Policymaking is a term most Americans heard of; and all Americans have directly been effected by on a daily basis. In a nutshell, policymaking occurs at a federal, state, or local level; and involves decision making to establish laws as solutions to problems with the goal of improving quality-of-life for all its citizens.
Premise of Policymaking
There are steps in the policy making process that include: (1) identification of a problem; (2) setting of an agenda; (3) formulation of a policy; (4) adoption of the policy; (5) implementation of the policy; and (6) evaluation of the policy (USHistory.Org, 2014). This process is familiar to healthcare professionals, especially nurses, when speaking about the nursing process. Does anyone in nursing remember the acronym ADPIE (e.g., assess, diagnose, plan, implement, and evaluate) that was implanted into our novice brains?
Back to policymaking…when it comes to health care policy, they are formulated with the goal of the pursuit of health; and led to such reforms as Medicare and Medicaid in 1965; and now the emergence of the Affordable Care Act (ACA) in 2010 (Longest, 2010). Policies like these were made at the federal level, but with Death With Dignity laws, the federal government has placed the decision in the states’ hands.
Here is a recent map depicting the current states either with aid in dying laws passed (e.g., green states) or in the campaigning stage (e.g., orange states):
(Compassion and Choices, 2015)
As one can deduce, the blue states are not in the campaigning stage; and will have to wait until a bill for aid in dying is either introduced or re-introduced (as in the case of Arizona where the bill came up for debate in the house multiple times).
There was an interesting article in the New York Times (2013) pertaining to how getting laws passed on the national level is challenging due to political polarization. In layman’s terms, this means Democrats and Republicans cannot reach an agreement in Congress to pass bills, hence the legislative process stalls. Such national issues like gay rights and aid in dying are now pushed to state governments to make decisions; and state officials have the power to challenge national policy by passing laws (New York Times, 2014).
This week I had the honor to interview former member of Maryland’s House of Delegates, Sam Arora. Since this week’s blog featured policymaking, I thought it would be a perfect opportunity to get answers from a person who was actually part of a state policy making process. Some interesting points Mr. Arora had to share were the following:
- A good bill usually doesn’t pass the first time it is introduced.
- A bill that is continually vetoed still has the potential to pass.
- Policymakers are not always “politicians”; and the majority of bills are drafted by lobbyist groups (although he didn’t operate that way).
- The biggest challenge of policymaking was time, staffing, and resources (he only had a budget of $39,000).
- A good policymaker has to reach across the aisle; and campaign for his bill to pass.
- Healthcare professionals, like advanced practice registered nurses (APRNs), have an important voice in policymaking; and can be extremely credible attesters for proposed bills.
Please click on the audio below for this intriguing view into policymaking on a state level.
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We learned the definition(s) and premise of policymaking, especially pertaining to healthcare. Please join me for Week Four for more thoughts on the issue of aid in dying.
Compassion & Choices AZ (2005). In your state. Retrieved from https://www.compassionandchoices.org/what-you-can-do/in-your-state/
Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.
New York Times (2014). States get things done, affecting national policy. Retrieved from http://www.nytimes.com/roomfordebate/2013/07/16/state-politics-vs-the-federal-government/states-get-things-done-affecting-national-policy
USHistory.Org (2014). Policymaking: Political interactions. Retrieved from http://www.ushistory.org/gov/11.asp