Policy and Advocacy Essay

Policy and Advocacy

Consider a population health topic that rises to the presidential agenda level. How did two recent presidents handle the problem?

Universal health care access is an issue of concern that presents at the presidential agenda level in all cases. This is a concern in Quadruple Aim Initiatives, particularly aim 3 that is concerned with reducing the cost of health care. This would make health care more affordable without compromising quality. Health care insurance is a good pathway for ensuring that affordable, quality care is accessible to the public, and that this care is provided by high-performing providers even as the public adopts a shoppers’ mindset that is always looking for the best deals (Johnson, 2020).

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A significant number of Americans are without health insurance even when they qualify for Medicare, Medicaid, and SCHIP. The government managed insurance programs have helped to improve the insurance rates among Americans. This has helped to improve health care access. However, the government programs have limited funds so that not all who qualify for the programs are beneficiaries. The Affordable Care Act (ACA) helps to increase access to health insurance and concurrently improve health care access. It achieves this through two approaches. Firstly, it creates eligibility for low incomes families to apply for subsidies (in the form of advance payment tax credits) to purchase private insurance through qualified health plans presented in health insurance exchanges within state marketplaces. Secondly, it expands access to government health insurance programs, particularly Medicaid who family income eligibility has been increased (Shi & Stevens, 2021).

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President Trump handled the problem by seeking to repeal and replace ACA while expanding private insurance programs. This was intended to reduce expenditure on government health insurance programs even as the number of uninsured persons increases. In contrast, President Biden has maintained ACA and even sought to increase funding for the public health insurance programs. This has resulted in government expenditure increasing even as more people are insured (Rice et al., 2021).

What would you do differently?

Both Presidents Trump and Biden were right. Government health insurance programs are a significant financial burden for the government. Addressing this concern requires that public health insurance programs be more accessible to the public by increasing the number of beneficiaries. In addition, private health insurance programs should be more affordable through regulating policies and rates, and allowing for more competition. This means that the uninsured who cannot afford insurance would be covered by the government programs, while those who can afford private insurance would have more options at lower prices.


Johnson, S. (2020). The Quadruple Aim in Nursing and Healthcare: Improving Care, Lowering Costs, Serving Populations, Elevating Work Life. McFarland & Company, Inc., Publishers.

Rice, T., Barnes, A. J., Rosenau, P., Unruh, L. Y., & van Ginneken, E. (2021). Health reforms in the United States: The outlook after Biden’s first 100 days. Health Policy, 125(10), 1277-1284. https://doi.org/10.1016/j.healthpol.2021.08.003

Shi, L., & Stevens, G. D. (2021). Vulnerable Populations in the United States (3rd ed.). Jossey Bass/John Wiley & Sons, Inc.



Discussion – Week 1

Presidential Agendas

Rather than focus on the treatment of chronic disease, policies that influence population health tend to emphasize prevention and wellness; the reduction or elimination of waste and the eradication of health disparities based on race, ethnicity, language, income, gender, sexual orientation, disability and other factors. The reasoning is that good health belongs to the whole, not just an individual. (New York State Dept. of Health, n.d.)


Regardless 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 (mental health, HIV, opioid epidemic, pandemics, obesity, prescription drug prices, or many others) that rises to the presidential level. How did the current and previous presidents handle the problem? What would you do differently?



New York State Department of Health. (n.d.). Making New York the healthiest state: Achieving the triple aim. Retrieved June 21, 2021 from https://www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf


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 1

Post your response to the discussion question: Consider a population health topic that rises to the presidential agenda level. How did two recent presidents handle the problem? What would you do differently?

By Day 6 of Week 1

Respond 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.

Keep this week’s narrative in context of the Quadruple Aim Initiatives.

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