1. Government, the Law, and Political Activism

2. Characteristics of the structure of the U.S. government Executive Branch – composed of President, staff, cabinet members, and various administrative and regulatory departments and agencies, such as the Department of Health and Human Services – This branch suggests, administers, and regulates policy

3. Legislative Branch – Composed of the U.S. Senate and the U.S. House of Representatives at the federal level – Their role is to identify problems and to propose, debate, pass, and modify laws to address these problems

4. Judicial Branch – Composed of a system of federal, state, and local courts guided by the opinions of the Supreme Court – Their role is to interpret laws and their meaning, as in its ongoing interpretation of states’ rights to define access to reproductive health services to citizens of the states

5. Government Health Care Functions Direct Services – Federal, state, and local governments provide direct health services to certain individuals and groups Examples – Federal level – health care to military, certain veterans and federal prisoners – State and Local levels – employ nurses to deliver a variety of services to individuals and families, frequently on the basis of financial need or the need for a particular service

6. Financing – Governments pay for some health care services Include entitlements and income based eligibility Medicare, Medicaid, Maryland Children’s Health Program, Maryland Pharmacy Program, Transitional Emergency Medical and Housing Assistance, Supplemental Security Income, Social Security Disability Income, Food Stamps, WIC

7. Information – All branches collect, analyze, and disseminate data about health care and health status of the citizens Examples include the annual report Health: United States, compiled each year by the U.S. Department of Health and Human Services, collecting vital statistics, census data and conducting health care surveys

8. Policy Setting – A chief governmental function – All levels of government make policy decisions – Examples include Title 18 – Medicare, Title 19 – Medicaid, the new Pharmacy provision for Medicare

9. Organizations that influence Community Health International Organization – World Health Organization Federal Agencies – U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institutes of Health, Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS)

10. Organizations that influence Community Health Federal Non-Health Agencies – Department of Defense, Department of Labor (OSHA), Department of Agriculture, Department of Justice

11. Types of Laws that influence health Constitutional Law – provides overall guidance for selected practice situations, such as quarantine Legislation – laws from any legislative branch that focus on health issues, such as Ryan White Law Regulations – specific statements of law related to defining or implanting individual pieces of legislation, such as Renal Dialysis regulations or Nurse Practice Acts Judicial and Common Law – based on case law, precedents are set

12. CHN Responsibilities Identifying unmet needs, referral, and advocacy Teaching Environmental management Collaboration and coordination Political action, consultation, and evaluation for adequate standards of living and health care services and resources

13. Political activities to empower Nursing Voting and encouraging voter turnout Participating in a candidate’s campaign Communicating Nursing and client needs in the community Forming protest activities Running for political office Drafting a bill Writing letters supporting issues/bills

14. Phases of Policymaking Formulating policy Implementing policy Modifying policy

15. How a bill becomes law Legislative proposal is initiated A member of the Legislature/Congress sponsors it It is introduced to a chamber The bill is numbered and referred to a standing committee Hearings are held and then the bill is marked up

16. The bill is placed on the legislative agenda and then debated, and then can be amended The bill is passed or defeated; if passed, it goes to the next chamber. If both chambers approve, it is sent to the Governor/President who may sign it, veto it, or hold it.

17. Communicating with your policymakers Phone calls -Admin. Asst will probably answer the phone…you can leave your message with him -identify yourself by name and hometown/area -identify the issue or bill -state your position and how you want the legislator to vote -leave your name and address, even if the person says it is not necessary -follow-up with a short note to the staff member with whom you spoke emphasizing your position and appreciation for his attention to the issue

18. Communicating (cont’d) Letters – Write it by hand or word processing and mail it individually – Decide if you are writing as an individual or as a member of a group…include this information…it will broaden your influence – Include name and address in letter

19. Communicating (cont’d) Visits with your elected officials – Schedule the meetings in advance – Don’t hesitate to suggest a group meeting – Be on time, be prepared, and bring material – Don’t hesitate to invite your elected official to visit your practice locale (if applicable) – Make good contacts with local congressional staff and the partisan and nonpartisan staff serving your state legislator