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/


3 thoughts on “Week 5: The Process of Developing Healthcare Policy

  1. You provided a clear and detailed picture regarding the development and current events concerning the passage of these 2 pieces of legislation. I believe that this is an issue that all nurses who work in the acute care setting should be paying attention to and contacting their representatives to voice their concerns. Regarding the 40 Hours is Full Time Act, are there any preliminary thoughts regarding whether this act will pass through both the House and Senate (or just one any not the other)?


    1. Thank you for your comment. I also believe that acute care nurses should be paying attention but more that, any one/ professional group that will be affected by this should be in touch with their respective representative to voice their opposition to this policy.
      I honestly have no feel for if this will pass or not. It doesn’t help matters that it passed the first time. I’m encouraged by reports that the President will veto the law if it passes and comes to him for signature but then again that can be overturned as we have learned in writing about the entire process of getting a law passed this week.
      With all this being said I would like to believe that not all organizations would strictly adhere to this law but if it means more profits for them then of course they will. I used to work at a facility where though we worked 3 12 hour shifts, full time employment, in the policy of the company, was a minimum of 30 hours/week.
      To be honest again, I don’t see how this policy will make the workforce more loyal to their employers and all the other reasons why proponents of this policy are giving for supporting it but I can tell you not a lot of “employees” are in support of this policy and in the end isn’t it a democracy where the voices of the majority should be heard. They (the government) should take a poll and see what the result is.

      Liked by 1 person

  2. Getting something out of committee(s) is always half the battle! The ANA has information on this and has a Legislative call for RN action on this issue. While its hard to tell which way this may go, I could see this going on to a court system to be fought. They frequently set policy, in a judicial way with Supreme Court rulings.


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