Global Perspective on Health Policy A macro perspective on health policy issues has been addressed in this paper. This paper identifies how health insurance problems became a policy issue and how this issue resulted in the creation of health care policy.

Controversial issue in health and how this issue has resulted a policy's creation

The American health insurance system is riddled with drawbacks, for instance, continuously escalating premiums, and finding decent coverage. Employers seldom provide health insurance; as well, car insurance and house insurance is not covered by employers (nor should they be). One deficiency of employer-provided health insurance is that there are fewer options to choose from while selecting from the sponsored health plans. This holds true for the various companies which provide various kinds of insurance for house and cars. This is because the health insurance market is not the same as the automobile and/or home insurance market. In case of health insurance, an employee has 2-3 plans provided by the employer to choose from irrespective of the plan meeting / not meeting the needs of an employee and might well be the products of just one insurance company. Another demerit of obtaining an employer-based health insurance policy is that in event of resigning from the job, the employee's health insurance is revoked, which may be a grave matter in this present market (Basu, 6).

In case of unavailability of a new job with health insurance, or during a period of hiatus, the individual will have to browse through the local marketplace for suitable health insurance. With an existing medical condition in previous employment, premiums are much higher while applying for a new health insurance, in comparison to the previous health plan during employment. The reason in this case is that pre-existing medical conditions are in a higher risk category. The health insurance application could also be rejected in this case (Basu, 6).

As a result of the above challenges related to health insurance, the Obama Administration introduced the Patient Protection and Affordable Care Act. The act proposed to have each American's health protected with basic care and have this entrenched in law. Popularly known as the Affordable Care Act and nicknamed Obamacare, the law was passed and signed by the president in March 2010. The Act did away with the exemption for previously existing medical conditions that barred insurers from covering persons based on their medical history and other conditions. It also extended insurance to over 30 million Americans previously uncovered through expansion of Medicaid and provision of federal subsidies enabling lower and middle income Americans to access private health insurance covers (HealthCare.gov).

The Patient Protection and Affordable Care Act (ACA) was promulgated in effect on March 23, 2010. One of the primary aims of this act was to manage health insurance. ACA provides health insurance consumers and providers with new ways to hold insurance companies liable. Notable characteristics of this law regarding insurance are:

Insurance choices: The primary objective of this law is to open up health care coverage to a majority of American citizens, allowing them to purchase a health insurance by law (HealthCare.gov, 2012a). The citizens can choose from Medicaid

Medicare

State based insurance coverage

Private insurance (Lachman, 248)

Insurance costs: Insurance companies are accountable under ACA. Furthermore, it is supposed to assist in keeping medical costs down for individuals; this is turning out not to be the reality.

Value for individual's premium dollar is a 'given' under the ACA. According to ACA bylaws, the insurance companies selling insurance to individuals and groups are to spend at a bare minimum 80% of their premiums on medicinal care and improving the quality of health.

Lifetime and annual limits: ACA has put restrictions and discontinued the annual dollar limit which puts constrictions on its benefits.

Rate review: Insurance companies will need to furnish proper documentation for their increases in rates for health insurance (Lachman, 248).

Rights and Protections: Under ACA guidelines, the consumers are in charge of personal healthcare instead of the insurance corporations. These rights and consumer safeguards are provided under ACA. Preventive care. The consumers won't need to pay any co-insurance, co-payment or any deductible prior to healthcare services such as counseling, vaccinations, and screenings.

Doctor choice and access to ER: Consumers can select any healthcare provider of their choice. Moreover, they can also use out-of-network providers without needing to obtain prior consent from their physician.

For people 65 and above: Under ACA, a broad range of preventive health care services exist for elders with no sharing of cost (Lachman, 248).

2. Steps in the state and federal policy...

For instance, certain policy options are compulsory while others are voluntary (Teitelbaum & Wilensky, 12). Public policymaking entails a complex structure involving different government branches, and including individuals and entities present in each branch to help in shaping and finalizing a policy. Every state has a government structured in three branches. The head of the state's executive branch is the governor who shapes policy, hires cabinet members, and utilizes the administrative agencies to bypass regulations which finalize state laws. State regulation is intricately linked with health policy. For instance, a state can standardize accreditation, provider licensing, and many other features of health insurance and public health issues (Teitelbaum & Wilensky, 13).
The U.S. Constitution has granted Congress "All legislative Powers" for the federal government as per Article 1. It also grants it the right to formulate 'mandatory and suitable laws' for producing the necessary prerogatives.

Formulating a policy is a combination of processes:

Pinpointing policy problems: In event of public demands of policy revision, may often lead to a scrutiny of the policy.

Finalizing policy proposals: A policy is formulated through a network of political channels including interest groups, policy planning organizations, state legislatures, government bureaucracies, Congress and the U.S. president.

Legalizing a public policy: A policy is officially implemented due to public statements or in other case, by government officials, elected from all echelons of government.

Effecting public policy: Each policy is promulgated in effect via public bureaucracies and expending public funds.

Public policy assessment: These policies are assessed by the government agencies formally and informally, third party consultants, by media, by interest groups, and lastly by the public (DiNitto, 13).

3. Differentiate between policy development and implementation.

The process of legislation is the phase of policy formulation, in which legislative proposals specified in chapter 3 as purely theoretical in nature and/or solutions-in-progress to existing issues, proceed step-by-step, concluding in finalized federal legislation.

These steps are highly sequential, similar to a dance sequence. A policy is finalized when all the necessary steps are completed; alternatively, an edit is made to a policy, more commonly known as amendment to a law. This chapter consists of the legislation development process which provides groundwork for majority of this chapter. The legislation development process commences with brainstorming for legislation ideas and concludes with the formulation of some ideas into legislation or amendment. The same steps apply in case of a new legislation or an amendment. Extensive explanation is given about the steps leading to a finalization of a federal legislation. Moreover, the majority of the states have detailed descriptions of how their legislative procedures work on their official websites. For instance, Making Law in Pennsylvania: Legislation in the PA House of Representatives is issued by Pennsylvania (Longest, 83).

Conversely, implementation of a policy entails all the necessary activities which are a resultant of its adoption. Policy implementation occurs after the law is approved. Merely passing legislation doesn't conclude the policymaking process. At times, laws are passed without any implementation of them. At other times, when laws are passed, executive agencies spring into action and achieve more than Congress originally had in mind. Conventionally, public administration is concerned with implementation of public policy. Policy opposers do not necessarily conclude their opposition subsequent to a law's approval. They can further oppose the policy's implementation phase by resisting actions to staff, direct, regulate, fund, organize, and cooperate with the program. For instance, abortion policy is one example. Therefore, conflict remains continuous in case of policy implementation (DiNitto, 13).

4. Stakeholders - involvement and why they drive health policy

Shareholders can include these in health policies:

Individuals with interest in healthcare policies relevant to their personal and others' health

Individuals with an aim in mind to achieve from these policies for instance, monetary benefit

These motives stimulate participation in such political proceedings, just like demands encourage participation in financial markets (Longest, 37). Shareholders are comprised of organizations and individuals. However, individuals participating in a financial market pose some restrictions and problems. For full participation, the individuals need to obtain a large amount of information on policy-relevant information, which takes considerable amount of time and capital. On the other hand, organizations (health insurance companies, health systems, and technology manufacturers) have a huge competitive edge over these individuals in this marketplace. They are equipped with the adequate resources to acquire policy relevant information and wield their influence to attain desired results. In retrospect, organizations are more effective than individuals in demanding health policy due to the fact that the stakes for them are higher (Longest, 37).

Interest groups are…