Question

1. Describe the model used for policy analysis
2. Discuss the problem that the Affordable Care Act addresses
3. Identify the stakeholders and the role they play in policy development and implementation
4. Describe the evidence or support used in the development of the Affordable Care Act
5. Discuss any benefit vs. risk analysis related to the Affordable Care Act

Answer 1

DESCRIBE THE MODEL USED FOR POLICY ANALYSIS

Policy analysis is a technique used in public administration to enable civil servants, activists, and others to examine and evaluate the available options to implement the goals of laws and elected officials. The process is also used in the administration of large organizations with complex policies                    

By definition, policy analysis is an analytic endeavor. And quantitative models are one of the most important tools of the policy analyst. Models can serve a variety of purposes in a policy analysis study, and even for the same purpose there may be many different types of models. Prior to developing a model, the policy analyst must decide what the purpose of the model is and which system or process he or she wants to model. A model can help a policymaker or a group of stakeholders in different ways depending on what is modeled. The question arises when to use which type of model. Appropriateness is relative to the purpose of the model and the context in which it is applied. Therefore, instead of providing a single answer, in this part of the book we will use the hexagon framework and an extension of the traditional framework for policy analysis to support analysts in choosing the appropriate type of model and understanding how to build and use it. The hexagon framework provides six generic purposes to which a modeling exercise may contribute. By understanding the questions that are addressed for each of these purposes, the type of model needed to find answers to those questions becomes clear. The six purposes are the vertices of the hexagon, the top half of the hexagon is primarily ‘object-oriented’, focusing on systems, policy measures, and system models, whereas the bottom half is ‘subject-oriented’, focusing on people (decision makers, stakeholders, researchers), and their interactions in a policy process, which require different kinds of models. labels were assigned to the arcs joining pairs of adjacent vertices, which are called ‘styles’ of policy analysis shows the six styles identified on the arcs. The following two chapters in this part of the book deal with the variety of models needed to support this diverse set of policy analysis purposes and styles

PROBLEM THAT THE AFFORDABLE CARE ACT ADDRESSES

The ACA may also create new challenges, as some insurance plans offer limited provider networks that may disrupt continuity of care, create tight prescription drug formularies, and require high cost-sharing responsibilities that may place a financial burden on patients

The slowdown in the rate of increase in health care spending over the past decade is welcome news, but no one is predicting that health care spending will not exceed the growth of income in future years. In fact, for the past 40 years real, per capita health care spending has been growing at twice the rate of growth of real, per capita income. That's not only true in this country; it is about the average for the whole developed world.

You don't need to be an accountant or a mathematician to know that if something you are buying is growing faster than your income it will crowd out everything else you are consuming. Health care spending will take more and more of the family budget; it will take an ever larger share of workers' gross pay. The Affordable Care Act (ACA) did not create this problem. But it limits our ability to manage it by restricting our ability to choose a smaller package of benefits, more cost sharing, etc. In short, the health reform law is trying to force us to remain on an unsustainable path.

Further, there are three "global budgets” in the ACA and (ironically) they are likely to make matters worse for ordinary citizens. The law restricts the growth of total Medicare spending, the growth of Medicaid hospital spending, and (after 2018) the growth of federal tax subsidies in the health insurance exchanges to no more than the rate of growth of real GDP per capita plus about ½ of a percent. This means that as health care costs become more and more of a burden for the average family, they will get less and less help from government through time.

The traditional idea of a global budget is to restrict overall spending. The global budgets in the ACA only restrict the government's outlays.

An obvious solution is to jettison the whole idea of a defined benefit. Instead, make a defined (tax subsidy) contribution to each family and let competition determine what benefits the market can provide.

The bulk of the Affordable Care Act's coverage provisions went into effect on January 1, 2014, including tax credits for Marketplace-based coverage, Medicaid expansion, and insurance industry reforms such as prohibitions on pre-existing condition coverage limits. For physicians and patients, the expansion of coverage presents an opportunity to improve patients' access to care and nurture the doctor-patient relationship. The ACA may also create new challenges, as some insurance plans offer limited provider networks that may disrupt continuity of care, create tight prescription drug formularies, and require high cost-sharing responsibilities that may place a financial burden on patients. This document will provide practical advice to physicians and their patients and what they can do to ensure access to patient-centered care in the reformed health system. ACP has created resources for physicians and their patients to help them learn about the ACA's coverage provisions

stakeholder is a person who has something to gain or lose through the outcomes of a planning process or project. In many circles these are called interest groups and they can have a powerful bearing on the outcomes of political processes. The term refers to persons, groups or organizations that must somehow be taken into account by leaders, managers and frontline staff. ‘Any group or individual who can affect or [be] affected by the achievement of an organization's objectives

When we think of stakeholders, it is possible to list many examples, but the ones that usually come to mind are shareholders, management, employees, trade unions, customers, suppliers, and communities. However, larger and more complex organizations can have many more stakeholders than these. Compare, for example, the different complexities of a small organization, such as a corner shop or street trader, with a large international organization such as a major

Stakeholders are the recipient of policy. The improvement in the lives of Stakeholders determine success or failure of public policy.

Policy makers especially those who are elected must listen to and please the stakeholders or else… Policy s2 s3 Rejection of policy= No vote Rejection of Policy= No vote Rejection of Policy= No Vote

The Influence of Stakeholders Stakeholders can utilize many ways to influence policy. In business, they can choose to boycott establishments that will not heed their requests or suggestions. In public policy they can: a) b) c) d) e) Lobby Call for conferences Support or advocate for non-support of a policy Support or advocate for the non-support of policy makers Rally

The relationship between stakeholders and policy makers In order for business to prosper there must be a reciprocal relationship between the stakeholders and the business

The relationship between stakeholders and policy makers In the context of public policy there is an ideal two-way relationship between the policy makers and the people (stakeholders). Stakeholders should contribute to inputs in policy formulation and should be given ample time, efficient and effective ways to evaluate the policy. But that does not happen all the time

Categorizing Stakeholders Stakeholders, were introduced firstly in the business and management field, hence their classification is business oriented in nature. Thomas R. Dye (Public Policy) states that the general classification should be target and nontarget groups. Target groups is that part of the population for whom a program or policy is intended. Such as policies to solve homelessness target the homeless. Non-target groups are those who receive impact of policy not directly intended at them. For example, providing the homeless with cheap but quality homes requires using

Stakeholder management We manage stakeholders by: identifying conflicts/potential conflicts, gaps, contradictions or incompatibilities between stakeholder requirements, so that a reconciliation strategy can be planned. ensuring ongoing communication, two-way information access, monitor changes in engagement, attitude and/or influence

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DESCRIBE THE EVIDENCE OR SUPPORT USED IN THE DEVELOPMENT OF THE AFFORDABLE CARE ACT

Expand Access to Insurance Coverage

• Require employers to cover their workers, or pay penalties, with exceptions for small employers.
• Provide tax credits to certain small businesses that cover specified costs of health insurance for their employees, beginning in tax year 2010.
• Require individuals to have insurance, with some exceptions, such as financial hardship or religious belief.
• Require creation of state-based (or multi-state) insurance exchanges to help individuals and small businesses purchase insurance. Federal subsidies will limit premium costs to between 2 percent of income for those with incomes at 133 percent of federal poverty guidelines, rising to 9.5 percent of income for those who earn between 300 percent and 400 percent of the poverty guidelines.
• Expand Medicaid to cover people with incomes below 133 percent of federal poverty guidelines.
• Require creation of temporary high-risk pools for those who cannot purchase insurance on the private market due to preexisting health conditions, beginning July 1, 2010.
• Require insurance plans to cover young adults on parents’ policies, effective Sept. 23, 2010.
• Establish a national, voluntary long-term care insurance program for “community living assistance services and supports” (CLASS), with regulations to be issued by Oct. 1, 2012.
• Enact consumer protections to enable people to retain their insurance coverage (see next section).

The ACA contains several provisions related to improving quality and system performance, including, but not limited to, the following:

• Comparative research to study the effectiveness of various medical treatments;
• Demonstration projects to develop medical malpractice alternatives and reduce medical errors;
• Demonstration projects to develop payment mechanisms to improve efficiency and results;
• Investments in health information technology;
• Improvements in care coordination between Medicare and Medicaid for patients who qualify for both;
• Options for states to create “health homes” for Medicaid enrollees with multiple chronic conditions to improve care; and
• Data collection and reporting mechanisms to address health disparities among populations based on ethnicity, geographic location, gender, disability status and language.

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