Week 14: Strategies for Increasing Consumer Participation in the Policy Process

It is important for consumers; this means every eligible citizen, to be involved in the process of policy making. According to Kraft and Furlong (2015), this ensures that the general public’s interests are taken into account during the policy process. The thing is that the public may not realize that they have a voice that needs to and will be heard. Kraft and Furlong (2015) describe it as citizens not completely understanding how policy decisions can and do affect their everyday lives and the fact that they could made a difference. Sometimes if there is enough support or opposition on an issue this can affect the decision that is made by policy makers but it is up to the public to make their point of view seen and understood. Fortunately there are a number of ways to help increase consumer participation in the policy process.

As this topic pertains to NPs as the consumers, according to Dr Denise Link (personal communication, April 13, 2015), it is imperative that people know about the opportunities to serve and actually participate in the endeavors. This means showing up and being a part of the conversation. Educating ourselves (consumers) about the issues and having educated and informed discussions about them (the issues) makes us better able to communicate the effects that the policy to be made would have on us.

The American Nurses Association (ANA) is helping to exemplify a strategy to increase consumer participation in the policy process by creating a forum for all registered nurses (RN) and advance practice nurses (APN) who feel that the 40 hour per week definition of full-time employment would impact them negatively to share their stories (www.rnaction.org, 2014). A link has been sent by email to RNs and APNs all over the country to make their comments. This is definitely a way for this sub population of the public to possibly make an impact on a policy that would affect their everyday lives through employment and livelihood.

Access to general information has become quite easy. The media is constantly reporting on issues even policy issues. Internet access is common place. Even people with no internet or computer at home can go to a library or their place of work, if they are allowed to, to use this method to research resources and information from databases. There are also social media outlets such as Facebook and Twitter where numerous topics are being discussed. While these are sources of information, not all information acquired from these sources are valid and further efforts by consumers would be needed to ensure that accurate information is what is being used in their efforts to participate in the policy process.

References

American Nurses Association (ANA). (2014). When Nurses Talk…Washington Listens. Retrieved from http://www.rnaction.org/site/MessageViewer?dlv_id=12121&em_id=15681.0

Kraft, M., & Furlong, S. (2015). Public policy: Politics, analysis, and alternatives (5th ed.). Thousand Oaks, CA: CQ Press.

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Week 13: Sustaining Innovative Environments: Consideration of Time and Scope

Sustaining an innovative environment requires continuously innovative contribution being made to that environment. Leonard-Barton (1995) describes a one method of building and sustaining the sources of innovation through knowledge building activities. The author further explains that this method requires sharing in and creatively solving problems, integrating and implementing new methods and tools to accomplish a stated innovative goal, and trying tested and proven strategies while not being afraid to try a new strategy that has never been used before, kind of a formal and informal experimentation of sorts; and utilizing external sources of expertise. This obviously requires a team effort. Members of the team would have a vital role to play in order to sustain the innovative enterprise even though it may be one team member’s idea that starts the entire process.

Any member could be the leader or all members may have leadership skills and roles that would assist in making sure that the expected innovative goal is always in sight and kept alive in everyone’s view. Deschamps (2013) describes innovation governance as an organized way of supporting goals, distributing resources and designating decision making authority for innovation across throughout the organization and its partners and customers. This is a way of making sure that no one loses sight of the goal including outsiders looking in at the innovation at whatever stage of the process it is in. Be it development, design, implementation or evaluation.

Buckley (n.d.) describes some ways to create and sustain a culture of innovation through immersing two companies’ executives and understanding how both organizations shared similar ways of starting the spark of innovation in the organizations. Accepting failure as part of the process is a way to learn from possible mistakes or just realize that the technique was not what was needed. Avoiding delays when trying an innovative idea is also important as wasting time only means finding out what will or will not work later rather than sooner. Allowing other team members input is vital as no one knows it all. This should be encouraged throughout the organization and creates a culture of innovation through innovative ideas. Encouraging leaders to emerge through innovative processes and allowing these leaders to actually lead is crucial as it contributes to sustaining innovation and all should accept that as humans we are always searching for a better way to do things and this in and of itself is innovation.

References

Buckley, L. (n.d.) Six Ways to Create—and Sustain—a Culture of Innovation. Retrieved from http://www.whatifinnovation.com/greenhouse/6-ways-to-create-and-sustain-a-culture-of-innovation

Deschamps, J. (2013). What is Innovation Governance? – Definition and Scope. Retrieved from http://www.innovationmanagement.se/2013/05/03/what-is-innovation-governance-definition-and-scope/

Leonard-Barton, D. (1995). Wellsprings of knowledge: Building and sustaining the sources of innovation. Boston, Mass: Harvard Business School Press.

Week 12: Health Care Financing

Pradhan (n.d). describes the definition of healthcare financing as a gathering of funds for use in healthcare and allocating these funds to places and populations that need the funds for specific healthcare issues. Funding comes from sources such as healthcare insurance which is generated through employment based insurance coverage premiums and there is also the government’s contributions to healthcare funding through the national budget that is created every year. These contributions better known as Medicare and Medicaid are healthcare insurance programs administered through the Center for Medicare and Medicaid Services and primarily provide healthcare coverage to a specific part of the population along with the Children’s Health Insurance Program (CHIP).

The U.S. Dept of Labor reported that approximately two thirds of the population was covered through employment-based medical plans (www.dol.gov, 2001). This appears to be old data but a more recent report by the Robert J Wood Foundation shows that that number is now about 60% and declining (www.rwjf.org, 2013). The report gave numerous the reasons for this decline as: fewer employers are offering employer sponsored insurance coverage and fewer employees are accepting what is offered; insurance premium costs have been rising steadily; just as the portion of the premium employees had to pay has risen while the dollar amounts of contributions from employees has doubled;  more young adults are receiving coverage from employer sponsored insurance plans; these employer sponsored insurance rates vary across states with some significance and the sector of the population with lower income is the most affected (www.rwjf.org, 2013).

From the above discussion employment, both employers and employees, has a significant role in contributing to healthcare financing. Employees, both full-time and part-time have the option of purchasing healthcare insurance coverage through their employer. Employers on the other hand are mandated to offer insurance benefits to full-time employees at the best rate they can negotiate with the insurance provider depending on how many employees will purchase the insurance plan. The question I ask is how this will be affected if the policy for full-time employment to be defined as 40 hours per week is passed. As mentioned in previous weeks the concern has been that employers may try to take advantage of the policy leaving employees with no healthcare insurance and these employees possibly becoming dependent on the government either through Medicaid or other programs causing a burden on healthcare financing.

It is therefore very important that the effects of this new policy be completely analyzed in order to ascertain that it will cause the most benefit and minimize negative consequences from its passage. Even I have to admit that not everything that is god for the goose is also good for the gander but I also know that not everyone can be satisfied by every decision and ultimately the impact with the most positive effects is what needs to be done.

References

Pradhan, P. (n.d). Health Care Financing. Retrieved from www.pitt.edu/~super7/16011-17001/16161.ppt

Robert J. Wood Foundation. (2013). Number of Americans Obtaining Health Insurance Through an Employer Declines Steadily Since 2000. Retrieved from http://www.rwjf.org/en/library/articles-and-news/2013/04/number-of-americans-obtaining-health-insurance-through-an-employ.html

United States Department of Labor. (2001). Report of the Working Group on Challenges to the Employment-Based Healthcare System. Retrieved from http://www.dol.gov/ebsa/publications/AC_1114b01_report.html

Week 11: Characteristics of Innovation and Change Agents

Week 10: Change Theory

Lewin’s Change Management Model could be applied to the ACA 40 hours is full time employment definition policy. Normandin (2012) explains the three stages of this model. The first is the unfreeze stage, the second is the transition stage and, the third is the refreezing stage. As it applies to the policy, those employees affected, would have to disassociate the definition of full time employment as they have always understood it and realize that full-time employment had never been defined through the government but was always to be determined by the employer (www.dol.gov, n.d.). The transition stage would then involve every employer’s policy and procedures regarding full-time employment to be updated to state that full-time employment is defined as working 40 hours a week and employees beginning to work 40 hours, where perhaps they never had to, and the refreezing stage would be this new definition sticking and becoming the culture for all organizations. The problem with this is that a lot of employers’ already defined full-time employment as working 40 hours a week so this change management model would apply more to those professions and employers/organizations where the definition of full-time employment was not 40 hours per week. Normandin (2012) discusses other change management models but acknowledges that other models may be helpful as they all provide a guide to assist in making the changes needed but, ultimately, change is difficult to implement and manage.

Forti (2012) explains that a good theory of change should address some major concerns: who would benefit, what would be the benefit, over what period of time with the benefits be achieved, how these benefits would be achieved and, work circumstances will need to be addressed. Interestingly, some of these concerns have been raised in previous weeks throughout the course of this blog. These are all important concerns as they may be representative of the needs of society and especially those affected by this policy. Is it really necessary to define full-time employment and why? Not defining fulltime employment may not be a perfect way to function but it has worked so far. The possibility that employers could use the policy to avoid having to offer health insurance coverage benefits to employees is very concerning and more than that the fact that Medicaid might have to bear the burden of providing healthcare benefits to these employees should be considered. The publics’ opinion should be sought through polls and other means to better gain some insight into how this might affect everyone and not just some sectors of the economy and maybe the change would not be so difficult.
References

Forti, M. (2012). Six Theory of Change Pitfalls to Avoid. Retrieved from http://www.ssireview.org/blog/entry/six_theory_of_change_pitfalls_to_avoid

Normandin, B. (2012). Three Types of Change Management Models. Retrieved from http://quickbase.intuit.com/blog/2012/08/28/three-types-of-change-management-models/

United States Department of Labor. (n.d.). Work Hours: Full-Time Employment. Retrieved from http://www.dol.gov/dol/topic/workhours/full-time.htm

Week 9: Policy Governing Access to Data in an Electronic and Genomic Age.

This week’s blog topic comes on the heels of me listening to the United States Senate Committee on Health, Education, Labor and Pensions full committee hearing on America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care (www.help.senate.gov, 2015). The hearing proceedings had testimony from individual from organizations that use, design and develop electronic health records (EHR), with one of them giving her testimony not just as a health informatics educator but as a parent of a child who could have benefitted from better access to data.

An article by Schilling (2011) describes how the federal government budgeted and made available $27 billion in 2009, as part of an incentive program that would encourage hospitals and healthcare providers to begin to use EHR systems as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The article further acknowledges that it is not cheap to implement an EHR but this is a concern, the main concern is loss of revenue during the time spent implementing the EHR. The president of the American Academy of Family Physicians (AAFP) was at the senate hearing mention above as a witness and discussed the challenges of implementing an EHR in his practice and the fact that his patient volume has never been at the same level, lower volume, as prior to using the EHR.

The most striking piece of the discussion and testimony given by the witnesses was the fact that EHR systems are supposed to share patient data and information but this is unfortunately not the case. It was suggested that one cause might be due to competition amongst healthcare facilities for patients and thus an unwillingness to share data that may already have been gathered just that week by a competing facility. The truth is that the technology is there and has been built to facilitate the sharing of information but it is not being used as fully intended. There is the Healthcare Insurance Portability and Accountability Act (HIPAA) of 1996 which gives guidance on the sharing of protected patient information electronically and individually which also has facilitated the use of EHR systems.

The conclusion of the hearing was that EHR systems are being used inefficiently thus far and a request that the exchange of health information should be more accessible as the technology is already in place to do so and though there is policy that currently supports the practice, members of congress should continue to develop policy to support the exchange of healthcare information.

References

Schilling, B. (2011). The Federal Government Has Put Billions into Promoting Electronic Health Record Use: How Is It Going? Retrieved from http://www.commonwealthfund.org/publications/newsletters/quality-matters/2011/june-july-2011/in-focus

United States Senate Committee on Health, Education, Labor and Pensions. (2015). Full Committee Hearing – America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care. Retrieved from http://www.help.senate.gov/hearings/hearing/?id=61101b45-5056-a032-5218-102ca4deb5e2

WEEK 8: PRIVATE SECTOR INNOVATION AND POLICY ADVANCEMENT.

This week’s blog discussion is on the private sector and its effect on policy advancement. The past few weeks have focused on the public sector and the fact that that sector is comprised of governmental organizations providing services to the general population. The private sector is however the part of the economy that is run by private individuals or groups such as businesses and so on. The private sector is influential not only in policy advancement but the innovative services offered and provided by the private sector have advanced the provision of healthcare services in a number of ways.

According to Smith, Brugha and Zwi (2001), the private sectors innovations in the delivery of healthcare are an important focus for governments because people use their services as they are often nearer and have longer hours of operation. These qualities make them more accessible though the government still has a say on standards and quality of care through healthcare policy (Kingdon, 2011).

This week there was a lobby day for the Advanced Practice Registered Nurses (APRN) in Arizona. The event was hosted by the Arizona Nurses Association (AzNA). This event and organization are an example of the private sector and its influence on public policy. The AzNA is the professional association in Arizona for registered nurses (RN) and is a member of the national organization, the American Nurses Association (ANA). AzNA works to advance the nursing profession to improve health care (aznurse.org, 2015). Though the ACA 40 hour full time employment definition bill was not on the agenda for discussion, the AzNa and its national body the ANA have been working to gather information to understand the effects that this bill would have on the nursing profession. Currently, the ANA opposes the bill and has been requesting input from nurses on how this bill would affect the profession negatively in order to forward the information to Congress (rnaction.org, 2014). This is an example of the private sectors role in the advancement of policy.

Other, private sector, nursing associations such as the Service Employees International Union’s  (SEIU) Nurse Alliance Northwest organization, according to their website http://www.seiu.org, have resumed their blog “Nurses Know the Truth,” Correct the Record on the 30-Hour Rule, to shed light on the facts associated with the passage of the 40- hour full-time employment policy one of which is that the bill could allow employers to cut hours for more people to avoid paying for their health insurance premiums (Barton, 2015). In an independent study, it was found that though employers would not face a penalty from the government for reducing work hours for employees, employers might still end up having to incur costs due to these employees with reduced hours having to use tax credits for health care coverage (Hope, 2013). The private sector is invaluable to any economy and has a lot to contribute to creating policies to assist with their delivery of services.

References

American Nurses Association (ANA). (2014). When Nurses Talk…Washington Listens. Retrieved from http://www.rnaction.org/site/MessageViewer?dlv_id=12121&em_id=15681.0

Barton, C. (2015). “Nurses Know the Truth,” Correct the Record on the 30-Hour Rule. Retrieved from http://www.seiu.org/2015/01/nurses-know-the-truth-correct-the-record-on-the-30.php

Hope, C. (2013). New Study Finds Failure to Expand Medicaid Could be Costly for Employers. Retrieved fromhttp://ccf.georgetown.edu/all/new-study-finds-failure-to-expand-medicaid-would-hurt-employers/

Kingdon, J. W. (2011). Agendas, alternatives, and public policy (updated 2nd ed.). Glenview, Il.: Pearson Education, Inc.

Smith, E., Brugha, R., & Zwi, A. (2001). Working with Private Sector Providers for Better Health Care: An Introductory Guide. Retrieved from http://www.who.int/management/partnerships/private/privatesectorguide.pdf

Week 7: Medicaid and the Affordable Care Act as Examples of Public Policy Implementation

As discussed last week the government is how the public sector provides services for the general public/population as needed. As previously defined, the public sector of an economy is the sector responsible for providing public services (investorwords.com, 2015). The Patient Protection and Affordable Care Act (PPACA) also known as the Affordable Care Act (ACA) was created to reform the health insurance industry and entire health care system (obamacarefacts.com, n.d). The purpose of the ACA policy is to make sure that all Americans have healthcare coverage though it may inadvertently causing some to be unable to continue to gain coverage for their health care insurance needs from their employer, thereby causing more people to need aid from the government. This ultimately puts a burden on the Medicaid. Eligibility for Medicaid is currently that individuals who make approximately 133% or less of the federal poverty level may qualify for coverage, including adults with dependent children (U.S. Department of Health and Human Services, 2014) which fall into categories such as a certain age, pregnant women, parents of Medicaid-eligible children who meet certain income requirements, and low-income seniors to mention a few and it is up to each state to define the details of each category. For example, in New York State, there is a program called the Medicaid Buy-in Program for Working People with Disabilities where on the website one of the requirements to be eligible is to be engaged in paid work either on a full or part-time basis. Neither full-time nor part-time employment are defined by this website or any other I could find. Hines (2012) had reported that Wal-Mart was attempting to lower costs by taking advantage of the, then, fairly new ACA policy.

Garfield, Damico, Stephens and Rouhani (2014) explained in a report that most people who fall into the coverage gap will not be able to afford ACA coverage without assistance though they work full or part-time but below the poverty line. Remember full and part-time work are still not being defined. These authors speculate that this portion of the population will still remain uninsured even after the ACA is fully implemented due to out-of-pocket costs and ineligibility for cost-sharing subsidies for Marketplace coverage. Ultimately reverting the burden to Medicaid. Another article reports that even though employees who do not qualify for insurance through their employers due to employment status (“full-time” or not) would qualify for Medicaid or be eligible to use tax credits at marketplace exchanges for coverage, with employers not facing a penalty, this could be expensive for employers in states that do not accept the Medicaid expansion option because the employers would then have to pay a higher shared responsibility payment for employees who use tax credits for health care coverage (Hope, 2013).

References.

Garfield, R., Damico, A., Stephens, J. & Rouhani, S. (2014). The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid – An Update. Retrieved from http://kff.org/health-reform/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid-an-update/

Healthcare.Gov. (n.d.). Medicaid and CHIP coverage. Retrieved from: https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

Hines, A. (2012). Walmart’s New Health Care Policy Shifts Burden to Medicaid, Obamacare

Retrieved from http://www.huffingtonpost.com/2012/12/01/walmart-health-care-policy-medicaid-obamacare_n_2220152.html

Hope, C. (2013). New Study Finds Failure to Expand Medicaid Could be Costly for Employers. Retrieved from http://ccf.georgetown.edu/all/new-study-finds-failure-to-expand-medicaid-would-hurt-employers/

U.S. Department of Health and Human Services. (2014). How the health care law is making a difference for the people of Arizona. Retrieved from: http://www.hhs.gov/healthcare/facts/bystate/az.html

WebFinance, Inc. (2015). Public Sector: Definition. Retrieved fromhttp://www.investorwords.com/3947/public_sector.html

Week 6 – The Public Sector and its Influence on Healthcare Policy

This week’s topics focus is on the public sector and its influence on healthcare policy and the efforts to assist the uninsured, under-insured and otherwise less advantaged with healthcare coverage. The public sector of an economy is the sector responsible for providing public services (investorwords.com, 2015). This is essentially the government. With regard to health care, the government of the United States (U.S.) currently has the Patient Protection and Affordable Care Act (PPACA), called the Affordable Care Act (ACA) for short, and its main purpose is to reform the health insurance industry in the U.S. and its entire health care system (obamacarefacts.com, n.d).

This health care policy is great because it is a way to aid every American get some form of health insurance whether employed or not. The only thing is part of the ACA law is defining full-time employment. The United States Department of Labor under the Fair Labor Standards Act (FLSA) clearly states that it “does not define full-time employment or part-time employment and that the matter is generally to be determined by the employer.” (www.dol.gov, n.d.). Every organization has been allowed to define the term full-time employment for the purposes of their business and what benefits to offer their employees. This has generally been at least 30 hours per week.

The thing now is, and this could be viewed as a problem, if employers adopt this new definition of full-time employment and then most of their employees are no longer under full-time employment (in an attempt to not have to follow the mandate of the ACA policy to offer healthcare insurance to full-time employees), then these employees would have to rely on the government, the ACA policy or Medicaid, for health care coverage which puts a burden on the federal budget (Reich in Frick, 2015). The purpose of the ACA policy is to make sure that all Americans have healthcare coverage though inadvertently causing some to be unable to continue to gain coverage for their health care insurance needs from their employer, thereby causing more people to need aid from the government.

The government, Congress and the House of Representatives, should further consider the long ranging effects of this piece of legislature to define full-time employment as 40 hours per week and its ripple effects, a few of which have been hinted at above such as employers using the new law to avoid the mandate to provide health care insurance to their full-time employees and these employees in turn having to rely on the government for coverage.

References

Frick, W. (Interviewer) & Reich, R. (Interviewee). (2015). Robert Reich on Redefining Full-Time Work, Obamacare, and Employer Benefits.  Retrieved from https://hbr.org/2015/01/robert-reich-on-redefining-full-time-work-obamacare-and-employer-benefits

Obamacare Facts. (n.d). ObamaCare Summary: Obama Health Care Summary. Retrieved from http://obamacarefacts.com/obamahealthcare-summary/

United States Department of Labor. (n.d.). Work Hours: Full-Time Employment. Retrieved from http://www.dol.gov/dol/topic/workhours/full-time.htm

WebFinance, Inc. (2015). Public Sector: Definition. Retrieved from http://www.investorwords.com/3947/public_sector.html

Week 5: The Process of Developing Healthcare Policy

The World Health Organization (WHO) defines health policy as “the decisions, actions and plans that are undertaken to achieve specific health care goals within a society.” (www.who.int, 2015). The entire healthcare system and the politics that affect its public and private sectors all contribute to the development of healthcare policy. A model I found that could be viewed as universal to all policy development is the Nurse’s Role in Policy Development Model (Edelstein, Gallagher, Hansen Ebeling &Turner, 2010). This model depicts the five stages of the process as identification, assessment, policy development, planning and implementation, with each stage further explained for a general knowledge of what that stage entails. Another explanation of the process of making a bill into law is described by the National Association for the Education of Young Children (NAEYC) at their website with a detailed description of the process in its entirety.  The explanation of the process is used to outline what has happened so far with the ACA 40 hour work week definition which has two bills. Both pieces of legislature seek to amend the current policy which mandates employers to provide health care coverage to their full time employees currently at 30 hours per week and increase the full time employment definition to be 40 hours per week.

At the government level, a policy starts as a bill. A bill has to be sponsored by any member of congress and it is that member that introduces the bill initially with the designations of H.R. for House bills and S. for Senate bills (www.naeyc.org, n.d.). After introduction of the bill and designation as mentioned previously, the bill is sent to the appropriate committee with jurisdiction over the bills primary issue.

In the case of the ACA 40 hour definition of the work week, the original bill was H.R.2575 – Save American Workers Act of 2014 and was introduced in June 2013 by Rep. Young, Todd C (R-IN-9) and passed in April 2014 (www.congress.gov, 2014). The bill was read again in April 2014 and then place on the Senates Legislative Calendar. In the Senate it was introduced by Sen. Susan Collins (R-ME) as S.30 – Forty hours is Full Time Act of 2015 where it was read twice upon introduction and has been referred to the Committee on Finance (www.congress.gov, 2015).At this time there is no date for further action.

A report of the bill detailing the intent, legislative history, its impact on current laws and programs and the position of the majority of the members of the committee is written by the referral Committee Chairman’s staff which speaks to the premise of the policy and the repercussions of its passage. If it passes again it is referred to the other chamber who reviews it again before there is a conference on the bill and then it goes on for action by the President. If the President approves of it or does not take action for 10 days whiles congress is in session, it is signed by the President and becomes the law. If the President opposes, the President could veto it or if the president takes no action and Congress’ second session is in adjournment, the bill becomes a “pocket veto” and the legislation dies. If a bill is vetoed by the President, Congress could attempt to override the veto which would require a two-thirds roll call vote of the members who are present and this has to be in enough numbers to meet a quorum (www.naeyc.org, n.d.).

Regulatory mechanisms would include the Department of Labor, Department of Justice and organizational and governmental bodies that would generally oversee employment (such as human resources) and the details of health care insurance for employees.

References

Congress.gov. (2014). H.R.2575 – Save American Workers Act of 2014. Retrieved from https://www.congress.gov/bill/113th-congress/house-bill/2575/

Congress.gov. (2015). S.30 – Forty Hours Is Full Time Act of 2015. Retrieved from https://www.congress.gov/bill/114th-congress/senate-bill/30?q=%7B%22search%22%3A%5B%22forty+hours+is+full+time+act+of+2015%22

Edelstein, J., Gallagher, R., Hansen, J., Ebeling, J., and Turner M. (2010). Shaping Public Health Nursing Practice: A Policy Development Toolkit. Linking Education and Practice for Excellence in Public Health Nursing. Retrieved from http://sspw.dpi.wi.gov/sites/default/files/imce/sspw/pdf/snpolicytoolkit.pdf

National Association for the Education of Young Children. (n.d.). Steps in Making a Bill a Law: The Federal Legislative Process. Retrieved from http://www.naeyc.org/policy/federal/bill_law

World Health Organization (WHO). 2015. Health topics: Health policy. Retrieved from http://www.who.int/topics/health_policy/en/