Monthly Archives: February 2015

Week Eight 3/4/15 – 3/11/15 Private Sector Innovation and Policy Advancement

private sector

Public Sector regarding Policy Advancement

Welcome back to the dignity discussion. In Week Six we talked about the public sector influences on policymaking. This week, let’s talk about the public sector.

We established that the public sector constitutes governmental federal, state, local, county, and city agencies that perform public services and establish laws for the greater good of its citizens. What about the private sector? Since the public sector is government run than the private sector is categorized as businesses, organizations, or agencies that are not government controlled. The private sector can also be divided into for profit (e.g., monetary goals) and not-for-profit categories (e.g., has a greater mission other than monetary).

Longest (2012) describes the influence of interest groups on the policymaking process hinges on the amount of resources they have at their disposal. In Week Two, former Maryland State Representative, Sam Arora, confirmed this by stating the following:

  • 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).

Other factors that can influence policymaking is the size of group’s membership and the prestige of the group (Longest, 2012; Ornstein and Elder, 1978).

Private Sector and Death With Dignity

In Arizona, the aid in dying bill had been repeatedly denied. When speaking with Mr. Arora, I inquired if this bill still has a chance to pass. Mr. Arora did say a good bill always has a chance to pass, especially when there are lobbyists or interest groups are supporting the bill.

Today, legislators wanting to pass the aid in dying bill in their states are looking to organizations like Death With Dignity and Compassion & Choices to help with education and legislation.

Here are a couple of articles about legislators who have reached out to these organizations to elicit public support; and help draft bills.

In the below article, Compassion & Choices is organizing rallies in California to support an aid in dying bill (Santa Barbara Independent, 2014).

http://www.independent.com/news/2014/nov/08/dying-dignity-santa-barbara/

In this article, the lawfirm Debevoise & Plimpton LLP and advocates with the groups Disability Rights Legal Center and End of Life Choices New York (EOLCNY) filed a lawsuit in the New York Supreme Court to allow doctors to prescribe lethal prescriptions (Newsweek, 2015).

http://www.newsweek.com/new-lawsuit-could-make-new-york-sixth-state-where-doctors-can-aid-dying-304495

compassion and choices

Final Thoughts

These examples show how the private sector could influence policymaking for the aid in dying  movement. I invite those who support the movement to visit the Death With Dignity (www.deathwithdignity.org) and Compassion & Choices  (www.choicesarizona.org) websites to learn more about the organizations; and to investigate how to bring the movement to Arizona.

References

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

Newsweek (2015). New lawsuit could make N.Y. 6th state where doctors can ‘aid in dying.’ Retrieved from http://www.newsweek.com/new-lawsuit-could-make-new-york-sixth-state-where-doctors-can-aid-dying-304495

Ornstein, N.J., & Elder, S. (1978). Interest groups, lobbying, and policymaking. Washington, DC: Congressional Quarterly.

Santa Barbara Independent (2014). Dying with dignity in Santa Barbara. Retrieved from http://www.independent.com/news/2014/nov/08/dying-dignity-santa-barbara/

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Week Seven 2/25/15 – 3/4/15 Medicare, Medicaid, and the Affordable Care Act as Examples of Public Policy Implementation

Image result for affordable care act

Medicare, Medicaid, and the Affordable Care Act as examples of Public Policy Implementation

Welcome back to Dignity Discussion. This week let’s talk about Medicare, Medicaid, and the Affordable Care Act (ACA) as examples of public policy implementation. In past weeks we acknowledged that Medicare, Medicaid, and the ACA were programs established to provide needed services to United States (US) citizens. Let’s recap:

  • The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).
  • In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).
  • The ACA was responsible for expanding healthcare coverage for millions of Americans; and also lowered healthcare costs; ended preexisting exclusions for children; and provided preventive care at no cost (US Department of Health and Human Services, 2015).

This all sounds like pretty good stuff? Let’s take look how this all relates to Death with Dignity laws…

Image result for death panels

Medicare, Medicaid, the ACA…and Death with Dignity?

The ACA’s goals are to to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors. There is only one section in the ACA that states no healthcare professional shall be discriminated against if he or she chooses not to supply items or care in the physician-assisted suicide process (e.g., ACA Section 1553) (Patients Rights Council, 2013).

Last week, it was mentioned that states with aid in dying laws received no federal money for these types of services; therefore, if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014). Currently, Medicare and Medicaid pays for hospice services (e.g., Medicare Part A); and under the ACA, patients under the age of 21 can seek curative treatments while still under a hospice program without jeopardizing being discharged or paying out-of-pocket for hospice services (Medicaid.gov, n.d.).

A provision of the ACA was the enactment of the Independent Payment Advisory Board (IPAB). This 15 member (non-political) board, chosen by President Barack Obama (and approved by members of the Senate and House of Representatives), is designed to cut Medicare healthcare costs (American Medical Association, 2015). This is the “death panel” I spoke about last week. Opposition to the IPAB suggests that cutting Medicare pay rates leads to limiting access to care. In simpler terms, if a person with a terminal illness wants to pursue aggressive treatments then it will not be paid for under the ACA.

Let’s look at a video from Fox News on The IPAB:

ACA “Death Panels”

In states like Oregon, where aid in dying exists, people have reported wanted treatment for terminal illnesses and getting coverage denied, but received letters that lethal prescriptions will be paid for.

Oregon Debate

Final Thoughts on ACA policy and Death with Dignity

Death and dying is a hard topic to discuss. I believe if health care decisions are broached early on it may make one’s decision about treatment options easier for themselves and their loved ones. Although, is it fair to deny a person aggressive treatment options for a life threatening disease, especially is that person is of advanced age?

One thing is for sure, opponents to aid in dying in the state of Arizona will have more ammunition with the death panel case when it comes to passing future bills.

Let’s take a poll. What do you think?

 

References

American Medical Association (2015). Independent payment advisory board. Retrieved from http://www.ama-assn.org/ama/pub/advocacy/topics/independent-payment-advisory-board.page?

KVAL.com (2008, July 31). Health plan covers assisted suicide but not new cancer treatment. Retrieved from http://www.kval.com/news/26140519.html?tab=video&c=y

Media Matters for America (2014, December 4). Fox resurrects ACA “Death Panels” myth. Retrieved from http://mediamatters.org/video/2014/12/04/fox-resurrects-aca-death-panels-myth/201773

Medicaid.gov (n.d.). Hospice benefits. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/hospice-benefits.html

Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

Patients Rights Council (2013). Health care reform. Retrieved from http://www.patientsrightscouncil.org/site/health-care-reform/

Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html

Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html

Week Six 2/18/16 – 2/25/15 Public Sector Influence on Healthcare Policy : Efforts to Aid the Uninsured, Underinsured, Disabled, and Decrease Health Disparities

Recent Public Sector Influences

Hello and welcome to the discussion about public sector’s influence on healthcare policy. Last week, we discussed the Affordable Care Act (ACA) 2010. The ACA was responsible for expanding healthcare coverage for millions of Americans; and accomplished the following

  • Lowered healthcare costs
  • Ended pre-existing exclusions for children
  • Kept young adults (under the age of 26) insured under their parent’s healthcare plan
  • Provided preventive care at no cost, and allows people to seek emergency services outside their plan (US Department of Health and Human Services, 2015).

The goal behind the ACA is to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors.

Public Sector Influences on Death With Dignity

Since no aid in dying law exists in Arizona, let’s look at how the public sector influences the Death With Dignity law and efforts to protect the uninsured, underinsured, disabled, and those with any other health disparities.

A great place to start was a guidebook for medical professionals written by an Oregon task force to improve the care for terminally-ill patients. In the guidebook it covered many areas including patient’s rights and responsibilities, mental health consultations, and financial issues.

Here are some statements I found important for this topic:

  • Patients have the right to their medical condition and prognosis to order to make informed decisions regarding treatment options
  • Patients have the right to know if their healthcare provider, healthcare plan, or system participates in the Death With Dignity Act
  • If a patient should change physicians in order to obtain a prescription from a participating physician, human and skilled care must continue until the transfer is complete.
  • Patients only deemed mentally-competent can participate in the law.
  • A Depression screening is recommended for all patients wanting a lethal prescription. If the screening is positive, a referral to a psychiatrist or psychologist is warranted.
  • If perceived patients are choosing lethal prescriptions due to financial burdens should be explored
  • Physicians, hospitals, or others involved in care who are perceived to have a direct or indirect financial interest should be disclosed during discussions about treatment options (Oregon Health and Science University, 2008).

I found the financial points interesting. It never states who exactly pays for lethal prescriptions, but through some more investigation I discovered that the Death With Dignity Act does not specify who pays for the services, but it is decided upon individual insurers (and under the Act it is not deemed suicide so insurers cannot view as such upon determination). Also, no federal funding can be utilized for services, so if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014).

Recent articles report how President Obama would like Medicare to reimburse providers for end-of-life counseling. Obama wanted to include this in the ACA, but opposition quickly followed. Remember Sarah Palin’s death panel discussions? Since 2010, Medicare did mandate coverage for advance care planning during wellness visits; and private insurance companies, like Blue Cross/Blue Shield of Michigan, are reimbursing  $35 for end-of-life discussions (Compassion & Choices of Washington, 2014).

Since aid in dying state’s decision, it will be up to the state government to influence healthcare policy; and protect the under served in it’s decision making process.

Below is a video about the ACA…do you agree with these stances? Are seniors and those with disabilities be targeted for these ‘death panels?’

See you in Week Seven!

References

Compassion & Choices of Washington (2014). Coverage for end-of-life talks. Retrieved from http://compassionwa.org/news/coverage-end-life-talks-gaining-ground/

Oregon Health and Science University (2008). The Oregon Death with Dignity Act: A guidebook for healthcare professionals. Retrieved from http://www.ohsu.edu/xd/education/continuing-education/center-for-ethics/ethics-outreach/upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf

Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf

The Big Picture (2014, May 22). Sarah Palin was right: There are death panels in America. Retrieved from https://www.youtube.com/watch?v=6mD7iYFovdk

United States Department of Health and Human Services (2015). About the law. Retrieved from http://www.hhs.gov/healthcare/rights/

Week Five 2/11/15 – 2/18/15 Healthcare Policymaking Including Statutory and Regulatory Mechanisms

Welcome to Week 5! Let us begin this week by reviewing some definitions. What exactly are statutes and regulations?; and how do they link in with the policymaking process, especially regarding Death with Dignity?

Statues and Regulations

Statutes are written laws made by legislators on a federal or state level (Georgetown Law, 2014).

Regulations are the force of the law that governs; and an explanation on how a governing agency intends to carry out laws (Kraft and Furlong, 2014; USA.gov, 2015).

How Does This Relate to Policymaking?

Let’s simplify this some more by giving a recent example. For instance, the Affordable Care Act (ACA) was passed by Congress; and signed into law (a statute) by President Barack Obama in 2010. With the passing of the ACA how does Congress have the time to enforce the new law? Truth is, after a law is passed there are agencies, boards, or commissions assigned to help with the rulemaking process. During this process, rules are created and with the help of public feedback, the rules are either changed, added, or kept; and then final rules are registered with the Federal Register (USA.gov, 2015). One regulatory agency for the ACA was the Center for Consumer Information and Insurance Oversight (CCIIO), which assisted with implementing many of the provisions of the ACA that dealt with private health insurance (Centers for Medicare and Medicaid Services, n.d.).

How Does This Apply to Our Death with Dignity Discussion?

As mentioned in previous posts, Arizona currently does not have any aid in dying laws on the horizon; and the federal government has told states to make their own statutes regarding aid in dying. So who helps with regulation process once an aid in dying law passes?

Let’s look at the state of Oregon, the Death with Dignity statue was initiated in 1997. Within the Death with Dignity Act (1997), it required the Oregon Health Authority (OHA) to be involved in the regulation process. For instance, the OHA collects all patient and physician information; mandates certain reporting practices, and publishes yearly statistical reports (Oregon Health Authority, (n.d.).

Here is the link to the most recent Death with Dignity Statute in Oregon; and Death with Dignity Rules:

http://public.health.oregon.gov/RulesRegulations/Pages/index.aspx

Final Thoughts

This week we talked about statutes and regulations. The policymaking and implementation process does appear to have its good points. I especially like the fact that during the regulatory process the public can voice opinions. But what do you think?

Please join me next week when we discuss how the public sector influences healthcare policy (especially in regards to aid in dying).

References

Centers for Medicare and Medicaid Services (n.d.). Consumer information and insurance oversight: Ensuring the Affordable Care Act serves the American people. Retrieved from http://www.cms.gov/cciio/

Georgetown Law (n.d.). Overview of administrative law. Retrieved from https://www.law.georgetown.edu/library/research/tutorials/admin/upload/1_overview_text.pdf

Kraft, M. E., & Furlong, S.R. (2015). Public policy: Politics, analysis, and alternatives (4th edition). Los Angeles, CA: Sage Publications, Ltd.

Oregon Health Authority (n.d.). Public health’s role. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/ohdrole.aspx

Oregon Health Authority (n.d.). Rules and regulations. Retrieved from https://public.health.oregon.gov/RulesRegulations/Pages/index.aspx

USA.gov (2015). Laws and regulations. Retrieved from http://www.usa.gov/Topics/Reference-Shelf/Laws.shtml

Week Four 2/4/15 – 2/11/15 The Historical and Contemporary Role of Institutions and Actors (Including Consumers) in Developing Healthcare Policies

Historical and Contemporary  Role of Institutions and Actors (Including Consumers) in Developing Healthcare        Policies

Welcome back to Week Four’s discussion. This week let’s delve a little further into healthcare policies by focusing on the historical and contemporary aspects involving the role of institutions and actors (including consumers) in the policymaking process.

Last week, I mentioned the basics about policies and why they exist. To reiterate, policies ensure people’s basic needs and rights are met (e.g., health, education, and safety). Also mentioned was the Medicare and Medicaid Act in 1965 that was an amendment to the original Social Security Act of 1935 signed by President Franklin Delano Roosevelt (Centers for Medicare and Medicaid Services (CMS), 2013). The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).

In recent times, there have more amendments and provisions to the Medicare and Medicaid Act:

  • In 2003, President George W. Bush signed the Medicare Modernization Act (MMA) that included an outpatient prescription drug benefit; and other provisions (CMS, 2013).
  • In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).

So now that we covered some historical and contemporary healthcare policies what does it mean when asked how does the role of institutions and actors (including consumers) play in development of healthcare policies? Longest (2008) discusses the role people, organizations, and interest groups have on healthcare policies; and prefaces the discussion by noting two related areas of interest between the groups:

  1. All have an analytical interest, meaning how will these policies affect me and the ones I love? And demand to know prior to prepare.
  2. All want to have influence on the policies proposed since the consequences will be affecting them and their loved ones.

So far this makes sense…and to add one more thing… when one can effectively analyze and influence policy, one is deemed having policy competence (Longest, 2008).

Who are these people, organizations and interest groups that affect policymaking? Longest (2008) goes on to clarify:

  • People – Would include citizens of the United States (US). The government mandates healthcare policies to aid its citizens for their pursuit of health.
  • Organizations – Would include hospitals, state or county health departments, health maintenance organizations (HMOs), nursing homes, or hospices. Many of these organizations developed as a result of healthcare policymaking.
  • Interest Groups – Would include groups like the American Hospital Association, the American Medical Association (AMA), the American Nurses Association (ANA), the Association of American Medical Colleges (AAMC); or the American Association of Retired Persons (AARP). it should be stated that these interest groups could be primary service providers (like the AHA); individual health practitioners (like the ANA); secondary service providers (like the AAMC); or individual (consumer) member constituencies (AARP). The interest groups are motivated to be involved in policymaking over the economic or health concerns of its members; or maybe both.

This brings up a good point that Sam Arora, the Maryland state legislator, mentioned last week during my interview which was having limited funds to pay staff to help develop and draft policies. You need staff to help in the policymaking process; hence why special interest groups are successful in developing policies because they have the money and staff to do these necessary tasks.

How Does This Relate to Death With Dignity?

A Death with Dignity law does not currently exist in the State of Arizona, but who could get involved (e.g, institutions or actors) to help develop this policy? To start, it helps to start with special interest groups because they have money. Organizations like Death with Dignity and Compassion & Choices have been essential to passing the aid in dying law in states like Oregon; and currently, they are helping states like California draft bills.

With stories like Brittany Maynard in the national spotlight, it gets individuals (actors) involved in their state policymaking for bills like aid in dying. Media attention equals exposure. Just this week I spotted Brittany Maynard’s widower on the cover of People magazine. This will only help in getting individuals to sign petitions and demand action from their elected officials. This is power!

Death with Dignity is not considered a money maker in the healthcare world (nor should it be). Meaning if it were to make some company or institution millions, it may have more institutions or actors behind the bill. Although when we look back in history, the Medicare and Medicaid Act in 1965 was supported heavily by such groups as the American Hospital Association (AHA), the American Federation of Labor and Congress of Industrial Organizations (AFI CIO) and the ANA. The AHA got involved heavily with the bill because private hospitals were losing money due to elderly patients being unable to pay their bills (Social Security Online, n.d.).

Let’s end this post with a poll. I am interested in your opinion…

References

Centers for Medicare and Medicaid Services (2013). History. Retrieved from http://www.cms.gov/About-CMS/Agency-Information/History/index.html?redirect=/history/

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

Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html

Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html

Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html