Presidential Agendas

A significant population health topic that frequently rises to the presidential agenda is healthcare access. One of the most critical social determinants affecting healthcare access is economic stability. People with lower incomes often face barriers such as lack of health insurance, inability to afford medical treatments, and limited access to quality healthcare facilities. These economic barriers lead to poorer health outcomes, higher rates of chronic disease, and preventable deaths.

 

How Two Recent Presidents Handled the Issue

1.  Barack Obama: President Obama addressed healthcare access primarily through the Affordable Care Act, also known as “Obamacare,” passed in 2010. The ACA, a landmark legislation, aimed to expand healthcare coverage by providing subsidies for lower-income individuals, expanding Medicaid in some states, and implementing regulations to prevent insurance companies from denying coverage based on pre-existing conditions. This legislation significantly increased healthcare access for millions of Americans, a testament to its impact, but faced ongoing legal and political challenges from opponents who viewed it as government overreach (Blumenthal, Abrams,& Nuzum,2015).
2. Donald Trump: President Trump sought to dismantle the ACA, advocating for a free-market approach to healthcare. He focused on reducing the federal government’s role by trying to repeal healthcare costs, such as promoting competition in drug pricing and removing individual mandates. While he could not repeal the ACA fully, his administration weakened parts of it, like reducing the penalty for not having health insurance, which led to the rise in uninsured rates (Sanger-Katz, 2018).

 

What I Would Do Differently

To address healthcare access, I would concentrate on bolstering the economic stability of underserved communities by further expanding healthcare coverage. Implementing a public healthcare option could be one method, allowing individuals to select a government-sponsored health plan alongside a private option. This may foster competition and lower costs while ensuring affordable healthcare for low-income groups.

Moreover, I would advocate for increased funding for preventive healthcare initiatives that focus on social determinants of health, such as housing and education. By tackling these underlying issues, we could enhance long-term health outcomes by preventing diseases before they necessitate expensive treatments.

 

 

Social Determinant

Mental health has had a dynamic impact in most groups since the pandemic. I work in a Med.Surg. unit where I have acknowledged more admissions on mental patients, both young and old, than I have ever seen. Alcohol and drug abuse increased significantly, and patients became more hostile toward medical staff. Some may just need some comfort and reassurance that everything will be okay, while there are genuinely others with long term issues that are unable to cope from their losses and other traumatic issues that are unforgettable in their minds (PTSD).

Some are easy to handle, and others are very complicated. We (nurses and other medical staff) became counselors, psych nurses, family, and nutritionists to get them going and I’ve played these many roles. After all the suffering and the confusion of this unknown killer virus, the lack of access to healthcare, lack of education, lack of access to grocery stores, depression/anxiety caused by unemployment, financial instability, social interaction with others, and the rising of shelters are all contributing significantly to the mental and physical behaviors NURS 6050 Week 1 Discussion: Presidential Agendas.

Recent President

President Trump’s administration reformed the delivery of the Obama Affordable Care Act, giving priority and encouraged the effort to address the opioid crisis which causes serious mental health concern in the country. Also supported the access to increased treatment for mental health patients, behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, substance use disorders.

The President Biden Administration issued and proposed rules that, if finalized, would continue the expansion of access to mental health and substance use care including the intensive coverage of outpatient services; increasing Medicare rates for crisis care, substance use disorder treatment, and psychotherapy; and allowing the provider to get paid by medicare. Support access to needed care such as behavioral health and through telehealth services.The administration also invested nearly 1 billion dollars to enhance crisis response on suicide.

What I would Do Differently

When it comes to change it could be for an organization or for an entire state, so we need to get adapted, it always takes longer for any change to get accepted by others. I will attend meetings in mental health care community-based, centered on the margin groups, meet with the big people who approve and  help the changes, collect information to find out the impact that change will bring/make on the patients, before proceeding. Some insights on what is the root problem that causes acute attack of mental illness to get proper referral for treatments. Establish a financial aid assistance program to help reduce the stress that can also cause mental illness. Keep pressing for insurance to continue to provide health coverage for all health mental treatments. Assist on providing transportation, safe housing programs, access to groceries, create job and vocational education, etc. Creates group events to help with interaction and reduce stress.  Most of the time change is for the better, even though at the beginning it looks like it is more work/complication, through time it is worth the change for an effective outcome, and can also fail for many reasons due to lack of communication, poor planning, and unmotivated organization. This is one of the reasons I encourage meetings to keep them informed and updated. Change can also stimulate positive behaviors, attitudes and improve outcomes and patients confidence and performance. According to Lewin, an early change scholar who proposed a three-step process for ensuring successful change[2]. Effective communication within the healthcare system between providers, specialists, healthcare staff, and mental health patients. New discoveries for the treatment of diseases, medical information within the reach of providers, help them understand what is going on throughout the treatment process, etc.

References

https://www.onpage.com/exploring-the-importance-of-chan

https://www.kff.org/report-section/president-trumps-record-on-health-care-issue-brief/#MentalHealth

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

https://www.whitehouse.gov/briefing-room/statements-releases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network-mental-health-care/#:~:text=The%20Administration%20 recently%20issues%20 proposed,mental%20health%20and%20 substance%20use

The opioid epidemic is a major health disparity that has grown in previous years in numbers affected and in complexity. One of the major influences on outcomes of health is access to healthcare. Access to care is highly based on social determinants such as race, gender, income, and socioeconomic status. Vulnerable populations are particularly at risk for insufficient health insurance coverage; people with lower incomes are often uninsured. Uninsured individuals are less likely to receive treatment and/or rehabilitation. A person with a higher income would be able to afford a greater access to care for opioid addiction than a lower income person.

In recent years President Biden has issued a National Security Memorandum, called on Congress to pass bills that are meant to provide a higher level of border control, increasing fines to deter drug traffickers, as well as increased the accessibility to naloxone kits. One major step the Biden administration has done was increase access to care by increasing affordable provider access of those who can prescribe medication assisted therapy for opioid use disorder.

During Trump’s time in office was a crucial time for all. It was during the COVID-19 pandemic and mental health and substance abuse overwhelmed the country. His administration put out an order that made an increase in the availability of telehealth and online mental-health and substance-use tools and services (The White House, 2020). It may be easier for providers to engage patients in treatment for substance use disorders through virtual meetings in the comfort of a patient’s own home, rather than via in-person meetings in justice settings (NIH, 2021). The use of telemedicine definitely allowed patients with opioid use disorder to stay in treatment and work on their recovery with reduced to no travel time, as well as increases in convenience.

I feel as if they both presidents had an outstanding approach to help the opioid epidemic in many aspects. Such as increasing access to care for preventive measures, treatment, rehabilitation. Overall the opioid epidemic is a major task to concur and is not easily done so over night or even in 1 term. I would continue to expand on the orders and policies both have implemented and take a greater focus into prevention.

 

References

The White House. (2024, March 08). FACT SHEET: President Biden’s Unity Agenda for the Nation. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/08/fact-sheet-president-bidens-unity-agenda-for-the-nation/

 

The White House. (2018, October 24). President Donald J. Trump’s initiative to stop opioid abuse and reduce drug supply and demand. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand-2/

 

The White House. (2020, October 5). Executive Order on Saving Lives Through Increased Support For Mental- and Behavioral-Health Needs. https://trumpwhitehouse.archives.gov/presidential-actions/executive-order-saving-lives-increased-support-mental-behavioral-health-needs/

 

National Institutes of Health. (2024, February 1). Telemedicine: Progress Made During Pandemic Offers Chance for Widespread Adoption. U.S. Department of Health and Human services. https://heal.nih.gov/news/stories/telemedicine

Prevention and Wellness as Effectively. A population health plan is anchored in preventive care and wellness. By addressing diseases before their occurrence, these policies strive to alleviate the burden that chronic conditions place on society, as they are often expensive and intricate to treat. Preventive approaches — like helping people live healthier lives, promoting physical activity, ensuring everyone has access to healthy food, and building environments supporting mental health— can reduce the incidence of most chronic diseases. This move towards prevention helps ease the burden on healthcare systems and improves the lives of people and communities across the board.

Moreover, well-being promotion is not centered on the person’s health but broadly supports wellness in social and environmental infrastructure. The idea of a good place that endures additionally came with the Whole World Health Organization (WHO), which for several years before realized much lower mortality rates due to poor quality diets in poorer countries. For example, clean air policies can benefit broader community well-being by reducing industrial emissions (Parks & rec) or promoting safe drinking water. Health is a collective social, where all work together to create healthier surroundings.

Addressing Health Disparities. The elimination of or reduction in health disparities is critical to these health policies. Health disparities are differences in health outcomes between groups that stem from social, economic, or environmental disadvantages. Many of these disparities originate from systemic inequities linked to race, ethnicity, language access, income level and distribution, gender, sexuality orientation identification abilities, or trends forCellis capabilities and compared with each other based on system attributes. Sarah Krüg of Cancer101 and Vice President at The midSIX Group explained, “When looking towards a healthier future for all through health policies that address the social determinants of life or improving equity in care across populations (PEICAP), I am optimistic.

For instance, efforts that deliver care that is culturally relevant to a specific demographic and are equipped with better language services, as well as target economic disparities, can help minimize such gaps in health outcomes. In addition to this, it is also important for equity-promoting policies in health care funding and resource allocation, as well as access to quality, which will be pivotal strategies for the population groups across distinct community divides. The more that we can close the health disparities gap, the greater the Health of everyone and the overall population.

Prevention and Equity: With 2040 Vision-economic return streams

Prevention and wellness offer the most significant economic opportunity. They are also a significant source of healthcare costs and the biggest killer worldwide, with heart disease being responsible for 1 in 3 deaths; cancer impacting more than doubled incidents since the mid-20th century to nearly 15 million new cases per year) benefit from increased awareness. Through the prevention of these diseases, healthcare systems also end up seeing savings in terms of a great deal less money on all those treatments that come with dealing with the disease. In addition, healthier populations are more productive and drive economic growth and stability.

There also economic impacts of policies that address health disparities. Decreasing disparities improves the efficiency of healthcare systems because there are costs associated with avoidable hospitalizations, emergency visits and sequelae from poorly controlled conditions. Also, equitable health policies lead to social cohesion and mitigate poverty thereby improving the general quality of life following a stronger approach in pandemic times.

Every one of Us is responsible for Health. All of that is simply saying good Health belongs to the whole, not an individual. The truth is that Health does not occur as a simple consequence of the choices we make on an individual level, but our Health is influenced and largely determined by the social, economic, and environmental circumstances in which people are born and grow up. This is why health promotion and the prevention of diseases are not solely a personal responsibility; they should also be shared ownership among the government, healthcare providers, community organizations, and individuals NURS 6050 Week 1 Discussion: Presidential Agendas.

Steering policies toward prevention, wellness and the diminution of health disparities will help make society fairer and healthier. This approach rests on the proposition that Health is a common good from which all can benefit. This results in a stronger, more resilient and productive population who are able to respond where necessary which overall means the Health and prosperity of society.

Policies that focus on preventing disease and promoting wellness, reducing waste in health care delivery, and addressing disparities provide a more comprehensive approach to improving the Nation’s Health. Through the lens of social determinants of Health and equity, these policies will work hand in hand to build a healthier community where everyone can reach their full potential. Good Health is standing in a community, reflecting on how we are tied together. When health, for all of us, is recognized as a public good and not just an individual possession to protect for whomever can afford it, we will have achieved the next level of mastery in transforming our world. Our economy becomes more prosperous, inclusive & environmentally sound by dangerous plans that divide nations being neutralized.

Addressing HIV: The Approach of Recent U.S. Presidents HIV continues to be a significant public health issue not only in the United States but also throughout the globe. Over the decades since its discovery in the 1980s, the U.S. has made various attempts to combat the epidemic through research and funding and by implementing changes in policies on prevention, treatment, and support for people living with HIV (PLWH). The response of U.S. presidents and their leadership was a crucial aspect of the national fight against HIV. This essay aims to describe the ways recent U.S. presidents, namely Donald Trump and Barack Obama, dealt with HIV in terms of their policies and initiatives. President Barack Obama, It is possible to mention that due to the more substantial timeline of operations, President Obama had more time and opportunities to influence the country’s HIV policy. In summary, his administration accomplished the following: President Obama made extensive efforts in terms of HIV/AIDS as part of a broader healthcare agenda. In 2010, the Obama administration developed the first National HIV/AIDS Strategy, or NHAS. NHAS is a comprehensive plan that includes four goals: to decrease new HIV infections, to increase the access of PLWH to care, to improve health outcomes of PLWH, and to reduce health disparities. Critical components of Obama’s approach are the following: * Affordable Care Act – “The ACA in 2012 enabled more than 20 million people to gain insurance coverage”. Specifically for PLWH, the ACA expanded Medicaid, prevented the insurance companies from discrimination based on pre-existing conditions, and made HIV testing a routine preventive service granted at no cost. Thus, the ACA “made it possible for millions of Americans, including those living with HIV,” to access more affordable and comprehensive health insurance.

National HIV/AIDS Strategy (NHAS): The NHASThe National HIV AIDS Strategy NC added the necessary information that was left out of this section, including held to improve coordination among federal, state, and local governments, and private organizations and communities to build support for prevention research care treatment efforts people living with Nationally goals reduce new infections increase access screening service result in multicultural collaboration provide education outreach normalize testing risk reduction behaviors fight stigma discrimination sentences weren’t connectedBuilderFactory.register(NationalTemplateUnit)); DummyBulletList.end(Optional.empty()); DeepState abuse omitPrevious.addDirective(BulletBuilder.newInstance(). Though Obama 2015 extended the strategy through 2020 — and added new objectives to fight HIV, such as a focus on Southern U.S. states hardest hit by the epidemic and efforts aimed at certain high-risk groups like gay men of color})();

Investing in Research and Prevention: The Obama administration further ramped up spending on HIV research and prevention, including efforts to speed the development of new treatments; a vaccine for protected populations; pre-exposure prophylaxis (PrEP) that can prevent fresh infections. The administration also collaborated with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) to advance scientific research in this area.

How President Donald Trump Deals with HIV

The challenges posed by coronavirus echo what once was the paralysis in China surrounding HIV and is the vow made to confront it head-on from 2017-2021, when President Donald Trump held court with his health policies. While with a different approach than his predecessor, the Trump administration did press forward on taking action to respond to this ongoing epidemic but concentrated predominantly in addressing specific objectives and programs.

Ending the HIV Epidemic Initiative: In his 2019 State of the Union address, President Trump unveiled a bold plan to terminate our Nation’s struggle with HIV in America by 2030. The “Ending the HIV Epidemic: A Plan for America” had set a target to decrease new HIV infections by 75% in five years and by 90% within ten years. These included diagnosing all people with HIV as soon as possible, treating HIV rapidly and effectively to achieve viral suppression that is long term, using proven interventions in prevention so no new transmissions occur, and responding quickly when a potential outbreak occurs.

Altekruse, S. F., Cosgrove, C. M., Altekruse, W. C., Jenkins, R. A., & Blanco, C. (2020). Socioeconomic risk factors for fatal opioid overdoses in the United States:

House, W. (2023, July 25). FACT SHEET: Biden-Harris Administration Takes Action to Make it Easier to Access In-Network Mental Health Care. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network-mental-health-care/

Findings from the Mortality Disparities in American Communities Study (MDAC). PLOS ONE, 15(1). https://doi.org/10.1371/journal.pone.0227966

President Donald J. Trump Is Safeguarding Americans’ Mental Health and Preventing The Tragedy of Suicide – The White House. (2020, October 5). The White House. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

USDA. (2021, March 3). Biden-Harris administration actions to reduce food insecurity amid the COVID-9 crisis. U.S. Department of Agriculture. Retrieved August 27, 2024, from https://www.usda.gov/media/press-releases/2021/03/03/biden-harris-administrations-actions-reduce-food-insecurity-amidLinks to an external site.

Week 1 Discussion

Vladimir Berrios- Student ID A01238310

MSN-PMHNP, Walden University

NURS-6050C-40: Policy & Advocacy for Pop Hlth-Fall 2024

Dr. Crystal Dodson

 

Healthcare Accessibility:

There probably is not a more important healthcare topic than its accessibility, for it is the first step in the often-long journey of finding proper and competent medical attention. Unfortunately, many American citizens do not have access to medical services and prescription medications. Without the ability to see a physician and have access to medications, any other healthcare question because all but mute.

When a national problem becomes important or chronic enough to many people it starts rising through the levels of government. Through the conscientious assistance of medical professionals, such as nurses and doctors that take it upon themselves to lobby their concerns about public health policies. Often this process takes a long time, and it takes tenacity and group efforts. But, when the problem is important and enough attention is brought to it, then it rises to the presidential level. We will be comparing how two presidents, Obama and Trump used their presidential influence to make healthcare more accessible.

Obama Presidency (2009-2017)

            President Obama asked a fundamental question, is it a human right to have healthcare? On March 23, 2010, the 111^th United States Congress signed Obama Care in to law (Seervai, ‘a monumental effort’: How Obamacare was passed 2020). The passing of The Affordable Care Act (ACA) answered the question with a resounding yes. Before this bill was signed into law nearly 1 out of 6 Americans did not have healthcare, that is around 50 million people. Therefore, it was time for a major healthcare overhaul. As of 2019 the uninsured number has been slashed in half to 25 million. Of course, there are flaws and there is room for improvement, but we are moving in the right direction. Importantly the law also protected Americans with pre-existing conditions, meaning you could no longer be denied insurance based on some medical condition and could not be charge exorbitant fees because of said condition.

Trump Presidency (2016-2021…?)

            It is common knowledge that the Trump Presidency was a very contentious moment in this country, partly because of a 1 in 100-year pandemic, as well as personality the created many ripples in American culture and life. However, there were some policies that helped make healthcare more accessible to Americans. And even more importantly, access to affordable medications. What is the use of having access to medical attention if you then cannot afford the medicines they prescribe? Trump and his famous executive orders included:

• Stopping a gag clause that prevented pharmacists from informing patients about the best prices for medications.
• Finalized the “Most Favored Nation” rule that ensured Americans received the same discounts that pharmaceutical companies give to other countries.
• Opening up the ability of patients to get their medications from Canada at lower prices.
• Terminal patients were given the right to try and have access to life saving cures that have not yet passed through the rigorous standards of the FDA.

Obviously, Trump is a very divisive topic, but credit must be given, as through these many efforts much was gained in the arena of healthcare accessibility.

What Could Be Done Differently?

            Of course, much praise should be given to the advances in giving Americans accessibility to healthcare. However, unfortunately it still remains a fact that the US spends more than any other country on healthcare and does not necessarily have the best outcomes. Which, include accessibility, there are still 25 million Americans that do not have healthcare (Seervai, ‘a monumental effort’: How Obamacare was passed 2020) Private interest groups with deep pockets are mostly to blame, so we must join the cause as nurses and nurse practitioners, and lobby for better, cheaper and more accessible healthcare so we can have better outcomes. As informed healthcare professionals, if we are not the ones at the table advocating for ourselves and our patients, it will be those with little to no knowledge making the decisions with ulterior motives.

Bibliography

Vankar, P. (2024, February 28). Affordable Care Act – Statistics & Facts. National Archives and Records Administration. https://trumpwhitehouse.archives.gov/issues/healthcare/

Seervai, S. (2020, March 20). “a monumental effort”: How Obamacare was passed. Commonwealth Fund. https://www.commonwealthfund.org/publications/podcast/2020/mar/monumental-effort

 

Main Discussion Post

The cost of healthcare in the United States continues to increase each year. Over the last decade, annual healthcare expenses have increased from three trillion to four and a half trillion (CMS, n.d.). Affording health insurance or paying for medical services and prescriptions has become more difficult. Strides are being made to improve access to care and improve the quality of the care provided. Our last several Presidents have included healthcare availability and affordability on their agendas.

According to The White House Archives (n.d.), during his administration President Trump made changes in American healthcare that decreased prescription costs, increased the information available to consumers regarding their healthcare costs, and increased healthcare plan availability. Drug prices were lowered for the first time in over 50 years (The White House Archives, n.d.) with caps placed on insulin copays during the Trump administration.

The White House (n.d.) reports that President Biden also took on pharmaceutical companies in an effort to decrease prescription pricing. Increasing access to health insurance and decreasing health insurance premiums have also been reported by The White House (n.d.) under the Biden administration. There has also been a push for creating streamlined access to healthcare and needed medications, with a focus on vulnerable populations such as children and the elderly (The White House, n.d.).

In 2001, the Institute of Medicine (IOM) Published Crossing the Quality Chasm outlining a plan to improve the quality of health and streamline accepted policies regarding care rooted in evidence-based practices. One goal of the IOM was to bridge the gap between care that was being provided and the quality care that was being provided (IOM, 2001, pp 236). Simply put, providers are reimbursed based meeting specific established outcomes. With increased focus on healthcare costs over the last twenty years and increased regulations, why do healthcare costs continue to rise? As nurses we should ask if the care being provided in our communities has suffered.

Yong (2010) reports missed opportunities in preventive care that potentially impacts overall healthcare costs. Not all patient care needs can be defined by specific pre-established outcomes. As nurses, we need to be familiar with what is impacting care in our own communities since challenges can be geographically and/or culturally specific and advocate for our patients. The Nursing Scope and Standards of Practice (2021) require us to coordinate care that achieves “safe, efficient, timely, person-centered, and equitable care” (pp. 84).

 

References

American Nurses Association (ANA). (2021). Nursing scope and standards of practice, 4^th ed. American Nurses Association.

Centers for Medicare and Medicaid Services (CMS). (n.d.). National health expenditure data. Retrieved from  https://www.cms.gov/data-research/statisti_cs-trends-and-reports/national-health-expenditure-data/historical

Institute of Medicine (IOM). (2001). Crossing the quality chasm: A New health system for the 21^st century. National Academy of Sciences.

The White House. (n.d.). Fact Sheet. Retrieved from https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/06/fact-sheet-president-biden-takes-new-steps-to-lower-prescription-drug-and-health-care-costs-expand-access-to-health-care-and-protect-consumers/

The White House Archives. (n.d.). Healthcare: Administration achievements. Retrieved from https://trumpwhitehouse.archives.gov/issues/healthcare/

Yong, P. L., Saunders, R. S., & Olsen, L. (2010). The healthcare imperative. [electronic resource] : lowering costs and improving outcomes : workshop series summary : Roundtable on value & Science-Driven Health Care. National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK53914/

Healthcare policy has always been a critical aspect of presidential agendas, with each administration choosing its own approach to addressing key issues. Considering a topic that rises to the presidential level I will discuss how the current and previous Presidents handle the 2020 COVID-19 Pandemic and the changes I would implement.

The previous President Donald Trump:

The Trump administration’s approach to the COVID-19 pandemic was marked by initial delays in response in mixed messaging on the severity of the virus. The administration implemented travel bans, promoted Operation Warp Speed to accelerate vaccine development, and pushed for rapid reopening of the economy. However, there was significant controversy over the handling of public health guidelines, including the use of masks and social distancing, and the federal governments in-consistence coordination with states.

 Current President Joe Biden:

The Current administration under President Biden, has taken significant steps to expand healthcare access through the Affordable Care ACT. Particularly during the COVID-19 pandemic. President Biden prioritize a more coordinated federal response emphasizing public health measures like widespread testing, mask mandates in federal buildings, and accelerating vaccine distribution. The Biden administration also past the American Rescue Plan, which provided significant funding for public health initiatives, economic relief, and support for struggling healthcare systems.

Personal Approach and Propose Changes:

I would strengthen Public Health Infrastructure by insuring more rapid and effected responses to pandemics. This would include better data integration across states, a more abundance of essential supplies like Personal Protective Equipment, and clear consistent public health messaging to prevent inconsistent information. This would help to avoid the fragmented response seen in the early months of the COVID-19 Pandemic.

In summary, while both administrations had their strengths and weaknesses in handling the pandemic, a more proactive, coordinated, and comprehensive approach, in terms of public health infrastructure could have mitigated some of the challenges faced during this crisis.

References:

Trump’s Pandemic Response

• Rucker, P., Dawsey J., & Abutaleb Y. (2020, August 31). Trump says U.S has ‘rounded the final turn’ on coronavirus, despite record cases and deaths. The Washington Post.

https://www.Washingtonpost.com/politics/trump-coronavirus-response/2020/08/31/acecaba2-ebf5-11ea-bd08-1b10132b458f.html

Biden’s Pandemic Response

• The White House. (2021, March 11) Fact sheet: The American Rescue Plan.

https://www.whitehouse.gov/briefing-room/statements-releases/2021/03/11/fact-sheet-the-american-rescue-plan/

 

Initial Post

 

A significant health topic that has risen to the presidential agenda level is opioids. This public health crisis has reached alarming proportions, impacting individuals, families, and communities across the United States (Hancocks, 2019). One of the most influential social determinants affecting the opioid crisis is socioeconomic status. Factors such as poverty, unemployment, and lack of access to education and healthcare contribute to higher rates of substance use and dependency. Communities with limited resources often face challenges in accessing treatment services and support systems, exacerbating the issue (Hancocks, 2019).  different administrations have attempted to tackle the complex issue of the opioid epidemic through policy changes, funding initiatives, and public awareness campaigns

 

1. President Barack Obama (2009-2017)

Opioid Policy Initiatives: President Obama declared the opioid epidemic a public health emergency and expanded access to treatment services through the Affordable Care Act, which aimed to cover addiction treatment (The White House, 2016).  His administration also implemented the “Prescription Drug Abuse Prevention Plan,” focusing on prevention, treatment, and enforcement (The White House, 2016).  This included funding for states to develop their own strategies for combating prescription drug abuse (The White House, 2016).

 

2. President Donald Trump (2017-2021)

National Emergency Declaration: In October 2017, President Trump declared the opioid crisis a national emergency, aiming to mobilize resources and attention to combat the epidemic (Haffajee & Frank, 2018). His administration proposed initiatives to improve access to treatment and prevent overdose deaths, including the creation of a task force and increased funding for drug prevention and treatment programs (Haffajee & Frank, 2018). This administration also focused on enhancing law enforcement efforts against illicit drug trafficking (Haffajee & Frank, 2018).

What would you do differently?

I would increase public awareness about the dangers of opioid misuse through campaigns and community programs. Education should also target healthcare providers to ensure they understand prescription guidelines and alternatives. Also improving access to treatment for those struggling with addiction is important. This includes expanding availability of medication assisted treatment and providing support services like counseling and detox programs.

References

Haffajee, R. L., & Frank, R. G. (2018). Making the opioid public health emergency effective. JAMA Psychiatry, 75(8), 767. https://doi.org/10.1001/jamapsychiatry.2018.0611

Hancocks, S. (2019, June 14). The opioid crisis in the USA. Nature News. https://www.nature.com/articles/s41415-019-0420-6

The White House (2016). National Archives and Records Administration. (n.d.). Fact sheet: President Obama proposes $1.1 billion in new funding to address the prescription opioid abuse and heroin use epidemic. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/2016/02/02/president-obama-proposes-11-billion-new-funding-address-prescription

Initial Post

Epidemic of Opioids

The epidemic of opioids has been among the most significant preventable public health problems in the United States that affected people, families, and communities. This issue has been of concern not only during Trump’s presidency but also during Biden’s presidency in different aspects.

President Trump

Studying changes in mental health policy in the past few presidents’ administrations demonstrates that mental health has become increasingly recognized as a significant part of overall healthcare systems in the United States and integrated into the general political agendas. The major accomplishment under Trump was the signing into law of the support for Patients and Communities Act of 2018 with a vision to expand mental health care options (Barr, 2023). The administration also focused on the veteran suicide rate with its own special task forces and executive orders for this problem. Nevertheless, the Trump administration’s approach was not without controversy since the administration simultaneously attempted to cut funding for some mental health programs and tried to repeal the Affordable Care Act (ACA), which is a significant source of mental health insurance coverage protection. This duality in policy approach to the mental health problem resulted in critiques from different stakeholders in the mental health field concerning the inherent contradictions of trying to balance budgetary repair with the growth of mental health services NURS 6050 Week 1 Discussion: Presidential Agendas.

President Biden

On the other hand, mental health has been given a central role in Biden’s blueprint for care for twentieth-century chronic diseases. President Biden’s plan incorporates a broad approach, doubling community health centers and school-based health programs to expand mental health services. The American Rescue Plan of 2021 has significantly progressed towards this, which provided $3.5 billion for block grants aimed at mental health and substance use disorders (The White House, 2017). The Biden administration has also been keen on mental health parity laws and has made efforts towards enhancing provisions for mental health for veterans and active duty military personnel. This approach, therefore, defines a new paradigm where mental health care is acknowledged and embedded even more in the general health care system, bearing in mind that the mind and body have a symbiotic relationship.

What Could Be Done Differently?

Despite the above efforts, more can still be done in mental health policy. Subsequent governments might allocate more funding to mental health to enhance treatment and prevention methodologies. Increasing mental health awareness camps nationwide in schools or, most often, in primary healthcare facilities can make early detection possible. Increasing the availability of telehealth in mental health care, especially in rural areas that lack adequate health facilities, would greatly benefit many Americans (Schaffer et al., 2020). The prejudices may be minimized if extensive mental health education programs were implemented. Moreover, there is potential to enhance primary care’s avenue for mental health treatment and boost patients’ overall health. Developing a national suicide prevention plan complete with set objectives and baseline outcomes by which to measure the initiative’s efficacy could assist in improving the situation. Lastly, the funding for mental health service education and loan forgiveness will assist in expanding the right workforce to provide mental health services for the increasing number of patients in need of such services.

References

The White House. (2017). The White House. The White House; The White House.

https://www.whitehouse.gov/

Barr, D. A. (2023). Introduction to US health policy: The organization, financing, and delivery of

health care in America. JHU Press.

https://books.google.co.ke/books?hl=en&lr=&id=PvnKEAAAQBAJ&oi=fnd&pg=PP1&dq=The+major+accomplishment+under+Trump+was+the+signing+into+law+of+the+SUPPORT+for+Patients+and+Communities+Act+of+2018+with+a+vision+to+expand+mental+health+care+options&ots=hfxCUrY16V&sig=6mnyIq95iHFBjVICfhlP4TLgDAw&redir_esc=y#v=onepage&q&f=false

Schaffer, C. T., Nakrani, P., & Pirraglia, P. A. (2020). Telemental health care: A review of

efficacy and interventions. Telehealth and Medicine Today, 5(4).

https://telehealthandmedicinetoday.com/index.php/journal/article/view/218

BreAnn Norris

Week 1 Main Discussion Post

According to Gao et al. (2024), poor mental health affects the well-being of a person, including an increased risk of developing diseases, overall life satisfaction, as well as financial stability. I chose to examine mental health since I am in pursuit of a psychiatric mental health nurse practitioner profession. Mental health issues are arising more frequently due to a multitude of reasons.

Social Determinants of Health and Mental Health

All social determinants of health can be related to mental health. Alegria et al. (2024) advise that social determinants of health needs must be met because they greatly impact general and mental health. If I had to select one social determinant of health that impacts this issue, it would be economic stability. Economic stability impacts mental health in numerous ways. Living in poverty can affect how people care for themselves, from the ability to purchase nutritional foods to the ability to access quality healthcare and education. However, community is also a large component of mental health stability. Having a group of people who support one another is extremely important in the general mental well-being of a person.

Current Presidential Mental Health Agenda

After reviewing the presidential agenda regarding mental health on The White House (2023), the Biden-Harris administration grouped improvement strategies in mental health into three groups, “strengthening the mental health workforce and system capacity, connecting more Americans to care, and creating a continuum of support” (The White House, 2023). Also, according to The White House (2023), a few of President Biden’s approaches are to increase behavioral health support in schools, implement the Brandon Act to assist service members and improve access to mental health assistance.

Previous Presidential Mental Health Agenda

The White House (2020) presidential agenda of President Donald J. Trump was to focus on the mental health of Americans who were suffering during the COVID-19 pandemic related to lockdowns and isolation. According to Gabet et al. (2023), an example of the negative mental health caused by the COVID-19 pandemic is isolation from lockdowns. The presidential agenda regarding mental health per The White House (2020), an Executive Order was signed to assist with mental health and decrease suicide rates. According to The White House (2020), other approaches include providing financial assistance to mental health professionals, creating a group to evaluate underserved populations’ mental health, and encouraging physical health.

Different Mental Health Improvement Ideas

I agree with the funding to increase mental health resources for those in underserved populations. However, I believe that mental health affects everyone, no matter the economic or demographic background. Therefore, I would create an initiative to make mental health access affordable and accessible for everyone by supplying funding to community-based programs in every socioeconomic group. There is also a stigma with mental health that prevents people from all backgrounds from reaching out for help. I believe investing in mental health education in every community would be beneficial. Also, increasing mental health screenings in supportive and comforting environments would help assess and support those in need. I would also like to assist with funding community groups that promote healthy lifestyles, such as exercise and a nutritious diet, as well as community support groups. 

Conclusion

In conclusion, each presidential agenda regarding mental health improvements proposes great ideas and help in desperately needed areas. I believe expanding on each agenda to reach the entire United States of America population would be beneficial. I say this because mental health is something that affects every socioeconomic background. Since there is a stigma associated with mental health, there are many who are suffering and not seeking help. My hope is that we can reduce the stigma and assist all of those who suffer from mental health issues.

References

Alegria, M., Cruz-Gonzalez, M., Markle, S.L., Falgas-Bague, I., Poindexter, C., Stein, G.L., Eddington, K., Martinez Vargas, A.E., Fuentes, L., Cheng, M., & Shrout, P.E. (2024). Referrals to community and state agencies to address social determinants of health for improving mental health, functioning, and quality of care outcomes for diverse adults. American Journal of Public Health, 114(S3), pp. S278-S288. https://doi.org/ 10.2105/AJPH.2023.307442

Gabet, S., Thierry, B. Wasfi, R., Simonelli, G., Hudon, C., Lessard, L., Dube, E., Nasri, B., Kestens, Y., and Moullec, G. (2023). How is the COVID-19 pandemic impacting our life, mental health, and well-being? Design and preliminary findings of the pan-Canadian longitudinal COHESION study. BMC Public Health, 23(1), pp. 2401. https.doi.org//10.1186/s12889-023-17297-w

Gao, Y., Burns, R., Leach, L., Chilver, M.R., & Butterworth, P. (2024). Examining the mental health services among people with mental disorders: a literature review. BMC Psychiatry, 24(1), pp. 568. https://doi.org/10.1186/s12888-024-05965-z

The White House (2020, October 5). President Donald J. Trump is safeguarding Americans’ mental health and preventing the tragedy of suicide. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

The White House (2023, May 18). Fact sheet: Biden-Harris administration announces new actions to tackle nation’s mental health crisis. https://www.whitehouse.gov/briefing-room/statements-releases/2023/05/18/fact-sheet-biden-harris-administration-announces-new-actions-to-tackle-nations-mental-health-crisis/

Social Determinant Impacting the Opioid Crisis

The opioid crisis is deeply influenced by the social determinant of economic stability, particularly through unemployment and poverty. Economic hardship can lead to increased stress, mental health issues, and subsequent substance use as a coping mechanism. As Cantu, Fields-Johnson, and Savannah (2023) highlight, addressing these underlying social factors is crucial to combating the opioid epidemic. By targeting economic disparities, we can mitigate the root causes that predispose certain populations to opioid misuse.

Presidential Responses to the Opioid Crisis

Recent presidents have approached the opioid crisis with varying strategies. President Obama emphasized expanding access to treatment, integrating mental health services, and supporting evidence-based prevention programs. His administration passed the Comprehensive Addiction and Recovery Act (CARA) in 2016, which was a significant step toward tackling the issue (Rivera & Friedman, 2024). On the other hand, President Trump declared the opioid crisis a public health emergency and focused on law enforcement measures, promoting the building of a border wall to prevent the influx of illicit drugs (Sun et al., 2023). While both approaches addressed critical aspects of the crisis, they also faced criticism for not sufficiently addressing the broader social determinants of health.

Proposed Alternative Approach

If I were to address the opioid crisis, I would focus on a comprehensive strategy that combines both economic and social interventions. I would advocate for policies that promote job creation, improve access to mental health and substance abuse services, and strengthen community support systems. By focusing on economic stability and community resilience, we can create a more sustainable solution to the opioid crisis, reducing the need for opioids as a means of coping with economic and social stressors. As Rivera and Friedman (2024) suggest, a multifaceted approach that addresses both the supply and demand sides of the crisis is essential for long-term success.

References

Cantu, R., Fields-Johnson, D., & Savannah, S. (2023). Applying a social determinants of health approach to the opioid epidemic. Health Promotion Practice, 24(1), 16-19. https://doi.org/10.1177/1524839920943207 

Rivera, B. D., & Friedman, S. R. (2024). What would it really take to solve the overdose epidemic in the United States? International Journal of Drug Policy, 128, 104435. https://doi.org/10.1016/j.drugpo.2024.104435 

Sun, D., Graham, A., Feldmeyer, B., Cullen, F. T., & Kulig, T. C. (2023). Public opinion about America’s opioid crisis: Severity, sources, and solutions in context. Deviant Behavior, 44(4), 567-590. https://doi.org/10.1080/01639625.2022.2071656 

One of the most significant healthcare crises in recent history across the country, affecting countless lives, is the opioid epidemic. This current epidemic and overdoses due to the opioid epidemic can be attributed to the increased levels of not only opioid prescribing in the past three decades but also the use of illegal opioids such as heroin and fentanyl analogs. Among the various social determinants that affect the opioid epidemic, socioeconomic statuses, such as income and education, are critical factors that can worsen the opioid epidemic. Individuals closer to the poverty level and lower educational level can lead to stress and increased susceptibility to substance abuse, including opioids. Healthy People 2030 data from the years 2018-2019 of those individuals 25 years and over shows that opioid use disorder is highest in those with a high school diploma or less and those at the poverty level and below.

In 2017, Donald Trump declared the opioid epidemic a public health emergency. President Trump’s approach to the opioid epidemic included in 2018 unveiling the Stop Opioid Abuse initiative. The three parts of this initiative include reducing the demand and over-prescription of opioids as well as educating people about the dangers of opioid abuse and misuse. Another part is cutting down on the supply of illicit drugs by cracking down on domestic and international drug supply chains. Lastly is providing evidence-based treatment and recovery support services to those who are battling opioid addiction. Donald Trump also worked with Congress to pass the SUPPORT Act, which included provisions such as providing states with a Medicaid plan option to cover residential treatment facilities, state Medicaid programs to cover services related to infants suffering from neonatal abstinence syndrome in recovery centers, an increase in funding to the CARA act and support services for those recovering from opioid use disorder transitioning from treatment to the workforce (The White House, 2018).

President Joe Biden named beating the opioid epidemic and overdose crisis through the White House Challenge to Save Lives from Overdose. This challenge is a commitment to save lives by increasing access and training to life-saving opioid overdose reversal medications. For the first time, the FDA has approved the availability of naloxone over the counter for nationwide purchase without prescription. President Biden has also invested funding to the State Opioid Response Grant Program, which provides opioid overdose reversal medications and kits at no cost to residents of states and Tribes. The Office of National Drug Control Policy also launched a social media campaign to educate young people on the dangers of Fentanyl and the effects of life-saving opioid overdose reversal medications (The White House, n.d.).

Provided the opportunity to do things differently, I would address not only expanding access to more evidence-based treatment options that include mental health services, medication-assisted treatment (MAT), and behavioral therapies but also increasing funding for community-based programs and education that offer support and services for individuals struggling with addiction in not only underserved communities but also those individuals whose social determinants place them at the greatest susceptibility to opioid use disorder. I would also expand the access for providers such as nurse practitioners and physician assistants, especially those in underserved communities, to obtain education and waivers to provide MAT, such as buprenorphine-naloxone, which is known as the gold standard in MAT treatment. This therapy not only helps to improve the quality of life of those individuals suffering from opioid use disorder but also saves lives.

 

Healthy People 2030. (n.d.). Reduce the proportion of people who had opioid use disorder in the past year-SU-18. Retrieved August 27, 2024, from https://health.gov/healthypeople/objectives-and-data/browse-objectives/drug-and-alcohol-use/reduce-proportion-people-who-had-opioid-use-disorder-past-year-su-18

The White House. (n.d). White House challenge saving lives from overdose. Retrieved August 26, 2024, from https://www.whitehouse.gov/savelivesfromoverdose/#challenge

The White House. (2018, October 24). President Donald J. Trump’s initiative to stop opioid abuse and reduce drug supply and demand. Retrieved August 26, 2024 from https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand-2/

El-Bassel, N., Shoptaw, S., Goodman-Meza, D., & Ono, H. (2021). Addressing long overdue social and structural determinants of the opioid epidemic. Drug & Alcohol Dependence, 222, N.PAG. https://doi.org/10.1016/j.drugalcdep.2021.108679

Moore, D. J. (2019). Nurse Practitioners’ Pivotal Role in Ending the Opioid Epidemic. Journal for Nurse Practitioners, 15(5), 323–327. https://doi.org/10.1016/j.nurpra.2019.01.005

Snodgrass, B. (2020). Opioid crisis: Placing blame or fixing the problem. Journal of the American Association of Nurse Practitioners, 32(1), 2–4. https://doi.org/10.1097/JXX.0000000000000344

DBP#1: Opioid Epidemic – A Federal Agenda Priority

                                                                                                       Introduction

The opioid epidemic in the United States represents a critical public health challenge that has garnered significant federal attention. This crisis, characterized by

widespread misuse of prescription and non-prescription opioids, has profound implications on social determinants of health. The opioid epidemic represents a high priority

public health crisis significantly influenced by social determinants such as socioeconomic status, educational levels, employment , housing, access to healthcare and social

support.  Each of these determinants can significantly influence both the prevalence of opioid misuse and the effectiveness of interventions aimed at curbing the epidemic

(Altekruse et al., 2020).

                                                                                Presidential Approaches to the Opioid Epidemic

President Joe Biden has taken a public health-oriented approach to the crisis, focusing on expanding access to treatment, advocating for insurance coverage of addiction

treatment, increasing funding for community-based interventions, and integrating harm reduction strategies into healthcare services (Affairs (ASPA), 2024). The Biden

administration has also emphasized the need for better data to track and manage the epidemic, integrating public health and public safety efforts.

In contrast, former President Donald Trump prioritized stringent law enforcement and border control to reduce the supply of illicit opioids. The administration declared the

opioid crisis a national emergency and focused on punitive measures along with promoting abstinence-based recovery programs (Ending America’s Opioid Crisis – the

White House, 2018). Critics argue that his approach was more reactive and focused on criminalization rather than providing comprehensive mental health services, putting

forth an intent to impose the “death penalty as necessary” to combat drug trafficking and subsequent addiction issues (Attorney General Sessions Issues Statement on

President Trump’s Plan to End the Devastating Opioid Epidemic, 2018).

                                                                          Social Determinant: Socioeconomic Status

Mental health is profoundly affected by social determinants, with socioeconomic status being paramount. Low socioeconomic status contributes to higher rates of mental

illness due to factors like stress, inadequate access to healthcare services, and limited educational opportunities (Alegría et al., 2018). This determinant not only

exacerbates the prevalence of mental health conditions but also impedes access to necessary care, perpetuating a cycle of mental health disparity (Latimore et al., 2023).

                                                                                         Alternative Strategies

In order to combat the opioid epidemic more effectively, I propose a more holistic approach that would consider a humanistic and engaged role of government.

 Education and Prevention: Implementing comprehensive educational programs in schools and workplaces to prevent opioid misuse. Focusing on education and

prevention efforts in schools and communities can assist in addressing issues by shifting the attitude towards preventative measures as opposed to punitive measures.

 

  Integrated Treatment Options: Enhancing and increasing access to both medication-assisted treatment (MAT) and psychological support across all healthcare

settings by integrating mental health services with primary care could promote early detection and intervention. This expansion of MAT options across all states will

enable these programs to reach the most vulnerable, such as rural and underserved communities.

 Data-Driven Strategies: Implementing a national database to track opioid prescriptions and treatments to prevent abuse while ensuring patients receive adequate

pain management. This national database would utilize real-time data to monitor prescribing patterns and identify high-risk areas needing targeted interventions.

                                                                                                      Conclusion

Tackling the opioid epidemic requires a multifaceted strategy that addresses the underlying social determinants, employs evidence-based interventions, and fosters a

collaborative approach across federal and community levels.

                                                                                                       References

Affairs (ASPA), A. S. for P. (2024, February 1). Biden-Harris administration marks two years of advancements in HHS’ overdose prevention strategy with new actions to

     treat addiction and save lives. Www.hhs.gov. https://www.hhs.gov/about/news/2024/02/01/biden-harris-administration-marks-two-years-advancements-hhs-overdose-

prevention-strategy-new-actions-treat-addiction-save-lives-press-release.html

Alegría, M. (2018). Social determinants of mental health: Where we are and where we need to Current Psychiatry Reports, 20(11).

https://doi.org/10.1007/s11920-018-0969-9

Altekruse, S. F., Cosgrove, C. M., Altekruse, W. C., Jenkins, R. A., & Blanco, C. (2020). Socioeconomic risk factors for fatal opioid overdoses in the United States:

Findings from the Mortality Disparities in American Communities Study (MDAC). PLOS ONE, 15(1). https://doi.org/10.1371/journal.pone.0227966

Attorney general sessions issues statement on president trump’s plan to end the devastating opioid epidemic. (2018, March 19). Www.Justice.gov.

https://www.justice.gov/opa/pr/attorney-general-sessions-issues-statement-president-trump-s-plan-end-devastating-opioid

Ending America’s Opioid Crisis – The White House. (2018). Trumpwhitehouse.archives.gov. https://trumpwhitehouse.archives.gov/opioids/

Latimore, A. D., Elizabeth Salisbury- Afshar, Duff, N., Freiling, E., Kellett, B., Sullenger, R., &Salman, A. (2023). Primary, secondary, and tertiary prevention of

substance use disorders through socioecological strategies. NAM Perspectives, 9(6). https://doi.org/10.31478/202309b

 

According to the National Institute of Mental Health in 2024, an estimated 57.8 million adults (19% of the country) had a mental illness, but only 43% received any kind of mental health care. This statistic shows just how much mental health is affecting those all over the nation. This rising issue leads to suicide and substance abuse and our previous and current president continue to come up with ways to decrease these numbers and improve overall well-being for all.

During President Trump’s presidency he put an order to improve access to rehabilitative services related to substance abuse and provided grant funding that would allow people to have access to telehealth services, peer to peer and in person therapy services. At a time where mental health was at an all-time high it was crucial to provide these kinds of resources. The pandemic cause increased anxiety, depression and stress. Working as a nurse throughout all of the pandemic I can understand why it affected so many people. Trump did a good job in recognizing this rising issue and worked to increase the resources that are available to all Americans.

President Biden has also done a great job with raising awareness on mental health. In 2023 he released a national strategy to allow Americans to have better access to mental health benefits within private insurance policies. These in network benefits would help cover costs of medications, therapy and psychiatric care resources. By doing this people can have access to the resources that they need to improve their mental health. In a time where the costs of everything is so high, offering to cover these kinds of services can vastly improve the lives of so many. We already have to pay so much for health insurance in America, so the fact that Biden recognized that health companies needed to improve in this area is very commendable.

Political stance or not, I believe that mental health is so important and that more resources need to be available to all. I strongly believe that more resources should be available in public schools, so that children and young teens can have an outlet and someone to turn to. Bullying, drugs, alcohol and suicide are all present in our young people today. These kids have so much exposure to these things at such a young age and I think it is so important to raise awareness on these mental health issues so that these kids know they are not alone. Providing therapy, guidance counselors and other resources would help decrease these issues and improve the overall well-being of our school aged children. I also think it is important to not only provide in network access to those with private insurance, but low-income families need options as well. Our Medicaid and uninsured population should also have access to mental health resources. Free conferences, medication trials and therapy sessions could really help this population as well. I think as a whole the United States has made some great strides towards mental health, but I do believe there is still a lot of work that needs to be done.

As a future provider I want to make sure that I am addressing these types of issues with all of my patients. I may not be able to make all the changes in the world, but if I can make an impact on the community that I will serve, then all of this work will be well worth it.

 

Resources

House, W. (2023, July 25). FACT SHEET: Biden-Harris Administration Takes Action to Make it Easier to Access In-Network Mental Health Care. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/07/25/fact-sheet-biden-harris-administration-takes-action-to-make-it-easier-to-access-in-network-mental-health-care/

President Donald J. Trump Is Safeguarding Americans’ Mental Health and Preventing The Tragedy of Suicide – The White House. (2020, October 5). The White House. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

Singh, V., Kumar, A., & Gupta, S. (2022). Mental Health Prevention and Promotion-A Narrative Review. Frontiers in Psychiatry, 13(898009). https://doi.org/10.3389/fpsyt.2022.898009

Week 1 Discussion Post:

For this week’s discussion, we are tasked with finding a healthcare concern that has become a political talking point. The rising cost of healthcare continues to be a political talking point, even at the presidential level. Leaders’ political ideas can directly or indirectly affect the price of healthcare for patients. Current statistics show that healthcare-related expenditures are rising (“Trends in Health Care Spending,” 2024). It is essential to understand why this increase is happening, as well as how policy changes can affect these costs for the end consumers. One of the key social determinants that influence the cost of healthcare would be access to health insurance. Lack of insurance coverage, or subpar coverage, can dramatically increase the cost of healthcare for patients.

One of the topics that fall under the umbrella of healthcare-related costs is the cost of medications. The cost of prescription medications is an important topic, as many medicines are required for patients to remain living or maintain a quality of life. This is also an area where we can see the influence of political agendas. An agenda that influenced the cost of medications is one from the previous presidential administration called the “Transparency in Coverage” rule. This would require insurance providers to list prices for drugs as well as provide patients with an itemized cost review (Houser, 2022). In theory, this would reduce costs to the consumer by removing the ability to hide the prices of medications. This differs from the current administration in the approach used to attempt to lower costs. Our current presidential administration, through bipartisan collaboration, has shown that significant progress can be made. Bills like the “Cap Insulin Prices Act” that aims to cap the maximum co-pay for specific medications to patients, are a testament to the potential benefits of such collaboration NURS 6050 Week 1 Discussion: Presidential Agendas.

Considering both administrations’ shortfalls, we see that more needs to be done to drive the cost of healthcare down. If it were up to me, I would attempt to create a bipartisan approach to combine the best ideas from each political point of view. This, combined with learning from other failed attempts to reform healthcare, can work to provide insight into how to create successful improvement (Bayat et al., 2023).

 

References:

Houser, R. S. (2022). The benefits of more government interference in prescription drug pricing. Health Policy OPEN, 3, 100071. https://doi.org/10.1016/j.hpopen.2022.100071

Trends in health care spending. (2024, July 9). American Medical Association. https://www.ama-assn.org/about/research/trends-health-care-spending#:~:text=Health%20spending%20in%20the%20U.S.,trillion%20or%20%2413%2C493%20per%20capita.

Bayat, M., Kashkalani, T., Khodadost, M., Shokri, A., Fattahi, H., Seproo, F. G., Younesi, F., & Khalilnezhad, R. (2023). Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis. Journal of Preventive Medicine and Public Health, 56(2), 128–144. https://doi.org/10.3961/jpmph.22.394

Population Health Topic: Food Security, Nutrition, and SDOH

Food security and nutrition are a population health topic that often rises to the presidential agenda (Seligman & Berkowitz, 2019). Food security, which refers to having consistent access to enough safe and nutritious food, is deeply impacted by the social determinant of economic stability (Drewnowski, 2022). Economic stability involves factors like income, employment, and various forms of finances that a household can use to support living expenses such as investments, savings, or credit (Drewnowski, 2022). Access to these resources directly impacts one’s capacity to afford and obtain healthy food (Drewnowski, 2022). Lack of economic stability often results in food insecurity, which can lead to poor nutrition and heighten the risk of diet-related chronic diseases, like type 2 diabetes, as well as mental health conditions, such as anxiety and depression (Levi et al., 2023 & Arenas et al., 2019).

Presidential Influence and Approaches

President Barack Obama and President Joe Biden took significant steps to address food security and nutrition (Tidwell, 2024 & USDA, 2021). During his administration, President Obama enacted the Healthy, Hunger-Free Kids Act of 2010, which sought to upgrade the nutritional quality of school meals and expand access to healthy food for children from low-income families (Tidwell, 2024). He also strengthened the Supplemental Nutrition Assistance Program (SNAP) to help more families afford nutritious food (USDA, n.d.). President Biden continued to focus on food security by implementing the American Rescue Plan, which extended SNAP benefits and provided additional funding for nutrition programs during the COVID-19 pandemic (USDA, 2021). President Biden also held a White House Conference on Hunger, Nutrition, and Health, aiming to end hunger and improve nutrition by 2030 (The White House, 2022).

What I Would Do Differently

If addressing this issue, I would focus on enhancing economic stability through comprehensive policies encompassing local and national solutions (Colson-Fearon & Versey, 2022 & Hartline-Grafton & Hassink, 2021). This would include expanding access to affordable, nutritious food by increasing support for local food systems, such as urban agriculture and community-based food cooperatives (Colson-Fearon & Versey, 2022). A Colson-Fearon & Versey study reveals that urban agricultural practices strengthen community ties, raise awareness about nutritious eating habits, and support affordable food distribution (2022). Additionally, I would advocate for policies that ensure living wages and job security, making it easier for families to afford healthy food (Hartline-Grafton & Hassink, 2021). By addressing the root causes of economic instability, we can create more sustainable and equitable strategies for improving food security and nutrition in our communities and nationwide (Hartline-Grafton & Hassink, 2021).

References

Arenas, D. J., Thomas, A., Wang, J., & DeLisser, H. M. (2019). A systemic review and meta-analysis of   depression, anxiety, and sleep disorders in US adults with food insecurity. PubMed. Retrieved August 27, 2024, from https://pubmed.ncbi.nlm.nih.gov/31385212/

Colson-Fearon, B., & Versey, H. S. (2022). Urban agriculture as a means to food sovereignty? A case study of Baltimore city residents. PubMed Central. Retrieved August 27, 2024, from https://doi.org/10.3390/ijerph191912752

Drewnowski, A. (2022). Food insecurity has economic root causes. nature food, 3, 555–556. Retrieved August 27, 2024, from https://doi.org/10.1038/s43016-022-00577-w

Hartline-Grafton, H., & Hassink, S. G. (2021). Food insecurity and health: practices and policies to address food insecurity among children. PubMed Central. Retrieved August 27, 2024, from https://doi.org/10.1016/j.acap.2020.07.006

Levi, R., Bleich, S. N., & Seligman, H. K. (2023). Food insecurity and diabetes: Overview of intersections and potential dual solutions. PubMed Central. Retrieved August 27, 2024, from https://doi.org/10.2337/dci23-0002

Seligman, H. K., & Berkowitz, S. A. (2019). Aligning programs and policies to support food security and public health goals in the United States. PubMed Central. Retrieved August 27, 2024, from https://doi.org/10.1146/annurev-publhealth-040218-044132

The White House. (2022, September 28). Fact sheet: The Biden-Harris administration announce more than $8 billion in new commitments as part of call to action for white house conference on hunger, nutrition, and health. Retrieved August 27, 2024, from https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/28/fact-sheet-the-biden-harris-administration-announces-more-than-8-billion-in-new-commitments-as-part-of-call-to-action-for-white-house-conference-on-hunger-nutrition-and-health/

Tidwell, T. (2024, February 21). Obama’s Healthy, Hunger-Free Kids Act, 14 years later. The Reflector. Retrieved August 27, 2024, from https://reflector-online.com/28000/news/obamas-healthy-hunger-free-kids-act-14-years-later/

USDA. (2021, March 3). Biden-Harris administration actions to reduce food insecurity amid the COVID-9 crisis. U.S. Department of Agriculture. Retrieved August 27, 2024, from https://www.usda.gov/media/press-releases/2021/03/03/biden-harris-administrations-actions-reduce-food-insecurity-amid

USDA. (n.d.). Fact sheet: Obama administration announces major investments in preventing child hunger. Food and Nutrition Service. Retrieved August 27, 2024, from https://www.fns.usda.gov/pressrelease/2016/wh-012716

 

 

I wanted to start this discussion with what the governing body looks for before talking about issues. We all know that the Trump and the Biden administration have disagreed on a lot, but I wanted to look at a topic that has been around since before they started in office. I wanted to talk about opioids. Opioids are a topic that both administrations have agreed needs to be controlled and stopped, if possible. Both parties saw the severity of the opioid crisis and wanted to mitigate strategies to fix the issue.

What Government Looks For

Since there is limited time for policymakers to get things done, and so much for them to discuss, our book discusses four different categories that might help get things into the office for discussion.

1. The agenda universe is any idea that might be brought up within society.
2. Systematic agenda, which are all issues that have the public’s attention and might fall within that government’s jurisdiction.
3. The institutional agenda refers to any items that have risen to the attention of a governing body.
4. Lastly, the decision agenda, which is the things being acted on. Short (2022)

Trump Administration Plan Against Opioids

According to Whitehouse.gov, the Trump administration began implementing a multi-step action plan to end the drug crisis within the United States. He wanted to create national drug control policies, which included efforts to increase access to treatment and strengthen law enforcement when those who might be selling illegal drugs to individuals struggling with addiction. The parts for the plan of the Trump administration are as follows:

Step 1: Educating Americans on the dangers of opioids and fixing over-prescribing.

Within this step, they created a safer prescribing plan which reduced opioid prescribing by 1/3.

Step 2: Cutting down on illegal drug trafficking.

Step 3: Helping addicts with treatment and counseling options.

Within this step, President Trump implemented safer borders and waterways to decrease the number of smuggled drugs coming into the country.

I found this to be a very interesting fact within the administration. “The number of first-time heroin users ages 12 and older fell by more than 50 percent in July 2017. Between President Trump’s Inauguration and October 2018, high-dose opioid prescriptions fell by 16 percent.” “Ending America’s Opioid Crisis” (n.d)

Biden Administration Plan Against Opioids

Biden’s administration addressed the opioid crisis with efforts to expand treatment and prevention services for addicts. The focus of this administration is to focus on harm reduction strategies and find the root cause of addiction. They found the criminalization to make the distribution of opioids worse, meaning that more drugs were being sold illegally because of the tighter border security. They think there needs to be less criminalization and more prevention services readily available.

Biden’s Administration gave National Drug Control agencies a 3.2 billion dollar increase to expand treatment and preventative services for addicts. They used this to target the areas and populations at most risk for substance abuse and possible overdose.  “Actions Taken by the Biden-Harris Administration to Address Addiction and the Overdose Epidemic” (n.d.)

What Would I Do Differently?

While I don’t feel as though either administration has done things incorrectly, I do feel that the trafficking of drugs needs to remain criminalized. I do, however, feel as though we need to become better at treating addiction and limiting the prescription of narcotic pain medication. There is no happy medium. We will continue to see addiction when we see broken people. This talk must start early. It is shown that overdose deaths have risen 30% from 2019-2020 with just over 1,800 of those being adolescents, according to the CDC. When children are bullied at school, it is likely because they are bullied at home. Teaching our youth that being a good person and a resource for others might help just one person in life. One day maybe we can teach each other that drugs are never going to make things better, we must cope without them.

 

References:

Actions Taken by the Biden-⁠Harris Administration to Address Addiction and the Overdose Epidemic. (n.d.). The White House. https://www.whitehouse.gov/ondcp/briefing-room/2022/08/31/actions-taken-by-the-biden-harris-administration-to-address-addiction-and-the-overdose-epidemic/

Ending America’s Opioid Crisis. (n.d.). The White House. https://trumpwhitehouse.archives.gov/opioids/

Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide (7th ed., pp. 58-59). : Jones & Bartlett Learning.

Tanz, L., Dinwiddie, A., Mattson, C., O’Donnell, J., Davis, N. (2022, December 16). Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. CDC. https://www.cdc.gov/mmwr/volumes/71/wr/mm7150a2.htm

Wen, L. S., & Sadeghi, N. B. (2020). The opioid crisis and the 2020 US election: crossroads for a national epidemic. Lancet (London, England), 396(10259), 1316–1318. https://doi.org/10.1016/S0140-6736(20)32113-9

One of the main comorbidities, which in turn induce other chronic diseases like diabetes, heart disease, and renal disease, to mention a few, is Obesity. Defined by World Health Organization Obesity is defined as “abnormal or excessive fat accumulation that presents a risk to health” (Obesity, n.d.). Due to several socioeconomic reasons, including geographic location to healthcare, quality, and access to nutrient-dense meals, this health issue frequently begins in adolescence (CDC.gov, 2024). Approximately one in five US children, according to the Centers for Disease Control and Prevention, suffer from obesity which affects other groups more than some, such as Hispanic and non-Hispanic black children who have lower incomes (CDC.gov, 2024).

The current and past presidential electors have made great efforts to bring attention to and find solutions to the obesity pandemic. The Biden-Harris Administration identified several struggles in food disparities that may have contributed to an incline in obesity. The administration held a conference in September of 2023 to discuss the efforts to end food disparities and reduce related comorbidities by 2030 (PCAST welcomes public input on Nutrition Research, 2023). The conference named “National Strategy on Hunger, Nutrition, and Health” discussed five pillars to be created in the effort to improve life-diminishing and threatening comorbidities by improving food access and affordability, integrating nutrition and health, empowering healthy choices, supporting physical activity, and enhancing research (PCAST welcomes public input on Nutrition Research, 2023).

In 2010, former President Barack Obama and former First Lady Michelle Obama produced a campaign titled “Let’s Move”, which was an initiative to help combat childhood obesity in the United States. This campaign was highly focused on encouraging healthier eating habits and increasing physical activity among children, promoting guidelines for physical activity, and collaborating with food manufacturers to reduce unhealthy products in our nation’s food, such as fats and sugars (Institute of Medicine, 2012). Both of these initiatives would encourage our nation’s population to create healthier eating habits, increasing access to nutritious foods while aiming to foster environments that would encourage physical activity and overall wellness.

I fully support the efforts that both presidential elects introduced to reduce the effects of obesity in our nation, so there is not anything I would change. I would continue the focal point of these efforts in the underserved communities, focusing on advocating for healthier food and increased physical activity in local school meals to improve the situation and to lower childhood obesity. Kids could be kept active by working with schools to implement after-school sports programs and regular physical education sessions, where for those less fortunate, community and city grants could be utilized for funding. Additionally, I would strive to increase public understanding of the value of a healthy diet and regular exercise through workshops and neighborhood gatherings. Lastly, I would get my nursing colleagues involved in this initiative as we know that collaboration is the key to making the process of agenda-setting prominent in attracting the attention of policymakers, the public, and the media (Setting the Agenda, 2018). By working together, we can establish a nurturing atmosphere that encourages our children to lead healthier lives NURS 6050 Week 1 Discussion: Presidential Agendas.

 

References

 

Centers for Disease Control and Prevention. (2024). Childhood obesity facts. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/php/data-research/childhood-obesity-facts.html

Institute of Medicine (US). How Far Have We Come in Reducing Health Disparities? Progress Since 2000: Workshop Summary. Washington (DC): National Academies Press (US); 2012. 5, Promising Practices in Addressing Social Determinants: Obesity Prevention. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114231/

The United States Government. (2023, August 17). PCAST welcomes public input on Nutrition Research. The White House. https://www.whitehouse.gov/pcast/briefing-room/2023/07/18/pcast-welcomes-public-input-on-nutrition-research/

Walden University, LLC. (2018). Setting the Agenda. Baltimore, MD. Retrieved April 26, 2024, from https://waldenu.instructure.com/courses/131071/pages/module-1-learning-resources?module_item_id=4984671.

World Health Organization. (n.d.). Obesity. World Health Organization. https://www.who.int/health-topics/obesity#tab=tab_1

Topic

Medication costs have been a significant debatable topic for each administration since President George W. Bush established Medicare Part D in 2006. The rise of chronic and acute illnesses nationwide has emphasized the need for medications to maintain and prevent chronic and recurrent diseases, especially in individuals sixty-five years of age and older. The original goal of Medicare Part D, as outlined by the Bush administration, was to provide Medicare beneficiaries with a plan to fully or partially cover necessary medicines for a better quality of life. Novel policies often have gaps that must be reviewed to allow for progressive reform and transformation that benefits the nation’s needs. It is important to note that these usually change over time (Short, 2022).

The prevalence of recurrent acute illnesses and poorly managed chronic diseases prompted healthcare professionals to investigate the underlying reasons for this trend (De Avila et al., 2021). Their investigations revealed that noncompliance with prescribed medications was a significant factor, with the cost of these medications emerging as the primary barrier to adherence (De Avila et al., 2021). This discovery set in motion a continuous effort to reform Medicare Part D and reduce drug coverage costs across multiple administrations. However, with the right reforms, we can anticipate a future where medication costs are more manageable and noncompliance is significantly reduced, leading to improved health outcomes (Short, 2022).

Presidential Policies and Influence

Administrations such as George W. Bush, Obama, Trump, and Biden have all had their perspectives on alleviating drug coverage burdens for individuals qualifying for Medicare coverage. The Bush Administration introduced The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, also known as Medicare Part D, to alleviate the cost of prescription medications by sharing the costs between taxpayers and Medicare beneficiaries (Trish et al., 2022). This was the most radical change to Medicare in over three decades. The Bush Administration made great strides to make drug coverage affordable to individuals 65 years of age and older. Still, a significant gap known as the “donut hole” remained, which the Obama Administration indirectly addressed with the Affordable Care Act (ACA). The ACA not only had an immediate response to drug coverage Part D by decreasing the drug cost for Part D enrollees from 100% to 25% by 2020 but also encouraged the continual review of how to aid Medicare Part D under future administrations (Hwang et al., 2022).

The Trump Administration attempted to dismantle almost every aspect of the ACA, except drug cost negotiations with large pharmaceutical companies for Medicare beneficiaries. In 2019, the Trump Administration passed the Elijah E. Cummings Lower Drug Costs Now Act, which laid out the guidelines for negation measures for excessive drug price increases and capped out-of-pocket negotiations with insurance companies (Trish et al., 2022). The Biden administration continued to focus on making prescription drugs more affordable through the Inflation Reduction Act (IRA) 2022 (Hwang et al., 2022). Similar to the ACA, this act shows incremental changes in drug cost policy to make it more palatable for large pharmaceutical companies, which historically have shown the most significant progress and benefit. Incremental introduction to policy and changes greatly impacts what appears on presidential agendas (Short, 2022).  The IRA builds on the ACA by expanding eligibility for Part D Low-Income Subsidy programs in 2024, incentives such as capped out-of-pocket spending of $2,000.00 in 2025, and allowing the Secretary of the Department of Health and Human Services to negotiate drug prices with pharmaceutical companies to aid in affordable cost to assist in medication compliance and care plan adherence, especially in individuals that qualify for Medicare (Trish et al., 2022). The IRA primarily focuses on specific drugs being negotiated for Part B and Part D Medicare-approved drugs. In 2025, there will be 15 drugs on the agenda, 15 more drugs in 2028, and 20 more each year after 2028, focusing on diseases such as cancer, diabetes, heart failure, and more (Trish et al., 2022).

Each Administration and its established policy focused on the needs of a specific population to resolve medication compliance and plan of care adherence for chronic and acute illnesses, especially those who take multiple medications (Short, 2022). More evidence-based research needs to be conducted to follow trends over time and see how beneficial novel policies are across various administrations.

Personal Input and Perspective

The formation and passing of policies are literal acts of Congress that must benefit the majority and be sacrificial and satisfactory (Short, 2022). I would introduce a policy based on previously passed policies that appealed to both parties, the target population and pharmaceutical companies. The IRA focuses on specific drugs to be on the agenda for negotiation with a maximum fare price (MFP) for Medicare beneficiaries (Kaltenboeck, 2023). Still, it does not specify a maximum percentage that pharmaceutical companies must decrease their drug costs (Kaltenboeck, 2023). Amending the IRA policy to abide by either MFP or mandated maximum decrease percentage of drug cost may encourage pharmaceutical companies to introduce more drugs on the agenda for decreased cost negotiations. More affordable drugs could improve medication and plan of care adherence, resulting in better quality of life and chronic disease management (Vijayakumar et al., 2021).

Conclusion

Healthcare reform will be a never-ending topic that will appear on presidential agendas until the end of time. So many aspects of our healthcare system need to change as life expectancy increases along with the prevalence of chronic illnesses (Vijayakumar et al., 2021). Inflation significantly affects our elderly population, which requires medications to manage illnesses. Policies for almost two decades have been reviewed and amended to alleviate and decrease drug costs for Medicare-qualifying individuals. As healthcare professionals, we must become informed advocates for the needs of the populations we serve because we are in the trenches and see firsthand deficiencies in the healthcare system (Short, 2022).

 

 

References

De Avila, J. L., Meltzer, D. O., & Zhang, J. X. (2021). Prevalence and persistence of cost-related medication nonadherence among Medicare beneficiaries at high risk of hospitalization. JAMA Network Open, 4(3). https://doi.org/10.1001/jamanetworkopen.2021.0498

Hwang, T. J., Kesselheim, A. S., & Rome, B. N. (2022). New reforms to prescription drug pricing in the US. JAMA, 328(11), 1041. https://doi.org/10.1001/jama.2022.15268

Kaltenboeck, A. (2023). What the inflation reduction act’s reforms to Medicare part D mean for prescription drug prices. Forefront Group. https://doi.org/10.1377/forefront.20230119.156895

Short, N. M. (2022). Milstead’s Health Policy & Politics (7th ed.). Jones & Bartlett Learning. https://mbsdirect.vitalsource.com/books/9781284238723

Trish, E., Kaiser, K. M., Celestin, J., & Joyce, G. (2022). Reforming the medicare part D benefit design: Financial implications for beneficiaries, private plans, drug manufacturers, and the Federal Government. Journal of Health Politics, Policy and Law, 47(6), 853–877. https://doi.org/10.1215/03616878-10041233

Vijayakumar, P., Punnapurath, S., Platty, P., Krishna, S., & Thomas, T. (2021). A study of medication compliance in geriatric patients with chronic illness. Journal of Family Medicine and Primary Care, 10(4), 1644. https://doi.org/10.4103/jfmpc.jfmpc_1302_20