NURS 8100 Discussion Federalism’s Impact on Policy
NURS 8100 Discussion Federalism’s Impact on Policy
The fragmentation of the U.S. health care system, with its differing modes of financing and service delivery, is a reflection of a dispersed government structure. Policy making is shared and distributed across various branches and levels of government. As a result, policy making processes can be slow to respond, manipulated towards personal interests, and often redundant. Consider, for example, the public entitlement programs such as Medicaid, Medicare, the State Children’s Health Insurance Program (SCHIPS), and the PPACA of 2010. Where is there overlap between these policies? How do they demonstrate a dispersed government structure?
This week, you will examine the federal government’s role in health-care policymaking.
To get ready:
Examine this week’s Learning Resources, with a focus on the France article and textbook readings.
Determine two nursing or health care policies that meet similar needs, one at the federal level and the other at a lower level of government (state or local).
By Day 3
Post a unified response that addresses the following points:
Give an example of two policies that meet comparable needs and were enacted at different levels of government (i.e., federal, state, or local).
What are the benefits and/or drawbacks of this duplication? What are the implications of federalism in this example? Provide literature backing for your stance.
How much involvement should the federal government have in health-care policymaking? Give specific examples to back up your claim.
Read a few of your coworkers’ postings.
By Day 6 of NURS 8100 Discussion Federalism’s Impact on Policy
Respond in one or more of the following ways to at least two of your colleagues:
Pose a probing question that is supported by further background information, facts, or research.
Share an insight gained from reading your coworkers’ postings, synthesizing the information to bring fresh viewpoints.
Use readings from the classroom or your own Walden Library research to offer and defend an opposing viewpoint.
Use your own experience and further research to validate a notion.
Make a recommendation based on further evidence gathered from readings or after synthesizing multiple postings.
Expand on your colleagues’ posts by offering new insights or opposing viewpoints based on readings and evidence.
Note: For formal Discussion question posting and response grading requirements, please consult the Syllabus and Discussion Rubric.
Return to this Discussion in a few days to read the replies to your first post. Take note of what you learned and/or any insights you acquired as a result of your colleagues’ comments.
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Be sure to support your work with specific citations from this week’s Learning Resources and any additional sources.
Also Read:
NURS 8100 Discussion Policy And State Boards Of Nursing
NURS 8100 Discussion Technology And Cost Containment
NURS 8100 Discussion Agenda Setting
Discussion : Nursing And Health Policy In Other Nations NURS 8100
NURS 8100 Discussion 2: Advocating Through Policy
NURS 8100 Discussion: Federalism’s Impact on Policy ANSWER
NURS 8100 Discussion: Individual Right Versus the Collective Good ANSWER
NURS 8100 Discussion: Selecting a Policy Analysis Framework
NURS 8100 Discussion: Agenda Setting
NURS 8100 Discussion: Unintended Consequences of Health Care Reform
NURS 8100 Assignment: Staying Current: Online Resources
NURS 8100 Week 1 Discussion The Doctoral Degree and Professional Nursing Practice
NURS 8100 Discussion Nursing and Health Policy in Other Nations
NURS 8100 Discussion Policy and State Boards of Nursing
NURS 8100 Discussion Federalism’s Impact on Policy
NURS 8100 Discussion Individual Right Versus the Collective Good
NURS 8100 Discussion Technology and Cost Containment
NURS 8100 Discussion Selecting a Policy Analysis Framework
NURS 8100 Discussion Agenda Setting
NURS 8100 Discussion Unintended Consequences of Health Care Reform
NURS 8100 Staying Current Online Resources
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 8 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Week 8 Discussion]
Historically, the elderly and the disabled receive long-term care in institutionally setting because Home and Community Base Care services (HCBS) were less available. However, in the 1980s, an amended federal law passed a federal-state Medicaid waiver authority for states to expand HCBS services to cover individuals at risk for institutionalized care (Musumeci et al., 2020). These individuals will receive broader services that were not allowed by Medicaid state plans. The HCBS 1915 (c) waivers authorized states to provide targeted services to populations such as seniors, people with physical or developmental disabilities, and individuals with specific conditions such as HIV/AIDS or traumatic brain injuries(Merryman et al., 2015). Essential to note every state’s eligibility requirement and criteria are different; however, HCBS waivers are limited to three years but may extend five years for those dually enrolled in Medicaid and Medicare (Merryman et al., 2015).
In response to the COVID-19 pandemic, President Biden signed the American Rescue Plan Act (ARPA), which provides $1.9 trillion for several provisions to include in the pandemic relief package (Miller & Beauregard, 2022). This legislation will significantly impact state and federal health policies and programs, such as federal funding for state Medicaid spending on HCBS. The ARPA will provide a one time10% increase in federal matching payment to states’ HCBS to supplement state expenditure which would only be available for a year(Miller & Beauregard, 2022. Therefore, states would have the flexibility in overlapping with federal policies targeting HCBS to specific populations. Nonetheless, the ARPA ensures that states benefit from the federal investment for HCBS to achieve the best outcomes for Medicaid beneficiaries to receive high-quality, cost-effective, person-centered care in their home (Watts et al., 2020).
Duplication Advantages & Disadvantages
The advantage to the federal-state funding of HCBS is that it provides states with good flexibility to utilize these funds that align with the priorities of local policies (Musumeci et al., 2020). As a result, states will be able to enhance their HCBS models (Watts et al., 2020). Furthermore, states taking advantage of access to federal funds will also address the shift in demand for healthcare needs because of COVID public health emergencies (Miller & Beauregard, 2022). On the other hand, states will need to determine how they will sustain this investment once the expiration of federal matching.
Implications of Federalism
Nevertheless, the enactment of the American Rescue Plan Act (ARPA) with the inclusion of increasing state funds to HCBS foreshadowed the United States as a federalist system. Oversight of health policy decisions responsibility is shared among federal and state in areas of administration and funding. The state and federal are jointly responsible for the healthcare financing for the health and long-term care of low-income populations with the appropriate balancing of these responsibilities (Collins, & Lambrew, J2019). However, federalism contributes to the fragmentation of the U.S healthcare system due to the different financing and service delivery modes, leading to duplication of services.
Federal Government Involvement in Healthcare Policymaking
According to Bialik (2018), the Pew research reported that 60% of American believe that the federal government should be responsible for ensuring healthcare coverage for all Americans. Essentially, the federal government plays a central role in the oversight and shaping of the American health care arena to develop policies that support cost-effective quality programs for the population’s health needs. Therefore, the federal government should maximize its involvement given its unique position as regulators, healthcare purchasers, sponsors of applied healthcare research, healthcare provider education, and healthcare providers (Crowley et al., 2020). Furthermore, federal leadership is a crucial stakeholder having extensive healthcare programs and market influence, which helps acquire sustainable healthcare reform and better quality and value in healthcare (Gluck & Huberfeld, 2018). For instance, the federal government has been a critical player in establishing Medicare and Medicaid to ensure access to insurance coverage for a large segment of the population, legislation for employer-sponsored health insurance, and expanded federal healthcare programs (Collins & Lambrew, 2019 ). Currently, the federal leadership plays a pivotal role in the Affordable Care Act by expanding health insurance coverage to the uninsured. Hence, the federal government plays an essential role in promoting healthcare services that contribute to healthcare efficiency and saving, so the federal government should maintain a central role in healthcare policymaking.
References
Bialik, K. (2018). More Americans say government should ensure health care coverage. Universal Health Care, 94.
Collins, S. R., & Lambrew, J. M. (2019). Federalism, the Affordable Care Act, and health reform in the 2020 election. The Commonwealth Fund.
Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of Internal Medicine, 172(2_Supplement), S7-S32.
Gluck, A. R., & Huberfeld, N. (2018). What is federalism in healthcare for. Stan. L. Rev., 70, 1689.
Merryman, M. B., Miller, N. A., Shockley, E., Eskow, K. G., & Chasson, G. S. (2015). State adoption of Medicaid 1915 (c) waivers for children and youth with autism spectrum disorder. Disability and health journal, 8(3), 443-451.
Miller, E. A., & Beauregard, L. K. (2022). Enhancing Federal Revenue under the American Rescue Plan Act: An Opportunity to Bolster State Medicaid Home and Community-Based Services Programs. Journal of Aging & Social Policy, 1-15.
Musumeci, M., Watts, M. O., & Chidambaram, P. (2020). Key state policy choices about Medicaid home and community-based services. Kaiser Family Foundation.
Watts, M. O., Musumeci, M., & Chidambaram, P. (2020). Medicaid home and community-based services enrollment and spending. Kaiser Fam Found.
Name: NURS_8100_Week8_Discussion_Rubric Grid View
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RESPONSIVENESS TO DISCUSSION QUESTION
Discussion post minimum requirements:
*The original posting must be completed by Wednesday, Day 3, at 11:59pm MST. Two response postings to two different peer original posts, on two different days, are required by Saturday, Day 6, at 11:59pm MST. Faculty member inquiries require responses, which are not included in the minimum number of posts. Your Discussion Board postings should be written in standard edited English and follow APA style for format and grammar as closely as possible given the constraints of the online platform. Be sure to support the postings with specific citations from this week’s Learning Resources as well as resources available through the Walden University online databases. Refer to the Essential Guide to APA Style for Walden Students to ensure your in-text citations and reference list are correct.
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses exceed the requirements of the Discussion instructions. They: Respond to the question being asked or the prompt provided; – Go beyond what is required in some meaningful way (e.g., the post contributes a new dimension, unearths something unanticipated); -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence. – Demonstrate significant ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning -Resources as well as additional resources and has read, viewed, or considered a sampling of colleagues’ postings; -Exceed the minimum requirements for discussion posts*.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses meet the requirements of the Discussion instructions. They: -Respond to the question being asked or the prompt provided; -Are substantive, reflective, with critical analysis and synthesis representative of knowledge gained from the course readings and current credible evidence.re -Demonstrate ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Demonstrate that the student has read, viewed, and considered the Learning Resources and has read, viewed, or considered a sampling of colleagues’ postings -Meet the minimum requirements for discussion posts*.
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses are minimally responsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or -May (lack) lack in depth, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence; and/or -Do not adequately demonstrate that the student has read, viewed, and considered the Learning -Resources and/or a sampling of colleagues’ postings; and/or has posted by the due date at least in part. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not meet the minimum requirements for discussion posts*.
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses are unresponsive to the requirements of the Discussion instructions. They: – do not clearly address the objectives of the discussion or the question or prompt; and/or – Lack in substance, reflection, analysis, or synthesis but rely more on anecdotal than scholarly evidence. – Lack ability to generalize and extend thinking and evaluate theories or concepts within the topic or context of the discussion. -Do not demonstrate that the student has read, viewed, and considered the Learning Resources and/or a sampling of colleagues’ postings; and/or does not meet the minimum requirements for discussion posts*.
CONTENT KNOWLEDGE
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses: -demonstrate in-depth understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; – are well supported by pertinent research/evidence from a variety of and multiple peer- reviewed books and journals, where appropriate; -Demonstrate significant mastery and thoughtful/accurate application of content, applicable skills or strategies presented in the course.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses: -demonstrate understanding and application of the concepts and issues presented in the course, presented with some understanding and application of concepts and issues presented in the course (e.g., insightful interpretations including analysis, synthesis and/or evaluation of topic; -are supported by research/evidence from peer-reviewed books and journals, where appropriate; and · demonstrate some mastery and application of content, applicable skills, or strategies presented in the course.
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses: – demonstrate minimal understanding of concepts and issues presented in the course, and, although generally accurate, display some omissions and/or errors; –lack support by research/evidence and/or the research/evidence is inappropriate or marginal in quality; and/or lack of analysis, synthesis or evaluation of topic – demonstrate minimal content, skills or strategies presented in the course. ——-Contain numerous errors when using the skills or strategies presented in the course
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses demonstrate: -A lack of understanding of the concepts and issues presented in the course; and/or are inaccurate, contain many omissions and/or errors; and/or are not supported by research/evidence; and/or lack of analysis, synthesis or evaluation of topic -Many critical errors when discussing content, applicable skills or strategies presented in the course.
CONTRIBUTION TO THE DISCUSSION
Points Range: 8 (26.67%) – 8 (26.67%)
Discussion postings and responses significantly contribute to the quality of the discussion/interaction and thinking and learning by: -providing Rich and relevant examples; discerning and thought-provoking ideas; and stimulating thoughts and probes; – -demonstrating original thinking, new perspectives, and extensive synthesis of ideas supported by the literature.
Points Range: 7 (23.33%) – 7 (23.33%)
Discussion postings and responses contribute to the quality of the discussion/interaction and thinking and learning by -providing relevant examples; thought-provoking ideas – Demonstrating synthesis of ideas supported by the literature
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses minimally contribute to the quality of discussion/interaction and thinking and learning by: – providing few and/or irrelevant examples; and/or – providing few if any thought- provoking ideas; and/or -. Information that is restated from the literature with no/little demonstration of critical thinking or synthesis of ideas.
Points Range: 0 (0%) – 5 (16.67%)
Discussion postings and responses do not contribute to the quality of interaction/discussion and thinking and learning as they do not: -Provide examples (or examples are irrelevant); and/or -Include interesting thoughts or ideas; and/or – Demonstrate of critical thinking or synthesis of ideas
QUALITY OF WRITING
Points Range: 6 (20%) – 6 (20%)
Discussion postings and responses exceed doctoral -level writing expectations. They: · Use grammar and syntax that is clear, concise, and appropriate to doctoral level writing; · Make few if any errors in spelling, grammar, and syntax; · Use original language and refrain from directly quoting original source materials; -provide correct APA · Are positive, courteous, and respectful when offering suggestions, constructive feedback, or opposing viewpoints.
Points Range: 5 (16.67%) – 5 (16.67%)
Discussion postings and responses meet doctoral -level writing expectations. They: ·Use grammar and syntax that is clear and appropriate to doctoral level writing; ; · Make a few errors in spelling, grammar, and syntax; · paraphrase but refrain from directly quoting original source materials; Provide correct APA format · Are courteous and respectful when offering suggestions, constructive feedback, or opposing viewpoints;.
Points Range: 4 (13.33%) – 4 (13.33%)
Discussion postings and responses are minimally below doctoral-level writing expectations. They: · Make more than occasional errors in spelling, grammar, and syntax; · Directly quote from original source materials and/or paraphrase rather than use original language; lack correct APA format; and/or · Are less than courteous and respectful when offering suggestions, feedback, or opposing viewpoints.
Points Range: 0 (0%) – 3 (10%)
Discussion postings and responses are well below doctoral -level writing expectations. They: · Use grammar and syntax that is that is unclear · Make many errors in spelling, grammar, and syntax; and –use incorrect APA format · Are discourteous and disrespectful when offering suggestions, feedback, or opposing viewpoints.
Total Points: 30
Name: NURS_8100_Week8_Discussion
RE: Discussion – Week 8
Top of Form
Federalism’s Impact on Policy
Federalism challenges and stabilizes public policy by introducing innovation that would otherwise not have been introduced. Understanding it is critical in understanding the current healthcare policy-making entangled in a complex maze of shared and competing powerstructures. In the United States, the impact of federalism is vital, particularly in the healthcare sector, where policies passed at the Federal level have overlapping enactments at the State or local level. Medicare, Medicaid, SCHIPS, and PPACA are all health insurance programs. They are designed to subsidize healthcare for Americans, but their operationalization is based on different factors. For instance, Medicare is a federal health insurance program based on age, while Medicaid is open to needy Americans without age restriction. On the other hand, PPACA introduces rights and protection designed to ensure fairness in health coverage. At the same time, SCHIPS is intended to offer a range to children, and each state administers it under different names.
These policies address the same population’s health needs, but they are differentiated using different names and eligibility criteria. State Health Insurance Assistance Program (SHIP) and Medicare are examples of overlapping healthcare policies because the State and Federal governments offer them. This overlap arises because SHIP gets funding from the Federal government to provide people with Medicare-free coverage at the state level. On one side, it creates better service delivery, mainly because the states better understand the population’s needs (Frankel, 2019). Nevertheless, it results in underexploited economies of scale that impede innovation for better service delivery (France, 2018). Again, given that the beneficiaries of SHIP are already covered under Medicare, it raises questions about why more money is channeled to the States via SHIP. Yet, it could be used to help vulnerable populations without any coverage.
According to Bodenheimer & Grumbach (2020), federalism has sparked controversies in the American healthcare policies’ political contentiousness and divergent interests from the public and private sectors. This creates conflicts that reduce efficiencies in the delivery of services. To streamline these challenges, the stakeholders involved ought to work in harmony so that they can benefit the consumers through efficient service delivery to avoid service duplication (Kennedy, 2017). The policy overlaps between the Federal and State levels are proof of the bureaucracy at both levels of governance. France (2018) notes that the Federal government championed policy initiatives during the liberal period, which changed in the conservative era after power was devolved to the States. Therefore, initiatives by the state can be argued as the best for delivering services to the people.
References
Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (7thed.). New York, NY: McGraw-Hill Medical.
France, C. (2018). The form and context of federalism: Meaning for health care financing. Journal of Health Politics, Policy & Law, 33(4), 649-705. doi: 10.1215/03616878-2008-012
Frankel, M. S. (2019). Commentary: Public outreach by the FDA: Evaluating oversight of human drugs and medical devices. Journal of Law, Medicine & Ethics, 37(4), 625-628.
Kennedy, E. M. (2017). The role of the federal government in eliminating health disparities. Health Affairs, 24(2), 425-428.