The history, structure, and process of health-care-policy and politics in nursing

Structure and Process of Policy Making

Healthcare policy in the U.S. is created and influenced at multiple levels: federal, state, and local.

Federal Level: This is the most complex level, involving all three branches of government. Congress drafts and passes legislation, the President signs or vetoes bills, and federal agencies like the Centers for Medicare & Medicaid Services (CMS) and the Food and Drug Administration (FDA) create and enforce regulations. The process often involves a bill being introduced, debated in committees, passed by both the House and Senate, and then signed into law. This can be a slow, contentious process influenced by political parties, special interest groups, and public opinion.

State Level: State governments play a critical role in licensing healthcare professionals, regulating insurance companies, and administering federal programs like Medicaid.

Local Level: Local health departments address community-specific health needs through local ordinances and public health initiatives.

Nurses and nursing organizations engage in this process through several avenues:

Lobbying: Directly influencing lawmakers by providing expert testimony and advocating for specific policies.

Grassroots Advocacy: Mobilizing nurses and the public to contact their representatives.

Political Action Committees (PACs): Providing financial support to political candidates who align with nursing's policy goals.

Sample Answer

History of Healthcare Policy and Politics in the U.S.

The history of healthcare policy in the U.S. is marked by a shift from a private, market-based system to one with increasing government intervention. In the early 20th century, healthcare was primarily a private matter, with most people paying out of pocket for medical services. The Great Depression highlighted the financial vulnerability of this model, leading to the rise of private health insurance and, later, employer-sponsored plans. Major government involvement began in the mid-20th century with the passage of Medicare and Medicaid in 1965, which provided health insurance for the elderly and the poor, respectively. This was a direct result of political advocacy and public demand. Since then, policy has evolved in response to rising costs and a desire for broader coverage, culminating in the Affordable Care Act (ACA) of 2010, which mandated health insurance coverage and expanded access to millions.

Nursing's role in this history has evolved from a passive position to one of active advocacy. Early nursing leaders like Florence Nightingale and Lillian Wald were instrumental in public health and sanitation policies. In the modern era, nursing organizations, such as the American Nurses Association (ANA), have become powerful political forces, lobbying for policies that affect patient care, nurse education, and practice authority.