Federal Health Policy Research Articles

Disability stories: personal perspectives of people with disabilities on navigating the U.S. health system

Americans with disabilities and chronic illness or injury tend to be in poorer health, use more health services, and pay more for healthcare than those without disabilities. Consequently, their lives can be profoundly affected by federal and state health policies. The concerns of this population do not figure prominently in national health policy discourse and related public health and health services research efforts. This study sought to give voice to the lived experiences of people with disabilities as they navigate a fragmented U.S. healthcare system. We interviewed 30 adults who self-identified as having a disability and spoke or otherwise communicated in the English language. Directed content analysis was used to examine words and phrases in professionally transcribed documents by experienced qualitative researchers. We report and discuss four themes from the perspective of the participant, presented in thematic statements, related to vocation, finances, stressors, and advocacy. Points of Interest It is critical to include people with disabilities and chronic illness or injury in national conversations about health policy because their lives can be greatly affected by it. The current definition of disability and models to explain thinking about disability are widely contested and debated by people with disabilities. Americans with disabilities desire to have a fulfilling work life, but find it hard to maintain full time regular employment due to a lack of insurance. American people with disabilities live with constant financial pressure and may not enjoy the retirement that others imagine for themselves. Navigating various insurance programs results in a great deal of stress for Americans with disabilities.

Diet and Cardiovascular Health

Diet and Cardiovascular Health

How the Trump Administration's Pandemic Health Care Response Failed Racial Health Equity: Case Studies of Structural Racism and a Call for Equity Mindfulness in Federal Health Policy Making

The racial health equity implications of the Trump administration's response to the COVID-19 pandemic. We focus on four key health care policy decisions made by the administration in response to the public health emergency: rejecting a special Marketplace enrollment period, failing to use its full powers to enhance state Medicaid emergency options, refusing to suspend the public charge rule, and failing to target provider relief funds to providers serving the uninsured. In each case, the administration's policy choices intensified, rather than mitigated, racial health inequality. Its choices had a disproportionate adverse impact on minority populations and patients who are more likely to depend on public programs, be poor, experience pandemic-related job loss, lack insurance, rely on health care safety net providers, and be exposed to public charge sanctions. Ending structural racism in health care and promoting racial health care equity demands an equity-mindful approach to the pursuit of policies that enhance-rather than undermine-health care accessibility and effectiveness and resources for the poorest communities and the providers that serve them.

Tribes are Public Health Authorities: Protecting Tribal Sovereignty in Times of Public Health Crisis

The COVID-19 pandemic has highlighted existing gaps in public health systems across the country including federal Indian health systems. Despite treaty obligations to provide health care to American Indians and Alaska Natives, the federal government has consistently underfunded Indian health facilities. Federal Indian health programming remains piecemeal, often falling victim to Congressional politics for continued funding, requiring inter-Tribal competition for grant and cooperative agreement funding, or requiring Tribal cost sharing. Tragically, but, unsurprisingly given failures in federal Indian health policy, many American Indian and Alaska Native communities have experienced health inequities throughout the pandemic. In several states, American Indians have higher rates of COVID-19 infections as well as worse health outcomes, including higher mortality, than their non-Indian counterparts. By exercising their inherent sovereignty as Tribal Nations, many Tribes have been able to mitigate failings in federal Indian health policy in their COVID-19 response. Unfortunately, reports across Indian country have found instances of state and local governments failing to adequately engage Tribal governments in public health activities, even those implicating Tribal members on Tribal lands, citing lack of Tribal public health authority. Not only is this legally inaccurate, but it also limits Tribal public health response efforts, and infringes on Tribal sovereignty.This issue brief discusses the legal authority for Tribes to serve as public health authorities. First, it describes the inherent authority of Tribes to engage in public health activities. Second, it discusses the recognition of Tribal public health authority across federal law and programs. This issue brief ends by discussing strategies to reinforce Tribal authority in times of public health crisis.

Promoting Healthy Aging Through Policy Change on the Federal Level: Strategies for Scholars and Clinicians

Influencing health policy change is a significant focus for scholars and clinicians in the aging field. Nevertheless, they seldom receive formal training on how to influence the policymaking process effectively or how to translate their clinical and research experiences to inform policymakers best. Exposing scholars and clinicians to the policymaking process can advance their effectiveness as they seek to realize meaningful change to promote healthy aging of our population. This poster presentation focuses on providing scholars and clinicians with strategies to understand and influence the federal policymaking process. The presentation addresses the current policy environment in which federal health and aging policy is made and describes challenges to this process. Four strategies are identified to help scholars and clinicians influence the policymaking process: 1) identify a problem and any relevant policy that corresponds to the issue, 2) identify evidence-based solutions that relate to quality improvement, population health, or reducing per capita cost of healthcare, 3) grow relevant networks, meet experts, build relationships and connect with key stakeholders, 4) identify potential unintended consequences or barriers to the implementation of policy. By providing examples, this how-to aging and health policy road map provides context and guidance to stakeholder engagement, frameworks, and methods that can be used to engage in the policymaking process. The final part of this presentation explores ways to integrate health policy training and experience into scholars’ and clinicians’ professional development.

Containing COVID-19 Through Contact Tracing

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.

ID/HIV Physician Ambassadors: Advancing Policy to Improve Health.

ID/HIV physicians and other healthcare professionals advocate within the healthcare system to ensure adults and children receive effective treatment. These advocacy skills can be used to inform domestic and global infectious disease policies to improve healthcare systems and public health. ID/HIV physicians have a unique frontline perspective to share with federal policymakers regarding how programs and policies benefit patients and public health. Providing this input is critical to the enactment of legislation that will maximize the response to infectious diseases. This article discusses the advocacy of ID/HIV physicians and other healthcare professionals in federal health policy. Key issues include funding for ID/HIV programs; the protection of public health and access to health care; improving research opportunities; and advancing the field of ID/HIV, including supporting the next generation of ID/HIV clinicians. The article also describes best practices for advocacy and provides case studies illustrating the impact of ID/HIV physician advocacy.

Infectious Diseases/Human Immunodeficiency Virus Physician Ambassadors: Advancing Policy to Improve Health.

Infectious diseases/human immunodeficiency virus (ID/HIV) physicians and other healthcare professionals advocate within the healthcare system to ensure adults and children receive effective treatment. These advocacy skills can be used to inform domestic and global infectious diseases policies to improve healthcare systems and public health. ID/HIV physicians have a unique frontline perspective to share with federal policymakers regarding how programs and policies benefit patients and public health. Providing this input is critical to the enactment of legislation that will maximize the response to infectious diseases. This article discusses the advocacy of ID/HIV physicians and other healthcare professionals in federal health policy. Key issues include funding for ID/HIV programs; the protection of public health and access to healthcare; improving research opportunities; and advancing the field of ID/HIV, including supporting the next generation of ID/HIV clinicians. The article also describes best practices for advocacy and provides case studies illustrating the impact of ID/HIV physician advocacy.

Innovations in Care: Complementary and Integrative Health in the Veterans Health Administration Whole Health System.

Innovations in Care: Complementary and Integrative Health in the Veterans Health Administration Whole Health System.

Question worth 20 million lives: Why federal housing assistance has not had its Obamacare

AbstractThe equitable character of a policy determines its progressiveness, yet some domestic policies are more equitable than others. The question of how and why this is the case is addressed by studying federal housing and health policies in the United States, a critical case known for its rampant inequalities in both sectors. Although social equity is a fundamental aspect of welfare provision, explaining differences in coverage and government support among policy areas remains a weakness in the literature. This comparative historical analysis shows that both housing assistance and health care suffered from inequities almost as early as their inception. But a progressive reform took shape with the Affordable Care Act (ACA) and extended coverage to 20 million people formerly uninsured. This essay tackles an unsolved puzzle: Why has such grand policy reform never taken place in housing where more than 20 million people are eligible for assistance but do not receive help? We found that it is largely explained by housing assistance distinctiveness with regard to its weak constituency, racial connotation and low public concern. We conclude with the analytical payoffs of studying social equity, both for political scientists and observers of social affairs.

A BUSY YEAR IN GERIATRIC MENTAL HEALTH ADVOCACY

This session, sponsored by the Public Policy Caucus, will provide updates on recent federal and state mental health legislation and policy issues and will feature Public Policy Caucus members who have been engaged advocates for geriatric mental health over this past year. Presenters from our advocacy partners in the APA Department of Government Relations will review the key current issues in aging and mental health policy, with specific focus on current federal and state health care legislation that may have impact on our patients and our practice. Presenters will review their advocacy work this past year, which highlight ways in which AAGP members can be involved in: being engaged at the community and state level; representing AAGP in the AMA House of Delegates; and working on Capitol Hill.

Federal Indian Law as a Structural Determinant of Health.

Federal Indian law is the body of law that defines the rights, responsibilities, and relationships between three sovereigns, Tribes, states, and the federal government. This area of law has defined, oftentimes poorly, the contours of treaty rights, criminal and civil jurisdiction, economic development, among other issues. Much has been documented in terms of the implications of social, legal, political, and economic systems that perpetuate inequities amongst American Indian and Alaska Native populations. There has also been substantial research on health inequalities. Yet, there has been less discussion on the role of law in perpetuating these adverse health outcomes in these populations. The social and structural determinants of health are the factors and conditions, such as housing, education, and politics, that create health disparities. For years, law has been described as a tool to promote health and even a determinant of health. And while research has explored Tribal health laws and federal Indian health policies, more needs to be analyzed in terms of the role of foundational principles of federal Indian law in perpetuating health disparities. This article argues that federal Indian law is a structural determinant of health by linking health disparities to the constructs of this body of law.

The discordance between evidence and health policy in the United States: the science of translational research and the critical role of diverse stakeholders

BackgroundThere is often a discordance between health research evidence and public health policies implemented by the United States federal government. In the process of developing health policy, discordance can arise through subjective and objective factors that are unrelated to the value of the evidence itself, and can inhibit the use of research evidence. We explore two common types of discordance through four illustrative examples and then propose a potential means of addressing discordance.DiscussionIn Discordance 1, public health authorities make recommendations for policy action, yet these are not based on high quality, rigorously synthesised research evidence. In Discordance 2, evidence-based public health recommendations are ignored or discounted in developing United States federal government policy. Both types could lead to serious risks of public health and clinical patient harms.We suggest that, to mitigate risks associated with these discordances, public health practitioners, health policy-makers, health advocates and other key stakeholders should take the opportunity to learn or expand their knowledge regarding current research methods, as well as improve their skills for appropriately considering the strengths and limitations of research evidence. This could help stakeholders to adopt a more nuanced approach to developing health policy. Stakeholders should also have a more insightful contextual awareness of these discordances and understand their potential harms. In Discordance 1, public health organisations and authorities need to acknowledge their own historical roles in making public health recommendations with insufficient evidence for improving health outcomes. In Discordance 2, policy-makers should recognise the larger impact of their decision-making based on minimal or flawed evidence, including the potential for poor health outcomes at population level and the waste of huge sums. In both types of discordance, stakeholders need to consider the impact of their own unconscious biases in championing evidence that may not be valid or conclusive.ConclusionPublic health policy needs to provide evidence-based solutions to public health problems, but this is not always done. We discuss some of the factors inhibiting evidence-based decision-making in United States federal government public health policy and suggest ways these could be addressed.

Sovereignty and social justice: how the concepts affect federal American Indian policy and American Indian health

ABSTRACTThe health disparities that are prevalent among American Indian and Alaska Native (AI/AN) communities are connected to the ideology of sovereignty and often ignored in social work and public health literature. Therefore, the purpose of this paper is to examine the health outcomes of American Indians from the time of contact with European settlers to the present through the ideology of sovereignty and federal government AI health policy. The foundation for the health outcomes of AIs and the governmental policies affecting them lie in the ideology of tribal sovereignty. This ideology has greatly impacted how the government views and treats AIs and consequently, how it has impacted their health. From the earliest treaties between European settlers and AIs, this legal relationship has been and remains a perplexing issue. With the examination of tribal sovereignty comes the realization that colonization and governmental polices have greatly contributed to the many social and health problems that AIs suffer from today. Understanding that the health disparities that exist among AI/AN populations cannot only be attributed to individual behavior and choice but is driven by societal, economic and political factors may be used to inform social work education, practice, and research.

Evolving Federal and State Health Care Policy: Toward a More Integrated and Comprehensive Care-Delivery System for Children With Medical Complexity.

Irrespective of any future changes in federal health policy, the momentum to shift from fee-for-service to value-based payment systems is likely to persist. Public and private payers continue to move toward alternative payment models that promote novel care-delivery systems and greater accountability for health outcomes. With a focus on population health, patient-centered medical homes, and care coordination, alternative payment models hold the potential to promote care-delivery systems that address the unique needs of children with medical complexity (CMC), including nonmedical needs and the social determinants of health. Notwithstanding, the implementation of care systems with meaningful quality measures for CMC poses unique and substantive challenges. Stakeholders must view policy options for CMC in the context of transformation within the overall health system to understand how broader health system changes impact care delivery for CMC.

Advancing the Legislative Priorities of Cardiothoracic Surgeons: The Society of Thoracic Surgeons Political Action Committee

In the late 1990s, several federal government health policy decisions threatened the viability of thoracic surgery as a specialty. To respond to such decisions, active participation in political processes was given extremely high priority by the Executive Committee of The Society of Thoracic Surgeons (STS). Creation of the STS Political Action Committee (STS-PAC) in 1997 was a part of the platform of participation. The purpose of the STS-PAC is to enhance the Society's voice and stature in health care policymaking. Although the STS-PAC receives voluntary contributions from STS members, on average, only 10% of STS members contribute to the STS-PAC. For the 2015-2016 election cycle, there were 542 contributors to the STS-PAC totaling $273,000. An annual contribution of $100 from every STS member would put the STS-PAC into the top 10 for medical PACs (whereas currently it is ranked 22nd of 28 in the group of physician and dental association PACs). Despite the relatively small dollar amount the STS-PAC directs, its strategic disbursement of these dollars has yielded impressive results. For example, the STS-PAC was able to use its influence to effectively stop the Centers for Medicare and Medicaid Services from implementing a potentially calamitous rule that would effectively end traditional global surgical payments. Other advocacy successes include providing guidance to the Centers for Medicare and Medicaid Services in developing the national coverage determination for transcatheter aortic valve replacement and structuring its complex reimbursement schedule, and ensuring that a provision was included in the bill that would give the STS National Database access to claims data. The STS-PAC is a principal component of the STS' advocacy armamentarium. Despite the many successes of the STS-PAC, with even modest contributions by more STS members, the STS-PAC could become a leading medical PAC, and would give the STS an even stronger presence and voice in Washington, DC. Clearly, contributing to the STS-PAC provides STS members the opportunity to have a voice and an impact on health policy and the care of their patients.

Patients With Serious Mental Illness Need Better Primary Care Integration, Health Advocacy

Patients With Serious Mental Illness Need Better Primary Care Integration, Health Advocacy

Religion, Medicine, and Politics: Catholic Physicians' Guilds in America,1909-32.

In 1909 the first Catholic physicians' guild formed in New York City. By 1911 guilds could be found in Philadelphia and Boston. They acted as professional organizations as well as brotherhoods built on a set of shared religious and moral convictions. They brought moral perspectives from Catholic doctrine into critical conversation with their medical work. By 1931, enough enthusiasm existed to form the National Federation of Catholic Physicians' Guilds (NFCPG). The creation of NFCPG marked a clear effort to insert Catholic values into America's health care debates. Focusing on the Philadelphia and Boston guilds, and with the use of archival collections at the Boston and Philadelphia archdioceses, this article examines the origins of the guild movement. Over the first several decades of their existence the guilds became an increasingly politically savvy force in American health care as they worked to influence local, state, and federal health policies surrounding women's health care.

Overview of Coronary Heart Disease Risk Initiatives in South Asia.

Cardiovascular disease (CVD) is now the leading cause of morbidity and mortality worldwide. Industrialization and economic growth have led to an unprecedented increment in the burden of CVD and their risk factors in less industrialized regions of the world. While there are abundant data on CVD and their risk factors from longitudinal cohort studies done in the West, good-quality data from South Asia are lacking. Several multi-institutional, observational, prospective registries, and epidemiologic cohorts in South Asia have been established to systematically evaluate the burden of CVD and their risk factors. The PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP), the Kerala Acute Coronary Syndrome (ACS), and Trivandrum Heart Failure registries have focused on secondary prevention of CVD and performance measurement in both outpatient and inpatient settings, respectively. The Prospective Urban and Rural Epidemiology (PURE), Centre for Cardiometabolic Risk Reduction in South Asia (CARRS), and other epidemiologic and genetic studies have focused on primary prevention of CVD and evaluated variables such as environment, smoking, physical activity, health systems, food and nutrition policy, dietary consumption patterns, socioeconomic factors, and healthy neighborhoods. The international cardiovascular community has been responsive to a burgeoning cardiovascular disease burden in South Asia. Several collaborations have formed between the West (North America in particular) and South Asia to catalyze evidence-based and data-driven changes in the federal health policy in this part of the world to promote cardiovascular health and mitigate cardiovascular risk.

Captain Brain versus Mister Mind. Une histoire américaine

ObjectiveVery often, the brain and the mind are objects of controversy in the world of psychiatry. The history of American psychiatry is instructive in this respect. From an early date, the United States embraced psychoanalysis, invented behaviorism, promoted biological psychiatry, used biometry and produced a highly successful classification of mental disorders. The objective of this paper is the study of this history. MethodThe paper proposes a detailed study of the theories, practices and ideological debates in the field of American psychiatry since the 18th century, and of federal mental health policies. ResultsPsychiatry in the United States has distinctive features linked to the concept of manifest destiny, Protestantism and pragmatism, to the manner in which the nation was constructed (slavery, conquest of the West, economic liberalism) and to the ceaseless wars, from the War of Independence to the Middle Eastern wars, not forgetting the Civil War and two World Wars. As the nation succeeded in integrating its immigrants, it also assimilated their different cultures and their discoveries in the field psychiatry. Many theories and practices that later diffused by globalization were instigated by the nation, among others the DSMs, part of the cultural, scientific, economic and political development of the nation. Lay people were early protagonists in the constructive shifts, conflicts and anti-psychiatry tendencies. DiscussionThis paper examines the growing success of psychoanalysis in the 1950s and the causes behind its loss of influence in the 1970s. It does not attribute this loss to the DSM-III, but to the psychoanalysts themselves. It sets out to demonstrate that the DSM-III and later DSMs did not result in a paradigm shift in the meaning of Thomas Kuhn. ConclusionThe history of American psychiatry proves that there is little chance of seeing an end to the conflicts between advocates of the brain, still poorly understood, and upholders of the mind, often poorly defined, as long as our knowledge in the field of mental disorders remains as slim as it is today.