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NURS 6050 Week 1 Discussion: Presidential Agendas

NURS 6050 Week 1 Discussion: Presidential AgendasNURS 6050 Week 1 Discussion: Presidential AgendasRegardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?To Prepare:NURS 6050 Week 1 Discussion: Presidential AgendasReview the Resources and reflect on the importance of agenda setting.Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.By Day 3 of Week 1Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?ORDER A PLAGIARISM-FREE PAPER HEREBy Day 6 of Week 1Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.*Note: Throughout this program, your fellow students are referred to as colleagues.NURS 6050 Week 1 Discussion: Presidential AgendasRubric DetailSelect Grid View or List View to change the rubric’s layout.ContentName: NURS_6050_Module01_Week01_Discussion_RubricGrid ViewList View Excellent Good Fair PoorMain Posting NURS 6050 Week 1 Discussion: Presidential AgendasPoints Range: 45 (45%) – 50 (50%)Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.NURS 6050 Week 1 Discussion: Presidential Agendas Points Range: 40 (40%) – 44 (44%)Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources.NURS 6050 Week 1 Discussion: Presidential AgendasWritten clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. Points Range: 35 (35%) – 39 (39%)Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors. Points Range: 0 (0%) – 34 (34%)Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.Main Post: Timeliness Points Range: 10 (10%) – 10 (10%)Posts main post by day 3. Points Range: 0 (0%) – 0 (0%)NURS 6050 Week 1 Discussion: Presidential Agendas Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%)Does not post by day 3.First Response Points Range: 17 (17%) – 18 (18%)Response exhibits synthesis, critical thinking, and application to practice settings. Communication is professional and respectful to colleagues.NURS 6050 Week 1 Discussion: Presidential AgendasResponses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English. Points Range: 15 (15%) – 16 (16%)Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources.NURS 6050 Week 1 Discussion: Presidential AgendasResponse is effectively written in standard, edited English. Points Range: 13 (13%) – 14 (14%)Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 12 (12%)Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Second Response Points Range: 16 (16%) – 17 (17%)Response exhibits synthesis, critical thinking, and application to practice settings.NURS 6050 Week 1 Discussion: Presidential AgendasCommunication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English. Points Range: 14 (14%) – 15 (15%)Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources.NURS 6050 Week 1 Discussion: Presidential AgendasResponse is effectively written in standard, edited English. Points Range: 12 (12%) – 13 (13%)Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. Points Range: 0 (0%) – 11 (11%)Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Participation Points Range: 5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.NURS 6050 Week 1 Discussion: Presidential Agendas Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%) Points Range: 0 (0%) – 0 (0%)Does not meet requirements for participation by posting on 3 different days.Total Points: 100Name: NURS_6050_Module01_Week01_Discussion_RubricDiscussion – Week 1CollapsePresidential AgendasRegardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?To Prepare:Review the Resources and reflect on the importance of agenda setting.Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.By Day 3 of Week 1Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?By Day 6 of Week 1Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.*Note: Throughout this program, your fellow students are referred to as colleagues.Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.NURS 6050 Week 1 Discussion: Presidential Agendas RE: Discussion – Week 1CollapsePolitics and MedicareMedicare is federally funded health insurance coverage for an increasing number of people.  Medicare is appropriate for those 65 and older and under age 65 with certain disabilities (“Medicare Program – General Information | CMS”, 2021).   There are currently over 61 million Americans that receive benefits, and the number is growing.  Why is Medicare a topic of political debate and concern? According to the United States Census Bureau, the population of aging adults and their life expectancies are on the rise (2021; Bureau, 2021).  This group accounts for the majority of voting Americans.  The past three presidents are no exception to Medicare considerations during political campaigning and reform.George W. Bush made most significant changes to improve Medicare.  He proposed and saw through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.  This “provided preventive care, offered Medicare beneficiaries market-based choices, and gave seniors and people with disabilities better access to the prescription drugs they need” (“THE BUSH RECORD – FACT SHEET: Empowering Medicare Beneficiaries with Affordable Options”, 2021).  The addition of prescription drug cost coverage provided a much-needed resource for many Americans.NURS 6050 Week 1 Discussion: Presidential AgendasFormer Preside Obama, under the Affordable Care Act (ACA), made changes to Medicare.  One of the biggest changes seen under the ACA was the closing of the “donut hole.”  This was when an individual reached the maximum covered for prescriptions drugs.  President Obama also stressed the importance of preventative care and added wellness visits (“Medicare vs Obamacare: the differences between Medicare and Obamacare – Plan Prescriber”, 2021).NURS 6050 Week 1 Discussion: Presidential AgendasThe Trump administration amended Medicare by proposing more transparency.  He made changes to the ACA, including reducing drug costs and proposed more competitive pricing.  Trump expanded coverage to include less traditional sources such as telehealth (“Trump Administration Announces Changes to Medicare Advantage and Part D to Provide Better Coverage and Increase Access for Medicare Beneficiaries | CMS”, 2021).Medicare is an essential program for many Americans.  The many changes and reforms over the years have made the policies and practices confusing.  Enrollment can be confusing for senior citizens and their families.  In my opinion, Medicare needs to be simplified.  I would limit access to true disabilities and elderly individuals.  Enrollment would be standardized and easy access to information.ReferencesBureau, U. (2021). 65 and Older Population Grows Rapidly as Baby Boomers Age. The United States Census Bureau. Retrieved 1 June 2021, from https://www.census.gov/newsroom/press-releases/2020/65-older-population-grows.html.Census.gov. (2021). Retrieved 1 June 2021, from https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1145.pdf.Medicare Program – General Information | CMS. Cms.gov. (2021). Retrieved 1 June 2021, from https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo.Medicare vs Obamacare: the differences between Medicare and Obamacare – Plan Prescriber. Plan Prescriber. (2021). Retrieved 1 June 2021, from https://www.planprescriber.com/about-medicare/medicare-vs-obamacare-the-differences-between-medicare-and-obamacare/.THE BUSH RECORD – FACT SHEET: Empowering Medicare Beneficiaries with Affordable Options. Georgewbush-whitehouse.archives.gov. (2021). Retrieved 1 June 2021, from https://georgewbush-whitehouse.archives.gov/infocus/bushrecord/factsheets/medicare.html.Trump Administration Announces Changes to Medicare Advantage and Part D to Provide Better Coverage and Increase Access for Medicare Beneficiaries | CMS. Cms.gov. (2021). Retrieved 1 June 2021, from https://www.cms.gov/newsroom/press-releases/trump-administration-announces-changes-medicare-advantage-and-part-d-provide-better-coverage-and.NURS 6050 Week 1 Discussion: Presidential AgendasThank you for a thorough response. I do have a question and it just requires your opinion. What do you mean by limiting access to “true disabilities.” Also , how are you defining “elderly?”  Some people define it as being over 70. Do you think people over 65 should be eligible?I look forward to your response. RE: Discussion – Week 1, instructor responseGood evening Dr. Politi,In my opinion, there are individuals on Medicare that could do some types of work.  As with many things, there are individuals that abuse and work around program guidelines and restrictions.  As far as age-appropriateness, I am not confident that 65 or any number should be the magic number.  Given the current financial instability in government, I feel it could be beneficial to have the qualifications be more health-specific.  I know some 65-year-olds that are more able to work than some much younger people.  There are also instances where younger individuals are diagnosed with chronic life-altering diseases that are physically unable to work and have no access to medical insurance—all opinions, of course.  I am confident that there is much room for improvement in the Medicare system.   NURS 6050 Week 1 Discussion: Presidential Agendas RE: Discussion – Week 1, instructor responseThank you for your reply. People pay into Medicare with the expectation that they can retire and reap the benefits of their many years of service/work. It is not easy to get on Medicare disability. Some people are just persistent! RE: Discussion – Week 1One grey area when defining “true disabilities” is when it comes to obese individuals. They are disabled, but they are causing the disability themselves. The United States spent 147 billion dollars toward healthcare for obese adults in 2008 (Finkelstein et al., 2009). I understand they are at high risk for illness, but it seems like by giving them benefits we are making them more sedentary and only worsening their condition. Do you think it would be possible to add a requirement for obese people on medicare to be enrolled and actively participating in a weight loss program to receive their benefits? NURS 6050 Week 1 Discussion: Presidential AgendasReferencesFinkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs, 28(Supplement 1), 822–831. https://doi.org/10.1377/hlthaff.28.5.w822 RE: Discussion – Week 1Medicare has so many parts and intricacies it is extremely hard to decipher for people that are eligible to receive Medicare benefits. My father is going through this right now with knowing the different plans to choose in conjunction with primary insurance. So many of my patients have had Medicare only with no prescription benefit or limitations on rehab etc. Unfortunately, Medicare recipients are not able to use drug discount cards when enrolled in a part D program. Being in a Part D program also does not absolve an individual from having extreme drug cost, “The Medicare Part D program defines specialty drugs as those with a negotiated monthly price of more than $600, although monthly prices for some of these specialty drugs can be much higher than that” (Trish, 2016, p. 1565). It is hard to fathom how this can be feasible with so many of our seniors on a fixed income.NURS 6050 Week 1 Discussion: Presidential AgendasYou mentioned that the Medicare process needs to be simplified, which I agree with. The system in which it is run needs a bit of an overhaul because it is so fragmented. For the average American, “Health care and health outcomes cannot make substantial improvements until the delivery system is changed. Medicare reform must support a coordinated health care delivery system” (Fox, 1999, p. 142). Medicare needs reform and should be the agenda of any administration. ReferencesFox, P. D., & Snyder, R. (1999). Should Medicare HMO benefits be standardized? Health                                  Affairs, 18(4), 40. https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.18.4.40 Trish, E., Xu, J., & Joyce, G. (2016). Medicare Beneficiaries Face                                                                         Growing Out-Of-Pocket Burden For Specialty Drugs While In                                                                              Catastrophic Coverage Phase. Health Affairs (Project Hope), 35(9), 1564–                                                          1571. https://doi-org.ezp.waldenulibrary.org/10.1377/hlthaff.2016.0418NURS 6050 Week 1 Discussion: Presidential Agendas RE: Discussion – Week 1Hi ,Medicare is indeed an essential program for many Americans. Medicare has two parts, Part A and Part B. Part A is a premium free hospital insurance for 65 or older and paid Medicare taxes for at least 10 years. Medicare is a beneficial and far-reaching program, but many patients still struggle to enroll and understand their coverage (Hohmann et al 2017). I agree with your views that enrollment can be confusing for senior citizens and the program needs simplifying but limiting access to true disabilities can be problematic. To be recognized as Medicare eligible, the person must have gone through the rigorous application process of applying for Social Security Disability Insurance which can take several months to complete (Feke, 2020). Yes, there are persons that seek to defraud the system and there should be measures put in place to weed out these bad actors, but we should not make it anymore difficult for qualified candidates to get access.ReferencesFeke, T. (2020, October 22). These are the disabilities that qualify you for Medicare. Verywell Health. https://www.verywellhealth.com/disability-requirements-for-medicare-2318667Hohmann, L. A., Hastings, T. J., McFarland, S. J., Hollingsworth, J. C., & Westrick, S. C. (2018). Implementation of a Medicare Plan Selection Assistance Program Through a Community Partnership. American Journal of Pharmaceutical Education, 82(9), 1111–1120. https://doi-org.ezp.waldenulibrary.org/10.5688/ajpe6452NURS 6050 Week 1 Discussion: Presidential AgendasRE: Discussion – Week 1Week One Discussion Reply 2Hi Francesca! You mentioned that the George W. Bush administration drafted and implemented the Medicare Prescription Drug Improvement and Modernization Act of 2003, which enhanced the provision of preventive care. Megellas (2017) posits that the act sought to change the title XVII of the SSA (Social Security Act) to ensure that the medical prescription benefits were offered to the American citizens within a voluntary context under the Medicare program and to reinforce the Medicare program. Also, the modernization Act included a part D section to the Medicare program, which enhanced the accessibility of FDA-approved medications, suppressing potential medication errors arising from non-FDA-approved pharmacological agents (Oberlander, 2017).Thank you for your informative post!ReferencesMegellas, M. M. (2017). Medicare modernization: The new prescription drug benefit and redesigned part B and part C. Baylor University Medical Center Proceedings, 19(1), 21–23. https://doi.org/10.1080/08998280.2006.11928119Oberlander, J. (2017). Through the looking glass: The politics of the medicare prescription drug, improvement, and modernization act. Journal of Health Politics, Policy and Law, 32(2), 187–219. https://doi.org/10.1215/03616878-2006-036NURS 6050 Week 1 Discussion: Presidential AgendasDiscussion Post 1(repost because there was an error)Healthcare Coverage and AffordabilityIt seems that in every Presidential election and term, some form of healthcare policy and change is brought to the forefront of their campaign. Lambrew (2018) states that health policy became a key platform around the mid-1940s after FDR mentioned the importance of adequate medical care and achieving good health in his State of the Union address, and then Truman shortly after proposed the idea of national health insurance in 1945. In this post, I am going to discuss how three former presidents: Trump, Obama, and Bush, handled the topic of healthcare coverage and affordability during their presidencies.  NURS 6050 Week 1 Discussion: Presidential AgendasThe most well-known healthcare reform is that of President Obama, who focused primarily on attempting to provide healthcare for all Americans. In 2010, the Affordable Care Act, otherwise known as “Obamacare,” was created with the intent of providing more Americans with health insurance coverage and was the first time something like this had ever been created in the United States (Milstead & Short, 2019). As stated in the article by Manchikanti et al. (2017), “The ACA had 3 primary goals: increasing the number of the insured, improving the quality of care, and reducing the costs of health care”.According to the article written by Lambrew (2018), President Bush focused his agenda on providing tax cuts and credits by establishing health savings accounts. The Bush Record (n.d.) stated that Bush not only helped increase funding for medical research but also improved the health system provided for our veterans. Bush is also best known for the Medicare Modernization Act of 2003 (The Bush Record, n.d.), which assisted in significantly lowering prescription drug costs, inadvertently lowering the cost of healthcare. NURS 6050 Week 1 Discussion: Presidential AgendasLambrew (2018) also stated in her article that Trump’s main campaign focus was to appeal the infamous Affordable Care Act. His plan was to replace it along with Medicare and Medicaid with grant coverages and small business covering pools. Although he was not successful in repealing the ACA, he turned his focus toward attempting to provide Americans with more affordable prescription drugs (Lambrew, 2018).Overall, I think former President Obama’s idea of healthcare for all was moving in the best direction and interest of the American people when it comes to accessible and affordable healthcare to those with lower incomes. I believe that healthcare is a right that should be available to all human beings. Healthcare, however, continues to need more changes toward accessibility and cost efficiency while providing high-quality care. More than 43 percent of working-age adults had inadequate health insurance, according to Collins et al. (2020), which shows there continues to be a persistent vulnerability of working-age adults when it comes to the affordability of healthcare and coverage.  NURS 6050 Week 1 Discussion: Presidential AgendasReferencesCollins, S., Gunja, M., & Aboulafia, G. (2020) U.S. Health Insurance Coverage in 2020: A Looming Crisis in  Affordability. Retrieved June 1, 2021 from https://www.commonwealthfund.org/  publications/issue-briefs/2020/aug/loomingcrisis-health-coverage-2020-biennial.Lambrew, J.M. (2018). Getting Ready for Health Reform 2020: What Past Presidential  Campaigns Can Teach Us. Retrieved on May 28, 2021 from https://www.  commonwealthfund.org/ sites/default/files/2018- 06/Lambrew_getting _ ready_hlt_reform_2020_presidential_0.pdf.Manchikanti, L., Helm li, S., Benyamin, R., & Hirsch, J. (2017). A Critical Analysis of Obamacare:Affordable Care or Insurance for Many and Coverage for Few? Pain Physician. 20(3):111- 138. https://pubmed.ncbi.nlm.nih.gov/28339427/Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.).  Burlington, MA: Jones & Bartlett Learning.The White House. (n.d.) The Bush Record. Retrieved May 29, 2021 from https://georgewbush- whitehouse.archives.gov/infocus/bushrecord/factsheets/healthcare.html. RE: Discussion Post 1(repost because there was an error)CollapseHi ,Sometimes I think those who created the ACA were not realistic to think that access can be improved/increased, costs decreased,  without quality being negatively impacted. The ACA expanded Medicaid and plans were not available/affordable for ALL citizens.The discussion of whether healthcare is a right or a privilege is an ethical one that has been discussed over many years.Do you agree or disagree with my statement that quality of care may be compromised if costs are lowered and access is increased? It’s okay to disagree, we’re just having a discussion.NURS 6050 Week 1 Discussion: Presidential Agendas ResponseCollapseDr. Politi,At first thought, I wanted to say that lowering costs and increasing access would compromise the quality of care because of lack of resources with more people requiring care. After some research, improving quality of care first, making sure patients are given the right treatment for the right diagnosis the first time, having medical systems share EMR so that doctors are not repeating scans unnecessarily, etc., would lower the costs overall. I read a news article (https://www.statnews.com/2019/04/05/high-quality-care-lower-costs/) that stated we ranked 35th out of 160 nations regarding our health index and pay twice as much for healthcare compared to the other industrialized countries. Also, increasing the number of people with access should set a precedent to truly focus on preventative health measures and nutrition. I feel this would lower costs in the long run because we would be healthier and catch things before it gets worse. RE: Response You uncovered some issues we have with the current system. There are many ways to improve efficiency (not repeating MRIs and other expensive tests) and focusing on prevention. The “sick” model that has driven our healthcare system must change.NURS 6050 Week 1 Discussion: Presidential Agendas RE: Discussion Post 1(repost because there was an error)Discussion 1, Reply 1I often hear that if we lower healthcare costs and increase accessibility, the quality of care will be lower. I want to challenge everyone and start thinking a bit differently about health care for everyone. I hope I am not too bias when it comes to socialized medicine, but I experienced it myself. According to Kurani and McDermot (2020), the mortality rates in the USA, even though decreasing, are still higher than in European countries that implemented the social model of healthcare. The USA also experienced an increase in premature death while that number continues to decrease across the Atlantic. Also, disease burden (measured in both – years of sudden death and years living with disability and chronic diseases) is the highest among all industrial countries. The United States also ranks last regarding health care access and quality (Kurani & McDermott, 2020)NURS 6050 Week 1 Discussion: Presidential Agendas. We often worry that more accessible care will cost more. While this is somewhat true, we as a taxpayer are paying for disabilities and other consequences of lack of consistent healthcare. As indicated in Patient Care (2007), the cost of care for people who recently gained insurance is much higher than those that had insurance consistently throughout their life. While seasoned, middle-aged beneficiaries were able to address health issues before they became more serious, newly insured individuals in the same age group became a huge burden to our healthcare as medics managed diseased in way advanced stadium.References Loss of insurance causes drop in health expenditures. (2007). Patient Care, 41(18), 1.Kurani. N., & McDermott. D. (2020, August 20). How does the quality of the U.S. healthcare system compared to other countries? Health System Tracker.How does the quality of the U.S. healthcare system compare to other countries? – Peterson-KFF Health System Tracker NURS 6050 Week 1 Discussion: Presidential AgendasRE: Discussion Post 1(repost because there was an error)Greetings ,It is unfortunate that there is a possibility that quality of care provided will be lowered if health care costs are lowered and accessibility is increased. My opinion is that everyone should receive quality health care. Not only because as health care professionals we take an oath to practice with traits that are not limited to but includes dignity, respect and ethics. Everyone deserves outstanding treatment when they are in need of it. The challenges involving health care access requires strategies to support the supply and delivery of medical care. Care delivered in clinics is 30-40 percent cheaper than similar care at physician offices and about 80 percent cheaper than emergency departments ( Atlas 2016).  This lead me to the the question of why is the cost significantly different? Also, is the focus truly on quality care or profit?Atlas, S. W. (2016). Restoring quality health care : a six-point plan for comprehensive reform at lower cost. Hoover Institution Press, Stanford University. RE: Discussion – Week 1Coming from a different healthcare system, I was shocked while reviewing the designated reading to find such a large population of impoverished and uninsured Americans. It is clear health policy is complex and not an easily remedied dilemma. Milstead and Short attribute the complexities to “state, federal, and international economies; social movements; education; resources; and religion.”(Milstead & Short, 2019)NURS 6050 Week 1 Discussion: Presidential AgendasThe Census Bureau reported that in 2018 27.5 million people did not have access to affordable health care through health insurance (Berchick et al., n.d.). Berchick et al.,  (n.d.) report this was almost a 7.9% increase from 2017. I found it interesting that 1.9 million more people became underserved and uninsured so quickly.  Being new to the American health system, I was uninformed; it seemed to me that the only change was the elected President. I wanted to explore how one person could impact an issue that affects so many people.NURS 6050 Week 1 Discussion: Presidential Agendas During President Bush’s term, creditable Census data only goes back to 2003, reporting the uninsured rate was 15.6% (US Census Bureau, n.d.). Bush ended his term in 2009 with an average uninsured rate of 15.4% (U.S. Census Bureau, 2009). I investigated how President Bush coordinated the uninsured issue and found documents outlining how the government would handle these issues. The White House National Economic Council, (2006) believed that insurance should be available to all working families at an affordable cost and introduced the Health Savings Account and suggested the need for health reform. President Bush goes on to rationalize how the introduction of the Health Savings Account (HSA) will be a “major shift in health care” (The White House National Economic Council, 2006, pg 4NURS 6050 Week 1 Discussion: Presidential Agendas). Meaning Americans could save pre-tax dollars to use for medical expenses (Kaiser Family Fountion, 2010). President Bush said he believed “Our government has a responsibility to promote access to quality affordable health care” (The White House National Economic Council, 2006, pg 5). However, during his term, only the HSA was implemented; the Kaiser Family Foundation (2010) report, although the President did announce the health reform plan, it is was not acted on by the members of congress, and therefore no other changes were made. Despite his intent to provide access to insurance and healthcare, President Bush vetoed the 2007 Congress attempt to reauthorize the State Children’s Health Insurance Program (CHIP), covering children from uninsured families, providing them with access to health services (Kaiser Family Fountion, 2010).NURS 6050 Week 1 Discussion: Presidential Agendas Reauthorizing CHIP is one of the first actions executed by President Obama in 2009, providing approximately 4.1 million children with access to healthcare through insurance (Kaiser Family Fountion, 2010). Obama shared Bush’s vision of health reform and acted swiftly, creating the Office of Health Reform and holding several Health Reform Summits focusing on low-income families. He continued to write and oversee legislation and health policies, and on March 23, 2012, members of Congress and the President signed the Patient Protection and Affordable care act (Kaiser Family Foundation, 2010). This act aimed to protect low- and middle-class individuals, providing them with coverage under Medicaid expansion or allowing them access to affordable healthcare under the “American Health Benefits Exchange.”  The Kaiser Family Foundation (2010) explains this would depend on family income. He was beginning with the population of uninsured Americans at 15.4%. Obama concludes his term with a remarkable 8.8% uninsured rate (Berchick et al., n.d.). Obama marveled, “After a century of striving, after a year of debate, after a historic vote, healthcare reform is no longer an unmet promise. It is the law of the land” (Dawes & Williams, 2020).NURS 6050 Week 1 Discussion: Presidential AgendasTrump took office in 2017 and began stripping critical protections individuals had been given under the ACA. He stated he would replace the ACA and provide “insurance for everybody and lower the cost” (Goodheart, 2020). Goodheart (2020) clarifies the Trump administration removed the mandate requiring people to have health coverage or pay the penalty. While Trump said he didn’t wish to force people into signing with ACA, multiple studies reviewed by Eibner & Nowark (2018) found consistent evidence that mandates such as the ACA increase health insurance enrollment. They speculate this is theoretically due to the idea of human behavior, that most individuals wish to abide by government laws (Eibner & Nowark, n.d.)NURS 6050 Week 1 Discussion: Presidential Agendas. In 2020 Coronavirus hit, and President Trump was faced with the worst health crisis since the Spanish flu, announcing a state of emergency on March 13, 2020 (Amadeo, 2021). This epidemic would ignite a domino effect of unemployment and uninsured Americas. The Commonwealth Fund Biennial Health Insurance Survey (2020) speculated that in 2020 the uninsured population rate had increased to 12.5% and expect it to climb over the next year. Trump began his campaign to promise he would provide “better health care plans;” however, Trump did not fulfill this promise. He aimed most of his policies at weakening ACA and Medicaid policies without a viable alternative. Growing up in New Zealand, I never had to think about how I could afford healthcare.  New Zealand has achieved a unique universal 100% public health coverage system administered regionally, which I believe could be implemented in the United States (New Zealand | Commonwealth Fund, n.d.). Comparable to the USA, the New Zealand government sets and reviews the budget and benefits packages. Unlike the USA, in New Zealand, 20 geographical District Health Boards are tasked with planning and providing needed health services specific to a particular region (New Zealand | Commonwealth Fund, n.d.)NURS 6050 Week 1 Discussion: Presidential Agendas. The District Health Board Members are not politicians; they are typically local nurses, doctors, and other healthcare workers and are expected to show a sense of social responsibility to foster the communities’ welfare (District Health Boards, 2020).  DeMarco & Tufts (2014) agree with this ideology, stating nurses are well respected and trusted by the public. DeMarco & Tutfs believe that using local nurses’ expertise to help reform and create health policies and initiatives can considerably improve health outcomes in the tasked community. Implementing smaller geographical districts and trusting them with delegating healthcare needs for their community would help Americans access affordable healthcare specific to their needs. In summary, Bush had various ideas for improving the healthcare system with the implementation of HSA and health reform.  He was unable to make the changes required for dramatic improvement; nevertheless, he did promote the need for change and got it on the agenda. Following the efforts of President Bush, President Obama was able to create and implement various healthcare policies, including the ACA and establishing healthcare reform, decreasing the uninsured rate by more than half. Subsequently, Trump then spent many of his campaigns attempting to weaken the ACA, claiming he would provide something more efficient.NURS 6050 Week 1 Discussion: Presidential Agendas.  Sadly, this was not to be, and more Americans lose their gateway to insurance through unemployment. One of the most significant issues with access to insurance and healthcare is it has become a political issue with politicians making important healthcare decisions. I would consider basing the U.S. health system on something similar to New Zealand’s publicly funded health care model. Allowing local communities led by local nurses, hospital staff, and respected community members to spend the destinated budget and benefits on geographically appropriate healthcare   Reference listAmadeo, K. (2021, February 23). Donald Trump’s Health Care Policies. https://www.thebalance.com/how-could-trump-change-health-care-in-america-4111422Berchick, E. R., Barnett, J. C., & Upton, R. D.NURS 6050 Week 1 Discussion: Presidential Agendas (n.d.). Health Insurance Coverage in the United States: 2018. 44.Dawes, D. E., & Williams, D. R. (2020). The Political Determinants of Health. Johns Hopkins University Press. https://books.google.com/books?id=3OLMDwAAQBAJDeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook, 62(3), 219–224. https://doi.org/10.1016/j.outlook.2014.04.002District health boards. (2020). Ministry of Health NZ. https://www.health.govt.nz/new-zealand-health-system/key-health-sector-organisations-and-people/district-health-boardsEibner, C., & Nowark. (n.d.). The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors | Commonwealth Fund. Retrieved May 30, 2021, from https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factorsGoodheart, J. (2020, September 18). Pre-pandemic, 2NURS 6050 Week 1 Discussion: Presidential Agendas.3M lost insurance under Trump. USA Today, 01D. Gale In Context: Opposing Viewpoints.Kaiser Family Fountion. (2010). Timeline: History of Health Reform in the US. https://www.kff.org/wp-content/uploads/2011/03/5-02-13-history-of-health-reform.pdfMilstead, J., & Short, N. (2019). Health Policy and Politics (sixth edition). Jones & Bartlett Learning.New Zealand | Commonwealth Fund. (n.d.). Retrieved May 30, 2021, from https://www.commonwealthfund.org/international-health-policy-center/countries/new-zealandThe White House National Economic Council. (2006). Reforming Helath Care for the 21st Century. https://georgewbush-whitehouse.archives.gov/stateoftheunion/2006/healthcare/healthcare_booklet.pdfUS Census Bureau. (n.d.). Current Popualtion Survey 2003 ans 2004 Annual and Social Economic Supplements. https://www2.census.gov/programs-surveys/demo/visualizations/p60/226/fig15.jpgU.S. Census Bureau. (2009). Current Population Survey, 1988 to 2009 Annual Social and Economic Supplements.NURS 6050 Week 1 Discussion: Presidential AgendasRE: Discussion – Week 1The opioid crisis has become more prevalent as time continues.  President Bush developed the National Drug Strategy to help contain and decrease the effect this crisis had on America.  Through this strategy Bush wanted to provide adequate treatment for those addicted to these drugs and to decrease the supply.  According to Bush, the health care system is taking the biggest hit during the crisis costing approximately $15 billion a year and around 20,000 deaths in America (US Department of State).  During Obamas time as president he presented the initiation of the  Prescription Drug Abuse Prevention Plan. This plan had 4 sections including, monitoring, education, proper medication disposal and enforcement.  Monitoring includes programs to track prescription drugs to view how frequently the patient is getting these medications and how many pills. Education is to be provided on the proper use, storage, and the dangers of over using these addictive medications.  Medication disposal is important in preventing the medications from getting in the wrong hands. Lastly, is enforcement, having adequate consequences in important in decreasing the increase of drug abuse and sales (The White House)NURS 6050 Week 1 Discussion: Presidential Agendas. During President Trumps time as president he began “setting restrictions on opioid prescriptions, calling for a public health emergency, launching ad campaigns aimed at young people who might abuse the drugs, expanding access to the opioid overdose antidote known as Naloxone and pushing for China to cease illicit fentanyl production and exporting, among other efforts” (CNN,2020). If I had the option I would take parts of all three presidents to help fight the opioid crisis.  It is important to have access to treatment to help decreased the number of addicts and the abuse of prescription and illegal drugs. As a nurse I have used the program used to track how much a person has received and how often they are getting refills. This has prevented patients from getting additional prescriptions when it is not time appropriate. In addition, it is imperative that consequences be given for the people who are selling these illegal/prescription drugs. Addicts need more options for treatment instead of just throwing them in jail.NURS 6050 Week 1 Discussion: Presidential AgendasCNN. What Trump’s drug policies have meant for America’s opioid epidemic.  February 2, 2020. Retrieved from https://www.cnn.com/2020/02/02/politics/opioid-epidemic-donald-trump-drug-policy./index.htmlThe White House President Barack Obama. https://obamawhitehouse.archives.gov/ondcp/prescription-drug-abuse1U.S Department of State https://2001-2009.state.gov/p/inl/rls/rm/8451.htmNURS 6050 Week 1 Discussion: Presidential Agendas

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