pubhlth 222a - week 2: politics of health policy

constitution - separation of powers

• legislation is making the laws

  • congress

    • house of rep

    • senate

• judicial interprets & give meaning to the law

  • supreme court

• exective passes the law

  • pres & vp

3 functions of the constitution

• federalism

  • allocate power between federal government and states

• separation of powers

  • divide powers b/w 3 government branches

• protect individual liberties

  • limit government power

policy definition

• authoritative decision

• has authority coming from the legislative branch

public policy

• policies enacted by legislative, judicial, or executive branches of government

health policy

policies regarding the health or pursuit of health

forms of health policies

• laws

  • legal bindings & penalties

• rules or regulations

  • implementation decisions

• judicial decisions

2 categories of health policies

• allocative policies

  • provide net benefits to some distinct group at the expense of others

  • equivalent to subsidies

  • direct provision of income, services, or goods to a group of indivd or organizations

• regulatory policies

  • designed to influence the actions, behaviors, & decisions of others by directive

  • five categories: (1) market entry restrictions, (2) rate or price setting controls on health services providers, (3) quality controls on the provision of health services, (4) market preserving controls, (5) social regulation

health policy —> health determinants —> health

• health determinants

  • physical environments

  • behavior & biology

  • social factors

  • health services

core model of public policymakng process

• decision making process

• cyclical (not linear) process

• political

• incremental (small modifications)

3 public policymaking cyclincal phrases

• formulation

  • agenda setting & legislation development

• implementation

  • designing, evaluation, operating, & rulemaking

• modification

legislative structure: federal

• U.S. senate and house of representatives

• committees have jurisdiction over different issues

  • senate committees vs. House subcommittees

• involved in authorizing programs/laws and appropriating resources

legislative structure: state

• state senates & assemblies

• may have different rules than federal government

• professional vs. part-time legislatures

legislative responsibilities

• the budget process

• medicaid, CHIP, healthcare programs

• mandatory vs discretionary spending (medi medi vs NIH & CDC)

4 agenda setting activities

• well informed guess

• combo of problems, solutions, & political circumstances that flow together to create a policy window

e-cigarettes

• part of a broader class of devices known as electronic nicotine delivery systems

  • battery-powered devices that deliver nicotine vapor, chemicals, & metals

  • ultrafine particles that can be inhaled deep in the lungs

  • flavorants (diacetyl)

  • heavy metals (nickel, tin, & lead)

high vaping taxes up to $17.90

• very west (including california) & very east states

7 (+ 4 options) how a bill becomes a law (steps in legislation development)

• bill is drafted

• bill introduces to representative & senator

• bill is read & assigned to a committee by the rep speaker & senate majority leader

• bill leaves committee & schedule for debate

• bill is passed

• both need to pass identical bills OR agree to one of their versions OR bill is amended & branches vote again

• bill presented to the president

  • pres signs bill

  • congressional in session, bill becomes law after 10 days w/o pres signature

  • congressional not in session, bill does not become law w/o pres signature

  • pres vetoes bill but 2/3 in house & senate can override veto

2020 no surprise act timeline

• aim to protect patients from large bills when treated by out-of-network providers at in-network facilities

• never passed house or senate

• was folded into the consolidated appropriations act of 2021 – H.R.133 (big budget bill)

• house & senate agrees to w/ amendment

• signed by pres & became law

u.s. congress committees that review health policy

• ways and means (house)

• committee on energy & commerce (house)

• committee on appropriations (house)

• health, education, labor, and pensions (senate)

• committee on finance (senate)

• committee on appropriations (senate)

executive orders

issued by the president and do no require congressional approval

3 core roles of courts

• constitutional referees

  • decide whether a branch of government has acted within the scope of its constitutional authority

• meaning givers

  • clarify the meanings of laws

• rights protectors

  • vindicate or reject the legal or constitutional rights of parties

  • roles are not mutually exclusive

  • judicial decisions affect public/private sectors

25 states of challenge

medicare & policy modification

• Medicare enacted as part of the SSA Amendments of 1965

• Why do you think it took so long (30 years!)?

• Political circumstances that may have delayed inclusion of health insurance, and Medicare in particular, in the SSA:

  • AMA opposition

  • Truman administration need to divert attention to Korea in 1950

  • Political prospects for universal health insurance – come to a compromise?

  • Not passed until Democratic margin in Congress was significantly increased in 1964 (with President Johnson’s election win)