The Policy Process: Part 1

HCS 455

January 13, 2014
The Policy Process: Part I – Health Care Reform Policies are considered and reviewed on a daily basis with intentions of solving problems and improving quality of life. The policies that are implemented in order to improve the health care system for Americans have an affect on every individual person. With this being said, it is especially essential that all policies are carefully contemplated before they are actually implemented. This paper will address how topics become policies. This will include three stages, which consist of the formulation stage, the legislative stage, and the implementation stage. There are several stages that a policy must go through before it can be established. These steps are essential to the process and need to be efficiently followed through throughout the policy process in order to be certain the the policy will in fact solve the problem that is at hand as well as be able to improve the quality of life for all citizens. The stages included in the establishment of a policy include: agenda building, formulation, adoption, implementation, evaluation, and termination. There are many situations that represent the economic need that America has for an improvement in health care as well as the introduction of the Patient Protection and Affordable Care Act, which is also known as the Health Care Reform. Before the country was able to experience the benefits of this policy, going through the formal legislative process was necessary.
Formulation Stage There is a great deal that goes into the implementation of new policies. It is necessary for there to be an existent problem before a policy can be created or formulated. “Once a problem hits the agenda, policy makers devise solutions. Every problem has countless potential answers: We can educate, subsidize, tax, regulate, or ignore; we can rely on individuals, on markets, on local government, on states, or on Washington DC” (Morone, Litman, & Robins, 2008, ). Policy makers must be prepared to provide an explanation of the problem that is at hand, as well as why the issue is important. There are a number of questions that one should be prepared for with the presentation of an existent problem. These questions could consist of the following:
What are implications of not acting on the issue?
What is at stake?
Why action is necessary?
When presenting a problem to the government, these questions are essential. The government will investigate a situation. The formulation stage consists of the government seeking different approaches that that may be used to solve a problem that is at hand. Several individuals are typically involved in the formulation stage including congress, the executive branch, the courts, and interest groups. Public opinion, demand, and national needs set the stage for the formulation of health care policies. According to Morone, Litman, and Robins (2008), has an influence on actions of the government such as Congressional and executive decision making, Supreme Court rulings, and changes in new policies. A new legislation or bill may begin with an increase of American concern regarding the health care industry. Any of the above listed situations either combined or individually engages media attention regularly, making the information available to the public. Americans can have numerous concerns which could consist of the stability of coverage, affordability, and the available access to coverage. The public definitely needs a speaker. This would be an individual that is in a position to enable enable changes and willing to initiate a proposal that will become escalated into a public agenda. Each individual person as well as groups want their needs to be heard, but unfortunately not every issue will gain national attention that is sufficient, nor have political clout that is sufficient enough to reach an agenda status. Organization, planning, and the right support system may be able to assist in the agenda setting stage of of a new legislation, since not all issues actually reach the government. After policy formation, a document is then ready for the legislative phase of the process.
Legislation Stage The first step of the legislation process begins with the assignment of a perspective number. The House of Representatives represents a House Bill, the Senate represents a Senate Bill. Once a bill is assigned an appropriate number, representatives or senators can then sponsor the bill and refer or introduce it to the committee or subcommittee. These areas are responsible for making decisions and debates regarding the content of bills, verbiage, process newly introduced bills, and perform research on any new legislative needs. Subcommittees are also responsible for conducting hearings and reviews in order to hear testimonies and support for the bill. After hearings have been completed, sessions are held in order to revise bills and make any necessary changes, before presenting a revised version to the full committee ("Introduction To The Legislative And Regulatory Process", 2014). When the full committee receives the report they may conduct the same process that the subcommittee has. This may include performing additional investigations and hearings before voting to send the bill to the Senate or House. The committee may then accept the bill as it was originally submitted to them, or with amendments. The chairperson of the committee documents the vote and then prepares a written report of the bill, which is next placed on the chamber calendar to appear on the floor. After the bill is debated on the floor by legislators, the subject is then voted on. After one chamber passes a vote, the bill is sent to the next to be voted on for approval. If both the House and the Senate pass the bill along with any amendments, it then goes before the president for his review ("Introduction To The Legislative And Regulatory Process", 2014). After the president signs the legislation it becomes law, and the next stage of the process is implementation.
Implementation
At this stage of the process, the law is passed and the government executes the policies and regulations. The government then identifies responsible parties, other government agencies, or state departments that will work towards implementing the new laws. These parties receive the necessary resources and authority in order to accomplish the task of enacting the law. The implementation process can consist of numerous decisions that involve procedures, staffing, and budgets. Translation is needed in new laws in order to determine the need of new guidelines, organizations, or processes. Some laws may not require implementation immediately, but can be completed in stages, so decision makers may also need to establish timelines for the various steps in the release process (Pennsylvania State University, n.d.). The Health Care Reform is an example of a law that was a timeline of release, rather than a single release date.
Conclusion
The Patient Protection and Affordable Care Act was signed into law by President Obama on March 23, 2010. Several changes were enacted that year, which includes an increase in coverage options for individuals with pre-existing conditions, the removal of pre-existing coverage for children, and denying insurance companies the ability to cancel coverage of individuals that is based on a previous error. In 2011, the next phase would allow senior citizens to receive free preventative care as well as free prescriptions. Medical cost ratio is also enforced by the Patient Protection and Affordable Care Act. Pay for performance systems became a key indicator to determine how hospitals receive payments for services based on patient outcomes in 2012, as well as the beginning stages of the transition to electronic medical records. Although the benefits of this plan come in stages, the stages of implementation can certainly be seen.
National demand and public opinion are the beginning of the process for new legislation. Health care is one topic that has been debated among politicians for years. The past several presidents, have submitted proposals to Congress for a universal style national health insurance system. These presidents include John F. Kennedy, Harry S. Truman, and Franklin D. Roosevelt. All three of these proposals failed because of insufficient support or a poor economy (Hoffman, 2013). The state of the economy reflected millions of Americans uninsured and unemployed, and individuals that were unable to obtain or afford health coverage because of pre-existing conditions in the case of the health care reform. Unlike other previous attempts for legislation that have failed, this bill actually obtained the necessary evidence and support to become a law.

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(Palomba C A Banta T W 1999 Assessment essentials: Planning, implementing, and improving assessment in higher education)