POWER & POLITICAL ACTION THE POLICY PROCESS POWER & POLITICAL ACTION

LEGISLATIVE EXECUTIVE JUDICIAL

FORMS OF HEALTH POLICIES LAWS RULES & REGULATIONS OPERATIONAL DECISIONS JUDICIAL DECISIONS

CATEGORIES OF HEALTH POLICIES ALLOCATIVE POLICIES REGULATORY POLICIES

THE POLICY PROCESS POLICY FORMULATION POLICY ENACTMENT POLICY IMPLEMENTATION

POLICY FORMULATION PROBLEM IDENTIFICATION AGENDA SETTING POSSIBLE SOLUTIONS STAKEHOLDERS WINDOW OF OPPORTUNITY

PAYING THE BILL BUDGET NEUTRAL PAY-AS-YOU-GO SIN TAXES PROVIDER OR INSURER TAXES EMPLOYER TAXES GENERAL TAXES

POLICY ENACTMENT WHO CAN DRAFT LEGISLATION? WHO CAN INTRODUCE LEGISLATION? WHAT IS THE PROCESS TO ENACT LEGISLATION? WHAT IS THE RELATIONSHIP OF THE LEGISLATIVE AND EXECUTIVE BRANCHES IN THE ENACTMENT OF LEGISLATION?

POLICY IMPLEMENTATION STRUCTURE & FUNCTION OF THE EXECUTIVE BRANCH THE REGULATORY PROCESS INFLUENCING THE REGULATORY PROCESS

CHANGING EXISTING POLICIES JUDICIAL BRANCH LEGISLATIVE BRANCH EXECUTIVE BRANCH

CASE STUDY: FEDERAL FUNDING OF TRAUMA CENTERS AUTHORIZING LEGISLATION ANNUAL APPROPRIATIONS IMPLEMENTATION

STATE HEALTH CARE REFORM STATE JURISDICTION FEDERAL & STATE RESPONSIBILITY FOR MEDICAID PROGRAM 10th Amendment to the US Constitution: Powers not delegated to the federal gov’t by the constitution are left to the states or the people State “PARENS PATRIAE” guardian fo health and welfare for those who can’t care for themselves (care of mentally ill, infirm, disabled) power to treat & quarantine communicable disease Medicaid Title 19 Soc Security Act - one of Johnson’s Great Society Programs of 1965 JOINT FEDERAL /STATE PROGRAM $ & mandated benefits from federal gov’t - additional $ & benefits from State budgets - in times of plenty DISCUSS WHAT HAPPENS IN RECESSION (numbers of eligible increase while available funds decrease - remind WINDOW OF OPPORTUNITY FOR NEW PROGRAMS) Health insurance program for certain poor (children & their mothers, disabled - Soc Security eligible, ESRD & elderly - Medicare eligible: typical Medicaid beneficiary = elderly white widow in a nursing home) Eligibility tied to federal poverty level -2004 $18,000+ for family of 4 Medicaid = comprehensive health insurance DISCUSS BENEFITS: nsg home, transportation, eye, dental BUT PROVIDERS COMPLAIN OF POOR REIMBURSEMENT/ STATES COMPLAIN OF UNFUNDED MANDATES

STATE INITIATIVES RATIONING MANAGED CARE MANDATED HEALTH INSURANCE

THE POLITICS MEDICARE DEALING WITH THE AMA THE END STAGE RENAL DISEASE PROGRAM ADVANCED PRACTICE NURSES CATASTROPHIC COVERAGE AND PROVIDER PAYMENT REDUCTIONS PRESCRIPTION DRUG BENEFIT 2004 AND 2010

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