Title ABC/123 Version X 1 Weekly Overview: Week Four HCS/550 Version 2 3 Weekly OverviewWeek FourOverview Policies are developed at all levels of government: federal, state, and local. The federal government is described in the US Constitution as sovereign, and no state may create laws that conflict with federal law. But states also create their own policies. States create policies that support the implementation of federal laws. Several states have created far-reaching health reform proposals. States sometimes create policy guidelines that are more strict than federal law, or may make specific laws where no federal laws exist. Local governments play a significant policy role as well, especially in public and environmental health, disaster management, etc. Morton Grodzins, a political scientist who lived in the early 20th century, famously described the roles of government as a marble cake rather than a layer cake because of its interwoven roles. Individuals can directly impact the policy process. For example, an individual with a powerful story can result in policy change. Sometimes stakeholders group together to form a more powerful coalition, such as an interest group, to create change. Major organizations and lobbyists also exert powerful pressure on policy makers by using a variety of adovacacy methods.What you will cover 1. Development of Health Policy a. Analyze local, state, and federal roles in the development of health policy. 1) Federalism refers to the relationship between the states and the federal government a) No role is completely independent or autonomous b) Morton Grodzin: roles are like a marble cake rather than a layer cake c) Federal government supersedes d) Supreme Court may intervene in cases of conflict between state and federal roles (1) Example: Supreme Court authorized states to opt out of the Medicaid expansion of ACA. Gave authority to states to make the Medicaid expansion decision. (2) Example: 2015 same-sex marriage ruling required states to authorize same-sex marriage. Removed authority of states to deny same-sex marriage. 2) State Roles a) States implement federal laws (1) State role in Medicaid program (a) Shared funding (b) May adjust the program to meet state-specific needs within federal guidelines (c) May opt into or out of the ACA Medicaid expansion b) States can strengthen or weaken federal policies (1) States and the ACA Medicaid expansion: How did the Supreme Court ruling in the ACA that allows states to opt out of the Medicaid expansion affect the strength of the Affordable Care Act? (2) Some states have implemented attempts at comprehensive health reform (a) Massachusetts: model for Affordable Care Act (b) Oregon Health Plan: model for wide-reaching health care coverage (c) Vermont’s single payer experiment: failed attempt at government-funded universal care c) States create policy (1) Marijuana legalized in some states, either for recreational or medical use (2) Abortion: ...

1. Title
ABC/123 Version X
1
Weekly Overview: Week Four
HCS/550 Version 2
3
Weekly OverviewWeek FourOverview
Policies are developed at all levels of government: federal,
state, and local. The federal government is described in the US
Constitution as sovereign, and no state may create laws that
conflict with federal law. But states also create their own
policies. States create policies that support the implementation
of federal laws. Several states have created far-reaching health
reform proposals. States sometimes create policy guidelines that
are more strict than federal law, or may make specific laws
where no federal laws exist. Local governments play a
significant policy role as well, especially in public and
environmental health, disaster management, etc. Morton
Grodzins, a political scientist who lived in the early 20th
century, famously described the roles of government as a marble
cake rather than a layer cake because of its interwoven roles.
Individuals can directly impact the policy process. For example,
an individual with a powerful story can result in policy change.
Sometimes stakeholders group together to form a more powerful
coalition, such as an interest group, to create change. Major
organizations and lobbyists also exert powerful pressure on
policy makers by using a variety of adovacacy methods.What
you will cover
1. Development of Health Policy
a. Analyze local, state, and federal roles in the development of
health policy.

2. 1) Federalism refers to the relationship between the states and
the federal government
a) No role is completely independent or autonomous
b) Morton Grodzin: roles are like a marble cake rather than a
layer cake
c) Federal government supersedes
d) Supreme Court may intervene in cases of conflict between
state and federal roles
(1) Example: Supreme Court authorized states to opt out of the
Medicaid expansion of ACA. Gave authority to states to make
the Medicaid expansion decision.
(2) Example: 2015 same-sex marriage ruling required states to
authorize same-sex marriage. Removed authority of states to
deny same-sex marriage.
2) State Roles
a) States implement federal laws
(1) State role in Medicaid program
(a) Shared funding
(b) May adjust the program to meet state-specific needs within
federal guidelines
(c) May opt into or out of the ACA Medicaid expansion
b) States can strengthen or weaken federal policies

3. (1) States and the ACA Medicaid expansion: How did the
Supreme Court ruling in the ACA that allows states to opt out
of the Medicaid expansion affect the strength of the Affordable
Care Act?
(2) Some states have implemented attempts at comprehensive
health reform
(a) Massachusetts: model for Affordable Care Act
(b) Oregon Health Plan: model for wide-reaching health care
coverage
(c) Vermont’s single payer experiment: failed attempt at
government-funded universal care
c) States create policy
(1) Marijuana legalized in some states, either for recreational or
medical use
(2) Abortion: states cannot deny abortion rights (Roe v. Wade)
but can create specific laws that affect abortion services
(3) Euthanasia: some states allow “right to die” with specific
legal requirements and restraint
d) States regulate
(1) State health departments
(2) State boards (medical, nursing, pharmacy, etc.)
(3) Certificates of Need

4. 3) Local Roles
a) Public health roles
(1) Public health nursing
(2) School health
(3) Occupational health
(4) Environmental health, sanitation, etc.
b) Emergency response and public safety
c) Focus on specific issues or programs
(1) County-owned institutions
(2) Health care funding may be authorized at local levels to help
pay for indigent care or incarcerated individuals
(3) Initiative experiments
(a) Example: New York City’s efforts to ban certain food types
(trans fats, sugary drinks)
(b) Example: Local anti-smoking laws
b. Evaluate the impact of individuals and groups on the
development of health policy.
1) What is policy competence, and why is it important?
2) “They're stakeholders when they're with you, and they're
interest groups when they're against you” (Mary Matalin)
a) Identifying Stakeholders:

5. (1) Who cares about the issue?
(2) How is the issue funded, and who is affected by funding?
(3) Who is involved in potential solutions to the issue?
(4) Who supports policy efforts to address the issue?
(5) Who opposes policy efforts to address the issue?
b) Interest groups
(1) Groups of like-minded stakeholders or stakeholders who
support a common cause
(2) Attempt to influence policy
(a) Lobbying efforts and contributions to parties or elected
officials
(b) Working to elect policy makers who will support their cause
(c) Developing public campaigns to bring awareness and
education to a specific issue or cause
(3) Structure
(a) Typically a non-profit organization
(b) Typically funded by stakeholder donations and contributions
c) Why are interest groups formed?
(1) Promote causes

6. (2) Maintain the status quo
(3) Represent the voice of a specific industry or economic group
(4) Represent the voice of a profession
c. Evaluate the impact of advocacy methods on the development
of health policy.
1) Personal advocacy: can an individual achieve change?
a) Providers drive change within the health care environment
b) Highly publicized individual stories drive interest, create
attention, and create an agenda item
(1) Social media
(2) Grassroots efforts
2) Stakeholder groups and Interest groups
a) Stakeholders band together to pool resources
b) Major health care advocacy group types in the US
(1) Providers
(2) Insurers and benefits
(3) Pharmaceutical Research and Manufacturers of America
(PhRMA) and medical equipment
(4) Religious institutions
(5) Patient voice

7. (6) Business and employers
c) Lobbyists
(1) Take stakeholder interests to public official target with goal
of policy outcome
(2) Work to influence policy makers and change public opinion
(3) Paid (professional) or volunteer experts on policy topics
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