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).


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.


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.


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/

Week 4: Actors and Institutions Roles in the Development of Healthcare Policy

As I reflected upon the Affordable Care Act (ACA) 40 hour fulltime employee definition, I began to wonder just who the players are in the development of this policy. It is not just our elected representatives but we all in the form of organizations, employers, employees, and legislators who have a role to play in the development of policy in general. The Patient Protection and Affordable Care Act (PPACA) is commonly referred to as the ACA or Obamacare.

For some history, the PPACAs original concept dates back to at least 1989 when it was proposed that single-payer healthcare system, which is defined as a system where healthcare service providers are paid by the government and not my private insurers (www.Mariam-Webster.com, 2015) would be an alternative to individuals being required by law to purchase healthcare insurance(Roy, 2012). Then in 1993 then Pres. Bill Clinton propose the health care reform bill which would have made it mandatory for employers to make health insurance available to all employees through a marketplace of health maintenance organizations which would’ve been regulated, But Republican senators had an alternative proposal that would’ve made individuals have to buy their own insurance and not employers (Cooper, 2012). Though President Clinton’s attempts failed, other efforts yielded in his signing the state children’s health insurance program (SCHIP) into law in 1997.

Fast forward to 2006 when the Massachusetts Health reform act was passed which required that all adults resident in the state had to obtain a minimum level of insurance coverage the state would provide free healthcare insurance for residents earning less than 150% of the Federal poverty level (FPL) and employers with more than 10 full-time employees were mandated to provide healthcare insurance to their employees (www.massresources.org, 2015).

Though health care reform was still a hot topic during the 2008 Democratic presidential primaries and much work went into developing a Health care reform bill, it wasn’t until 2010 that the ACA bill, also known as the PPACA was signed into law. More recently part of the ACA bill which is being referred to as  the ACA 40 hour definition of the work week was introduced as  H.R.2575 – Save American Workers Act of 2014 June 2013 and passed in Congress in April 2014 (www.congress.gov, 2014).  And most recently it was introduced in the Senate as S.30 – Forty hours is Full Time Act of 2015 where it was read twice upon introduction and its current status is that it has been referred to the Committee on Finance (www.congress.gov, 2015).

This bill to define full time employment per week as 40 hours is being criticized by both political parties (Holpuch, 2015). There is a report that Pres. Obama will veto the legislation (Pavlich, 2015) and the American Nurses Association (ANA) opposes the bill and is requesting input from nurses to be forwarded to congress on why this bill would negatively impact this work population (www.rnaction.org, 2014). These are only a few examples of some of the players involved in the making of this policy. There are supporters of the bill but the overwhelming reaction seems to be to oppose the bill.

All parties involved in the development of a policy will most likely be affected by that policy in one way or another and so due diligence needs to be brought to bear in order to make the most appropriate decisions/policies that will benefit the majority and not the minority of the population.

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

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

Community Resources Information, Inc. (2015). Massachusetts Health Insurance Requirements. Healthcare Reform Act. Retrieved from http://www.massresources.org/health-reform.html

Cooper, M. (2012). Conservatives Sowed Idea of Health Care Mandate, Only to Spurn It Later. Retrieved from http://www.nytimes.com/2012/02/15/health/policy/health-care-mandate-was-first-backed-by-conservatives.html

Holpuch, A. (2015). Bill to define work week as 40 hours gets criticized by both political parties. Retrieved from http://www.rawstory.com/rs/2015/01/bill-to-define-work-week-as-40-hours-comes-in-for-criticism-from-both-political-parties/

Merriam-Webster, Incorporated. (2015). Single-Payer. Retrieved from http://www.merriam-webster.com/dictionary/single-payer

Pavlich, K. (2015). Obama Will Veto Legislation Restoring the 40-Hour Work Week. Retrieved from http://townhall.com/tipsheet/katiepavlich/2015/01/08/obama-will-veto-legislation-restoring-the-40hour-work-week-n1939704

Roy, A. (2012). The Tortuous History of Conservatives and the Individual Mandate. Retrieved from http://www.forbes.com/sites/theapothecary/2012/02/07/the-tortuous-conservative-history-of-the-individual-mandate/