in 2018). The goal of this policy is to enhance vaccination rates for children by removing these obstacles and focusing on marginalized communities specifically.

Supporting Evidence

Numerous studies have provided evidence in favor of implementing this policy due to its importance and effectiveness in public health efforts. Research has clearly demonstrated that making vaccines more accessible is closely tied to a decrease in the occurrence of diseases (as highlighted by Kahn et al., 2021). For instance, community driven vaccination initiatives have effectively raised immunization levels among marginalized groups, leading to a decline in disease rates and better health outcomes for the public. Through utilizing community assets and applying proven methods, this policy seeks to safeguard at risk populations and promote well being within communities.

References:

Kahn, K. D., Hu, H., & Holtzman, D. (2021). Community interventions to improve vaccination rates: Evidence from recent studies. 
American Journal of Public Health
, 111(5), 768-776.

Marmot, M. (2018). Social determinants of health inequalities. 
The Lancet
, 372(9650), 1661-1669.

McKee, C., & Bohannon, K. (2016). Vaccine hesitancy: A public health challenge. 
Journal of Public Health Policy
, 37(3), 378-390.

Salmon, D. A., McCauley, M. M., & Moulton, L. H. (2020). Vaccine refusal and the risks of vaccine-preventable diseases: A systematic review. 
Health Affairs
, 39(2), 242-248.

Expand discussion thread from Erica Danielle De Los Santos

1 Reply, 1 Unread

1 Reply, 1 Unread

Mark as Unread
Mark as Unread

SU

Stella Chinelo Ukakogu

Oct 8, 2024 12:25pm
| 
Last reply Oct 12, 2024 10:24am

Reply from Stella Chinelo Ukakogu

Main Post

The American Rescue Plan Act of 2021 (ARPA)

The American Rescue Plan Act of 2021 (ARPA) is an all-inclusive health policy enacted to address the challenges posed by the COVID-19 pandemic. ARPA, signed into law on March 11, 2021, allocated $1.9 trillion in fiscal stimulus funds to strengthen the healthcare system, financially assist people and families, and support public health initiatives (Statista, n.d). These include expanding health insurance through the Affordable Care Act, increased funding for vaccine distribution, and increased access to mental health services. The act represents one of the remarkable commitments at the federal level to improve health outcomes against the background of an unprecedented crisis.

Background for the Problem or Issue Addressed

The COVID-19 pandemic widened inequities in healthcare access and health outcomes throughout various populations in the United States. Before COVID-19, many Americans struggled with inadequate health coverage, as well as the economic fallout due to COVID-19 pushed these issues to their limits. According to records by the U.S. Census Bureau, an estimated 29 million were uninsured in 2019, a figure that was predicted to increase as millions more people during the pandemic lost their employment and employer-sponsored health insurance (Statista, n.d). Given these emerging issues, the ARPA expands Medicaid eligibility in participating states and temporarily enhances subsidies under the ACA, further allowing more people to access health coverage. Moreover, due to the pandemic, people realized the need to put measures in place to protect public health, putting high demand on vaccination and healthcare resources.

Social Determinants Affecting the Policy

The most significant socio-economic determinant influencing this policy is the status of an individual’s socio-economic standing. Low-income communities have often been on the receiving end of the major impacts of this pandemic, related to the fact that these would still manage to trickle down to the remaining barriers through unemployment, lack of health insurance, limited access to healthcare facilities, and many more. ARPA seeks to better these disparities by expanding ACA subsidies and providing financial assistance that caters to the affordability of health insurance. This initiative is most important to the low-income population, who usually work on the frontline and are more exposed to COVID-19. It calls for comprehensive health coverage and support.

Evidence Base Supporting the Proposed Policy

Support for health policies from ARPA is deeply evidence-based. Several studies confirm that more health access correlates with better results among the most vulnerable members of the population. These include expanding ACA subsidies, which have been shown to greatly lower the number of uninsured. However, the research by Wisk et al. (2020) denotes that, under the ACA, increased subsidies admittedly lower the number of uninsured; this, in turn, is related to positive health consequences such as higher use of preventive services and lower mortality rates. Donohue et al. (2022) also found that states that expanded Medicaid significantly improved access to care and health outcomes for low-income individuals, amplifying the individual mandate and health insurance subsidies to improve population health. Moreover, it advances vaccine distribution, for which studies have shown evidence of being integral to combatting infectious diseases and preventing severe diseases. ARPA applies data-centered methods to create a more resilient health system that is better positioned to respond to today’s health crises and those of the future.

 

 

References

Donohue, J. M., Cole, E. S., James, C. V., Jarlenski, M., Michener, J. D., & Roberts, E. T. (2022). The U.S. Medicaid program: coverage, financing, reforms, and implications for health equity. 
Jama
, 
328
(11), 1085-1099.

Statista, (n.d). Number of health insured vs. uninsured adults in the United States from 2003 to 2020. Retrieved from 
https://www.statista.com/statistics/671672/development-of-uninsured-adults-in-us-by-number/
Links to an external site.

Wisk, L. E., Peltz, A., & Galbraith, A. A. (2020). Changes in health care–related financial burden for U.S. families with children associated with the Affordable Care Act. 
JAMA pediatrics
, 
174
(11), 1032-1040.

Expand discussion thread from Stella Chinelo Ukakogu

1 Reply, 1 Unread

1 Reply, 1 Unread

Mark as Unread
Mark as Unread

RC

Rebecca Carico

Oct 8, 2024 8:33am
| 
Last reply Oct 10, 2024 4:40pm

Reply from Rebecca Carico

Introduced to the Senate on March 30, 2023, Congress proposed “
S. 1113-118
th
 Nurse Staffing Standards for Hospital Patient Safety and Qualify Care Act of 2023”. According to Congress.gov (n.d.), this bill will require hospitals to have a staffing plan that complies with a certain minimum nurse-to-patient ratio and submit this information to the Department of Health and Human Services. This will also require hospitals to post a public notice stating what the required nurse-to-patient ratios are in each unit and must maintain records of what the ratios are versus what the ratios should be during each shift. Congress.gov (n.d.) also mentions that the bill will require protocols and procedures to be put in place at each hospital that will help determine what the best and safest ratio for each unit is. Funding for this bill is proposed by expanding Medicare payments to cover any additional close to help comply with this ratio requirement.

This bill is well over-due for nurses in the hospital setting. As a nurse who worked in the ER for five years, I can attest that safe nurse-to-patient ratios are of the upmost importance to patient safety and overall patient and nurse satisfaction. Overworked nurses that have a heavy patient load are statistically more likely to make errors and provide less than ideal care compared to nurses who work in a unit that requires safe nurse-to-patient ratios (Kim et al., 2024). By providing safe ratios in the hospital setting, this could improve the overall patient care and satisfaction, and decrease the burnout that nurses are experiencing.

Social determinants, as defined by Wood et al. (2024), are non-medical factors that can affect someone’s health such as: environmental conditions, social background, education, and economic status. A social determinant that could be affected by this bill would be the economic status of the nurses and hospitals that would be affected by the increase in staffing needs. This would include health care workers in the hospital setting, specifically nurses and the patients that they care for, Medicare funding within the economy, and the cost of the increase in potential staffing needed in these specific hospitals and organizations to meet the required ratios. After working first-hand in the emergency department and experiencing the critical importance of safe staffing ratios, I think there will be more than enough evidence to support this proposed policy. Over the years, especially since COVID, our rural hospitals have gotten used to running on “skeleton crews” to provide the minimum care needed. They have relied on giving a single person multiple jobs with no incentives or extra resources, and very few organizations have reevaluated the critical need for restructuring within each unit. Each unit has its own individualized staffing ratios depending on the acuity of the patients they care for and should be evaluated properly to ensure a safe health care environment is being provided to both the nursing staff and patients. If Congress and Medicare can determine an appropriate way to fund this bill, I believe this could be life changing for our hospitals.

 

References

Congress.gov, (n.d.). Retrieved October 7
th
, 2024, from 
https://www.congress.gov/bill/118th-congress/senate-bill/1113?s=1&r=21&q=%7B%22search%22%3A%22Health+Care+Policy%22%7D
Links to an external site.

Kim, Y., Lee, K., & Jung, M. (2024). Improvement in nurse staffing ratios according to policy changes: a prospective cohort study. 
BMC Nursing
, 
23
(1), 1–13. 
https://doi.org/10.1186/s12912-024-01995-w
Links to an external site.

Wood, E. B., Brown, A., Douglas, C. S., Lawrence, J., Wotherspoon, Z., & Gollenberg, A. (2024). Engaging Emergency Nurses in Strategies to Address the Social Determinants of Health. 
Journal of Emergency Nursing
, 
50
(1), 145–152. https://doi.org/10.1016/j.jen.2023.06.014

Expand discussion thread from Rebecca Carico

2 Replies

2 Replies

Mark as Unread
Mark as Unread

LA

Lucia Almeida

Oct 8, 2024 4:04am
| 
Last reply Oct 10, 2024 3:56am

Reply from Lucia Almeida

The newly proposed health policy, the Telehealth Extension and Evaluation Act of 2022, aims to expand telehealth services to Medicare enrollees. This policy aims to make telehealth use permanent by extending the congratulations made when COVID-19 made it possible for Medicare to offer a broader range of telehealth services in the future (Saharkhiz et al., 2024). The objective is to ensure that people on Medicare and those in rural and remote areas can still access telehealth services beyond the COVID-19 pandemic.

An important factor that has led to the formulation of this policy is the lack of adequate healthcare facilities in rural areas and other areas with low physician population density. Most Medicare patients encounter service delivery complications owing to provider scarcities for intricate reasons, leading to longer distances to cover to access healthcare services(Schaefer et al., 2024). This policy directly correlates with a social determinant of healthcare in that it seeks to sustain and develop telehealth services under Medicare. An issue such as additional limitations for independent physicians and general lack of access to healthcare services, which is a significant problem for residents of rural areas, is a risk factor that is negatively associated with health outcomes, particularly in people with chronic diseases, including elderly patients who need frequent follow-ups.

The rationale for this policy is well-supported by numerous research arguments that speak to the benefits of telehealth in universally increasing access to healthcare, decreasing expenses, and continually maintaining patient satisfaction. According to a report by HHS, it has been revealed that Medicare telehealth utilization increased by more than half during the pandemic. Numerous studies confirm improved health outcomes from telehealth visits, especially for chronic diseases (Centers for Medicare & Medicaid Services, 2021). Moreover, according to Saharkhiz et al. (2024), telehealth can potentially decrease the number of patients attending EDs and admissions by offering continuous care, proving its effectiveness as an accessible, cost-saving solution compared to face-to-face consultations.

Telehealth stakeholders also support this policy because they believe that there should be consistency in offering telehealth services. For instance, permanently addressing telehealth coverage has been supported by the AMA based on the fact that studies have shown that telehealth service increases the availability and utilization of mental health services, which is a pressing issue due to the effects caused by the pandemic. In expanding the telehealth services under Medicare, this policy is thus responsive to telehealth evidence where telehealth sessions on mental health are as practical as face-to-face visits. This element is essential to Medicare beneficiaries who can experience stigmatization or lack of access to a suitable physical venue for mental health services.

References

Centers for Medicare & Medicaid Services. (2021, December 3). 
New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic | CMS
. Www.cms.gov. 
https://www.cms.gov/newsroom/press-releases/new-hhs-study-shows-63-fold-increase-medicare-telehealth-utilization-during-pandemic
Links to an external site.

Saharkhiz, M., Rao, T., Parker-Lue, S., Borelli, S., Johnson, K., & Cataife, G. (2024). Telehealth Expansion and Medicare Beneficiaries’ Care Quality and Access. 
JAMA Network Open
, 
7
(5), e2411006. 
https://doi.org/10.1001/jamanetworkopen.2024.11006
Links to an external site.

Schaefer, S. L., Shukri, Kunnath, N., Scott, J. W., & Ibrahim, A. M. (2024). Higher Rates Of Emergency Surgery, Serious Complications, And Readmissions In Primary Care Shortage

Constitutional Convention – Purpose of the Federal Convention

In response to the Shays’ Rebellion, the Confederation Congress asked the states to send delegates to attend a Convention in Philadelphia, Pennsylvania on 
February 21, 1787
. Twelve states sent delegates; Rhode Island refused to participate because it believed that it was a meeting that was “masquerading for a discussion on interstate trade” (Berkin, Miller, Cherny, and Gormly 174). New Hampshire delegates did not arrive at the Convention until late July when much of the major work had already been done.

The delegates were only designated to “
revise
” the Articles of Confederation and nothing more. You may remember that the Annapolis Convention had sent a document to the Congress asking it to call for another meeting to discuss the broader questions of governing under the Articles of Confederation.

The Congress thought that the Convention would essentially be an 
“
 
advisory body
” that would propose amendments that would help to fix the problems. 
It told the delegates that
 
the Congress and all 13 state legislatures would have to approve any changes as outlined in the Articles.

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

Seventy-four delegates were appointed by their state legislatures to attend what is now known as the 
Constitutional Convention 
during 
May-September 1787
, one of the hottest summers on record 
.
 Only 55 men actually attended the proceedings. These delegates were well educated and they came from diverse backgrounds such as merchants, farmers, bankers, lawyers, governors, legislators, professors, and presidents of colleges. Roughly 40 delegates went to the Philadelphia State House (“
Independence Hall
“) on a daily basis (Magleby 14-15).

“The Key Players” – Delegates to the Convention

 

Benjamin Franklin
 who was admired for his inventions, diplomatic accomplishments, and wit came to the Convention as part of Pennsylvania delegation. He was the 
oldest delegate
 present and not in good health (81 years old). James Wilson, his colleague, read Franklin’s comments and proposals to the delegates throughout the Convention.

George Washington 
was asked by his fellow delegates to be the “presiding officer” or President of the Convention. He had been reluctant to attend the meeting, but his fellow Virginians urged him to come to Philadelphia to lend his prestige to the proceedings.

 

James Madison
 is considered the “
Father of the U. S. Constitution
.” Prior to the Convention, he served in the Virginia legislature and was a member of the Confederation Congress. Madison wrote the Virginia Plan , 
a draft of
 
the U. S. Constitution
. He also took detailed notes of the debates which were published on the death of the last delegate (ironically, Madison himself!). Since the debates were closed to the public, he wanted to make sure there was a historical record for future generations.

Project Gutenberg provides a detailed record of the debates of the Constitution which can be found at their 
EBook #40861 – OOCAPG Resource
 and 
EBook #41095 – OOCAPG Resource
 for your browsing.

 

Alexander Hamilton 
of New York participated in the debates and advocated strengthening the national government “
toned as high
 
as possible
” (Burns). Hamilton’s major contribution was getting his state to approve the new Constitution and later serving as President Washington’s Secretary of the Treasury. We will talk about him later.

We are fortunate that Madison took time out of his busy legislative schedule to study the problems of governing under the Articles. After his study, he concluded that changes could not be made to improve the current system and major changes would need to be made to establish a workable democracy. He advocated the creation of a 
federal republic
 instead of a confederacy of states.

To learn more about the founding fathers go to:

NARA: U.S. National Archives & Records Administration

Why were the debates held

in secret?

 

“Critical Compromises”

The delegates recognized almost immediately that they could not revise the Articles of Confederation. They would have to write a new national Constitution. No changes could be made to improve the current Constitution. They decided to establish a 
federal republic
, a 
representative democracy
, where 
people would be the source of power
. The people could elect individuals who would govern and be accountable to them at election time. They would not have a monarch or nobility like England.

They also returned to the idea of 
separating power
 
among 
three branches of government.
 Also, states would determine who would be qualified to vote in national elections. As you are aware, in all states, except New Jersey, only white men who were 21 years old, owned property or paid taxes could vote in state elections. New Jersey permitted women to vote only in local elections (later repealed).

Since Madison had done his homework early, the Virginia delegation introduced the 
Virginia Plan
 for consideration. It outlined the need for a federal republic, a single executive, a bicameral Congress (a two-house legislature), and national courts. During the contentious debate over Madison’s plan, the issue of state representation in the Congress almost stopped the proceedings cold.

The 
Virginia Plan
 favored by the large states like Virginia (the largest state), Massachusetts, and Pennsylvania stated that the number of representatives who would serve in the U.S. Congress would be based upon the size of the state’s population known as 
proportional representation
. As a result, large states would have greater influence in making national policy. As we are going to find out later, the large states thought that since they had more people living in their states that they should have more power in the U. S. House of Representatives and U. S. Senate. It is interesting to note that the Congress would elect the president and the House would nominate the federal judges. So all and all, the larger states would dominate the entire national government!

The small states led by William Paterson (NJ) produced the 
New Jersey Plan 
as an alternative to the Virginia Plan. They wanted to keep a 
unicameral legislature
 just like under the Articles of Confederation. 
Equal representation
would provide small and large states alike with equal power in the new Congress. The Congress would elect the Executive, a committee, and a U. S. Supreme Court would resolve legal disputes over national law. Constitutional Convention

The delegates voted over and over again on this issue with no resolution. The large states would not budge and the smaller states demanded at least equal vote in one chamber of the national legislature. Recognizing the critical necessity for compromise, the delegates put together a committee to resolve the issue of state representation in the U. S. Congress. 
Roger Sherman (CT)
 forged what is known as the 
Connecticut Compromise, “the Great Compromise.”

The Connecticut Compromise

It called for a 
bicameral Congress
. The number of representatives who would serve in the U.S. House of Representatives would be based on population and directly elected by the people every two years. The U. S. Senate would have two Senators who served a six-year term and were elected by state legislatures (the people would not elect their U. S. Senators until 1913 with the adoption of the 17th Amendment).

Under the original U.S. Constitution, the U.S. House was directly elected by the people in order to establish a representative democracy. The Electoral College would elect the president. The framers wanted to make each branch and chamber in the legislature accountable to different groups of people and thus, make it more difficult for a particular group or faction to dominate our national government.

To learn more about the Connecticut Compromise go to

Formative Years of the Senate: 1787-1800

3/5 (Three Fifth’s) Compromise

The 
Connecticut Compromise
settled the question of state representation in the U. S. Congress, but raised a new question, how to define the term population. What groups would be included in the population count for purposes of determining the number of U. S. House representatives from each state? Constitutional Convention

They agreed to include free persons, indentured servants, and Indians who paid taxes, but what about the slaves? The southern states insisted that slaves be included in such a count to avoid being dominated by the northern states. Less population meant fewer representatives and thus, less influence in the U. S. House of Representatives!

There were delegates like Ben Franklin who opposed the institution of slavery (although he did own a few slaves) but they agreed to a compromise which included at least some of the slaves in the population count to balance the power between the north and south;
five slaves would equal three free persons.
 Thus, the south increased its influence in setting national policy, but in exchange bore a greater percentage of the tax burden then it would have had to do otherwise if slaves had not been included in the population count.

If you read the 
Article 1, clause 3
 
closely it states that 
“Representatives and direct taxes shall be apportioned among the several states..”
 As a result, there were fewer free persons to work to pay the taxes in the southern states.

Shown on the left is an image of slaves picking cotton, a common association.

Since the adoption of the 
14th Amendment
, 
all persons except Indians who do not pay taxes
, are included every 10 years in the census count to determine the population of a state and the number of representatives that serve in the U. S. House. Legal and illegal aliens are included in the census.

The Slave Trade

There was a compromise reached on the slave trade. A number of delegates wanted to ban this commercial activity. The southern states were concerned that if Congress was given the power to regulate interstate commerce, regulating business activities across state lines, that it would ban the slave trade that supported the region’s economy.

The delegates reached an agreement that provided Congress the power to regulate commerce but it could not interfere with the slave trade for 20 years after ratification of the new Constitution (
Article I, sec. 9
, powers denied Congress). In 1808, the U. S. Congress banned the slave trade!

2/3 (Two-Third’s) Compromise

During debates regional concerns continued to divide delegates. The south insisted that any international trade agreements negotiated by the President must be approved by a super majority in the U. S. Senate. It is always interesting to me that the required 2/3 rd’s vote to approve a treaty was based upon the southern states desire to protect their agricultural exports.

Originally, the U.S. Senate had 26 Senators, two from each state. As a result, southern states only had 10 votes. They could not muster a majority to vote down an unfavorable trade agreement, but they could band together to defeat a treaty with more than one-third of the votes!

You may remember that James Madison did not think that states would be divided because of their size, large states versus small state issues, but because of 
regional issues
. This view was not only confirmed by debates at the Constitutional Convention, but by future events.

 Shown here is President George W. Bush and Russian President Vladimir Putin after exchanging documents of ratification inside the Konstantin Palace after a private meeting in St. Petersburg, Russia, June 1, 2003. Constitutional Convention

Boards of Nursing and Professional Nurse Associations – Regulation for Nursing Practice Staff Development Meeting

 

Differences Between a Board of Nursing and a Professional Nurse Association

Board of Nursing regulates nursing practice to protect public, as mandated by state.

BON ensures proper licensure, sets education standards, and handles disciplinary actions for nurses.

Professional nurse associations advance nursing profession and promote high practice standards.

BONs focus on public protection through regulation; associations support professional growth and advocacy.

Nurse associations influence policy, provide networking opportunities, and improve nurses’ working conditions.

A board of Nursing is a regulatory entity legislated by a state government with the mandate to protect the public by regulating the nursing practice (Nursejournal.org, (2023). The BON ensures that a nurse has the requisite licensure qualifications and can practice safely and competently. Its roles include licensure, setting educational standards, and disciplinary actions. In contrast, professional nurse associations, such as the American Nurses Association (ANA), work to advance the nursing profession by fostering high standards of nursing practice, promoting a safe and healthy environment. Also, ensures quality of health and well-being for all people, and influencing policy through accurate, timely information to policymakers and helping nurses network (ANA, n.d.). Whereas BONs center their activities on protecting the public via regulation, the nurse associations tend to focus on issues related to the professional growth of nurses and furthering their profession to improve working conditions. They have complementary but distinct missions and purposes- the BONs regulate practice; associations provide professional support and advocacy.

Texas Board of Nursing

The Texas Board of Nursing governs nursing practice for safe patient care.

Board comprises thirteen members: six RNs, three LVNs, and four public members.

Governor appoints members representing diverse nursing specialties and the general public.

Board composition ensures representation from education, administration, and direct care sectors.

Board influences policies affecting nursing practice, including the Code of Ethics.

The Texas Board of Nursing is the governing board of nursing practice in Texas and works for safe and competent patient care. The board includes thirteen members: six registered nurses, three licensed vocational nurses, and four public members. They are appointed by the governor and come from a wide variety of nursing specialties as well as the public at large (Bon.texas.gov, n.d). The composition of the committee is such that both the education, administration, and direct care sectors of nursing are fully represented to provide completeness to the nursing profession. It is a board that can play a major role in influencing policies affecting nursing practice in Texas, including the practice of nurses under the Code of Ethics.

Becoming a Member of the Texas Board of Nursing

Texas BON members are appointed by the governor with Senate advice and consent.

Candidates are nominated based on nursing expertise or to represent the public.

Nurse members must be in active practice and not in education/regulation.

Public members cannot be in healthcare professions; members serve six-year staggered terms.

BON writes nursing practice rules and takes disciplinary actions to protect public.

A person becomes a member of the Texas BON by appointment of the governor of Texas with the advice and consent of the Senate. Such an appointment is made after nominating candidates for specific qualifications, including expertise in the practice or education of nursing, or to represent the public. The nurse members must also be in active practice for at least five years and cannot be employed with any nursing education program or regulatory agency. Public members cannot be in the healthcare professions (Bon.texas.gov, n.d). Members are appointed to serve six-year staggered terms. Other activities include writing rules and regulations regarding the practice of nursing in addition to licensure disciplinary actions when such actions are necessary to protect the public.

Texas Regulation on Nurse Scope of Practice

The Texas NPA outlines nurses’ scope of practice and promotes patient safety.

Nurses must act within their education, experience, and competence level.

The NPA guides nurses to avoid working beyond their competence level.

Nurses can provide care within self-government boundaries while collaborating with others.

Continuing education is required for nurses to maintain competence in practice.

The Texas Nurse Practice Act (NPA) outlines the general description of the scope of practice for all nurses and speaks to patient safety through care delivery and professional accountability. Among such key regulations is that the nurse is supposed to act within her scope as defined by her education, experience, and competence. This provision guides a nurse’s responsibility to not work up to or beyond their level of competence, which involves the patients’ safety and ethics. The NPA allows a nurse to give care within the boundaries of self-government while still providing the best care for the patient in collaboration with other interdisciplinary professionals. They must also engage in continuing education about staying competent (Bon.texas.gov, n.d).

Influence of Regulation on Healthcare Delivery, Cost, and Access

Texas nurse practice regulation ensures consistent, safe patient care and effective care delivery.

Regulation reduces medical errors and improves patient outcomes in healthcare settings.

Strict practice limitations may reduce access to care in underserved areas.

Healthcare costs increase when specialized tasks must be performed by more expensive professionals.

Regulation prevents improper care, costly lawsuits, and patient injuries in medical practice.

The regulation of the Texas nurses on the scope of practice affects them in care delivery because it ensures that patient care is delivered consistently and safely; therefore, it has been effective in the care provided. This then reduces the chances of medical errors, thereby improving the patient’s outcomes. However, strict practice limitations can reduce access to care, especially in underserved areas where patients may, otherwise, in theory, receive other services from nurses. Healthcare costs also suffer because specialized tasks must be performed by more expensive professionals such as physicians (Bon.texas.gov, n.d). On the regulation-plus side, improper care is prevented, along with costly lawsuits and patient injuries.

Impact of Regulation on Care for Culturally Diverse Patients

Nursing scope of practice regulations influence care for patients from diverse cultures.

Texas exemplifies the need for cultural competence due to its Hispanic population.

Nurses must provide education within their scope, sometimes involving other professionals.

Cultural liaisons may be necessary to address culturally specific health practices.

Overcoming language barriers is crucial for patient understanding of care and procedures.

The regulation ensuring nurses practice within their scope directly influences how nurses provide care and education to patients from diverse cultures. For example, Texas would fall into this category due to its vast population of Hispanics, requiring a nurse to be culturally competent in order to provide appropriate care in the interest of the patient’s cultural and linguistic needs. The scope of practice regulations mandates that education must be provided within the scope of practice for nurses, which at times will involve cooperation with other professionals or cultural liaisons to appropriately cover culturally specific health practices. This also encompasses making sure language barriers are not barriers to patients’ understanding of their care, particularly on the part of medical procedures and patient education.

ORDER HERE

Texas Regulation on Advanced Practice Registered Nurses (APRNs)

Texas regulates APRN practice under guidelines requiring physician supervision or collaboration.

APRNs must enter agreements with physicians to prescribe medication or offer advanced services.

This regulation limits APRNs’ ability to practice independently within their competence level.

The requirement polarizes APRNs to work with physicians even in their areas of expertise.

Care access may be limited in rural or underserved areas lacking physician availability.

In Texas, the scope of practice for Advanced Practice Registered Nurses (APRNs) is regulated under specific guidelines requiring physician supervision or collaboration (Bon.texas.gov, n.d). One of the key regulations makes it obligatory that an APRN enters into a supervisory or collaborative agreement with a physician to prescribe medication or offer specific advanced services. This regulation curtails the APRN’s scope of practice to the level at which they probably can independently practice, polarizing them to work with a physician even in areas where they are competent and could offer their services. This may be very limiting, especially in rural or underserved areas where physicians may not be available, thus leaving a limit to care.

Influence of APRN Regulation on Healthcare Delivery, Cost, and Access

Texas regulation requiring physician oversight for APRNs impacts healthcare delivery, cost, and access.

Physician collaboration may improve quality but often restricts APRN independent practice in rural areas.

Regulation delays care as patients must wait for physician collaboration, increasing administrative costs.

Physician oversight requirement adds financial burden to patients and healthcare settings.

APRN autonomous practice relieves shortages and lowers costs compared to physician care.

The Texas regulation requiring physician oversight for APRNs strongly impacts healthcare delivery, cost, and access. While collaboration might offer improved quality through integrated approaches, it too often restricts APRNs from practicing independently, as so many are doing in rural areas of the state where physicians are limited. This regulation delays care because a patient must wait for physician collaboration. Besides, the need for physician oversight calls for added administrative and financial costs to have the care of a physician-oversight setting; this increases the cost of care for both the patients and the healthcare setting (Bon.texas.gov, n.d). On the other hand, the free hand given to APRNs in autonomous practice has benefits in relieving shortages and lowering replacement costs, as APRNs charge less compared to physicians.

Recent Changes in APRN Regulation in Texas

APRNs in Texas have seen little change in their status over five years.

Texas BON continues to regulate APRNs through physician oversight requirements despite reform attempts.

COVID-19 pandemic highlighted workforce shortages, prompting discussions about relaxing APRN practice restrictions.

A 2021 legislative attempt to provide greater APRN autonomy in Texas failed.

Advocates argue full practice authority would improve access, lower costs, and enhance outcomes.

APRNs in Texas have seen little change in their status over the past five years, with much discussion but minimal actual action. The Texas BON regulation via physician oversight requirements for APRNs is ongoing, although there have been attempts to relax these restrictions, especially due to the COVID-19 pandemic and its impact on workforce shortages in health services (Bon.texas.gov, n.d). A 2021 legislative attempt to provide greater practitioner autonomy for APRNs failed. This debate about full practice authority for APRNs is still quite timely, and its advocates argue that this will enhance access to care in areas with the highest need, lower costs in healthcare, and improve patient outcomes.

References

ANA, (n.d).About ANA. Retrieved from https://www.nursingworld.org/ana/about-ana/

Bon.texas.gov, (n,d). Nursing Practice Act- Chapter 301. Retrieved from https://www.bon.texas.gov/npa1.asp.html#:~:text=(a)%20The%20Texas%20Board%20of,of%20a%20nurse%20faculty%3B%20and

Bon.texas.gov, (n.d). Practice-APRN Scope of Practice. retrieved from https://www.bon.texas.gov/practice_scope_of_practice_aprn.asp.html

Nursejournal.org, (2023). What Is the Role of the State Board of Nursing? Retrieved from https://nursejournal.org/resources/what-is-the-role-of-the-state-board-of-nursing/

Regulation for Nursing Practice Staff Development Meeting

Nursing is a very highly regulated profession. There are over 100 boards of nursing and national nursing associations throughout the United States and its territories. Their existence helps regulate, inform, and promote the nursing profession. With such numbers, it can be difficult to distinguish between BONs and nursing associations, and overwhelming to consider various benefits and options offered by each.

Both
boards of nursing and national nursing associations have significant impacts on the nurse practitioner
profession and scope of practice. Understanding these differences helps lend credence to your expertise as a professional. In this Assignment, you will practice the application of such expertise by communicating a comparison of boards of nursing and professional nurse associations. You will also share an analysis of your state board of nursing.

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:

Assume that you are leading a staff development meeting on regulation for nursing practice at your healthcare organization or agency.

Review the NCSBN and ANA websites to prepare for your presentation.

The Assignment: (8- to 9-slide PowerPoint presentation)

Develop a 8- to 9-slide PowerPoint Presentation that addresses the following:

Describe the differences between a board of nursing and a professional nurse association.

Describe the board for your specific region/area.

Who is on the board?

How does one become a member of the board?

Describe at least one state regulation related to general nurse scope of practice.

How does this regulation influence the nurse’s role?

How does this regulation influence delivery, cost, and access to healthcare?

If a patient is from another culture, how would this regulation impact the nurse’s care/education?

Describe at least one state regulation related to Advanced Practice Registered Nurses (APRNs).

How does this regulation influence the nurse’s role?

How does this regulation influence delivery, cost, and access to healthcare?

Has there been any change to the regulation within the past 5 years? Explain.

Include Speaker Notes on Each Slide (except on the title page and reference page)

Regulation for Nursing Practice Staff Development Meeting

Adoption of U.S. Constitution and Bill of Rights

The Final Vote

Most of the delegates who attended the Constitutional Convention signed the new Constitution on September 17, 1787. George Mason was one of a few men present who did not sign the final draft because it did not include a list of protected liberties. Benjamin Franklin encouraged his colleagues to approve the new national constitution even though he did not agree entirely with it. James Madison recorded in his notes that James Wilson (PA) read Franklin’s speech to the convention.

Ben Franklin said:

“I confess that there are several parts of this constitution which I do not at present approve, but I am not sure I shall never approve them. I doubt too whether any other Convention we can obtain, may be able to make a better Constitution.

For when you assemble a number of men to have the advantage of their joint wisdom, you inevitably assemble with those men, all their prejudices, their passions, their errors of opinion, their local interest, and their selfish views. From such an assembly can a perfect production be expected?

It therefore astonishes me, Sir, to find this system approaching so near to perfection as it does. Thus I consent, Sir, to this Constitution because I expect no better, and because I am not sure, that it is not the best. The opinions I have had of its errors, I sacrifice to the public good.”
 (Madison 653-654)
.

Why did the delegates decide to have state ratifying conventions approve the new Constitution?

You may remember that when the Confederation Congress called the meeting in Philadelphia to revise the Articles of Confederation, it reminded the delegates that any changes or amendments proposed to the current national constitution would require the approval of all 13 state legislatures (as required under the Articles).

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

 

As you can imagine, it would be impossible to get all the states to approve the new national constitution. Rhode Island for starters. It did not even send delegates to the Federal Convention because it feared it would give the national government greater power to regulate commerce. As a result, the delegates required that nine ratifying conventions approve the new Constitution (see Article VII). This way they could by-pass the state legislatures and also have the new Constitution approved by the people!

Further, by allowing the people to approve the constitution would make it more rigorous. The people would apt to be more supportive of the new government if they had a role in approving it Adoption of U.S. Constitution and Bill of Rights.

After the U.S. Constitution was signed delegates who were Congressmen took the document to New York and presented it to the Confederation Congress. It forwarded the new Constitution to the state legislatures who called for elections to state ratifying conventions.

Why is it important to know about the Federalist Papers?

When Alexander Hamilton arrived back in New York, he asked several people to contribute articles describing problems governing under the Articles and why it was critical to replace the confederacy with a republican form of government.

James Madison and John Jay agreed to help try to persuade New Yorkers to support the new Constitution. Hamilton, Madison, and Jay wrote 85 essays under a false name, “Publius”-after a Roman military hero.

It is unclear how persuasive they were in convincing the New York delegates to vote in favor of ratification in July 1788, but 
The Federalist
 sometimes referred to as the Federalist Papers is one of the best sources we have on the reasons for establishing a federal republic with the people the source of power in our nation.

Today, the Supreme Court justices look to these essays to help them interpret the Constitution. Some of you may remember that during the Clinton impeachment proceedings, Congressmen went to their bookshelves to dig out a copy of the Federalist Papers! Hamilton wrote four essays about Congress’ role in the impeachment process.

Click on the link below to see the Federalists Papers:

The Federalist Papers

Why did supporters and opponents of the new Constitution both win at the end of the day?

The states engaged in long heated debates over the Constitution from late 1787 until July 1788. Delaware was the first to approve it on December 1787 and Rhode Island was the last state to do so in May 1790 (see Table 1-2, Ratification of the U.S. Constitution, for the timeline).

 

Why did it take so long for Rhode

Island to approve our current

Constitution?

 

Generally speaking, smaller states supported the new Constitution because they had equal voice in the new Senate and they saw greater economic benefits in being a part of larger union. Virginia and New York did not approve the new Constitution until mid-summer of 1788.

One of the strongest criticisms advanced by the Anti-federalists regarding the Constitution was that it lacked a national Bill of Rights that limited the power of our national leaders like the states’ constitutions which included a Bill of Rights limited the power of state officials. It was a powerful and very effective argument used against the supporters of the Constitution, the Federalists.

“The Promise-A national Bill of Rights”

James Madison told his fellow delegates at the Virginia ratifying convention that if they adopted the Constitution in its current form, he would draft amendments that included a Bill of Rights when he got elected to the U.S. House of Representatives. His promise helped to defuse the power of his anti-federalist opponents’ arguments, notably the passionate advocate of liberty, Patrick Henry Adoption of U.S. Constitution and Bill of Rights.

arguments presented by Federalists

and Anti-federalists?

 

In the spring of 1789, after a tough Congressional election against James Monroe, James Madison followed up immediately on his promise to include a national Bill of Rights. He talked with his fellow representatives regarding any changes they wanted made to the new Constitution, and he came up with 17 amendments. 
This is why James Madison is considered the “author” of the Bill of Rights.

Twelve amendments which included a list of protected liberties were approved by 2/3rd’s of the House and Senate and submitted to the state legislatures for their approval in October 1789. Only 10 amendments obtained the necessary support in the states. They are our 
Bill of Rights
 -e.g. freedom of religion, freedom of expression, right to assemble, and petition for redress of grievances, protection against unreasonable search and seizures, protection against self-incrimination, right to a public trial by jury in a federal criminal case, right to counsel, states reserved powers, etc. (
See the First Ten Amendments – the Bill of Rights
).

Click on the link below to go to the 
National Archives
‘s website and view 
America’s Historical Documents
. Click on the image of the 
Bill of Rights
:

America’s Historical Documents — Bill of Rights

To learn more about the Anti-Federalists, click on the links below:

George Mason s home, Gunston Hall

Patrick Henry s home, Redhill

Why didn’t the delegates include

a national Bill of Rights in our

Constitution in the first place?

 

How do you amend the U.S. Constitution?

The U.S. Constitution provides under Article V (5) that amendments or changes can be made by future generations to address their problems. It is not an easy process. Congress has proposed only 33 amendments and 27 amendments have been approved by states (most recently, the 27th Amendment that requires Congressmen to first stand for election before receiving their pay raise — Madison’s Congressional pay raise amendment).

Only Congress and the States play an official role in the amendment process. Once an amendment is proposed it is sent directly to the states for approval. The President does not have a formal role in this process. He cannot veto a proposed amendment. A President can try to influence Congress to support or oppose a resolution proposing an amendment like President Clinton’s efforts to defeat any efforts to pass a proposed Constitutional amendment to balance the budget.  Also, President G. W. Bush tried to influence the public on the proposed amendment to ban gay marriage. He officially supported an amendment to the U.S. Constitution that states that marriage is between a man and woman. However, he did support “civil unions.”

More recently, President Obama talked about the need to overturn the U.S. Supreme Court’s  2010 
Citizens United 
decision (prohibited limits on spending by corporations, unions, nonprofits, etc., in elections) by having states and Congress place “reasonable limitation” on raising and spending funds in elections. During his presidency, this proposed amendment failed to get the necessary super majority support in the U.S. Senate even with all the Democrats support of this idea (Prokop, Andrew. 
“
President Obama: I’d love a constitutional amendment to reverse Citizens United
,”).
 

In 2014, this Democratic propose Constitutional amendment was blocked in the U.S. Senate by a Republican led filibuster.  It was reintroduced in 2019 in the U.S. House and U.S. Senate by Congressman Schiff (D-CA) and Senator Tom Udall (D-NM) (Carney, Jordain. “
Democrats introduce constitutional amendment to overturn Citizens United
“).

As you are aware,the 
Citizen United
 decision raised the issue of whether Congress can limit corporations, unions, and nonprofit corporations spending on behalf or opposed to political candidates during an elections. Did it violate the First Amendment Freedom of Expression–“political speech?”  Also, it raised the question of whether a corporation is a “person.” It also contributed to the rise of “Super PACs” used by wealthy individuals and fewer than anticipated corporations raise and spend dollars to support their candidates and oppose others. What are your thoughts?

To learn more about this proposed amendment 
go to 
Citizens United v. Federal Election Commission
,
 January 21, 2010,  and at History.com editors, 
Citizens United vs. FEC
,

Article V provides for two methods used to propose a Constitutional amendment:

The Congress-2/3rd’s vote in U.S. House and 2/3rd’s vote in the U.S. Senate (traditional route).

2/3rd’s state legislatures can petition Congress to call for a convention to propose an amendment (s)-never been done.

Under the Constitution, the Congress can decide who will approve the proposed amendment. It can choose 3/4th’s of state legislatures or 3/4th’s of state ratifying conventions to approve a proposed amendment. (All proposed amendments have been approved by state legislatures except the 21st Amendment that repealed prohibition).

What happened to the federal

amendment banning gay marriage?

Did it die?

 

 

What do you think?

Do you support the proposed federal Constitutional Amendment prohibiting flag burning? In 1989, the U.S. Supreme Court struck down a Texas law banning flag burning as a violation of First Amendment freedom of speech-symbolic speech (Texas v. Johnson). The act of burning the flag was used as a form of political protest. This is an example of using the Amendment process to overturn decisions of the U.S. Supreme Court (a check on the Court).

On June 27, 2006, the U.S. Senate failed to pass a proposed Constitutional amendment banning flag burning by one (1) vote (66-34). It needed 2/3rd’s supermajority for passage (67 votes). Last year the U.S. House of Representatives passed this amendment by 2/3rd’s vote (286-130).

If you are interested in learning more about this federal Amendment, please see 
Congress — Legislative Information on the Internet
 and click on 
109th Congress
(Congress has considered this Amendment in past Congresses, but it has not achieved the super majority in both Houses to be sent to the States). Adoption of U.S. Constitution and Bill of Rights

Constitutional Limitations on Power

What is a Democracy?

It is important to have a general understanding about the differences between a
democracy
, an 
autocracy
, and an 
oligarchy
.

DEMOCRACY – 
The term democracy is generally defined as 
“
Government by the 
Many
“-
 Power is in the hands of many individuals. The people are the source of power in a nation.

AUTOCRACY – 
A democratic state is very different from an autocracy where only one person holds power like King Louis XIV of France, an absolute monarch, or a dictator like Adolph Hitler or Saddam Hussein.

OLIGARCHY
 – In an oligarchy, only a few people hold power in a nation, e.g. a group of nobles.

THEOCRACY
 – Today we are more familiar with a theocracy when power is in the hands of a 
few religious clerics
 like in Iran or the former Taliban regime in Afghanistan.

At this time, I want to turn your attention to two definitions of democracy:

pure/direct democracy

representative democracy
 
(known as a 
Republic
 
)

In a 
pure democracy
, the people participate in actually governing their communities. They write the laws and administer and enforce laws like in New England town meetings and the Athenian assembly in 500 B.C. We live in a 
Republic
, a 
representative democracy
, where the people elect other individuals known as representatives to govern–make laws and implement and enforce the laws. These elected officials are accountable to the people at election time.

Is a Constitutional Monarchy like Great Britain a democracy?

Yes. Queen Elizabeth II is not an absolute monarch! She has limited powers under the British Constitution. In Great Britain, the people elect individuals known as Members of Parliament (MP’s) to the House of Commons. As a result, the people are the source of power in Great Britain because the House of Commons has the most power. The House of Lords was stripped of its power in the last century and further reforms are being considered. The United States is a republic because there is no monarchy or aristocracy, only the people!

 

Why did the Framers Decide to Establish a Republican Form of Government?

In 
Federalist #10
, James Madison analyzed the 
problems created by factions or interest groups or political parties
 in our society. The framers were concerned that a majority group might dominate our government at the expense of other smaller groups and individual liberties. Madison was concerned, for example, that debtor interests would be promoted over creditors or a majority within the public might pressure their representatives to equalize the distribution of property at the expense of property owners.

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

 

The cure for the mischief of faction
 – 
the best way to minimize the influence of a majority interest group was to establish a representative democracy, a republic.

If you had the people elect their representative, that public official could consider both individual constituent concerns and all the interest groups’ concerns as well before making a decision regarding a bill. The lobbyists from various organizations representing labor, business, professionals, farmers, gun owners, advocates against abortion would have to compete for the representative’s attention – it would dilute the power of any one interest group.

Madison believed that the representative would filter all this information and be much more objective in making decisions that would indeed promote the ” public good” rather than just a single majority interest group.

In a pure democracy when the people governed, it was easier for a majority group to find a common interest and promote it over the interests of the minority groups or the public good.

In a 
large federal republic
 that extended over a large area, Madison believed there would be more people, thus more interests, and as a result, it would be more difficult for a majority to form within the public. Also, one group might be able to dominate a representative(s) in one state, but not in other states. For example, the farmers might have a strong influence on Congressmen from agriculture states, but not too much influence on Congressmen who represent the inner cities. By having representatives and power given to both national and state governments, it would make it much more difficult for a majority interest to dominate the entire government.

The U.S. Constitution

What Limits were Placed on the Power of the National Government?

“
In framing a government which is to be administered by men over men, the great difficulty lies in this; you must first enable the government to control the governed; and in the next place oblige it to control itself”
 (Madison, 
Federalist 
#51, A-5).

Our federal republic is a 
Constitutional democracy
 because it gets its power from a 
written constitution
 that was approved by the people. When you look at Article I-VII of the U.S. Constitution, you can see the powers of the Congress, President, and Federal Courts listed there. You will also find that Congress and the states are denied certain powers which I will discuss in a later lesson on federalism. For the moment, it is only important that you appreciate that our federal republic receives its power from the people as expressed in our national Constitution.

During this part of the lesson, please keep in mind that the framers wanted to prevent tyranny and to reduce the power and influence of a particular group that might use their power to harm the interests of minority groups in our society or our individual liberties. They wanted to create a stronger and more effective national government that could promote the general welfare, protect national security, and maintain order, but at the same time they recognized the tantalizing appeal of power and man’s need to consolidate his own power to promote his own interests.

Limits were placed not only on our representatives, but on the people themselves.

We often think only that our leaders will repress our liberties but fail to recognize that some of our own demands for action may deprive other people of their rights and freedoms. As a result, the framers of our Constitution placed limits on the power of the Congress, President, and Federal Courts.

The limits on power are the following:

FREE AND FAIR ELECTIONS 
— the people. A 
free and fair election
 is a defining feature of a democracy.

At the very outset, if the people are going to retain the power in a nation, they have to hold their representatives accountable at election time. The voters must be permitted to choose their own representatives without force. I often tell my students that in our country we can exercise our right to vote or not to vote. We will not be fined or imprisoned or face a worse fate.

Elections must also be fair in that opposing candidates can run and get media coverage and that ballots are accurately counted and not destroyed or lost (there were allegations in the 2000 Presidential election that ballot boxes were discovered in a closet). In general, corruption must be kept at a minimum to ensure a fair election.

You may remember that in the 2005 Ukrainian Presidential election, the government used invisible ink on some of the ballots. The voter went to the polls, marked his ballot, and when the ink dried, his X was gone! Viktor Yushchenko was sworn in as president of Ukraine in 2005 after massive protests over his loss in a fraud-plagued election plunged the Ukraine into political crisis. Constitutional Limitations on Power

No wonder the government s candidate won on the first round.

In 
Federalist #51
, James Madison wrote:

{A} dependence on the people is, no doubt, the primary control on the government; but experience has taught mankind the necessity of auxiliary precautions.”

Madison recognized that you would need more than the ability of the people to throw the rascals out at election time to prevent the potential for tyranny. You would need to take extra precautions and structure the government in such a way as to minimize the potential for the abuse of power by not only our elected officials, but the people themselves.

SEPARATION OF POWERS — BALANCE THE POWER —
 The United States Constitution gives power to three (3) separate, equal,and politically independent branches of government.

The 
Executive Branch
 carries out and enforces the law.

The 
Legislative Branch
 makes or writes law.

The 
Judiciary Branch
 interprets the law and resolves legal disputes.

Each branch of our national government is equal in power, has different responsibilities, and is accountable to different groups of people.

Under the 
Articles of Confederation
, our national government had only 
one branch
, the Confederation Congress, which had principally legislative authority. There was no Executive Branch to implement or enforce laws passed by Congress or national courts to resolve legal disputes that involved national laws, several states, and citizens of different states (the federal courts provided a neutral forum).

When the framers returned to the idea of separation of powers, they were heavily influenced by their own personal experience, and the work of the 18th century Frenchman, Comte Charles Montesquieu.

In his book, 
Spirit of the Laws
 
(1748), Montesquieu strongly advocated balancing power. He writes that tyranny usually results when power is concentrated in a single government body. He was a great admirer of the British system of government because power was defused between officials in three branches of government: the Monarch, Parliament, and Courts.

Montesquieu believed that no particular class of British society (royalty, aristocracy, commoners) would dominate the government if each branch was accountable to different groups of people. During that time, the King represented the interests of the royal family; and the bicameral Parliament composed of the House of Lords and the House of Commons promoted the interests of the nobility and the men of property respectively.

In our country,our representatives are accountable to different groups of people as well. Before a President signs a bill into law, he considers whether it promotes the best interests of the entire nation; a United States Senator will see how a bill would impact his state; and a Congressman will consider whether a bill will improve the lives of people residing in his Congressional district. Our federal courts have judges who are appointed for life and are insulated from public pressure.

James Madison wrote in 
Federalist #51
 
that:

{I}t is of great importance in a republic not only to guard against the society against oppression of its rulers, but to guard one part of society against the injustice of the other part. Different interests necessarily exist in different classes of citizens. If a majority be united by a common interest, the rights of the minority will be insecure
.”

The framers believed that by giving each branch different responsibilities and holding them accountable to different constituencies, that it would make it more difficult for a majority to dominate our national government. They did not want executive, legislative, and judicial power put in the same hands.

James Madison also writes in 
Federalist #47
 
that:

“
the accumulation of all powers, legislative, executive, and judiciary, in the same hands, whether of one, a few, or many, and whether hereditary, self—appointed, or elective, may justly be pronounced the definition of tyranny.”. “{T}he preservation of liberty requires that the three great departments of power should be separate and distinct.”

CHECKS AND BALANCES SYSTEM — SHARED POWERS —
 each branch has authority over the other branches. Each branch can limit the power of the other branches by sharing power.

The framers of the U.S. Constitution, particularly James Madison, did not think that just by giving three branches different responsibilities by itself would be enough to prevent the concentration of power by their leaders or to prevent the majority of the public from pressuring their representatives to make laws that might harm minority groups interests (e.g. property owners).

To prevent government officials from pooling their authority together in order to consolidate power, the framers gave officials in each branch the ability to limit the power of the other branches. They did this by having the public officials 
share certain responsibilities.

For example, the President participates in the legislative process by proposing a federal budget and signing or vetoing bills; and Congress ultimately can check the President if they disapprove of his military missions by denying funding; and the U.S. Senate can approve or reject Presidential appointments and treaties.

The general idea was that not only would public officials be busy carrying out their own responsibilities, but they would make sure that other public officials in another branch were not abusing their power. If they were busy playing the role of 
watchdog
, they would be less tempted to join with other branches to promote a particular interest(s) and consolidate power.

The framers deliberately built in inefficiency into our political system. We call it 
Gridlock
. We often complain that our representatives can never act quickly enough to address our nation s problems Constitutional Limitations on Power.

Politics does become personal sometimes and tensions are often created by differing ideologies and party strife, but do not forget that our forcing the branches to share power also exacerbates the problem of governing.

The framers put in these structural barriers (
checks
) in place to ensure that not any one branch becomes too powerful. They wanted the 
President and Congress to compromise 
and find solutions to public problems that promoted the 
public good
 , and not just one group or coalition of groups interests as noted earlier in our lesson. This is why getting bills through Congress and signed into law by the President can sometimes be a very SLOW, SLOW process. However, rest assured that when our national interests are threatened, Congress and the President can and will act swiftly, and this too can sometimes present Constitutional problems!

JUDICIAL REVIEW —The U.S. Supreme Court 
can declare acts (bills) of Congress signed into law by the President unconstitutional—make the laws void and unenforceable.

Marbury v. Madison 
(1803) is probably the most important case ever decided by the U.S. Supreme Court. Although the case involved the question of whether John Adams judicial nominees were entitled to their federal judgeships since their commissions were signed, but not delivered to them at the end of Adams Administration, the Court took the opportunity to assert its independence and to check the power of Congress and the President.

The case raised two critical questions :

Who will be the 
Guardian
 of the U.S. Constitution? The Executive, Legislature, or Judiciary?

Does the U.S. Supreme Court have the power to declare legislation passed by Congress and signed into law by the President unconstitutional?

The Court held that since judges have the responsibility to interpret law and the U.S. Constitution is fundamental law, it is within their purview to determine its meaning and protect the people s will reflected in the document. It is 
not
 the responsibility of the Congress or the President to interpret law.

If Congress and the President produce laws that conflict with the U.S. Constitution, it is the duty of the Court to strike them down as unenforceable. The Court must prefer the U.S. Constitution that is supreme law of the land over ordinary statutes passed by Congress and signed into law by the President (
National Archives, National History Day, and USA Freedom Corps
).

As a result of its decision, we can challenge a federal law in federal court if it infringes on our individual liberties, and hope that ultimately the U.S. Supreme Court will declare it unconstitutional. The power of judicial review was a serendipitous check on the Congress and the President. There was nothing written in the U.S. Constitution that gave the U.S. Supreme Court this power.

The Court took it upon itself to act as an intermediary between the people and the legislature. Chief Justice John Marshall was strongly influenced by Alexander Hamilton, author of 
Federalist
# 78
 
, who believed that if the Judicial Branch did not check the Congress that it would pass laws all day long that were contrary to the meaning of the U.S. Constitution and undermine the will of the people expressed in the document. Hamilton said that if the people want to change the U.S. Constitution, they will have to go through the Constitutional amendment process!

 United Kingdom’s Supreme Court

In the United Kingdom, the Guardian of the British Constitution is the Parliament (House of Commons). If someone challenges a law passed by Parliament as conflicting with the British Constitution, new elections are called and it is up to the people to decide by voting out or re-electing their representatives.

In 2009, the United Kingdom formally established a Supreme Court with 
nonbinding power of judicial review
.  In 2005, Parliament passed a Constitutional Reform Act that included removing the highest appellate court in the land from the House of Lords (a committee of “Law Lords”) and creating an independent court modeled after the United States Supreme Court. They were incorporating the idea of separation of powers and an independent judiciary (
The Supreme Court 2009
)
!

The United Kingdom Supreme Court has ruled on several cases in recent years and found certain Parliamentary acts unconstitutional.  In 2019, the Court held that Prime Minister Boris Johnson’s effort to suspend Parliament for a month was unconstitutional.  Members of the House of Commons returned immediately to London and reopened the House.  Since this Court’s opinion is not binding, it rests ultimately with the Parliamentarians whether they agree with its decision regarding the constitutionality of a law.

Read 
Marbury v. Madison
 (1803) at 
https://www.law.cornell.edu/supremecourt/text/5/137
.

To hear a discussion on the importance of Marbury v. Madison (1803)
, please watch 
C-span’s presentation of Landmark decisions.

Also, 
you may watch a film
 on this case produced by the Judicial Conference of the United States (1977).

FEDERALISM – The U.S. Constitution
divides power between a national government and state governments. Both the national government and state governments have authority over the people and are accountable to the people. (We will discuss this final limit that was placed on the power of the national government in our next lesson on American Federalism.) Constitutional Limitations on Power

Federalist #10 – federalist 10 questions answer key

How did the people in the 18
th 
Century perceive democracy—popular government? Positively or negatively?

Answer: 
They generally had a negative perception of democracy where power rested with the people. Their study of classical history and their own state government experience showed that when people governed that a majority group passed laws that favored their own interests at the expense of the public good. Minority groups in society were often ignored. Clashes between these factions caused unstable governments, and in the case of the classical Athens, someone had to be called in to restore order at the expense of individual liberty. When you read our U. S. Constitution, you may notice there is no mention of the word democracy! Our framers equated it with “mob rule” where property rights would go unprotected.

Define a faction.

Answer :
 Madison writes that “[b]y a faction, I understand a number of citizens, whether amounting to a majority or a minority of the whole, who are united and actuated by some common impulse of passion, or of interest, adverse to the rights of other citizens, or to the permanent and aggregate interests of the community.”

What did Madison consider the source/cause of faction? List two (2) main causes of faction:

Answer:

Sown in the nature of man
 —men have different abilities, strengths, intellects, and experiences, and as a result, different interests or concerns….

Various and Unequal distribution of property
—“most common and durable source of faction….” Madison writes that there are different economic interests in society. We sometimes refer to it as “the haves and the have nots.” If you own your own home and your friend rents an apartment, you will have different concerns. You will be concerned about paying property taxes and keeping the lawn mowed. If you are farmer, you will have different interests than a financier, tradesman, or manufacturer. Creditors and debtors have different views about the collection of debts. “Different views and sentiments” will divide us into groups.

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

 

What are the two (2) methods of curing the mischief of faction?

Answer :

Remove the causes or

control its effects.

How does Madison recommend removing the causes of faction?

Answer :

Destroy liberty or

make all men’s passions/interests the same.

What did Madison recommend to “control” the effects of faction?

Answer :
 A representative democracy, a Republic.

Why would a republican form of government be the best means to reduce the influence of factions or interest groups—“cure the mischief of factions? Federalist 10 Questions Answer Key

Answer :
 A representative, like Congressman Mike Turner (R-OH), could more objectively consider the concerns of constituents and competing interest groups and support legislation that promotes the public good (the interests of the entire community) rather than interest of one group. By competing for the attention of our representative(s), it would help to minimize the influence of a particular group on the making of public policy.

Madison writes “…. 
to refine and enlarge the public views, by passing them through the medium of a chosen body of citizens, whose wisdom may best discern the true interest of their country, and whose patriotism and love of justice will be least likely to sacrifice it to temporary or partial considerations. Under such a regulation, it may well happen that the public voice, pronounced by the representatives of the people, will be more consonant to the public good than if pronounced by the people themselves….”

Why did he believe a large
federal
republic rather than a small republic would help to minimize the influence of “special interests” on our government?

Answer :
 In a large republic there would be more people, more diverse interests/concerns, and it would make it more difficult, not impossible, for a majority of the people to find a common interest and try to dominate our national government at the expense of other groups and individual liberty.

Madison was concerned that in a small republic it would still be easier for a majority interest to form because there were fewer competing interest groups. If you had a large nation with a diverse population, “
you make it less probable that a majority of the whole will have a common motive to invade the rights of other citizens; or if such a common motive exists, it will be more difficult for all who feel it to discover their own strength, and to act in unison with each other.
”

Madison explains that “
[t]he influence of factious leaders may kindle a flame within their particular States, but will be unable to spread a general conflagration through other States.”
He was concerned about religious groups, those advocating for eliminating debts or the need for paper money, or the equal distribution of property would try to dominate our government and pass laws that favored their interests. A federal republic would make it just that much more difficult for a majority group to dominate our entire government Federalist 10 Questions Answer Key

Federalist #51 Quiz

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

Federalist #51 Worksheet

What is the purpose of separating power between the branches of the national government?

Does Madison believe in the complete separation of powers?

Please explain Madison’s comment that the primary control of government is the people but “auxiliary (extra) precautions” need to be taken. What are the extra precautions?

How do you prevent a gradual concentration of power in one or several branches of the national government?

What does Madison mean when he states “ambition must be made to counteract ambition?”

Why does Madison favor the need for a large Federal Republic?

Federalist
#51 Quiz

Federalist #78 questions

Why is it important that our Federal Judiciary (federal courts) be independent?

Who appoints the Federal judges and justices to the U.S. Supreme Court?

How long can a Federal judge remain on the Federal bench and a justice on the U.S. Supreme Court?

Who is to be the “Guardian of the U.S. Constitution? Why?

Who is to interpret the U.S. Constitution? Why?

What is the role of the Federal judiciary?

GET WRITING HELP HERE 

HUMAN-WRITTEN
AND
PLAGIARISM-FREE 

Federalist #78 questions

Discussion – Introduce Yourself BIS 1120 INTRO TO SOFTWARE APPS

Introduce yourself to the class. Use your first and last name for the subject of your posting (also list your 
preferred
 name if you have one you go by).

Respond to the following items in your posting, numbering your responses:

Personal information you care to share such as employment, family life, and hobbies.

Educational information such as your major/education goals, how long you have been at Sinclair, what you would like to get out of this course, and/or why you chose to register for this particular course.

Your backup plan for completing coursework should your initial plan fail. Such as, what will you do if your Internet is down and/or your computer is inoperable for an extended period of time?

Tip(s) for being successful in a college course.

Use appropriate spelling (proof your posting) and grammar (capitalization, punctuation, etc.) in your posting. Read other student postings to become familiar with other students enrolled in the course. You are welcome to reply to others, but it is not required in this class.

Discussion – Introduce Yourself BIS 1120 INTRO TO SOFTWARE APPS

Introduction and Getting Started

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Participate in the 
Discussion | Introduce Yourself

Review the following in the 
BIS 1120 Resource Library > SIMnet Resources
 module to get familiar with using SIMnet:

McGraw Hill Digital Technical Support

Navigating in SIMnet

Library Bookshelf in SIMnet

Contact your instructor with any questions about the course and/or assignments

List of Topics and Sub-Modules for Introduction and Getting Started

Introduction and Objectives

Link

Microsoft 365/2021

Link

This course requires the Microsoft 365/2021 software applications. As an active student, you can install the software applications on your Windows PC or Mac. Click this link to visit Sinclair’s IT site to learn more and install the software applications on your computer. If you have any questions or need assistance, please contact 
Sinclair’s IT Help & Support
.

NOTE:
 Using a Chromebook or the web-based version of the software applications are not acceptable (and will not work) for completing assigned activities in this course.

Discussion | Introduce Yourself

Discussion Topic

 
Available until Jun 23, 2025 11:59 PM. 
Submission restricted after availability ends.

Introduce yourself to the class. Use your first and last name for the subject of your posting (also list your 
preferred
 name if you have one you go by).

Respond to the following items in your posting, numbering your responses:

Personal information you care to share such as employment, family life, and hobbies.

Educational information such as your major/education goals, how long you have been at Sinclair, what you would like to get out of this course, and/or why you chose to register for this particular course.

Your backup plan for completing coursework should your initial plan fail. Such as, what will you do if your Internet is down and/or your computer is inoperable for an extended period of time?

Tip(s) for being successful in a college course.

Use appropriate spelling (proof your posting) and grammar (capitalization, punctuation, etc.) in your posting. Read other student postings to become familiar with other students enrolled in the course. You are welcome to reply to others, but it is not required in this class.

This discussion is worth 10 points.

Windows/Office/File Management

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Review the following in the 
BIS 1120 Resource Library > SIMnet Resources
 module to get familiar with using SIMnet:

SIMbook Navigation in SIMnet

Completing a SIMbook – Video

SIMpaths in SIMnet

SIMpaths in SIMnet – Video

Objective Quizzes in SIMnet

Grades in SIMnet

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Intro: Windows and Office and File Management
, including the 
Show Me > Guide Me > Let Me Try
 activities

Refer to the 
Windows, Office, and File Management 
Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Windows and Office and File Management

Objective Quiz – Windows and Office and File Management

Contact your instructor with any questions about the course and/or assignments

BIS 1120 INTRO TO SOFTWARE APPS

List of Topics and Sub-Modules for Windows/Office/File Management

Introduction and Objectives

Link

SIMbook – Intro: Windows and Office and File Management

External Learning Tool

SIMpath – Windows and Office and File Management

External Learning Tool

 
Due 
June 23 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM
Ends Jun 30, 2025 11:59 PM

Objective Quiz – Windows and Office and File Management

External Learning Tool

 
Due 
June 23 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM
Ends Jun 30, 2025 11:59 PM

Word 1 | Creating and Editing Documents

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Review the following in the 
BIS 1120 Resource Library > SIMnet Resources
 module to get familiar with using SIMnet:

Completing a Project in SIMnet

Completing a Project in SIMnet – Video

Projects in SIMnet – Best Practices

Reviewing Project Results in SIMnet

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Word Chapter 1: Creating and Editing Documents
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Word 1

Refer to the 
Word Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Word 1

Project – Word 1

Objective Quiz – Word 1

Contact your instructor with any questions about the course and/or assignments

Word 2 | Formatting and Customizing Documents

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page.

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Word Chapter 2: Formatting and Customizing Documents
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Word 2

Refer to the 
Word Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Word 2

Project – Word 2

Objective Quiz – Word 2

Contact your instructor with any questions about the course and/or assignments

Word 3 | Collaborating with Others and Working with Reports

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page.

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Word Chapter 3: Collaborating with Others and Working with Reports
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Word 3

Refer to the 
Word Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Word 3

Project – Word 3

Objective Quiz – Word 3

Contact your instructor with any questions about the course and/or assignments

Word 4 | Using Tables, Columns, and Graphics

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page.

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Word Chapter 4: Using Tables, Columns, and Graphics
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Word 4

Refer to the 
Word Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Word 4

Project – Word 4

Objective Quiz – Word 4

Contact your instructor with any questions about the course and/or assignments

BIS 1120 INTRO TO SOFTWARE APPS

Word Exam

Print

To meet the learning objectives for this module, you will complete these activities.

Review the following in the 
BIS 1120 Resource Library > SIMnet Resources
 module to get familiar with using SIMnet:

Completing a SIMnet Exam – Video

Refer to the 
Word Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered for this exam

Complete the two-part 
Word Exam
 in SIMnet

Capstone Project – Word

SIMexam – Word

Contact your instructor with any questions about the course and/or assignments

 

Discussion | Introduce Yourself

Discussion Topic

 
Available until Jun 23, 2025 11:59 PM. 
Submission restricted after availability ends.

Introduce yourself to the class. Use your first and last name for the subject of your posting (also list your 
preferred
 name if you have one you go by).

Respond to the following items in your posting, numbering your responses:

Personal information you care to share such as employment, family life, and hobbies.

Educational information such as your major/education goals, how long you have been at Sinclair, what you would like to get out of this course, and/or why you chose to register for this particular course.

Your backup plan for completing coursework should your initial plan fail. Such as, what will you do if your Internet is down and/or your computer is inoperable for an extended period of time?

Tip(s) for being successful in a college course.

Use appropriate spelling (proof your posting) and grammar (capitalization, punctuation, etc.) in your posting. Read other student postings to become familiar with other students enrolled in the course. You are welcome to reply to others, but it is not required in this class.

This discussion is worth 10 points.

Excel 1 | Creating and Editing Workbooks

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Excel Chapter 1: Creating and Editing Workbooks
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Excel 1

Refer to the 
Excel Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Excel 1

Project – Excel 1

Objective Quiz – Excel 1

Contact your instructor with any questions about the course and/or assignments

Excel 2 | Working with Formulas and Functions

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Excel Chapter 2: Working with Formulas and Functions
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Excel 2

Refer to the 
Excel Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Excel 2

Project – Excel 2

Objective Quiz – Excel 2

Contact your instructor with any questions about the course and/or assignments

Excel 3 | Creating and Editing Charts

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Excel Chapter 3: Creating and Editing Charts
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Excel 3

Refer to the 
Excel Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Excel 3

Project – Excel 3

Objective Quiz – Excel 3

Contact your instructor with any questions about the course and/or assignments

Excel 4 | Getting and Managing Data

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Excel Chapter 4: Getting and Managing Data 
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Excel 4

Refer to the 
Excel Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Excel 4

Project – Excel 4

Objective Quiz – Excel 4

Contact your instructor with any questions about the course and/or assignments

Excel Exam

Print

To meet the learning objectives for this module, you will complete these activities.

Refer to the 
Excel Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered for this exam

Complete the two-part 
Excel Exam
 in SIMnet

Capstone Project – Excel

SIMexam – Excel

Contact your instructor with any questions about the course and/or assignments

List of Topics and Sub-Modules for Excel Exam

Capstone Project – Excel

External Learning Tool

 
Due 
July 28 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM
Ends Jul 30, 2025 11:59 PM

SIMexam – Excel

External Learning Tool

 
Due 
July 28 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM
Ends Jul 30, 2025 11:59 PM

You may access this activity only one time. There are 60 items to complete in 60 minutes with three attempts per item. The password for accessing this activity is 
AJVpkFdw
.

Access | Introduction to Databases

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

Lesson: Access – Introduction to Databases
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – Access 1

Guided Project – Access 2

Refer to the 
Access Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Access

Objective Quiz – Access

Contact your instructor with any questions about the course and/or assignments

PowerPoint 1 | Creating and Editing Presentations

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – PowerPoint Chapter 1: Creating and Editing Presentations
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – PowerPoint 1

Refer to the 
PowerPoint 
Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – PowerPoint 1

Project – PowerPoint 1

Objective Quiz – PowerPoint 1

Contact your instructor with any questions about the course and/or assignments

 

PowerPoint 2 | Illustrating with Pictures and Information Graphics

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – PowerPoint Chapter 2: 
Illustrating with Pictures and Information Graphics
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – PowerPoint 2

Refer to the 
PowerPoint 
Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – PowerPoint 2

Project – PowerPoint 2

Objective Quiz – PowerPoint 2

Contact your instructor with any questions about the course and/or assignments

PowerPoint 3 | Preparing for Delivery and Using a Slide Presentation

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – PowerPoint Chapter 3: 
Preparing for Delivery and Using a Slide Presentation
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – PowerPoint 3

Refer to the 
PowerPoint 
Resources
 in the 
BIS 1120 Resource Library
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – PowerPoint 3

Project – PowerPoint 3

Objective Quiz – PowerPoint 3

Contact your instructor with any questions about the course and/or assignments

PowerPoint 4 | Customizing Images, Illustrations, and Themes

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – PowerPoint Chapter 4: 
Customizing Images, Illustrations, and Themes
, including the 
Show Me > Guide Me > Let Me Try
 activities

Guided Project – PowerPoint 4

Refer to the 
PowerPoint 
Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – PowerPoint 4

Project – PowerPoint 4

Objective Quiz – PowerPoint 4

Contact your instructor with any questions about the course and/or assignments

PowerPoint Exam

Print

To meet the learning objectives for this module, you will complete these activities.

Refer to the 
PowerPoint Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered for this exam

Complete the two-part 
PowerPoint 
Exam
 in SIMnet

Capstone Project – PowerPoint

BIS 1120 INTRO TO SOFTWARE APPS

SIMexam – PowerPoint

Contact your instructor with any questions about the course and/or assignments

List of Topics and Sub-Modules for PowerPoint Exam

Capstone Project – PowerPoint

External Learning Tool

 
Due 
August 9 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM

SIMexam – PowerPoint

External Learning Tool

 
Due 
August 9 at 11:59 PM

 
Starts Jun 16, 2025 12:00 AM

You may access this activity only one time. There are 60 items to complete in 60 minutes with three attempts per item. The password for accessing this activity is 
ato3gZF9
.

Windows/Office/File Management

Print

To meet the learning objectives for this module, you will complete these activities.

Review the 
Introduction and Objectives
 page

Review the following in the 
BIS 1120 Resource Library > SIMnet Resources
 module to get familiar with using SIMnet:

SIMbook Navigation in SIMnet

Completing a SIMbook – Video

SIMpaths in SIMnet

SIMpaths in SIMnet – Video

Objective Quizzes in SIMnet

Grades in SIMnet

Complete these 
optional
 learning activities in preparation for completing this module’s graded activities:

SIMbook – Intro: Windows and Office and File Management
, including the 
Show Me > Guide Me > Let Me Try
 activities

Refer to the 
Windows, Office, and File Management 
Resources
 in the 
BIS 1120 Resource Library
 
to help with the skills covered in this module

Complete these 
graded activities
 in SIMnet:

SIMpath – Windows and Office and File Management

Objective Quiz – Windows and Office and File Management

Contact your instructor with any questions about the course and/or assignments

BIS 1120 INTRO TO SOFTWARE APPS