PPL Final - Second Half of Semester

What are the characteristics of US healthcare policy?

• Relies on private market and individual choices

• U.S. gov’t plays small role compared to other developed nations

• Healthcare services are primarily provided by doctors in private clinics or hospitals (for-profit or non profit)

• Most adults under the age of 65 have employer-sponsored health insurance

What happened in the 1950s regarding healthcare policy?

1950s - IRS rules that the cost of employer-sponsored health insurance is a tax-deductible business expense

What happened in 1965 regarding healthcare policy?

1965: Amendments to the social security act created medicare and medicaid insurance programs

What happened in 1997 regarding healthcare policy?

1997: Creation of the Childrens Health Insurance Program (CHIP)

• Provides low-cost health coverage to children and pregnant people in families that earn too much to qualify for medicaid.

What happened in 2010 regarding healthcare policy?

2010: Creation of Patient Protection & Affordable Care Act (ACA or Obamacare)

• Makes affordable health insurance available to more people.

Who does Medicaid cover:

• low-income families

• People with disabilities

• Pregnant people

• People who need long term care

Where does medicaid get its funding from?

Federal and state sources

Who does Medicare cover?

• people 65+

• Disabled people

• People with end-stage renal disease requiring dialysis or kidney transplant

• Medical (part A)

• Hospital (Part B)

• Medicare Advantage (Part C)

• Prescription Drug Costs (Part D)

How is Medicare funded?

• Payroll taxes from employers, employees, and self-employed

• Income taxes on social security benefits

• Premiums from people enrolled in medicare

• Interest earned on investments

What is most medical spending under?

Mandatory Spending (spending guaranteed by law) - 70%

Other spending:

Discretionary -adjusted annually- (covers veteran health and NIH (research)) - 11%

Tax Subsidies - 19%

What are some persistent issues in the US healthcare system

• high spending, poor results

• Inequalities in access, cost, and quality by geography, education, and race/ethnicity

What are current financial issues with US healthcare policy?

• Large cuts to medicaid funding

• Cus to NIH and other research funding

• Medicare prescription drug prices negotiations

What is the Policy Analysis Process?

1. Define the problem

2. Construct policy alternatives

3. Choose criteria to evaluate the policy outcomes

4. Evaluate the likely outcomes of the alternatives according to each criterion

What are the steps to construct policy alternatives?

• Understand current policies

• Scan policies of other jurisdictions (Benchmarking)

• Learn from people in a policy network

• Read “grey” literature (policy reports/briefs from think tanks and advocacy groups)

• Read policy research literature

• Brainstorm

• Listen to people affected by the policy

What are the categories or criteria when evaluating the likely outcomes of alternatives?

• Effectiveness and Cost-effectiveness/efficiency

  • Effectiveness: evidence that the alternative will have the desired effect on the problem

    • Improvement - how much?

  • Efficiency: Cost of the alternative compared to its likely effects

• Technical Considerations

  • Capacity: tech?, tools?, knowledge/skills?

  • Ease of implementation

  • Legality

• Ethical Considerations

  • Equality: is it the same/uniform

  • Equity: Cost and benefits distributed equally

  • Liberty/Freedom

    • Negative: The freedom to use and dispose of ones resources as one wishes without interference

    • Positive: The ability to choose ones life path

  • Well-being/prosperity

  • Fairness

  • Security/saftey

• Political Landscape Considerations

  • Precedent

  • Cohesion of policy community around the problem definition and alternative

  • Support from current political leadership

  • Acceptability among the public

  • Sustainability: How will the alternative fare through major change in future political leadership

- Aim to select 3-4 criteria

What are ways to evaluate the likely outcomes of alternatives

Analytical Approaches

• Cost-benefit analysis: All benefits and costs put into $ amounts and expressed as net benefits (benefits - costs) or ratio of benefits to costs (benefits/costs)

  • Use rate to estimate how costs and benefits change over time

• Cost-Effectiveness Analysis: Examines variation in benefits at a fixed cost, but does not need to be in $ amounts

• Risk Assessment: Magnitude of adverse consequences of an event or exposure

• Forecasting: Anticipation what the future is likely to hold based on understanding of current conditions and how they change over time

In your Policy analysis, what criteria did you choose?

Effectiveness: All effective

Costs:

• Making recycling facilities

• Financing recycling practices

  • More employees to do that (pay them)

Ethics:

• Recycling factories emitting pollutants to nearby communities

• Where will waste be kept if recycling facilities/ practices are not made

  • Harms both environment and people

What are Federal policies for early childhood education?

• Headstart (1965) or Early Head Start (1999)

• Child Care and Development Block Grant (1990)

• Preschool Developments Grant (2015)

Where do most early childhood education federal policies come from?

The US Dept. of Health and Human Services (sent to state health services)

What are federal elementary and secondary education policies?

• Elementary and Secondary Education Act of 1965

  • Title 1: disadvantaged students

  • Title 2: pay more teachers → reduced class sizes → higher quality lessons

• Individuals with Disabilities Education Act of 1975

• Carl D. Perkins Act of 1984 (inc. quality of technical education)

• U.S. Dept. of Agriculture - Child Nutirion Programs:

  • National School Lunch Program (1946)

What are some federal policies for postsecondary education?

• Morrill Acts of 1862 and 1890

  • Land Grants

    • UKY (1865)

    • KY State Uni. (1890)

• Higher Education Act of 1965

  • Title 2: Teacher quality

  • Title 3: Institutional aid

  • Title 4: Student Assistance (pell grants, student loans)

• Workforce Innovation and Opportunity Act of 1998

What are some state and local services for early childhood education?

• Team KY- Cabinet for Health and Human Services

• Team KY - Governors Office of Early Childhood

• KY Depy. Of Education

• Central KY Community Action

• Child Dev. Center of the Bluegrass

What are some state and local services for elementary and secondary education

• Team KY

• KY Dept. of Education

What are some state and local services for post secondary education

• CPE

• KHEAA

• KY Community and Tech. College System

• Association of Independent KY Colleges and Universities

Where does the majority of Kentucky education funding come from?

Most of Kentucky’s education is funded through the state (38%), via income/sales tax

31% of KY education is through local means (property taxes) which could be and equity concern because not all property costs the same

15% of KY education comes from the federal government through grants

Roughly, how much does KY spend on each student (2023-‘24)

$19,020 per student

relatively low compared to other states

Why was the National Environmental Policy Act of 1969 important?

The NEPA ushered in the modern era of environmental policy

• Required preparation and public reporting of Environmental Impact Statements (EIS) for federal actions that may impact the environment

• Many states have adopted state-level versions of the NEPA

What is the timeline of modern environmental policy?

1969 - National Environmental Policy Act of 1969 (NEPA)

1970 - Clean Air Act

1972 - EPA established

1973 - Clean Water Act

1974 - Safe Water Act

1992 - Energy Policy Act

2021 - Bipartisan Infrastructure Law

2022 - Inflation Reduction Act

What is policy innovation?

A program or policy that is new to the government adopting it

What is policy diffusion?

• One governments policy choices being influenced by the choices of other governments

• Can be horizontal (state → state) or vertical (local → state)

What are mechanisms used for state environmental policy

• Policy standards, monitoring, penalties on environmental risks such as fracking

• Incentives - green taxes, cap-and-trade systems

• Regulations about fuel standards, energy efficiency, chemical use, etc.

• Renewable Portfolio Standards (RPS): Mandates that utilities use a minimum percentage of renewable resources for electricity production

  • Designed to reduce GHG emissions, diversify energy sources, and promote economic development

What are some important energy policies?

• Energy policy and conservation act of 1975

• Energy Independence and Security Act (EISA) of 2007

• American Recovery and Reinvestment Act (ARRA) of 2004

• Bipartisan Infrastructure Law of 2021

• CHIPS and Science Act of 2022

• Inflation Reduction Act of 2022