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The policy process, which governs health reform, involves several stages. Each stage
contains specific goals and requirements that must be met if adequate reform and much needed
change are destined to occur. Health policy is constantly changing to meet the needs of the
communities and citizens who are served by health care facilities and medical professionals.
Reform is considered in an attempt to improve the quality of care as well as keep prices
affordable. Ethical and moral issues may arise that call for changes to be made to existing
policies. Federal and state guidelines are considered when attempts are made to bring about
changes to existing policies.
The Formulation Stage
The formulation stage of the policy process begins with an idea or concept that needs to
be addressed in health care. The idea is discussed, debated and researched in an attempt to find
the best possible way to create the maximum benefit for all involved. Solutions are suggested,
along with any possible repercussions and consequences and what may need to be done to
counteract them. The policy continues to be developed by considering the input of stakeholders
from several areas. Considerations are reviewed that would limit the policy from being effective,
while measures would be investigated that would allow the policy to be adapted to specific
situations (“The process,” 2012).
Every aspect of the policy is reviewed and analyzed. Its overall concept, the language
used within the policy as well as its strengths and weaknesses, are all discussed and each area
must be agreed on before a bill or policy can begin to take shape. Issues of a controversial
nature, such as abortion or stem cell research, may take several years to develop and frame so
that everyone involved is willing to accept the final draft. Legal, ethical and moral issues must be
addressed and all parties satisfied with the result before the policy can continue to move forward.
Framing an issue consists of debates and discussions that help to prioritize key points
within the legislation that will make the policy effective. Stakeholders can influence the
language and structure of health care policy by letting policy makers know how they feel about
specific issues. They can support certain aspects of a policy, while asking for compromise when
it comes to portions they disagree with. When the policy begins to come together and parties
begin to agree on its content, language and basic structure, it is considered ready to be submitted
to legislators for voting. The review and discussion process can be lengthy, taking years to settle
and multiple compromises from all parties involved.
The Legislative Stage
The legislative stage begins once the policy has been drafted, reviewed and approved. It
is then ready to continue its journey along the process– to be introduced into legislation that will
then be voted on by the members of Congress. The House of Representatives and the Senate
must each pass the policy reform legislation for it to be able to continue moving through the
system. If it passes the Senate, it then proceeds into the House of Representatives and vice versa.
Passing through one chamber does not ensure it will pass through the other. In some cases,
changes may be requested in how the policy is worded or in its general concepts (Rossetti, and
Bossert, 1999).
Committees that have approved a health care reform bill will have it sent back if it is
rejected by the other chamber. If it is rejected, a list of changes is outlined which the other
chamber is demanding before they will grant approval. Changes may be minor, such as changing
a few words or phrases, while others may call for drastic revisions that could eventually change
the entire makeup of the bill. Depending on the severity of the changes called for, the committee
that originated the legislation may opt to start the process over from scratch instead of rebuilding
a policy from the ground up.
If sufficient changes are made so that both parties can come to a majority agreement, the
bill will pass through each chamber of Congress and be sent to the President to be signed into
law. Health care reform policies must pass each chamber with a two-thirds majority vote.
Committees in both houses will continue to review and monitor the bill’s progress as it makes its
way through the system and prepares to be ratified. The President can sign the policy into effect
or veto it. A veto can stop a bill in its tracks, or it can be sent back through the system for
changes (“Health,” 2012).
The President’s signature does not ensure the end of a policy’s safe journey. Members of
several different House or Senate committees can file suit with the United States Court of
Appeals and the Supreme Court to determine whether the policy abides by the laws and
regulations set forth by the Constitution of the United States. If it is determined the policy holds
merit and follows the laws listed in the Constitution, the policy remains intact. If it is determined
that it violates the Constitution in any way, it is rendered ineffective and the process must start
The Implementation Stage
The implementation stage of health care policy reform begins with the passage of the bill
through both chambers of Congress. It goes from Congress to the desk of the President where he
will sign it and place it into effect, if he believes it is best for the health care industry and the
people they serve. Specific rules and regulations are built into the reform policy that helps to
make the implementation and transition to the new laws easier and more readily enforceable. For
example, policies must be followed explicitly by insurance and medical providers who, up until
the reform was signed into effect, had refused to cover certain procedures and diagnoses. Once
the reform policy was signed into effect, provisions within the policy made it much easier to
enforce penalties levied against companies who refuse to comply with the new rules and
regulations. Continued communication between nurses, physicians and insurance providers can
help to ensure all protocols are followed as well as any new rules and regulations.
State legislation can be reinforced as well to bring health care practices on that level into
compliance as well. Nursing organizations can work with state agencies to remove restrictions
placed on practices associated with the nursing profession. State regulations can often have an
impact on the quality of healthcare and whether patients receive the care they truly need. Nursing
organizations are in a position to gauge the needs of their patients and provide them the type of
care they need on an individual basis. Implementing new health care policies ensures that each
patient has access to the services and medical care they need on both state and federal levels
(“Issues,” 2010).
New health care reform policies not only cover the type of health care and services a
patient is entitled to receive; it also establishes uniform pay scales for LPNs, ARPNs, nurse
practitioners and physicians. Team-based approaches involve allowing those individuals to offer
specialized services, if they intend on caring for patients. When a service is denied or repeatedly
refused to a patient, the payment that practitioner receives can be reduced until they eliminate
restrictions placed on health care and medical services.
Health care reform policies allow for the creation of organizations and commissions such
as the National Health Care Workforce Commission which ensures issues found within existing
medical policies are reviewed and addressed in the most legal and ethical way possible. The
rules and regulations that help to establish the Commission requires that at least one registered
nurse should appear on the panel of board of directors (“Funders,” 2010).
Nurses are put in a unique position to help associations and organizations. Continual
communication between nurses, organizations and government agencies can create situations
where reform policies are entered into smoothly and fluently without disrupting effective health
care practices that are already in place. Their input can dramatically affect how reform policies
are implemented within an existing health care system. They can point out flaws, suggest
benefits and forecast trends. When health care reform is being structured and framed, input from
nurses can supply valuable information both from the patient’s standpoint as well as from that of
the physician in charge.
Health care reform is a necessary part of maintaining a productive and effective system
within which medical facilities and health professionals operate. As technology becomes more
advanced and medicine begins to reach new levels of care, new issues and problems present
themselves that demand changes are made to a system that moves toward being obsolete. Health
care reform policies are drafted with the intention of improving and safeguarding the system as
well as the practitioners and patients. Any reform must be able to balance the needs of the
people, with the ability of facilities, and health care professionals’ capability to provide adequate
medical care while remaining within the legal and ethical constraints of the law.

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