Option #1: Assessment of Legislative Roles

Option #1: Assessment of Legislative Roles

Given the readings this week, you now have an understanding of the legislative and judicial branches. Write a paper examining the roles of the legislative branch in health policy. Describe how this branch needs to relate to other stakeholders and assess where conflict between the stakeholders may and does occur.

Your paper should be 2-3 pages in length, not including the title or references pages and conform to APA Requirements. Include at least three scholarly references in addition to the course textbook.

 

Module Introduction

Readings

Required

· Chapters 3 and 5 in Health Politics and Policy

· Young, J. L., Pollack, K. & Rutkow, L. (2015).  Review of state legislative approaches to eliminating racial and ethnic health disparities, 2002-2011. American Journal of Public Health, Supplement, 105,S388-S394. doi:10.2105/AJPH.2015.302590

· Martin, E. J. (2015).  Healthcare policy legislation and administration: Patient protection and affordable care act of 2010.  Journal of Health and Human Services Administration, 37(4), 407-411

Recommended

· Chernew, M. E., Baicker, K., & Hsu, J. (2010).  The specter of financial armageddon—health care and federal debt in the United States.  New England Journal of Medicine, 362(13), 1166-1168.

For Your Success

In this module, you will explore some of the complexities of healthcare policy in relation to the federal government, the courts, and the judicial branch. You should be able to describe the roles of the legislative and judicial branches in health policy formulation, and the relationship between the two branches.

The following brief video provides a description of the U.S. Congress and health policy formulation. While viewing this presentation, note some of the priorities of Congress and the roles of Medicare, Medicaid, the Veteran’s Health Administration, the National Institutes of Health, the military healthcare system, and healthcare reform.

The U.S. Congress and Health Policy Tutorial:

http://kff.org/interactive/the-u-s-congress-and-health-policy-tutorial/

To understand health policy, you must have a basic knowledge of how Congress operates. Understanding the role of the political parties, the basic structure of Congress, and the influencing factors (since Congress is an open system) allows us to comprehend how health policy is formulated.

In our political system, we have two major political parties: the Democratic Party and the Republican Party. Each party’s philosophy has quite a bit of influence over its elected members. This influence can often lead to block voting based on party association. Block voting is a term that means voting along party lines (i.e., Democrats vote one way, and Republicans vote another way). Such block voting is what occurred when the Affordable Care Act was passed by Congress.

A major focus of these and other political parties (e.g., Libertarian) is to press forward the agenda and perspectives of the constituents of the respective parties, thereby influencing the passing of laws that are in support of those agendas. An example of this is the decades old “right to life” (Roe vs. Wade) debate and, most recently, the addition of the concept of “personhood.” As a recap, the right to life campaign believes that pregnancy should result in the birth of a child, and that measures taken to interfere with that process are not only immoral but also illegal (citation). This has expanded to the concept that life, consciousness, and individualism begins at conception. This expansion states that a person becomes a full and sentient being with conception, not birth.

Both of these concepts are deeply rooted in the Republican Party:

“Abortion is the right-or-wrong issue of our time. We should parallel the words of Abraham Lincoln today and say: The Republican Party looks upon abortion as a wrong, and the Democratic Party does not look upon it as a wrong. That’s the crucial difference between the two parties”

(Republican National Coalition for Life, 2001).

On the other hand, the Democratic Party supports a woman’s right to choose the outcome of an event that is occurring with her body:

“The Democratic Party strongly and unequivocally supports Roe v. Wade and a woman’s right to make decisions regarding her pregnancy, including a safe and legal abortion, regardless of ability to pay. We oppose any and all efforts to weaken or undermine that right. Abortion is an intensely personal decision between a woman, her family, her doctor, and her clergy; there is no place for politicians or government to get in the way. We also recognize that healthcare and education help reduce the number of unintended pregnancies and thereby also reduce the need for abortions. We strongly and unequivocally support a woman’s decision to have a child by providing affordable healthcare and ensuring the availability of and access to programs that help women during pregnancy and after the birth of a child, including caring adoption programs”

Democratic Party Platform, 2012 (On the Issues, 2014).

These differing views greatly impact the health policy that is associated with this subject. For instance, the State of Indiana is known as a Republican State, and in 2011, then Governor Mitch Daniels signed into law a measure to prevent Planned Parenthood from receiving any funding from Medicaid (Culp-Pressler, 2013). This was an extreme blow to the financial stability of the agency that provides basic women’s healthcare support (including abortions).

The majority party has greater control over agendas, floor debates, and committees. The majority controls the committee chairs, number of committee members, and votes; has greater staff and funding allocations; can use procedural tools to influence policies (e.g., veto override and, right of first recognition); and can call for hearings and investigations.

The U.S. Congress is structured as a bicameral legislature, composed of the House of Representatives and the Senate. Each branch has leadership that is predominantly from one party or the other (i.e., Democratic-controlled or Republican-controlled). The Founding Fathers brilliantly established this system to prevent too much haste in legislative decision making, and to limit the legislature’s power. But this structure, which inhibits haste in the movements of the legislative branch, can create the unintended consequence of being unable to act at all. When both houses of Congress are controlled by one party, legislation might move more speedily, as any fighting would be internal to that party; however, when control of the houses is split, the process of reaching consensus may fail. Consider the inability of the two houses of government to pass budget reduction measures after the 2011 Standard & Poor downgrade of U.S. debt. The Republican House fought for cutting budget items without raising taxes, while the Democratic Senate fought for raising taxes to generate revenue. No viable solution was reached. A simple table summarizing a few of the significant differences between the House and the Senate follows:

HOUSE	SENATE
The House of Representatives is more than four times the size of the Senate.	A Senator represents a broader constituency than a single representative in the House.
Floor debate in the House has more limits and is more expeditious than the equivalent process in the Senate.	Senators serve longer terms (six years), while House members must run for re-election every two years.
Power is less evenly distributed among members in the House, but the majority party wields more power in the House.	A Senate filibuster can block action on legislation with only 41 votes.

(Table constructed by the author; data retrieved from http://www.kaiseredu.org/Tutorials-and-Presentations/%20US-Congress-and-Health-Policy.aspx.)

In the case of the Affordable Care Act, several factors made passage of the legislation more likely. First, the Congress needed to be composed of a Democratic Party majority. Second, pressure needed to be exerted so that Democrats would vote largely along party lines. Third, persuasion needed to be applied to key players in the minority party. All three events occurred, resulting in the narrow passage of this act.

2. The Courts, the Law, and the Legal System

http://www.kjrh.com/news

Understanding the judicial system is an important part of understanding health policy, because the courts interpret the law formulated by the legislature. The role of the courts has expanded over many decades, and today its influence is more significant than ever. Therefore, it is important to look at the competing forces that influence the legal interpretation of health policy. These forces derive largely from the historical relationship of the court system to the development of medicine in the U.S.  Your textbook readings for this module describe three models of health law that were popular during different eras. These models progress from the authority of the medical profession era, to a modestly egalitarian era, to a free market era. In each of these models, the judicial bodies reflected the values of that era, making interpretations largely congruent with the pervasive societal norms.

3. The Influence of Judicial Rulings on Healthcare Policy

Protest outside a Supreme Court hearing on healthcare.

http://www.upi.com

The earlier descriptions outline the often tumultuous influence of the judiciary system on healthcare policy. We are very familiar with the impact of the recent Supreme Court decision in support of the ACA individual mandate, but there have been various cases throughout history demonstrating the interconnectedness of the judicial system and health policy. For example, in 1992 an Illinois coal tar exposure was believed to have caused a number of cases of neuroblastoma in children within that region (May v. Central Illinois Public Service Co.). The parents sued the Central Illinois Public Service Company and a local engineering firm, and requested that files from the Illinois Department of Public Health be provided to demonstrate the rate of cancers in that area. The department refused, citing the current privacy laws; however, a circuit court ruled that a cancer registry be developed by the department outlining the type of cancer, date of diagnosis, and ZIP code for every patient. While this may seem to be a reasonable request, we must consider the ethical and legal impact of releasing the cancer registry to third parties and how that affects a person’s right to privacy. As a result of this case, healthcare laws have been updated in Illinois and other states.

4. Conclusions

It is clear that there are competing opinions and forces in the making of healthcare policy. With a bicameral, two-party Congress, and disparate court opinions reflecting current thinking about how healthcare should operate, the production of reasonable healthcare legislation may be a little like making sausage. While the sausage might taste pretty good in the end, the process and the ingredients themselves are not always appetizing.

Balancing the three Es, along with cost, quality, and access, is a difficult challenge for legislators. Determining what is, or is not, constitutionally appropriate and acceptable from a societal perspective is problematic for the courts. The making of health policy is non-trivial, as you will see in the next module, A History of Healthcare Reform.