Implementation of State Policies Paper Example

Q1: Federalism- State Presentation

The South Dakota Senate Bill 105 (SB105) and Oregon's Death with Dignity Act of 1994 both represent different concepts of federalism as their foundations. The South Dakota Bill aims at protecting unborn babies from toxins ingested by their mothers. The argument is that those infants cannot argue for themselves. While Washington funds healthcare services, South Dakota decides to spend a section of it in protecting the health status of the unborn babies. This is clearly an application of Cooperative Federalism. Oregon's Death with Dignity Act of 1994, on the other hand, is aimed at fulfilling the wishes of terminal patients who opt to have physician-assisted dying. While Washington funds medical activities, it doesn't dictate how individual states conduct certain medical activities. These states have the rights to determine their healthcare bills. That is what Oregon utilized in passing the 1994 Act in question. This is, thus, an application of Dual Federalism.

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Q2: Implementation- State Bill

The chosen bill is West Virginia Opioid Reduction Act also referred to as Senate Bill 273 (SB 273). This bill was passed as a result of numerous deaths related to opium overdose in West Virginia. According to National Institute of Drug Abuse (2018), West Virginia led in a number of opioid-related deaths in the year 2016, claiming a whole 43.4% nationwide. That is almost 50% of the total number of deaths that opioid-related across all the States. The main goal of that act was to respond to the menace because it had actually become an epidemic. It did not just aim at reducing the number of deaths related to opioids, but also cub its abuse and so avoid the deadly overdose.

Implementation of SB 273 had a lot of methodologies to employ in achieving its goal. The first is to limit emergency room prescription to a three-day supply, second is to limit the first ever opioid prescription to a seven-day supply, third is that doctors are also required by the bill to properly educate patients about the dangers of opioid, fourth is to allow patients to willfully quit opioid prescriptions, and finally allow medical licensing boards to flag doctors or take any other necessary precautions.

Rule-making: The West Virginia Opioid Reduction Act is quite clear and precise. However, there is still more that can be done to make it more effective and focused. For example, the first method which is to limit the initial to a period of one week of supply is not focused. The fact is prescriptions majorly depend on the doctor's assessment. Additionally, the role of medical licensing boards is also not stated explicitly. It has been left too open to handle any particular problem.

Operations: While the Act doesn't explicitly state how operations, as regards its implementations, shall be carried out, it is worth deducing from the proposed methodologies. Included here is the civic education by medical doctors to offer proper education to patients about the dangers of opioid. Also, the operations have clearly been left in the hands of medical doctors because they are the ones who issue prescriptions. On that note, therefore, the bill limits doctors to only half a week supply of opioids to patients in the emergency services. They are restricted to a maximum of seven-day supply for first-timers.

Oversight: Medical activities are best audited by medical experts. The oversight of West Virginia Opioid Reduction Act shall fall on the shoulders of the Medical Licensing Board. Their duties in this regard shall include but no be limited to flagging doctors. The Policy also allows the board to have the discretion of taking any necessary action that would help implement the bill successfully. In that regard, therefore, it is worth deducing to conclude that the board shall thus act in a manner that will carry out disciplinary actions to doctors who sabotage the bill.

Q3: Policy Lessons from Oberlander & Models/Affordable Care Act

Policy-related characteristics

The features of the policy are a sample of the theories that dictate the fruitfulness of policy actualization. The idea paints a picture of the characteristics of the policy and manner in which the features are significant to the ultimate fulfillment of the set goals and objectives of the policy model. In this theory, the register and structure of the policy are keys to its success. The policy should have a clear and concise manner in which its elements (goals and objectives) are communicated. The entire policy must be succinct for a fruitful implementation. There is a close connection between the theory and the policy model; it makes sure that policies that are too wide are broken down, analyzed and condensed into easily understandable concepts. The problem with a broad policy is that certain elements may collide with each other thus hindering the ultimate success.

Oberlander's extensive discussion on Medicare suggests features of policy which prompted opposition of the goals and objectives regardless of them being clear. The result was an attempt to bar the government from clinical medicine (Oberlander, 2003). The American Medical Association also joined in the campaign against mandatory health insurance. Slowly, the campaign intensified and even opposed political endeavors that were involved in actualizing the universal health insurance in 1920. Consequently, features of a policy are very influential in determining the success or failure of a policy (Oberlander, 2003).

The elements of the policy can help one get a clear picture of the past by analyzing the intentions with which the policy was put forward in the first place. Clashing aims at the policy point to translucent intentions for the past. It follows that revising the policy makes comprehending the present and predicting the future possible. The revision should include making the register as concise and precise as possible because that is one of the barriers to a successful implementation of the policy. However, in Medicare, the future of Affordable Care Act is too bleak in the hands of Republicans because of them, either the policy lacks a clear path or the policy itself is unclear.

The Capabilities and Characteristics of the Executive Branch

This idea establishes the success of the policy because the driving power of the policy is a willing executive branch. Additionally, the executive-affiliated agencies have the goodwill for the success of the implementation of the policy. It must be noted that those two are in charge of the operations involved in implementing the policy. The bottom line here is that any particular policy that has the full support of the executive shall be successful. On the other hand, a policy that lacks the willful support of the executive has almost no chance to be successful.

This idea has a close connection to the operations model of the policy. This is because; it makes reference to the executive which is always in charge of the operations of policies. Operation refers to all the activities that are carried out during the implementation of a policy. It is the role of the executive arm to ensure that all operations that are necessary for the fulfillment of a policy are running smoothly and successfully.

Oberlander provides a vast wealth of lessons as regards policy making, operations, and political goodwill. For instance, the most conspicuous from the story is that all the Acts under Medicaid to which it makes reference were successful if and only if they had support from the presidents. One good example is the case of President Johnson. He had support for the Medicaid reforms. However, his strong advocacy for it was not enough. However, his unyielding support for the reforms pushed him to urge all the agencies concerned to join his Medicaid reform campaign. Oberlander (2003) points out that the costs for championing for such Medicaid legislative reforms as that of President Johnson are high, and that is why he had to solicit support from relevant agencies. As it is clear, the unwavering support of the executive is crucial to the success of any policy.

This very idea of winning the support of the executive as a requirement for the success of a policy is also seen during the reign of President Barrack Obama. His push for the Affordable Care Act was relentless. In his tenure, he talked about it public places and sold the idea to the relevant agencies. Because of that massive support from the executive, the policy had a future. The present president and the executive have no goodwill for the act. Therefore, the policy is facing serious threats that would mean its failure even before it is enacted, if it gets lucky to be enacted that is.

The Speed of Implementation

This idea brings out the concept of timing; the amount of time it would have to wait before it gets implemented. Therefore, the speed of implementation refers to the period of time that is created as an allowance for the people who support the policy and those who hold dissenting opinions to go through the policy in its entirety.it follows that for the policy to be successful, the time allowed for the speed of implementation should be intentionally shortened. The logic behind this is that a longer period of time grants dissenting voices more time to find even more reasons to bring it down.

This idea is linked to the implementation model because of all the models, it explicitly identifies with the implementation process. The reason behind this is that implementation involves the procedures and steps to be followed some of which involve rule-making. The rule-making is essentially the legislative juncture where dissenting politicians get the chance to oppose the policy. Sandwiched between the processes involved and the phase of rule-making is the speed of implementation which ought to be short for the sole purpose of making the implementation a success.

Oberlander (2003) provides insightful scenes that resonate with this idea. Bill Clinton's Health Security Act of 1993 failed whereas Johnson's Act was successful. The contrast in those two policies is that Johnson moved hastily in his push for the policy, thereby giving his critics no chance to lobby for the sabotage of the policy. Bill Clinton's failure occurred because he dragged the introduction of the Act for nine solid months. By the time he was introducing it; his critics had already gained momentum and so sabotaged the policy.

Considering the speed with which policies were enacted in the past and their consequences, it is crystal clear that swiftness guarantees successful implementation of a policy, while sluggishness is a sure permit for failure. Therefore, the same tactic can be applied today and in the future. While dissenting voices will also revise their speed, proposers of various policies can further accelerate their speeds.

Q4: How am I going to use this? Reflect on what you have learned about health policy from the course

Throughout this health policy course, I have learned so much about the various players in the policy-making and implementation process. Such stakeholders include the federal government, consumers, insurers, suppliers, and provider organizations. I have gained insight into the influence that such interest-groups have on various Medicaid policies. As a researcher, I will borrow a lesson from this course in working out the probabilities of certain policies to be successful depending on various factors among them the concerned interest-groups. That will, in essence, be like a feasibility to determine the best approach of presenting and campaigning for a policy. As a healthcare professional, I will make sure that I support policies that seem to have wide-spread support. I will also make sure that my reviews of individual policies are unbiased and are based on considerations of the viewpoints of all th...