HCS/455 Health Care Policy: The Past and the Future
November 24, 2014
Facilitator: Steve Linerode
The Policy Process: Formulation, Legislation, and Implementation
Contemporary health status of American Indians can be best viewed through the lens of various federal policies. These policies were developed largely in response to dramatic population losses among the indigenous peoples of America, resulting from genocidal actions of military campaigns, the lack of immunity to the diseases that accompanied European colonizers, and the assimilation efforts that destroyed tribal structures and wellness practices. Medical services were first coordinated through army physicians in the Department of War in an effort to control the spread of diseases from early reservation sites placed on or near military forts. By the twentieth century, the rapid decline of the Indigenous population, documented by the “Meriam Report” of 1928 prompted new assimilation efforts to save the first Americans (Meriam, 1928). Medical services were re-coordinated within the Bureau of Indian Affairs and then in 1954 into the Public Health Service, finally resting within the Federal Indian Health Service (OTA, 1986). The future status of health and wellness among American indigenous populations requires an understanding of the inherited damage resulting from various federal policies along with attention to the strengthening of tribal wellness practices. Looking through this lens it is important to understand the various steps that are included in the policy making process containing these three stages: Formulation, legislative, and implementation.
Policies are constantly under review with consideration to work towards a more improved health care system. Before a policy is initiated or reviewed there must be an issue that calls for improvement. Policies almost always begin because there is an issue that must be addressed.
The recent passage of the Patient Protection and Affordable Care Act (ACA) in 2010 has significant implications for American Indian health care with reference to these issues. Under the ACA, the Indian Health Care Improvement Act (IHCIA) is made permanent eliminating yearly authorizations. While appropriations for Indian healthcare have never been entirely denied, this removes the uncertainty that often accompanies the political battles and national economic concerns that impact the budget. The ACA also calls for the creation of new programs to address disparities. The implementation of the ACA affects sovereign tribes and tribal members differently than the general American population. According to the United States Department of Health and Human Services the national health expenditure grew 4.0% to $2.5 trillion in 2009, or $8,086 per person, and accounted for 17.6% of gross domestic product. In 2008, the total gross domestic product was 16.2%. The national health expenditure is continuing to rise year after year and is projected to grow 6.1% each year for the next decade (United States Department of Health and Human Services, 2011). The formulation stage of a policy is when all the information and data is exposed about the issue. This step is when all the research is reviewed to make a decision about the action that must be taken. This stage acts as the planning for the policy process. The purpose and desired outcomes of the policy are identified with the appropriate strategies that will be used.
The legislative stage in a policy process is an important step for policy to overcome to be enacted. This stage in the process is the one that enacts laws and balances health policy with other policies for the interest of the public. When an issue is identified the key players in the policy process must address their concerns to a government official that will support their bill. The legislative