I.A. MoonesAr U.S. Public Health Policy examines health policy in the United States, which reflects U.S. PUblic authoritative decisions and the process of decision-making, carried out at the federal, state, and local levels, which affect personal health and access to and delivery of health services. The publication provides an analysis of health policy making in the U.S., including how health policy proposals move through the policy process. It also assesses HealtH Policy the key challenges with regards to addressing cost, access, and quality issues in health care and an evaluation of the existing policies in these arenas. In addition, it contains an analysis of the diversity of perspectives held by policy makers, interest groups, health care professionals, and other stakeholders regarding existing and proposed health policy; in addition to the identification of the ways in which health care a cUrrent briefing professionals can participate in and influence health policy development. The AuThor JURISDICTIONS Immanuel Azaad Moonesar is the Managing Director at “I AM Consulting.” He was formerly the GLOBAL Itnhset iItnustitoitnuatli oRneasl eEafrfcehc tiOvfefinceesrs a&t tAhcec rUendiivtaetrisointy doefp Warotmlloenngto nagt Mino Dhaumbami e(dU OBWinD )R aasnhdi dn oSwch hooela dosf A N I E S S Y S T ERME S E A R C HE GBCDHcPohhooiepnaiv allhfoeropeadsrmtrnse oem amrpnp. hcieueHnyemnb i sIstl(nbi ,P s( seqMhhctruoDie Btao-du)Rafl tii oiuSfinotvthGc nheHae)aroe. t l riA2a HoeCc8lndetoa hs mpid b suSeimo nbeamocrlulkisvlycnusoi acid o ttteayefihso n NeI:nadn usL V ttMb eeiricronaianetod isp aokePtent reriecs oer&rhh ns- oaiiaDrpdfpel i.e evt QBn eti euerut swats(i Dlcieitntshadye ut a sjasMonsb ud aaf–ra nsna rae a.MB glHM aeiadecmard htriilekescenel l oettcE risuna (o,Drgs frp t ie&Ss enNtec itOirnole-yurcnr tttehpcrivoe ueinAa reis)cfnw,ruh iHecia)nd au ag Pmin (noaAdats IentEBDrg xnE-oreaMacccdottEuioluooNtrani gvAtoayee)f.l OregoWnaPshOSingtoLnICYDIDdahEoEFGBICAONETOMoXVnEItaNnDPaWMFEyoEOmDRGingNPRENVSEPPMAEEIAMEGLSTODEOIENNEPoSNrItDoNPLhuS DthEaM kDPTBToaItkaLUAoSCtEaSRRNAREIACTTILUTGIOMCEinSnReSHsNoAOtaCPTTWYHHCRSOIWOAiDnIcRoAnVsRAGiOnCEMLACWPURNEAUSSIHSSVNMYCicAhigOIEaTnDIIUVOOEITNEDNICRCAOSEPLATNIeOw LYoNrk SVermCooMNnnaentswesc atHRcicahhMumuotadspienest ehtIssirleand E E G B S ConTenTs RP H Iowa INREATLICSUPennsyElvania New Jersey IAQCncoutcsraoetl idsctuysh caccthlhiloeaannllll geeennsgg eeassn adan npddo lppicooilleiiccsii eess California NCVIeCEvSaAda RRIVATEEPUtah ORECMoloradOoLVWINOGIRNLebrDaCsOIkkalNaFhoEmUaCCNEOLNDUNSMHisOsDouRriMIENIlIlinECoisFDITeRUOBAnNnIneGdssEiaKeIneeAanNtFuOckNyFSEAIOCUhCRio IAIRWVNEireRgsitnANiNGaoGrMthaU rCVyCailrargnoMindliniaIaEEWNSashiTnDgetloanw,a Dre.C. 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Moonesar Chartridge Books Oxford Hexagon House Avenue 4 Station Lane Witney Oxford OX28 4BN, UK Tel: +44(0) 1865 598888 Email: [email protected] www.chartridgebooksoxford.com First published in 2013 by Chartridge Books Oxford ISBN print: 978-1-909287-86-0 ISBN ebook: 978-1-909287-87-7 © I. A. Moonesar, 2013 The right of I. A. Moonesar to be identifi ed as author of this Work has been asserted by him/her in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. British Library Cataloguing-in-Publication Data: a catalogue record for this book is available from the British Library. All rights reserved. No part of this publication may be reproduced, stored in or introduced into a retrieval system, or transmitted, in any form, or by any means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. 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Ltd., India Printed in the UK and USA Contents Preface vii List of abbreviations ix About the author xi 1 Introduction 1 The policy process and case scenarios 1 The role of presidential leadership and public opinion in policy making 2 The policy and political environment and case scenarios 4 Infl uence of stakeholders on the policy-making process and case scenarios 5 Specifi c strategies and tools and case scenarios 6 Understanding policy and politics 7 2 Access challenges and policies 9 Health care reform to address access 10 Access to insurance versus access to care 12 Health access: care or insurance? 12 3 Quality challenges and policies 15 Government versus private options for quality 15 Pros and cons of pay-for-performance 17 4 Cost challenges and policies 21 Challenges in containing health care costs 21 Legislation on cost containment 24 5 Disease and emergency-related health policy 31 6 Conclusion 33 Getting involved in health policy 33 References 35 Preface This publication provides an appreciation of the United States (U.S.) health policy, which reflects authoritative decisions and the process of decision- making, carried out at the federal, state, and local levels, which affect personal health and access to and delivery of health services. Health policy is based on rules, laws, and regulations to implement legislatures or on legal standards established through judicial decisions. The U.S. Policy-Making Process has three major channels before it becomes a law through County/Local level, State level and Federal level. Overall, this publication examines the processes of health policy making in the U.S., including how health policy proposals move through the policy process. There is also a thorough assessment of the key challenges to addressing cost, access, and quality issues in health care and an evaluation of the existing policies in these arenas. The publication also contains an analysis of the diversity of perspectives held by policy makers, interest groups, healthcare professionals, and other stakeholders regarding existing and proposed health policy; in addition to the identification of the ways in which healthcare professionals can participate in and influence health policy development. Keywords: Health Policy-Making, Access, Quality, Cost. Abbreviations AARP: American Association of Retired Persons ACA: Affordable Care Act CARE: R yan White Comprehensive AIDS Resource Emergency Act CBO: Congressional Budget Office DM: Diabetes Mellitus HSC: Health System Change HRSA: Health Resources and Services Administration LTC: Long-Term Care MMA: Medicare Prescription Drug, Improvement, and Modernization Act P4P: Pay-For-Performance PPACA: Patient Protection and Affordable Care Act PHRMA: Pharmaceutical Research of Manufacturers of America QPS: Quality and Patient Safety JCIA: Joint Commission International Accreditation SWOT: Strengths-Weakness-Threats-Opportunities