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/


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

  1. There are two sides to this issue. I can see the benefits of each one. As a business owner myself (albeit without employees) I can see why there is support for the 40 hour work week. If an employer is going to provide health insurance, they will need some sort of commitment or return on investment from their employees. Some employees will try to make the minimum amount of hours to get benefits, but then the employer is stuck with less help when they need employees who will work to their full potential, thus costing them revenue. Contrary to popular belief, running a business is not as profitable as some would assume. There are tremendous taxes, which keep rising every year, as well as insurance and enormous overhead costs. However, many dentists use the 30 hour work-week to their advantage, never letting their dental hygienists work past 30 hours because they do not want to provide them with health insurance. Advocating the 30 hour work week would continue to stifle dental hygienists’ income.

    On the other side, I see how many RN’s harbor concern over the 40 hour work week, as many of them work three 12-hour shifts and therefore only put in 36 hour per week. Yet, I genuinely believe that large hospital organizations would NOT cut all the health insurance for RNs. RN’s would quit in mass numbers if they did! Just because something is law, does not mean employers will have to enact it. There are many employers who elect to pay higher than minimum wage, even though they are not required to do so. It will be interesting to see how this issue pans out.

    Liked by 1 person

    1. After reading Lorraine’s comments, I further see the two sides of the discussion but I honestly don’t want anything to take away from those professions that have seen the benefits of working less than 40 hours but more than 30. That being said I like Lorraine’s point also that RNs would quit, en masse, if hospitals decided to not offer health insurance just because they didn’t have to. I’m not trying to sit on the fence but if its not broken, lets not try to fix anything.


  2. You have provided many relevant examples of the players involved in health policy making in regards to the ACA 40 hour full time definition. Interest groups can range from provider organizations, health practitioners, state and local groups, as well as groups that consumers can join (Longest, 2010). This topic significantly impacts consumers and individuals, which is an example of why it is necessary as a consumer to be involved in policy development if possible. As nurses, who would largely be affected by this bill, it is important to be involved in organizations that are standing up for them, such as the American Nurses Association. The ANA’s actions are a good example of how consumers can be involved and contribute to the development of this policy.

    Longest, B.B. Jr. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.


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