Posted: June 12th, 2022

Policy and Advocacy for Improving Population Health

Agenda Comparison Grid Assignment Template for Part 1 and Part 2

Part 1: Agenda Comparison Grid

Use this Agenda Comparison Grid to document information about the population health/healthcare issue you selected and the presidential agendas. By completing this grid, you will develop a more in depth understanding of your selected issue and how you might position it politically based on the presidential agendas.

You will use the information in the Part 1: Agenda Comparison Grid to complete the remaining Part 2 and Part 3 of your Assignment.

Identify the Population Health concern you selected.
Describe the Population Health concern you selected.
Administration (President Name)
Explain how each of the two presidential administrations approached the issue.
Identify the allocations of resources that the current and previous presidents dedicated to this issue.

Part 2: Agenda Comparison Grid Analysis

Using the information you recorded in Part 1: Agenda Comparison Grid, complete the following to document information about the population health/healthcare issue you selected

Administration
Which administrative agency (like HHS, CDC, FDA, OHSA) would most likely be responsible for helping you address the healthcare issue you selected? Why is this agency the most helpful?

How do you think your selected healthcare issue might get on the presidential agenda? How does it stay there?
Who would you choose to be the entrepreneur/ champion/sponsor (this can be a celebrity, a legislator, an agency director, or others) of the healthcare issue you selected? An example is Michael J. Fox a champion for Parkinson’s disease.

Mental health
I will be discussing the topic of mental health and its role at the presidential level, discuss how different presidential administrations addressed it and what I would have done differently. I will discuss the Obama, the Trump, and the Biden administrations. Mental Health According to the National Institute of Mental Health (n.d.), nearly one out of every five United States adults live with a mental illness. However, the average delay between the onset of symptoms in those experiencing a mental health illness and receiving treatment and/or counseling is 11 years (NAMI,2021). The issue of suicide and mental health began its climb up the political ladder in the mid-1990s when a small, lower-level group replicated the United Nation’s guidelines to encourage a national strategy addressing mental health (U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention, 2012). This effort birthed two Congressional Resolutions that placed suicide a national problem and its prevention a national priority (U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention, 2012). Since then, there has been an ebb inflow in the level of public attention or directed national reforms in mental health. Nonetheless, progress was never halted with new legislative achievements including acts providing grants to implement suicide prevention, suicide prevention programs for veterans, and the establishment of the National Suicide Prevention Line. In the following sections, I will evaluate the different presidential agencies’ strategies and progression in mental health reform, acts, and improvements.

The Obama Administration

The Obama administration demonstrated major leaps in many areas of healthcare reform. In 2010, President Obama placed the Affordable Care Act into action. This act required all small-group health plans starting January 2014 to cover ten essential health benefits in which mental health and addiction treatment were included (Norris, 2021). Although the act could not require large-group plans to cover the ten essential health benefits if they did provide mental health or addiction services the coverage rates had to be in parity with medical/surgical benefits (Norris, 2021). In December of 2016, the Obama administration signed the 21st Century Cures act into place. This Act not only supported major mental health and substance abuse treatment but also recruitment, training, and keeping the mental health workforce through grants for those who practiced psychiatry and/or addiction in underserved communities (Levin, 2017). The drive to form and implement these acts is sourced from a noted strong deficit in healthcare coverage or affordable healthcare. With the acknowledgment of the low percentage of healthcare coverage in the lower economic status, a lack of support for mental health providers, and the noticed under-recognized mental illness, lobbyists and healthcare reformers were eager to seek attention and seize the open window of a change in administration Just as John W. Kingdon (2001) describes in his stream analogy when a problem is recognized, a solution is recognized and the political environment is right, the three metaphorical streams are joined and conditions to successfully push proposals are made. Mental health activists successfully lobbied for their identified problems and when the Obama administration opened the ‘window’ they were able to set reform into place.

The Trump Administration

With another change in the political climate, the Trump administration had its own reforms in contrast to the Affordable Care Act. The Trump administration sought to repeal the ACA formerly put into place. This would retract the security that the ACA set of equal parity requirements in the small-group and Medicaid health coverage (Nuzum & Abrams, 2020). In doing this, access to mental health services became limited to a large percentage of the lower socioeconomic status population and the older population. Although the act was not completely repealed, changes were made so that those covered were affected and the requirements to have coverage were altered. This modification, however, came with demand and recognition of lobbyists during a time of ‘open window’ at the change of administration. The start of a pandemic sparked a different type of ‘change’ availability. In response, the Trump administration signed an order that had the potential to increase mental health services to those suffering from symptoms that were worsened by the global pandemic. This order spawned the Coronavirus Mental Health Working Group which collaborates with the public, stakeholders, and agencies to help people in crisis (Le, 2020). However, there was a noticed shortage of mental health providers which demanded action and recognition as well. In 2021 the Trump administration presented a 24% increase in the budget for behavioral health workforce programs (Nuzum & Abrams, 2020). President Trump also set an executive order laying the pandemic-related mental health needs as a national priority (Nuzum & Abrams, 2020). In this administration’s time frame, we can directly see the correlation between identified problems, proposed solutions, and the opportunities created by ‘open windows’ of different types (change in administration, the onset of pandemic setting).

The Biden Administration

Once again, in a very distinct political battle, the figurative window for policy change was opened again. The Biden administration quickly placed an executive order that opened a special enrollment time frame for citizens and reeled back Trump’s constraints on the ACA and Medicaid (NAMI, 2021). The demand for another healthcare reform inspired expansions of the ACA. This expansion was part of the American Rescue Plan Act (ARPA) which gave $10.7 million to expand pediatric mental health access (Department of Health and Human Services, 2021). The ARPA also gave $2.5 billion to the states to address the mental illness and addiction crisis in the nation, $20 million toward programs for mental health professionals and first responders, $20 million to carry out Youth Suicide Prevention Programs, $100 million for mental health education grants and much more (Le, 2021).

What Would I Do Differently?

In studying the different administrations and the reactions to political and social influence, I was both encouraged and slightly concerned about the lengthy and sometimes politically biased process reform has to go through to come to action. Although, I understand different platforms of perspectives on social, economic, and most recently pandemic change; the interruption of progress strikes me as anti-progressive. As a healthcare professional, my ideal strategy to keep a flow of progressing solutions would be to present my addressed problem/topic (mental health) that was appealing to multiple ‘open window’ scenarios. Keeping my mental health problem at the forefront and making sure my proposed solutions are sustainable through different political stances would be my strategy to keep it from faltering in progression through partisan changes. Federal Agenda and Healthcare IssuesHealthcare issues become political agenda priorities through a system of defining problems, finding solutions, promoting those solutions to policymakers, and through the mechanism of politics, those solutions become policies, laws, or regulations. (Laureate Education, 2018). The timing and readiness of policymakers are imperative to the effectiveness of the presentation of a proposed problem and solution. Any change in administration, social crisis, or pandemic can represent a change or opening in the federal agenda. When this change or opening occurs, lobbyists and representatives must be quick and ready to briefly yet effectively present. Just as DeMarco & Tufts (2014) describe, a policy brief is a condensed report containing information that can be understood quickly, provide findings and offer recommendations to those who may not be an expert in the proposed field. Therefore, healthcare issues become federal agenda priorities through identification, preparedness, and correct timing and opportunity of information provided, and in return, the federal agenda promotes healthcare issues by bringing awareness of the problem to those, not healthcare professionals and seeking a solution to implement by way of policy, laws or regulations.

References

Department of Health and Human Services. (2021, August 27). Biden-Harris Administration invests $10.7 million in American rescue plan funds to expand Pediatric Mental Health Care Access. HHS.gov. https://www.hhs.gov/about/news/2021/08/27/biden-harris-admin-invests-nearly-11-million-for-pediatric-mental-health-access.html

DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook,62(3), 219-224. DOI: 10.1016/j.outlook.2014.04.002

Kingdon, J.W. (2001). A model of agenda-setting with the application. Law Review M.S.U.-D.C.L., 2(331)

Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.

Le, D. (2021, March 12). President Biden Signs American Rescue Plan Into Law. American Counseling Association. https://www.counseling.org/news/updates/2021/03/12/president-biden-signs-american-rescue-plan-into-law.

Le, D. (2020, October 6). Latest news from ACA. American Counseling Association. https://www.counseling.org/news/updates/2020/10/06/president-trump-issues-executive-order-on-behavioral-health.

Levin, A. (2016). Obama signs landmark legislation with major mental health provisions. Psychiatric News, 52(1), 1-1. https://doi.org/10.1176/appi.pn.2017.1a10

National Alliance on Mental Illness (2021) Mental health by the numbers. NAMI. https://www.nami.org/mhstats.National Alliance on Mental Illness. (2021, January 28).

NAMI Applauds President Biden’s Efforts to Strengthen Access to Quality, Affordable Health Care [Press release]. https://www.nami.org/Press-Media/Press-Releases/2021/NAMI-Applauds-President-Biden-s-Efforts-to-Quality-Affordable-Health-CareNational Institute of Mental Health (n.d.). Mental Illness.

National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.

Norris, L. (2021, March 30). How Obamacare improved mental health coverage. health insurance.org.https://www.healthinsurance.org/obamacare/how-obamacare-improved-mental-health-coverage/

Nuzum, R., & Abrams, M. (2020, October 14). Health care in the 2020 presidential election: Mental health and substance use disorders. Commonwealth Fund. https://www.commonwealthfund.org/blog/2020/health-care-2020-presidential-election-mental-health-and-substance-use-disorders.

U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention. (2012). 2012 National Strategy for Suicide Prevention: Goals and Objectives For Action: A Report of the U.S. surgeon general and of the National Action Alliance for Suicide Prevention.v
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Policy and Advocacy for Improving Population Health

NURS 6050

Part 1: Agenda Comparison Grid
Identify the Population Health concern you selected.
Mental health
Describe the Population Health concern you selected and the factors that contribute to it. National Institute of Mental Health indicate that at least one out of five American adults live with mental health problems. However, the average period between onset of symptom and treatment is 11 years (NAMI,2021). Mental health and suicide issues started to climb in 1990s. United Nation’s guidelines encouraged nations to develop strategies to address mental health (U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention, 2012). Congressional resolutions a national problem and its prevention a national priority. Since then, national reforms have been made to counter mental health.
Administration (President Name) President Biden President Trump President Obama
Describe the administrative agenda focus related to this issue for the current and two previous presidents.
President Biden gave an executive order to eliminate the constraints placed by the former administration on ACA and Medicaid (Department of Health and Human Services, 2021).
President Trump made attempts to alter and repeal the ACA, an act that would affect healthcare delivery to millions of low-income communities. Although the act was not completed, its alteration affected delivery of mental healthcare to low-income communities. In 2021, Trump presented a 24 percent increase in funding for the behavior workforce programs. Trump gave an executive order indicating mental health need is a national priority (Yan et al., 2021).
In 2012, Obama placed the Affordable Care Act into action to cater for health issues such as mental health. In 2016, Obama signed 21st Century Cures act to ensure mental healthcare workers were receiving appropriate funding, training, and recruitment. Obama administration encouraged reforms to enhance mental healthcare delivery (Levin, 2016).
Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
The administration through American Rescue Plan Act (ARPA) gave an extra $10.7 million to expand pediatric mental health access. ARPA gave $2.5 billion to counter mental health issues and addiction. The amount was subdivided into $20 million towards mental health and $20 million towards Youth Suicide Prevention Programs and $100 million for education grants on mental health issues (Department of Health and Human Services, 2021).
President Trump allocated $15 million for a new Assertive Community Treatment. $425 million in emergency funds and $175 billion grant program and other healthcare entities (Yan et al., 2021).
President Obama allocated $500 for mental health. Obama increased National Institute of Mental Health (NIMH) budget by $56 from $1.434 billion to $1.489 billion to facilitate mental health research. $482.5 million for the Mental Health Services Block Grant and $7.5 billion for mental health care for veteran affairs (Levin, 2016).
Explain how each of the presidential administrations approached the issue.
President Biden approached the issue proactively increasing funding, eliminating barriers, and promoting wider coverage (Department of Health and Human Services, 2021).

President Trump made an attempt to repeal ACA, an issue which created barriers to access to mental healthcare (Yan et al., 2021).
President Obama was effective in handling the issue by increasing coverage among low-income communities (Levin, 2016).

Part 2: Agenda Comparison Grid Analysis
Using the information you recorded in Part 1: Agenda Comparison Grid, complete the following to document information about the population health/healthcare issue your selected
Administration (President Name) President Trump President Obama President Bush
Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected?

The Center for Disease Control and Prevention and National Institute of Health are the best placed to address the problem. National Agency for Food and Drug Administration and Control (NAFDAC), National Health Insurance Scheme (NHIS), and CDC.
Department of Health and Human Services, The Center for Disease Control and Prevention, and National Agency for Food and Drug Administration and Control.
How do you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there?
The mental health issue can get into the agenda of the current president since it has been declared Congress as a national problem that require national priority. Post-Covid-19 era presents diverse health issues relating to mental problems.
The Trump administrative gave an executive order to counter the rising cases of mental health issues in 2021 during the pandemic.
Mental health issue was a priority for the Obama administrative since he was concerned about the mental health issues affecting the low-income communities.
Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected for the current and two previous presidents?
I would choose the Bill Clinton Foundation and NBC’s Dr. John Torres
I would choose the Bill Clinton Foundation and NBC’s Dr. John Torres
I would choose the Bill Clinton Foundation and NBC’s Dr. John Torres

References
Department of Health and Human Services. (2021, August 27). Biden-Harris Administration invests $10.7 million in American rescue plan funds to expand Pediatric Mental Health Care Access. HHS.gov. https://www.hhs.gov/about/news/2021/08/27/biden-harris-admin-invests-nearly-11-million-for-pediatric-mental-health-access.html
Yan, B. W., Hsia, R. Y., Yeung, V., & Sloan, F. A. (2021). Changes in mental health following the 2016 presidential election. Journal of general internal medicine, 36(1), 170-177.
Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.
Levin, A. (2016). Obama signs landmark legislation with major mental health provisions. Psychiatric News, 52(1), 1-1. https://doi.org/10.1176/appi.pn.2017.1a10
NAMI Applauds President Biden’s Efforts to Strengthen Access to Quality, Affordable Health Care [Press release]. https://www.nami.org/Press-Media/Press-Releases/2021/NAMI-Applauds-President-Biden-s-Efforts-to-Quality-Affordable-Health-CareNational
Institute of Mental Health (n.d.). Mental Illness
National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.

References

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