Overview of Government and Legislative Processes

Public Health Law

A statute, ordinance or code that prescribes sanitary standards and regulation for the purpose of promoting and preserving the community's health. consists of legislation, regulations, and court decisions enacted by governments at the federal, state, and local levels to protect the public's health. New York State Public Health Law §2164: "Every person in parental relation to a child in this state shall have administered to such child an adequate dose of an immunizing agent against poliomyelitis, mumps, measles, diphtheria, rubella, varicella, Hemophilus influenza type b, and hepatitis B..."

International Organizations

An association of countries, established by and operated according to a multilateral treaty, whose purpose is to pursue the common aims of those countries. Ex: World Health Organization

The Case of Jacobson v. Commonwealth of Massachusetts (1905)

Balancing the Responsibilities of the Government with Individual Rights/Example of Statutory and Common Law •Massachusetts passes a statute requiring everyone to be vaccinated for smallpox. •Jacobson refuses to be vaccinated, claiming the requirement of vaccination violated his liberty interests of bodily integrity and decisional privacy. •The U.S. Supreme Court ruled that "a community has the right to protect itself against an epidemic of disease which threatens the safety of its members". Also, that individual liberty "does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraints. There are manifold restraints to which every person is necessarily subject for the common good." Result of the Ruling: the Supreme Court ruled that the Massachusetts law was constitutional. But when the Court rules against a statutory law, the Supreme Court's decision becomes the law.

HARRY S TRUMAN 1945-1953

By 1945, WWII was over. President Harry S Truman, voiced the need for a national health insurance program for those willing to pay voluntary fees. The idea died when the American Medical Association denounced the plan as a step toward "socialized medicine."

Schoolhouse Rock Video How a Bill Becomes a Law

Capitol Hill Bill sits in committee idea -> local congressman -> write out and introduce to congress and becomes a bill until a it becomes a law few key congressman discuss and debate the bill to determine if its a law most bills don't get this far they can kill the bill in committee House of Rep, if vote yes -> Senate if vote yes -> White House for the president to sign than it becomes a law president can still say no - veto then goes back to congress and votes again, by that time its very unlikely to become a law

Nixon Administration

During the 1970s, the Nixon administration tried to shift emphasis in health policy issues to state and local agencies by combining local initiatives with policy input and national standards. In Nixon's presidential term, two important pieces of health legislation were passed. The HMO Act was passed in 1973 and required employers to offer an HMO alternative to conventional health insurance. The National Health Planning and Resources Development Act of 1974 required states to obtain a Certificate of Need for new hospital construction and modernization projects, including technology, to procure federal funding. During this period, many of the federal responsibilities for a uniform, cooperative national public health system were removed and individual states were expected to assume those responsibilities.

Balance of Powers

Federalism is the relationship and distribution of power between the national and the state governments. This balance flows directly from the text of the Constitution: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States , are reserved to the States respectively, or to the people. " States retain powers not delegated to the federal government; therefore much of public health law is under state jurisdiction and, as a result, varies considerably among state, these powers are referred to as the states' "police powers". states may delegate this right to local government. In the United States, legislative activities of the three levels of government (federal, state, and local) may vary greatly in their expectations, actions, and results. The state legislatures, for the most part, are directly involved in health care, yet the federal government influences health policy, directly and indirectly, through financing of health care for many groups (Medicare), regulation activities ( approval of drugs), and setting of standards (air quality). Decisions affecting the public's health are made not only at every level of government, but also in each branch. The separation and balance of powers, referred to as checks and balances, is as important to health as it is to the economic or military status of the country.

Health Legislation Disadvantage

Few elected officials are knowledgeable about the health care field. Although health is readily recognized as a national resource, it is not easily quantified into the economic terms that make the issue easy to grasp. backgrounds, biases, and ambitions of each legislator. The decision to run for public office is often made in keeping with personal goals that are likely to differ from health values for the public good. Despite these obstacles, good health laws can be passed when concerned nurses and other health care workers understand the legislative process and use it effectively. For nurses, this is yet another mode of intervention on behalf of clients. Legislation passed to reduce abuse for all children is as important as physical and emotional care of the abused child

BARACK OBAMA 2009-2017

Finally, after nearly 100 years, and many presidential administrations later, health care reform is enacted through the Affordable Care Act, although this is not a national health insurance plan as Teddy Roosevelt, Franklin Delano Roosevelt, Harry S Truman, or Bill Clinton envisioned. A major aspect of the Act, that health insurance is mandated for all (if someone does not have health coverage, they will be fined) has survived a Supreme Court battle. History will determine whether this Act will improve the overall health of the nation. Often overlooked in this Act, is that insurance companies can no longer deny applicants who already have a significant health problem, called a pre-existing condition, to obtain coverage. This ends the long standing practice of the insurers to "cherry pick" the healthiest individuals to cover and to deny coverage to those who would be costly to insure. The Act assumes that since everyone must pick an insurance policy, there are more people, including young, healthy people paying premiums. This will off-set the costs the insurers incur providing coverage to those with pre-existing conditions.

BILL CLINTON 1993-2001

He gave first lady Hillary Clinton the task of developing a plan for universal health care which would have required businesses to cover their workers and everyone else would be mandated to have health insurance, which was dubbed, "Hillary Care" by those who opposed the plan. Businesses and the health-care industry (and once again, the AMA) lobbied against the plan. The bill was killed by the Senate in 1993. However, Clinton in 1997, signed a bipartisan plan creating a federally subsidized program for states to provide health coverage for children families with incomes that were low, but too high for them to qualify for Medicaid, called the State Child Health Insurance Plan (SCHIPs).

World Health Organization

Historically, global concerns for health centered primarily on the spread of infectious disease. These concerns lead to the formation of the World Health Organization. Defining health was central to the formation and mission of WHO. This definition was written as the preamble to its constitution: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." WHO directed most of its efforts in the last 50 years to disease containment. recent world events have led WHO back to its initial definition such as the environmental issues of nuclear contamination and industrial toxins, developed nations exporting carcinogenic commercial products, such as tobacco, and antibiotic resistant strains of bacteria it has been the emergence of the human immunodeficiency virus (HIV) that has changed the global health paradigm from the traditional notions of containment and treatment to a more comprehensive approach of social intervention that has brought WHO back to its stated definition of health and the realization that health is a basic human right. The World Health Organization's experience with the HIV pandemic revealed that health problems are linked to government actions and thus, affect human rights. Human rights violations occur when governments fail to provide their people with the infrastructure, services, and information necessary to prevent and control disease. One example of how health is dramatically affected by human right issues is the estimation that for every year of education a woman has, infant mortality decreases by 10%,yet education of women is not a global reality.

FRANKLIN D. ROOSEVELT 1933-1945

In 1935, national health insurance became an agenda item again. The country was in the depths of the Great Depression and American society was in dire economic trouble. FDR decided it was more realistic to push for Social Security instead. Social Security was a huge step toward addressing poverty which at the time (as it is now) was associated with old age in America. A plan for national health insurance could have been possible as a follow-up, but World War II intervened. By 1942 Roosevelt, to stabilize the war effort, had ordered wage and price controls. Companies could not use higher pay to attract the best workers, so they began offering such benefits as health insurance which seemed to ease the need to a national health insurance act.

History of Government Funded Health Care

In 1965, the Social Security Act established both Medicare and Medicaid. Medicare was a responsibility of the Social Security Administration (SSA), while Federal assistance to the State Medicaid programs was administered by the Social and Rehabilitation Service (SRS). SSA and SRS were agencies in the Department of Health, Education, and Welfare(HEW). In 1977, the Health Care Financing Administration (HCFA) was created under HEW to effectively coordinate Medicare and Medicaid. In 1980 HEW was divided into the Department of Education and the Department of Health and Human Services (HHS). In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services (CMS). CMS is the federal agency which administers the Medicare Program.

Centers for Disease Control

In CDC's 2004 annual report, health is described as "... health is more than the absence of threats of disease and disability ... it's a precious resource that helps us to create productive and satisfying lives for ourselves and our families." A stated goal of the CDC is that "All people, and especially those at greatest risk for health disparities, will achieve their optimal lifespan with the best possible quality of health in every stage of life". CDC FROM: TO: Disease orientation................................................Health protection focus Designing and implementing sponsored programs..........Informing and guiding health system actors Allocating agency resources................................... Leveraging resources to steer larger health system Emphasis on clinical prevention.............................. Focus on prevention and health protection Transaction-based relationships...............................Partnerships and strategic alliances Program requirements...........................................Incentives for participation/cooperation Collecting and analyzing health data...................... ..Creating integrated health information systems Issuing advisories and guidelines............................ Building decision-support system

Historical Foundations of Health Legislation and Policy

In the United States, the government has been involved in efforts to improve or maintain the health of citizens since the late 1700s. over the past two centuries, federal, state, and local initiatives, laws, and organizations have fostered significant improvements in the health and life expectancy of Americans the strength and focus of health policy efforts from the federal level were largely imparted during the latter part of the twentieth century.

LYNDON B. JOHNSON 1963-1969

National health care became the centerpiece of President Lyndon B. Johnson's "Great Society" programs in 1965. LBJ a legendary political arm-twister, managed to create two landmark programs — Medicare, for elderly Americans, and Medicaid for the poor.

JOHN F. KENNEDY 1961-1963

National health care for the elderly, was made a major 1960 campaign issue Remember, there was no Medicare then. JFK won the White House, but when he presented his health care proposal, Congress would have nothing to do with it.

Hill-Burton Hospital Construction Act

One of the earliest pieces of comprehensive health care legislation was passed during the Truman administration in 1946 . The Hill-Burton Act provided grants to states for the construction of new hospitals, targeting low-income and rural areas. Two decades later, President Johnson's terms in office marked a time of dramatic growth in federal health policy, highlighted by the passage of Medicare and Medicaid in 1965. This landmark legislation strengthened the government's role in the health care system and dramatically shaped its rapid growth.

DWIGHT D. EISENHOWER 1953-1961

President Eisenhower advocated for expanding health insurance to cover more than just hospitalization. He also advocated for increasing mental health services through federal grants. A link to the speech that President Eisenhower gave to Congress, sixty years earlier, in 1955 is eerily familiar: http://www.presidency.ucsb.edu/ws/?pid=10399

Bill of Rights

The Constitution not only set forth the responsibilities of the federal government, it also provided for individual citizen's rights and freedoms These are contained in the ten Amendments (Bill of Rights) which were added after the original Articles of the Constitution were ratified. right of free speech and freedom of religion only applied to the laws and actions of the federal government. It would take another 72 years for these rights to be guaranteed within the states. "Liberty interests" and "Privacy rights" have been found to exist by determinations by the Supreme Court and have become guiding principles in setting policy and enacting legislation. Note that these rights are only applicable to state or federal government interaction with people, violations of restrictions on rights such as free speech do not apply to non-government entities, unless a specific law states otherwise (an example would be the federal Health Insurance Portability and Accountability Act, HIPAA, which regulates speech about a patient's medical condition).

Reponse to Bill by President

The President may issue a response to a bill, here is one example of the President's response to a Senate Bill: STATEMENT OF ADMINISTRATION POLICY S. 306 - Genetic Information Nondiscrimination Act of 2005 (Sen. Snowe (R) ME and 19 cosponsors) The Administration favors enactment of legislation to prohibit the improper use of genetic information in health insurance and employment. The Administration supports Senate passage of S. 306 as reported, which would prohibit group health plans and health insurers from denying coverage to a healthy individual or charging that person higher premiums based solely on a genetic predisposition to developing a disease in the future. The legislation also would bar employers from using individuals' genetic information when making hiring, firing, job placement, or promotion decisions.

1980's & 1990's

The federal government's involvement in public health services revived when Ronald Reagan took office in 1980. In response to the alarming inflation of health care costs under Reagan, new Medicare cost-control approaches for hospitals and physicians (e.g., DRGs) were created. In the early 1990s, the public was anxious for reform and President Clinton's administration worked diligently to set up a national health policy. This attempt to bring about national health insurance was the first since Truman's initiatives to provide nationally sponsored health coverage for all Americans in the late 1940s. However, like Truman's, Clinton's policy initiative was not successful.

Branches of Government

The legislative branch (Congress at the federal level and the legislature, general assembly, or general court at the state level) enacts the statutory laws that are the basis for governance. The executive branch administers and enforces the laws through regulatory agencies. These agencies define more specific implementation of the statutes through rules and regulations (i.e., regulatory or administrative law). The judiciary body provides protection against oppressive governance and against professional malpractice, fraud, and abuse. Its function, through the courts, both state and federal, is to determine the constitutionality of laws, interpret them, and decide on their legitimacy when they are challenged. Decisions of the United States Supreme Court are binding law for the nation. Decisions of the individual state's highest court are binding law within that state alone. The courts also have jurisdiction over specific infractions of laws and regulations.

How a Bill becomes a Law

The procedure through which legislation must pass to eventually become law is similar for all U.S. legislative bodies. Once a concept has been drafted into legislative language, it becomes a bill, is given a number, and moves through a series of steps. The bill's passage is sometimes smooth, but more often than not the bill is extensively altered through amendments or even killed at various stages. In Congress and in the 49 states that have a two-house legislature, a bill must succeed through the two legislative bodies, the House of Representatives, and the Senate. Nebraska, which has a single house legislature, is the exception. A bill that has moved successfully through the legislative process has one final hurdle, which is the chief executive's approval. The approval may be a clear endorsement, in which case the governor or president signs it. If the executive neither signs nor vetoes it, the bill may become law by default. An explicit veto conclusively kills the bill, which then can be revived only by a substantial vote of the legislature to override the veto. This is another example of the checks and balances of the government process. Issues that find their way into the legislative arena are commonly controversial and proponents and opponents quickly align themselves. Defeating a bill is much easier than getting one passed; therefore the opposition always has the advantage. Health legislation, which usually requires preventive action (e.g., toxic waste management) or creates a new service (e.g., nursing center organizations for Medicare recipients), is at a disadvantage from several other standpoints.

Which Entities Create Laws?

a balance of powers exists between the branches of government and between the states and federal government. Laws which can be statutes, regulations, ordinances are created in all three branches and at the federal, state, and local ( municipality) levels. Laws created by the legislature are called statutes Laws created by regulatory bodies are called regulations. Laws created by municipalities are called ordinances. Laws created by courts are called common law: The courts ( a branch of government) create laws when a higher court such as the Supreme Court of the US or a state's highest court ( in New York, this is the Court of Appeals) makes a decision. That decision is called stare decisis and is the law. A well known example of common law that became the law of the land after a Supreme Court decision is Roe v. Wade which made it legal in all states for a woman to have an abortion in the first trimester of pregnancy.

Policy

a course of action to be followed by a government or institution to obtain a desired end. reflects values and encompasses the choices that a society, segment of society, or organization makes regarding goals and priorities and the criteria used to allocate resources involves the application of reason and evidence to problem solving in public and private settings.

Administrative agency

a department of the executive branch with the authority to implement or administer particular legislation.

a. List four or more ways balance of power is acheived in the United States. b. List three entitities that create laws, statutes, or ordinances. c. Define an administrative agency and give an example of an administrative agency regulation. d. List three or more steps of policy formation. e. List the possible actions that can be taken after a bill is introduced to a governing body. f. State the health care policy associated with the following Presidents: 1. Johnson 2. Nixon 3. Clinton 4. Obama

a. States retain powers not delegated to the federal government; states may delegate this right to local government. In the United States, legislative activities of the three levels of government (federal, state, and local) may vary greatly in their expectations, actions, and results. bicameralism - ensures that the power to enact laws is shared between the House of Representatives and the Senate providing another check on power. creating laws b. Laws which can be statutes, regulations, ordinances are created in all three branches and at the federal, state, and local ( municipality) levels. Laws created by the legislature are called statutes Laws created by municipalities are called ordinances. The courts ( a branch of government) create laws when a higher court such as the Supreme Court of the US or a state's highest court ( in New York, this is the Court of Appeals) makes a decision. That decision is called stare decisis and is the law. c. a department of the executive branch with the authority to implement or administer particular legislation. one most dramatic changes in American government since the ratification of the Constitution is the growth of these. Federal administrative agencies have broad power- they exercise all of the powers of government: executive, legislative and judicial. The Federal Drug Administration (FDA) is one example HIPPA is an example of an administrative agency regulation d. begins with most critical step: defining the issue and placing it on the agenda A regulatory schedule for the implementation of the law into program is formulated. Then an evaluation process is designed that satisfies regulatory and legislative remedies should they be needed. e. extensively altered through amendments or even killed at various stages. In Congress and in the 49 states that have a two-house legislature, a bill must succeed through the two legislative bodies, the House of Representatives, and the Senate. A bill that has moved successfully through the legislative process has one final hurdle, which is the chief executive's approval. The approval may be a clear endorsement, in which case the governor or president signs it. If the executive neither signs nor vetoes it, the bill may become law by default. An explicit veto conclusively kills the bill, which then can be revived only by a substantial vote of the legislature to override the veto. This is another example of the checks and balances of the government process. f. 1. Medicare and Medicaid 2. HMO Act 3. Hillary Care and State Child Health Insurance Plan (SCHIPs) 4. ACA (Affordable Care Act)

Policy Analysis

an objective process that identifies the sources and consequences of policy decisions in the context of the factors that influence them. determines those who benefit and those who experience a loss as the result of a policy. These considerations are critical to ensure health policies that are fair to all those affected.

Statutes

any laws passed by a legislative body. Many states have enacted statutes that allow minors to give permission for treatment of sexually transmitted infections or drug or alcohol problems without parental consent.

Organizations

are associations that set standards in a particular area. They may be recognized by the corresponding government body as an accrediting body such as the not for profit organization, The Joint Commission on Accreditation of Healthcare Organizations. Although it is not a government agency, they may enforces standards. In the case of JCAHO, accreditation by an institution is voluntary, but confers Medicare and Medicaid certification on a health care facility.

Treaties

are binding agreements between nations Ex: Treaty to Eliminate All Forms of Discrimination Against Women

Laws

are the combination of legislation, judicial decisions, and administrative actions (the law of the land).

Policy Formation

authorized authoritative bodies (e.g., state health departments, OSHA, the Center for Medicare and Medicaid Services (CMS) ,and a fiscal oversight subcommittee) rationally determine actions to create, amend, implement, or rescind health care policy These groups would decide what is right or best and then develop the political strategies to affect the desired outcomes. The question of whether a particular policy is advocated or adopted would depend on the degree that a group or the society as a whole may benefit without harm or detriment to subgroups group need and group demand should be the strongest determinants that may influence policy formation The premises supporting the goals of health policy should be equitable distribution of services and the assurance that the appropriate care is given to the right people, at the right time, and at a reasonable cost.

bicameralism

balance of powers within the government at the state and federal level. separation of powers of the three branches of government, there is also one other mechanism that balances the power of the Congress. insures that the power to enact laws is shared between the House of Representatives and the Senate providing another check on power.

Steps in Policy Formulation

begins with most critical step: defining the issue and placing it on the agenda A regulatory schedule for the implementation of the law into program is formulated. Then an evaluation process is designed that satisfies regulatory and legislative remedies should they be needed.

THEODORE ROOSEVELT 1901-1909

did not address health policy or reform while he was President, rather he took up the cause for national health insurance in 1912 when he made a bid for another run at the White House. He ran as a third party against the Republican and Progressive candidates, Taft and Wilson. His third party was called the Bull Moose party. He lost, Wilson, the progressive, won. National health insurance, an innovation appearing prominently for the first in national politics, was one of his platform's primary positions. World War I and its aftermath took national health insurance off the table.

Health Policy

exemplifies both conflict and social change theories product of continuous interactive processes in which interested professionals, citizens, institutions, industries, and other groups compete with one another for the attention of various branches of government The most obvious and prominent among these is the legislative branch, although policy is also made through regulatory mechanisms, and court decisions. may also issue from the recommendations of fact-finding commissions established by the legislative or executive branch. rarely created through discrete, momentous determinations in relation to single problems or issues. It often evolves slowly and incrementally as an accumulation of many small decisions. It also changes slowly because changes in the social beliefs and values that underlie established policy develop within the context of actual service delivery. Once a direct health care service is offered, especially an official tax-funded service, it is often difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement on the part of the public. This tradition also exerts political influence in a natural effort for self-preservation.

Institutional policies

govern work sites and identify the institution's goals, operation, and treatment of employees. Nurse's documentation signed consent is obtained prior to a procedure.

2000s to Current

health care insurance costs and coverage have worsened. The lack of coordinated government influence, coupled with the decline in insurance coverage, has increased the emphasis on managed care, yet, many observers view managed care as perhaps economically successful but popularly and practically a failure. Control of health decisions has moved from physician providers to the insurers and often the patient seems to be a helpless bystander. The publication of Healthy People 2000 in 1990 led to a resurgence of interest by the federal government in the welfare of Americans. fiscal resources for public health interventions continued to decline and only marginal progress was made in meeting the goals. In early 2000, Healthy People 2010 marked the beginning of the new millennium and an enhanced focus on population-based health promotion strategies. Many Healthy People 2010 objectives directly or indirectly involve health policy. New objectives for the new century are to see a reduction in health disparities among groups and witness even greater improvements in the health of all Americans.

Lecture

health care policy in general - as of Jan 2017 Congress has taken steps towards dismantling the ACA, tremendous changes and discussion regarding health care access and policy in US this year

S.1132 - Registered Nurse Safe Staffing Act of 2015

https://www.congress.gov/bill/114th-congress/senate-bill/1132 Sponsor: Sen. Merkley, Jeff [D-OR] (Introduced 04/29/2015) Cosponsor: Sen. Baldwin, Tammy [D-WI] 10/29/2015 Committees: Senate - Finance Latest Action: 04/29/2015 Read twice and referred to the Committee on Finance. A bill to amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers, and for other purposes. Amends title XVIII (Medicare) of the Social Security Act to require each Medicare participating hospital to implement a hospital-wide staffing plan for nursing services furnished in the hospital. Requires the plan to require that an appropriate number of registered nurses provide direct patient care in each unit and on each shift of the hospital to ensure staffing levels that: (1) address the unique characteristics of the patients and hospital units; and (2) result in the delivery of safe, quality patient care consistent with specified requirements. Requires each participating hospital to establish a hospital nurse staffing committee which shall implement such plan. Specifies civil monetary and other penalties for violation of the requirements of this Act. Sets forth whistleblower protections against discrimination and retaliation involving patients or employees of the hospital for their grievances, complaints, or involvement in investigations relating to such plan. S. 1132 To amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers, and for other purposes. IN THE SENATE OF THE UNITED STATES April 29, 2015 Mr. Merkley introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide for patient protection by establishing safe nurse staffing levels at certain Medicare providers, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. Short title. This Act may be cited as the "Registered Nurse Safe Staffing Act of 2015". SEC. 2. Findings. Congress makes the following findings: (1) Research shows that patient safety in hospitals is directly proportionate to the number of registered nurses working in the hospital. Higher staffing levels by experienced registered nurses are related to lower rates of negative patient outcomes. (2) A 2011 study on nurse staffing and inpatient hospital mortality shows that sub-optimal nurse staffing is linked with a greater likelihood of patient death in the hospital. A 2012 study of serious patient events reported to the Joint Commission demonstrates that one of the leading causes of all hospital sentinel events is human factors, including staffing and staffing skill mix. (3) Health care worker fatigue has been identified as a major patient safety hazard, and appropriate staffing policies and practices are indicated as an effective strategy to reduce health care worker fatigue and to protect patients. A national survey of registered nurses found that 74 percent experience acute or chronic effects of stress and overwork. (4) A strategy that ensures optimal nurse staffing and skill mix greatly influences patient satisfaction and results in greater overall savings to hospitals through reductions in adverse patient events. (5) A 2009 study demonstrated that improved patient satisfaction due to increased and appropriate nurse staffing is reflected on hospital scores on HCAHPS, which is a key measure for value-based payment programs under the Medicare program and used by other payors. (6) Registered nurses play a vital role in preventing patient care errors. A 2009 study found that sufficient staffing of critical care nurses can prevent adverse patient events, which can cost anywhere from $2,200,000 to $13,200,000. By contrast, the nurse staffing costs in the study time period were only $1,360,000. (7) Higher nurse staffing also generates cost savings to payors, as demonstrated in a 2011 cost-benefit analysis that weighed registered nursing personnel costs against emergency department utilization after patient discharge from a hospital. (8) A 2012 study of Pennsylvania hospitals shows that by reducing nurse burnout, which is attributed in part to poor nurse staffing, those hospitals could prevent an estimated 4,160 infections with an associated savings of $41,000,000. That study also found that for each additional patient assigned to a registered nurse for care, there is an incidence of roughly one additional catheter-acquired urinary tract infection per 1,000 patients or 1,351 infections per year, costing those hospitals as much as $1,100,000 annually. (9) When hospitals employ insufficient numbers of nursing staff, registered nurses are being required to perform professional services under conditions that do not support quality health care or a healthful work environment for registered nurses. (10) As a payor for inpatient and outpatient hospital services furnished to Medicare beneficiaries, the Federal Government has a compelling interest in promoting the safety of these patients by requiring any hospital participating in the Medicare program to establish minimum safe staffing levels for registered nurses. SEC. 3. Establishment of safe nurse staffing levels by Medicare participating hospitals. (a) Requirement of medicare provider agreement.—Section 1866(a)(1) of the Social Security Act (42 U.S.C. 1395cc(a)(1)) is amended— (1) in subparagraph (V), by striking "and" at the end; (2) in subparagraph (W), as added by section 3005 of the Patient Protection and Affordable Care Act (Public Law 111-148)— (A) by moving such subparagraph 2 ems to the left; and (B) by striking the period at the end; (3) in subparagraph (W), as added by section 6406(b) of the Patient Protection and Affordable Care Act (Public Law 111-148)— (A) by moving such subparagraph 2 ems to the left; (B) by redesignating such subparagraph as subparagraph (X); and (C) by striking the period at the end and inserting ", and"; and (4) by inserting after subparagraph (X), as redesignated by paragraph (3)(B), the following new subparagraph: "(Y) in the case of a hospital (as defined in section 1861(e)), to meet the requirements of section 1899C.". (b) Requirements.—Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is amended by adding at the end the following new section: "Nurse staffing requirements for Medicare participating hospitals "Sec. 1899C. (a) Implementation of nurse staffing plan.— "(1) IN GENERAL.—Each participating hospital shall implement a hospital-wide staffing plan for nursing services furnished in the hospital. "(2) REQUIREMENT FOR DEVELOPMENT OF STAFFING PLAN BY HOSPITAL NURSE STAFFING COMMITTEE.—The hospital-wide staffing plan for nursing services implemented by a hospital pursuant to paragraph (1)— "(A) shall be developed by the hospital nurse staffing committee established under subsection (b); and "(B) shall require that an appropriate number of registered nurses provide direct patient care in each unit and on each shift of the hospital to ensure staffing levels that— "(i) address the unique characteristics of the patients and hospital units; and "(ii) result in the delivery of safe, quality patient care, consistent with the requirements under subsection (c). "(b) Hospital nurse staffing committee.— "(1) ESTABLISHMENT.—Each participating hospital shall establish a hospital nurse staffing committee (hereinafter in this section referred to as the 'Committee'). "(2) COMPOSITION.—A Committee established pursuant to this subsection shall be composed of members as follows: "(A) MINIMUM 55 PERCENT NURSE PARTICIPATION.—Not less than 55 percent of the members of the Committee shall be registered nurses who provide direct patient care but who are neither hospital nurse managers nor part of the hospital administration staff. "(B) INCLUSION OF HOSPITAL NURSE MANAGERS.—The Committee shall include members who are hospital nurse managers. "(C) INCLUSION OF NURSES FROM SPECIALTY UNITS.—The members of the Committee shall include at least 1 registered nurse who provides direct care from each nurse specialty or unit of the hospital (each such specialty or unit as determined by the hospital). "(D) OTHER HOSPITAL PERSONNEL.—The Committee shall include such other personnel of the hospital as the hospital determines to be appropriate. "(3) DUTIES.— "(A) DEVELOPMENT OF STAFFING PLAN.—The Committee shall develop a hospital-wide staffing plan for nursing services furnished in the hospital consistent with the requirements under subsection (c). "(B) REVIEW AND MODIFICATION OF STAFFING PLAN.—The Committee shall— "(i) conduct regular, ongoing monitoring of the implementation of the hospital-wide staffing plan for nursing services furnished in the hospital; "(ii) carry out evaluations of the hospital-wide staffing plan for nursing services at least annually; and "(iii) make such modifications to the hospital-wide staffing plan for nursing services as may be appropriate. "(C) ADDITIONAL DUTIES.—The Committee shall— "(i) develop policies and procedures for overtime requirements of registered nurses providing direct patient care and for appropriate time and manner of relief of such registered nurses during routine absences; and "(ii) carry out such additional duties as the Committee determines to be appropriate. "(c) Staffing plan requirements.— "(1) PLAN REQUIREMENTS.—Subject to paragraph (2), a hospital-wide staffing plan for nursing services developed and implemented under this section shall— "(A) be based upon input from the registered nurse staff of the hospital who provide direct patient care or their exclusive representatives, as well as the chief nurse executive; "(B) be based upon the number of patients and the level and variability of intensity of care to be provided to those patients, with appropriate consideration given to admissions, discharges, and transfers during each shift; "(C) take into account contextual issues affecting nurse staffing and the delivery of care, including architecture and geography of the environment and available technology; "(D) take into account the level of education, training, and experience of those registered nurses providing direct patient care; "(E) take into account the staffing levels and services provided by other health care personnel associated with nursing care, such as certified nurse assistants, licensed vocational nurses, licensed psychiatric technicians, nursing assistants, aides, and orderlies; "(F) take into account staffing levels recommended by specialty nursing organizations; "(G) establish upwardly adjustable minimum ratios of direct care registered nurses to patients for each unit and for each shift of the hospital, based upon an assessment by registered nurses of the level and variability of intensity of care required by patients under existing conditions; "(H) take into account unit and facility level staffing, quality and patient outcome data, and national comparisons, as available; "(I) ensure that a registered nurse shall not be assigned to work in a particular unit of the hospital without first having established the ability to provide professional care in such unit; and "(J) provide for exemptions from some or all requirements of the hospital-wide staffing plan for nursing services during a declared state of emergency (as defined in subsection (l)(1)) if the hospital is requested or expected to provide an exceptional level of emergency or other medical services. "(2) LIMITATION.—A hospital-wide staffing plan for nursing services developed and implemented under this section— "(A) shall not preempt any registered-nurse staffing levels established under State law or regulation; and "(B) may not utilize any minimum number of registered nurses established under paragraph (1)(G) as an upper limit on the nurse staffing of the hospital to which such minimum number applies. "(d) Reporting and release to public of certain staffing information.— "(1) REQUIREMENTS FOR HOSPITALS.—Each participating hospital shall— "(A) post daily for each shift, in a clearly visible place, a document that specifies in a uniform manner (as prescribed by the Secretary) the current number of licensed and unlicensed nursing staff directly responsible for patient care in each unit of the hospital, identifying specifically the number of registered nurses; "(B) upon request, make available to the public— "(i) the nursing staff information described in subparagraph (A); "(ii) a detailed written description of the hospital-wide staffing plan implemented by the hospital pursuant to subsection (a); and "(iii) not later than 90 days after the date on which an evaluation is carried out by the Committee under subsection (b)(3)(B)(ii), a copy of such evaluation; and "(C) not less frequently than quarterly, submit to the Secretary in a uniform manner (as prescribed by the Secretary) the nursing staff information described in subparagraph (A) through electronic data submission. "(2) SECRETARIAL RESPONSIBILITIES.—The Secretary shall— "(A) make the information submitted pursuant to paragraph (1)(C) publicly available in a comprehensible format (as described in subsection (e)(2)(D)(ii)), including by publication on the Hospital Compare Internet Web site of the Department of Health and Human Services; and "(B) provide for the auditing of such information for accuracy as a part of the process of determining whether the participating hospital is in compliance with the conditions of its agreement with the Secretary under section 1866, including under subsection (a)(1)(Y) of such section. "(e) Recordkeeping; collection and reporting of quality data; evaluation.— "(1) RECORDKEEPING.—Each participating hospital shall maintain for a period of at least 3 years (or, if longer, until the conclusion of any pending enforcement activities) such records as the Secretary deems necessary to determine whether the hospital has implemented a hospital-wide staffing plan for nursing services pursuant to subsection (a). "(2) COLLECTION AND REPORTING OF QUALITY DATA ON NURSING SERVICES.— "(A) IN GENERAL.—The Secretary shall require the collection, aggregation, maintenance, and reporting of quality data relating to nursing services furnished by each participating hospital. "(B) USE OF ENDORSED MEASURES.—In carrying out this paragraph, the Secretary shall use only quality measures for nursing-sensitive care that are endorsed by the consensus-based entity with a contract under section 1890(a). "(C) USE OF QUALIFIED THIRD-PARTY ENTITIES FOR COLLECTION AND SUBMISSION OF DATA.— "(i) IN GENERAL.—A participating hospital may enter into agreements with third-party entities that have demonstrated expertise in the collection and submission of quality data on nursing services to collect, aggregate, maintain, and report the quality data of the hospital pursuant to subparagraph (A). "(ii) CONSTRUCTION.—Nothing in clause (i) shall be construed to excuse or exempt a participating hospital that has entered into an agreement described in such clause from compliance with requirements for quality data collection, aggregation, maintenance, and reporting imposed under this paragraph. "(D) REPORTING OF QUALITY DATA.— "(i) PUBLICATION ON HOSPITAL COMPARE WEB SITE.—Subject to the succeeding provisions of this subparagraph, the Secretary shall make the data submitted pursuant to subparagraph (A) publicly available, including by publication on the Hospital Compare Internet Web site of the Department of Health and Human Services. "(ii) COMPREHENSIBLE FORMAT.—Data made available to the public under clause (i) shall be presented in a clearly understandable format that permits consumers of hospital services to make meaningful comparisons among hospitals, including concise explanations in plain English of how to interpret the data, of the difference in types of nursing staff, of the relationship between nurse staffing levels and quality of care, and of how nurse staffing may vary based on patient case mix. "(iii) OPPORTUNITY TO CORRECT ERRORS.—The Secretary shall establish a process under which participating hospitals may review data submitted to the Secretary pursuant to subparagraph (A) to correct errors, if any, contained in that data submission before making the data available to the public under clause (i). "(3) EVALUATION OF DATA.—The Secretary shall provide for the analysis of quality data collected from participating hospitals under paragraph (2) in order to evaluate the effect of hospital-wide staffing plans for nursing services implemented pursuant to subsection (a) on— "(A) patient outcomes that are nursing sensitive (such as pressure ulcers, fall occurrence, falls resulting in injury, length of stay, and central line catheter infections); and "(B) nursing workforce safety and retention (including work-related injury, staff skill mix, nursing care hours per patient day, vacancy and voluntary turnover rates, overtime rates, use of temporary agency personnel, and nurse satisfaction). "(f) Refusal of assignment.—A nurse may refuse to accept an assignment as a nurse in a participating hospital, or in a unit of a participating hospital, if— "(1) the assignment is in violation of the hospital-wide staffing plan for nursing services implemented pursuant to subsection (a); or "(2) the nurse is not prepared by education, training, or experience to fulfill the assignment without compromising the safety of any patient or jeopardizing the license of the nurse. "(g) Enforcement.— "(1) RESPONSIBILITY.—The Secretary shall enforce the requirements and prohibitions of this section in accordance with the succeeding provisions of this subsection. "(2) PROCEDURES FOR RECEIVING AND INVESTIGATING COMPLAINTS.—The Secretary shall establish procedures under which— "(A) any person may file a complaint that a participating hospital has violated a requirement of or a prohibition under this section; and "(B) such complaints are investigated by the Secretary. "(3) REMEDIES.—Except as provided in paragraph (5), if the Secretary determines that a participating hospital has violated a requirement of this section, the Secretary— "(A) shall require the hospital to establish a corrective action plan to prevent the recurrence of such violation; and "(B) may impose civil money penalties under paragraph (4). "(4) CIVIL MONEY PENALTIES.— "(A) IN GENERAL.—In addition to any other penalties prescribed by law, the Secretary may impose a civil money penalty of not more than $10,000 for each knowing violation of a requirement of this section, except that the Secretary shall impose a civil money penalty of more than $10,000 for each such violation in the case of a participating hospital that the Secretary determines has a pattern or practice of such violations (with the amount of such additional penalties being determined in accordance with a schedule or methodology specified in regulations). "(B) PROCEDURES.—The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under this paragraph in the same manner as such provisions apply to a penalty or proceeding under section 1128A. "(C) PUBLIC NOTICE OF VIOLATIONS.— "(i) INTERNET WEB SITE.—The Secretary shall publish on an appropriate Internet Web site of the Department of Health and Human Services the names of participating hospitals on which civil money penalties have been imposed under this section, the violation for which the penalty was imposed, and such additional information as the Secretary determines appropriate. "(ii) CHANGE OF OWNERSHIP.—With respect to a participating hospital that had a change in ownership, as determined by the Secretary, penalties imposed on the hospital while under previous ownership shall no longer be published by the Secretary of such Internet Web site after the 1-year period beginning on the date of the change in ownership. "(5) PENALTY FOR FAILURE TO COLLECT AND REPORT QUALITY DATA ON NURSING SERVICES.— "(A) IN GENERAL.—In the case of a participating hospital that fails to comply with requirements under subsection (e)(2) to collect, aggregate, maintain, and report quality data relating to nursing services furnished by the hospital, instead of the remedies described in paragraph (3), the provisions of subparagraph (B) shall apply with respect to each such failure of the participating hospital. "(B) PENALTY.—In the case of a failure by a participating hospital to comply with the requirements under subsection (e)(2) for a year, each such failure shall be deemed to be a failure to submit data required under section 1833(t)(17)(A), section 1886(b)(3)(B)(viii), section 1886(j)(7)(A), or section 1886(m)(5)(A), as the case may be, with respect to the participating hospital involved for that year. "(h) Whistleblower protections.— "(1) PROHIBITION OF DISCRIMINATION AND RETALIATION.—A participating hospital shall not discriminate or retaliate in any manner against any patient or employee of the hospital because that patient or employee, or any other person, has presented a grievance or complaint, or has initiated or cooperated in any investigation or proceeding of any kind, relating to— "(A) the hospital-wide staffing plan for nursing services developed and implemented under this section; or "(B) any right, other requirement or prohibition under this section, including a refusal to accept an assignment described in subsection (f). "(2) RELIEF FOR PREVAILING EMPLOYEES.—An employee of a participating hospital who has been discriminated or retaliated against in employment in violation of this subsection may initiate judicial action in a United States district court and shall be entitled to reinstatement, reimbursement for lost wages, and work benefits caused by the unlawful acts of the employing hospital. Prevailing employees are entitled to reasonable attorney's fees and costs associated with pursuing the case. "(3) RELIEF FOR PREVAILING PATIENTS.—A patient who has been discriminated or retaliated against in violation of this subsection may initiate judicial action in a United States district court. A prevailing patient shall be entitled to liquidated damages of $5,000 for a violation of this statute in addition to any other damages under other applicable statutes, regulations, or common law. Prevailing patients are entitled to reasonable attorney's fees and costs associated with pursuing the case. "(4) LIMITATION ON ACTIONS.—No action may be brought under paragraph (2) or (3) more than 2 years after the discrimination or retaliation with respect to which the action is brought. "(5) TREATMENT OF ADVERSE EMPLOYMENT ACTIONS.—For purposes of this subsection— "(A) an adverse employment action shall be treated as discrimination or retaliation; and "(B) the term 'adverse employment action' includes— "(i) the failure to promote an individual or provide any other employment-related benefit for which the individual would otherwise be eligible; "(ii) an adverse evaluation or decision made in relation to accreditation, certification, credentialing, or licensing of the individual; and "(iii) a personnel action that is adverse to the individual concerned. "(i) Relationship to state laws.—Nothing in this section shall be construed as exempting or relieving any person from any liability, duty, penalty, or punishment provided by the law of any State or political subdivision of a State, other than any such law which purports to require or permit any action prohibited under this title. "(j) Relationship to conduct prohibited under the national labor relations act or other collective bargaining laws.—Nothing in this section shall be construed as— "(1) permitting conduct prohibited under the National Labor Relations Act or under any other Federal, State, or local collective bargaining law; or "(2) preempting, limiting, or modifying a collective bargaining agreement entered into by a participating hospital. "(k) Regulations.— "(1) IN GENERAL.—The Secretary shall promulgate such regulations as are appropriate and necessary to implement this section. "(2) IMPLEMENTATION.— "(A) IN GENERAL.—Except as provided in subparagraph (B), as soon as practicable but not later than 2 years after the date of the enactment of this section, a participating hospital shall have implemented a hospital-wide staffing plan for nursing services under this section. "(B) SPECIAL RULE FOR RURAL HOSPITALS.—In the case of a participating hospital located in a rural area (as defined in section 1886(d)(2)(D)), such participating hospital shall have implemented a hospital-wide staffing plan for nursing services under this section as soon as practicable but not later than 4 years after the date of the enactment of this section. "(l) Definitions.—In this section: "(1) DECLARED STATE OF EMERGENCY.—The term 'declared state of emergency' means an officially designated state of emergency that has been declared by the Federal Government or the head of the appropriate State or local governmental agency having authority to declare that the State, county, municipality, or locality is in a state of emergency, but does not include a state of emergency that results from a labor dispute in the health care industry or consistent understaffing. "(2) PARTICIPATING HOSPITAL.—The term 'participating hospital' means a hospital (as defined in section 1861(e)) that has entered into a provider agreement under section 1866. "(3) PERSON.—The term 'person' means one or more individuals, associations, corporations, unincorporated organizations, or labor unions. "(4) REGISTERED NURSE.—The term 'registered nurse' means an individual who has been granted a license to practice as a registered nurse in at least 1 State. "(5) SHIFT.—The term 'shift' means a scheduled set of hours or duty period to be worked at a participating hospital. "(6) UNIT.—The term 'unit' means, with respect to a hospital, an organizational department or separate geographic area of a hospital, including a burn unit, a labor and delivery room, a post-anesthesia service area, an emergency department, an operating room, a pediatric unit, a stepdown or intermediate care unit, a specialty care unit, a telemetry unit, a general medical care unit, a subacute care unit, and a transitional inpatient care unit.".

Senate Bill S2145

https://www.nysenate.gov/legislation/bills/2015/s2145/amendment/original Relates to the educational preparation for practice of professional nursing Sponsored By: John J. Flanagan (R, C, IP) 2ND SENATE DISTRICT ARCHIVE: LAST BILL STATUS - IN SENATE COMMITTEE Introduced -> In Committee Jan 06, 2016 REFERRED TO HIGHER EDUCATION Jan 21, 2015 REFERRED TO HIGHER EDUCATION Requires registered professional nurses to attain a baccalaureate degree in nursing within ten years of their initial licensure; provides exemptions for those currently licensed or enrolled in nursing programs. BILL NUMBER:S2145 TITLE OF BILL: An act to amend the education law, in relation to the educational preparation for practice of professional nursing PURPOSE: To expand the educational preparation of registered professional nurses to require that a baccalaureate degree be obtained within ten years after initial licensure while maintaining the multiple entry points into the profession. SUMMARY OF PROVISIONS: Section 1 outlines the legislative intent of the bill. Section 2 amends subdivision 2 of section 6905 of the education law in several key respects. First, this section would require that in order to continue to maintain registration as a professional nurse in New York state, such person must attain a baccalaureate degree in nursing within ten (10) years of initial licensure. Second, this section would allow the State Education Department to issue a conditional registration to a licensee who fails to complete the baccalaureate degree but who agrees to meet the additional requirements within a year. Furthermore, the section outlines the additional fee for such conditional registration, as well as provides for a one year conditional registration which may be extended, with the payment of a fee, for no more than one additional year. Finally, this section calls for disciplinary proceedings to be taken against any licensee who is notified of the denial of a registration for failure to complete the additional educational requirements and who practices as a registered professional nurse without such registration Section 3 outlines that the provisions of this act shall not apply to: (1) any student entering a generic baccalaureate program preparing registered professional nurses after the effective of this act; (2) any student currently enrolled in, or having an application pending in, a program preparing registered nurses as of the effective date of this act; and (3) any person already licensed as a registered professional nurse or any unlicensed graduate professional who is eligible to take the National Council Licensure Examination as of the effective date of this act. Section 4 provides the effective date JUSTIFICATION: In December 2003, the New York State Board of Nursing unanimously passed a motion recommending that statutory change be sought requiring future licensed registered nurses to attain a baccalaureate degree in nursing within ten years after initial licensure to practice in New York, More recently, the National Advisory Council on Nursing Education and Practice ("NACNEP") recommended that by 2010, two-thirds of nurses should hold baccalaureate or higher degrees. This position was based on NACNEP's analysis of evolving needs associated with patient care and public protection. Specifically, shorter lengths of stays, higher patient acuity, and more sophisticated technologies and procedures are increasing the complexity of patient care, and because of this, are placing significantly greater demands on the competencies of nurses. This bill is not anticipated to reduce the supply of nurses in New York. To the contrary, prospective nurses are currently in such supply that a 2004 study at the Center for Health Workforce Studies at SUNY Albany showed that over 2,000 qualified students were denied admission to nursing programs. As the bill lays out, those who are already nurses, those who are currently enrolled in nursing programs, and those with admissions pending to nursing programs are exempt from this change. Importantly, this bill will allow continuation of entry at the associate degree level where many nurses begin their educational careers. In an effort to facilitate the implementation of additional educational requirements for registered professional nurses, the New York State Associate Degree Nursing Council and the Council of Deans of Nursing, Senior Colleges and Universities of New York ("CDNSCUNY") have actively collaborated to standardize requirements between the associate and baccalaureate degree levels. In December 2004, CDNSCUNY adopted the position that registered nurses prepared in New York State associate degree nursing programs applying to baccalaureate degree programs would be granted 30 nursing credits in addition to liberal arts and sciences credits that could be applied to the 120 credits needed for a baccalaureate degree. By requiring the baccalaureate degree for continued registration as a professional nurse, this bill seeks to be responsive to meet the increasingly complex health care needs of the residents of New York. LEGISLATIVE HISTORY: 2014 - S. 5924 (Flanagan) Higher Education Committee. 2013 - S. 5924 (Flanagan) Rules Committee. 2013 - S. 658 (Stavisky) Higher Education Committee; Enacting clause stricken. 2011/2012 - S. 2553-A (Alesi) Higher Education Committee. 2009/2010 - S. 1074 (Alesi) Higher Education Committee. 2007/2008 - S. 294 (Alesi) Higher Education Committee. 2005/2006 - S 5056-A (Alesi) Higher Education Committee. FISCAL IMPLICATIONS: None to the State. EFFECTIVE DATE: This act shall take effect immediately and the commissioner is authorized to promulgate any rule or regulation necessary to implement the provisions of this act.

GEORGE H.W. BUSH 1989-1993

in his January 8, 1992 State of the Union address called for reform of the nation's health care system, saying that "exploding" health care costs risked damaging America's ability to compete in world the marketplace. "The cost of health care shows up not only in your family budget, but in the price of everything we buy and everything we sell. When health coverage for a fellow on the assembly line costs thousands of dollars, the cost goes into the product he makes. And you pay the bill. Now we must make a choice," he said. Bush called for reforms to the health-insurance market, a personal mandate for middle-class workers and a health-insurance tax credit for low-income families. Bush's proposal was for the tax system "to encourage and empower" individuals to buy health insurance and through legislated market reforms, to be able to obtain insurance, even those with pre-existing conditions. The plan was derailed by bi-partisan interests.

Non Government Organizations

international organizations that use donations and grants to assist communities in need, with minimal support or influence of a particular nation. Ex: Amnesty International

Common Law

is the body of law derived from judicial decisions, rather than from statutes or constitutions. May also be referred to as case law. Ex: The Supreme Court decision in Roe v. Wade ruling first trimester abortion is legal

Administrative Agencies

one most dramatic changes in American government since the ratification of the Constitution is the growth of these. Federal administrative agencies have broad power- they exercise all of the powers of government: executive, legislative and judicial. The Federal Drug Administration (FDA) is one example

GEORGE W. BUSH 2001-2009

persuaded Congress to update Reagan's prescription-drug coverage plan for Medicare recipients, a major expansion of Medicare. Although the plan has obvious fingerprints of Washington Lobbyists, it has nonetheless, become an important and popular aspect of Medicare.

Other Policy Influences

policy is based on values and the first step in forming policy is identification of the issue. Therefore, it would seem rational to define "health" as the starting point for any policy annexed to health care issues since concepts of health are widely diverse. Policy analysts can look to the experience of the international community and its recently altered view of health as one such definition.

Public Policies

principles and standards regarded by the legislature or by the courts as being of fundamental concern to the state and the whole of society. More narrowly, the principle that a person should not be allowed to do anything that would tend to injure the public at large. authoritative decisions made in the legislative, executive, or judicial branch of government intended to direct or influence the actions, behaviors, or decisions of others. intended to serve the interests of the public as a whole. Health policy refers to public policies that pertain to or influence the pursuit of health, or a course of action to obtain a desired health outcome for an individual, family, group, community, or society. Nursing policy can be viewed independently or as a subset within the larger health policy arena. Ex: Right to health of the majority must be preserved over individual freedoms. For example, a corporation may not dump hazardous waste into a river that is a source of drinking water for a community; the welfare of the people must prevail over short-term corporate profits. Another example is local or regional efforts to prevent the sale of tobacco or alcohol to minors.

Organizational policies

rules that govern organizations and their positions on issues with which the organization is concerned.

The Constitution of the United States

signed by the representatives of the individual states - the federal government realized its sovereign power. limit to power: The drafters sought to balance the need to empower the new federal government to "establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty" for its people but with limits on that power. The federal government is a government of limited powers, which means that for a federal action to be legitimate, it must be authorized. Only those actions that are within the scope of the Constitution, the supreme law of the land, are authorized. The Constitution separates governmental powers among the branches of government: the executive branch, which includes the President, the Vice President and the administrative agencies; the legislative branch, which includes the Senate and the House of Representatives (Congress); and the judicial branch, which at the federal level includes district courts, circuit courts and the highest court in the land, the Supreme Court. examples of the separation of powers doctrine: the legislature is prohibited from interfering with the courts' final judgments; the Supreme Court cannot decide a "political question", it must be an actual case or controversy; Congress must present to the President every bill before it can become law; the President needs consent of Senate to appoint Supreme Court Justices or to make treaties: the President and members of Congress are elected, the Judiciary is appointed.

RONALD REAGAN 1981-1989

signed the Consolidated Omnibus Reconciliation Act, better known by its acronym, COBRA, a health-insurance initiative that allowed some workers to keep their employer provided health insurance for a while if they lost their jobs. In the interest of the greater good, corporations were required by the federal government under this act to pay for something they had not needed to pay for in the past. In 1988, Reagan signed a major expansion to Medicare that, for a price, gave senior citizens access to prescription drug benefits and catastrophic care, but this was so widely unpopular, that Congress repealed it in 1989.

RICHARD M. NIXON 1969-1974

signed the HMO Act of 1973 which was proposed to reduce the cost of health insurance. A Health Maintenance Organization (HMO) is a managed care plan that incorporates financing and delivery of an inclusive set of health care services to individuals enrolled in a network The Act required employers to offer coverage from at least one federally qualified HMO to all employees, which was called "dual choice". This Act expired in 1995.

GERALD FORD 1974-1977

strengthened the dual option of the HMO Act and funded drug abuse and drug prevention programs, but did not propose any major initiatives.

Politics

the art of influencing others to accept a specific course of action. It is a process by which an individual exerts control over situations and events. this constitutes a means and policy is the end or outcome. All policies are shaped by politics and reflect social values, beliefs, and attitudes.

Regulations

the rules or orders that have legal force that are issued by an administrative agency. Ex: HIPAA

Government

the structure of principles and rules determining how a state or organization is regulated. purposes: regulation of conditions beyond individual control and provision of individual protection through a population-wide focus tasks accomplished through passage and enforcement of laws Requirements of childhood immunizations for school attendance, vector control, and sewage treatment are examples of regulations to protect the health of the population. the sovereign power (the independent and supreme authority of the nation; can also be found in each state) vested in a nation or state The basis of the government's responsibility for health in the United States and the subsequent authority to enact health laws (or any laws) comes from specific sources contained in our historic documents that reflect the values of the country's founders. They give the government the authority to enact laws, but they also limit that power. The earliest of these statements was the Mayflower Compact, through which the Pilgrims committed themselves to making "just and equal laws" for the general good. The Declaration of Independence later established the doctrine of inalienable rights, life, liberty, and the pursuit of happiness.

JIMMY CARTER 1977-1981

tried again to create a mandatory national health insurance program, but failed. The nation was in an economic recession with runaway inflation at that time.