Instructions
Please read the instructions below because they are different than previous discussion board postings. Please read the up to the minute postings in the Readings section of Module 6 on projected Congressional changes to healthcare policy. Choose at least 2 of the issues listed below that affect health of either state or federal residents.
This part of the course focuses on social policy and the underpinnings of social contract theory, social welfare foundations, and distributive justice. Not all nurses vote alike but we are all Americans who want the best for patients, families, and populations. We must work together for the common good.
Background:
A new president and vice president were elected in 2016. Approximately half of voters are satisfied with the election results and half are not. Midterm elections in 2018 shifted the House to a Democratic majority, Senate majority remains Republican. In the state legislatures, there were more Democrats elected than at any other time in US history.
Many policy positions for the Cabinet remain unfilled and there has been substantial turnover in those positions during the Trump administration. President Trump has stated numerous times that he will repeal or severely alter the ACA 2010 even though the American Healthcare Act of 2017 was not supported in Congress.
Americans are no longer required to have health insurance or pay a penalty. Individuals may purchase health insurance through employment, through insurance exchanges that are subsidized and based on personal income, through Medicare if 65 or older, or if impoverished, through Medicaid which has been expanded to cover those who work but have lower incomes. Many states especially poorer Southern states, did not adhere to Medicaid expansion. Men are now eligible for Medicaid when previously they were excluded unless disabled. Congress has
The insurance exchanges count on young healthy individuals to join so that costs for older sicker individuals who need more care are spread out by a larger denominator. This is how all insurance companies set their premiums so that they can provide coverage and still make a profit. Premiums for health insurance have escalated due to these changes.
There has been much discussion by presidential candidates for the 2020 election about universal health coverage through expansion of Medicare for all. Some believe that this approach equalizes health care access and reduces disparities and social injustice, others feel it is excessively expensive and does not meet the need of the general population.
Congress has decreased funding for exchanges and changed the income levels at which individuals can receive Medicaid. This will mean that more people who have lower incomes but are above the poverty level will have to purchase insurance that was previously provided by Medicaid. This is predicted to significantly affect individuals who earn just above the minimum wage, many of whom are working young parents with infants and children, pregnant women, and college students. Older adults between 60 and 65 who lose their jobs and are not eligible for Medicaid and can not afford insurance will also be affected.
Pharmaceutical companies have directly benefitted from Congressional deregulation changes in the amount that they can charge for medications including generics. A large percentage of healthcare costs are for medications prescribed for largely preventable illness such as type II diabetes, hypertension, and hyperlipidemia.
States have made sweeping changes to laws surrounding women’s health access and have decreased funding to clinics that provide cervical and breast cancer screening, STI screening and treatment, contraception, prenatal care, and pregnancy termination. Many states have banned pregnancy termination after 6 weeks (most women don’t know they are pregnant until 7-8 weeks) even in cases of birth defects, sexual assault, or danger to maternal health.
Funding to the National Institute of Health has been drastically cut so that researchers are having difficulty obtaining funding for much needed healthcare research. Funding for healthcare professional has been drastically cut in the federal budget which means that nurses may have less funding for education and tuition remission.
The depth of those affected by COVID-19 has taken attention in Congress away from other issues and directly focused it upon healthcare needs for all of us in the US. There are an estimated 3.5 million unemployed Americans (some have not filed for unemployment insurance payments yet). As of March 27, 2020 Congress passed a 2 trillion dollar stimulus and aid package to support failing businesses and to provide much needed personal protective equipment (PPE), ventilators, and other emergency medical equipment. These funds are needed on an emergent basis to provide support to our healthcare system which is clearly straining under the surge in patient census at all hospitals but especially in the Bay Area, LA, and New York.
Nurses:
There are more than 3 million professionally active registered nurses in the US, making us the largest population of healthcare providers. As nurses we must reflect on these health policy changes because these are issues that we deal with on a daily basis. The ANA Code of Ethics With Interpretive Statements (2015) is clear in describing our ethical duty to vulnerable populations and in describing our duty to adhere to principles of justice, autonomy, beneficence, non-maleficence, veracity, and fidelity.
This discussion board will reflect these proposed healthcare policy changes and our responses as nurses in out duties to our individual patients, populations we serve, and the communities we live in.
You must read the presentation and all of the resources published in this module to complete this assignment.
PLEASE BE RESPECTFUL OF EACH OTHERS’ OPINIONS WHETHER YOU AGREE OR NOT, WE CAN HAVE DIFFERENT OPINIONS AND STILL WORK TO IMPROVE HEALTHCARE SERVICE DELIVERY.
Choose at least two topics but you can select more if you like.
The topic of this discussion board is the information that is posted above about:
- Lack of sufficient PPE for RNs, MDs, RTs and other staff working in healthcare systems offering screening, prevention, early intervention, and treatment for those experiencing COVID-19. Healthcare personnel are placed at high risk for occupational injury due to lack of PPE.
- Lack of sufficient mechanical ventilators to provide life sustaining treatment for those with adult respiratory distress syndrome from COVID-19. Healthcare personnel are asked to make extremely difficult choices in life or death instances which many are not ethically prepared for because such decisions are in opposition to our personal moral code and the ANA Code of Ethics (2015).
- Lack of appropriately trained staff to care for the burgeoning numbers of patients that are seeking care for COVID-19 related symptoms and other on-goin healthcare needs (MI, cancer care, pregnancy and birth, child health, etc.). As staff become exhausted from working additional shifts, many become ill, or experience PTSD and must be given time to recuperate. Newly trained staff or staff transferred from another department may be required to work in high density areas such as EDs, ICUs, and step down units.
- During the COVID-19 pandemic, patients in labor are not allowed to have their partner, doula, or support person with them during labor. Lack of adequate emotional support for laboring individuals has been demonstrated to increase rates of postpartum depression, inhibit parent-infant bonding, and increase maternal mortality rates. The US has the highest rate of maternal mortality of any industrialized nation.
- Escalating health insurance premiums that affect all those not on Medicare or Medicaid so that a larger percentage of earned income will be used to pay for insurance
- The lowering of the “poverty level” so that low income individuals and families most of who are working will no longer have Medicaid and will have to purchase insurance
- Infants, children, adolescents, pregnant women, college/graduate students, those in rural locations, and older individuals who have lost employment and no longer have insurance and are too young for Medicare are disproportionately affected. These vulnerable populations will access expensive emergency departments for care that is better provided in primary care settings.
- Women (especially low income and minority women) have decreased access to reproductive healthcare including contraception, prenatal care, cervical and breast cancer screening, and pregnancy termination) in many states. This is due to federal decreases in funding for these services and laws in various states restricting pregnancy termination for any reason. Many women will have unintended and unwanted pregnancies due to lack of access to contraception.
- Decreased funding for healthcare research delays important advances in research and decreases the number of students who can get loans or grants for nursing education in undergraduate and graduate programs.
- Nurse practitioners in California have restricted practice authority which is “supervised” by physicians. Out state is one of only 3 states west of the Mississippi River that has such limited practice. Legislative efforts to expand NP practice in California have been historically defeated by various organizations, most of then led by physicians. Lack of access to care further deepens health care disparities for underserved populations. NPs often provide services for rural or underserved populations.
Please analyze these healthcare policy approaches for the presence of beneficence, maleficence, justice, autonomy, veracity, and fidelity. The focus may be on populations of patients, communities, or some aspect of the nursing profession.
In your initial analysis of this legislation or general approach to healthcare policy, please describe or identify the following:
- Presence or lack of ethical principles within the policy or legislation and any language that is conflicting or congruent with the ANA COE, or ICN COE (choose at least one).
- Identification of the population and/or professional organization(s) that will be affected by this policy and the impact the policy or legislation will have on them
- Cultural, gender, personal (or religious) values, education, or geographic location of the individuals or groups affected by this legislation or policy
- Potential alternatives or modifications to the proposed legislation, policy, or policy approach
- Ethical rationale of your stance on this particular policy or legislation with APA references
- Response to another student’s posting with a rationale in APA style for your stance in support or in opposition to the other student’s post
Select at least two of the topics listed above and discuss them using the 6 criteria listed above. Postings must be at least 250 words or more which is about one-two sentences for each of the points listed above. Please include at least one reference in APA style for your posting or response. You may use one of our textbooks or other materials posted in the course.
Each student must respond to at least one other student’s posting (more is encouraged). The response must include alternative courses of action and expected outcomes that the were not provided by the student who made the initial posting. Implications for nursing practice must also be included. Student responses should be at least 4-6 sentences (one paragraph).
The grading rubric is based on the six bullet points listed above.
