MHA6050 WEEK 5 DISCUSSION AND PROJECT INSTRUCTIONS

MHA6050 WEEK 5 LECTURE NOTES

Policy Modification: Medicare

When we view policy making as a series of phases, we can group its activities into policy formulation, policy implementation, and policy modification. As this course draws to a close, it is important to note that public health policy is often incorrect, based on available information at a given point in time, and subject to change. The policy modification process allow for adjustments to be made over time to reflect these changes. For policies that specifically benefit a group, there will be attempts to increase those benefits. For policies that harm a group or organization, there will be attempts to change or remove those policies. Ultimately, if the intent of the policy is not met by current activities, then modifications are needed to align preferences and reality.

Policy modification, which is exceedingly common, contrasts with policy initiation or the introduction of a new and original piece of public law, which is exceedingly rare. In the United States, modification of existing health policy is an ongoing process. When the Medicare program first emerged as part of the 1935 Social Security Act, it looked nothing like the program we know today. Several policy modifications over time, including landmark initiatives by President Johnson, resulted in the current program—a program still subject to ongoing modifications. Current modifications deal primarily with benefits, eligibility, premiums, and payment mechanisms. The process is slow and painstaking, but perhaps that is for the greater good.

Policy Modification: Medicare

Review the respective year to learn more about its Medicare activities.

1960s

· 1965: President Lyndon B. Johnson made the Medicare law by signing H.R. 6675.

1970s

· 1972: President Richard M. Nixon signed into law Medicare expansion to include individuals under sixty-five years of age with long-term disabilities.

1980s

· 1980: The Omnibus Reconciliation Act expanded home health services and incorporated Medigap (supplemental) insurance.

· 1982: Medicare benefits expanded to include hospice care.

· 1988: The Medicare Catastrophic Coverage Act was passed, adding a limit to out-of-pocket expenses.

1990s

· 1995: The Qualified Individual (QI) program required Medicaid to pay premiums for Part B members 120 to 135 percent below the poverty line.

· 1995: Medicare Part C or Medicare Advantage continued to expand in the private market.

2000s

· 2000: Individuals with amyotrophic lateral sclerosis (ALS) who were approved for Social Security Disability Income were enrolled in Medicare.

· 2003: President George W. Bush enacted the Medicare Prescription Drug Improvement and Modernization Act (Part D).

2010s

· 2010: The Patient Protection and Affordable Care Act (PPACA) included an extensive list of reforms to contain Medicare costs and streamline service delivery.

· 2015: Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) to promote value and quality.

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Modification

Incrementalism in Policy Making

Changes to public policy are often minimal; that is, they are modified slowly over time, in incremental stages. And, this is the preferred approach, particularly in healthcare. But, why? Incrementalism, which is the adjustment of existing policy through minor modifications over time, facilitates change in social, political, and economic circles. The preference for incremental change does not negate possibilities of wide-sweeping changes, such as with the Affordable Care Act (ACA), but this is not the norm. Incremental decision-making processes allow for greater collaboration and cooperation among stakeholders in the policy marketplace. As with the policy formulation and implementation stages, all three branches of the government participate in the modification stage.

Incrementalism

Advantages · Is practical as the changes are small and reasonable, helps avoid conflict, and promotes change · Is simple and does not require specialized knowledge · Is flexible and allows for ongoing adjustments to be made Disadvantages · Encourages shortsightedness with minimal changes · Does not support innovation or creativity · May encourage waste by relying on a base of outdated policies

Legislators are tasked with the responsibility to identify policies in need of modification and to set a timeline for change. The executive branch, which may include presidents, governors, and mayors, helps to highlight necessary adjustments as they work through the implementation process. Finally, courts may determine modifications needed when policies appear in conflict with one another. Modification can also occur through the policy making process: formulation, implementation, and modification. Modification in the formulation stage hinges on the amendment of existing policies through agenda setting and legislation development. Modification in the implementation phase can occur through any of the four activities: designing, rulemaking, operating, and evaluating; however, most modifications occur during rulemaking and operating stages. Modification of policies establishes the cyclical nature of public policy making and allows for continual opportunities to align intention with observation.

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Policy Modification

· Building Policy Competence

· Health policy competence is defined as an understanding of the process through which health policy is formulated, implemented, and modified that enables professionals to improve population health. As healthcare administrators, you must have an understanding of the process if you wish to guide, participate, and improve that process. Only through competency are you able to ethically influence policy making processes at the local, state, or national levels. And, this ethical behavior can and should be driven by the principles of medical ethics: autonomy, justice, beneficence, and non-maleficence. Administrators of healthcare programs uphold policies that respect the rights of individuals while promoting their best interest through fair and equal treatment that does not bring harm. Influencing policy making mandates that we encourage policies that show respect for persons, their choices, and their privacy.

· Principles of Ethical Policy Making

· Review each principle to learn more about it.

An excellent example is support for advance directives, which allows individuals to prescribe instructions for their care at a later date when their rational ability may be compromised. Justice pertains to all health policies that seek to establish distributive justice or fair distribution of health-related benefits and burdens. Here, the establishment of fairness is driven largely by opinion and perspective. Beneficence in policy making asks that you, as policy influencers, are kind and seek to help others.

An example of a beneficent healthcare policy is the ACA, which intends to increase healthcare coverage and improve access to quality and timely healthcare. In healthcare, we rely heavily on implementation organizations such as the Food and Drug Administration to ensure the safety of health products. The importance of being competent in health policy making is clear. The question then becomes, how is it done? How do we influence policy making? First, observe the process to identify policies that impact personal and professional interests. Next, become an active participant in the process by monitoring those policies and predicting potential changes that will be needed, based on personal and professional experience. And, finally, influence the policy making process. Start right now . . .

Additional Materials

From your course textbook, Health Policymaking in the United States, read the following chapter:

· Building Policy Competence for Health Professionals

From the Internet, review the following:

· Shaping policy for development. (n.d.). 10 things to know about how to influence policy with research. Retrieved from https://www.odi.org/publications/10671-10-things-know-about-how-influence-policy-research

· Coleman, C., Bouësseau, M., Reis, A., & Capron, A. World Health Organization. (n.d.). How should ethics be incorporated into public health policy and practice?. Retrieved from http://www.who.int/bulletin/volumes/85/7/07-044040/en/

· Boden, L.A., & McKendrick, I.J. (n.d.). Model-Based Policymaking: A Framework to Promote Ethical "Good Practice" in Mathematical Modeling for Public Health Policymaking. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380671/