Week 14- Strategies for Increasing Consumer Participation in the Policy Process.

Women’s rights relating to family planning can lead to consumer participation in regards to policy change. Public trust and confidence in government, or policy capacity is important to gage in regards to a policy analyses (Kraft, 2013). The Supreme Court decision for private organizations regarding family planning affected the consumer and their rights, or impact on society. Kraft (2013) states that in a democracy public policies should be consistent with public inclinations and needs of the citizen. However, as seen in the Burwell vs Hobby Lobby Supreme Court decision, policymakers were more receptive to organized interest than in the general public.

consumer adovacy

Strategies have been to strengthen citizen capacity to participate in the policy process, one example can be given with the Tea Party activism (Kraft, 2013). It is noted that public participation in the policy process has degenerated in past decades. Arguments are made as to why the average citizen has detached from public policy making, and some say it’s because citizens do not see an impact on their life or cannot see how they can affect government policy (Kraft, 2013).

Social media could improve consumer participation such as Facebook or blogging in regards to information put out to the consumer. Promoting participation and education is important for the consumer to understand the repercussions from policies that are being presented in government. Providing information on the effects of a policy can lead to empowerment and advocacy for the consumer. Public participation can go beyond voting, letters to congressmen, or emailing policymakers. Organizing groups can lead to advocacy demonstrations as was seen before and after the Supreme Court decision in 2014, which brought media attention. Some policymakers advocate the use of web promotions like e-government to engage the public (Kraft, 2013).

Policy analyses have set 5 goals to further public involvement. They are:

“1) incorporating public values into decisions (a fundamental expectation in democracy); 2) improving substantive quality of those decisions (for example, by suggesting alternatives and finding errors of inappropriate assumptions underlying policy proposals); 3) resolving conflict among the various competing interest (by emphasizing collaborative rather than adversarial decision making); 4) building trust in institutions and processes (thereby improving their ability to solve public problems); 5) educating and informing the public (raising public understanding of the issues and building a shared perspective on possible solutions)” (Kraft, 2013, p. 518).


Kraft, M. E., & Furlong, S. R. (2013). Public policy: Politics, analysis, and alternatives (4th Ed.). Thousand Oaks, CA: SAGE.


Week 13- Sustaining Innovative Environments.

On June 30, 2014, the Supreme Court ruled with Burwell vs. Hobby Lobby that “for-profit” or private corporations can be exempt from the Affordable Care Act’s accountability of providing family planning to its employees if it goes against their religious beliefs. The Supreme Court decision was based on the interpretation of the Religious Freedom Restoration Act (RFRA). It did not address whether such corporations are protected by the free-exercise of religion clause of the First Amendment of the Constitution” (Wikipedia, 2015).

There have been attempts to rescind the Supreme Court decision since then, without success. In the Model of the Public Policymaking Process, or policy modification phase, one would hope that after feedback from individuals, organizations, and interest groups this policy can be changed (Longest, 2010). Can we argue if this was a well-executed maneuver of private organizations to prevent Obamacare or government from dictating to them what is paid for by private insurance to keep cost down for them?


Incrementation reflects on the historical modifications or modest changes to public policies, but some predict that Obamacare’s health care reform will lead to major modifications in healthcare policies (Longest, 2010).  Longest terms “incremental universalism as getting to universal health insurance coverage by filling in the gaps in the existing system, rather than ripping up the system and starting over” (Longest, 2010, p 150). So, will we see modification of the Hobby Lobby issue in increments or can there be major changes to accommodate the individual who works for organizations like Hobby Lobby to provide family planning services.


Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Wikipedia, (2015). Burwell v. Hobby Lobby Stores, Inc. Retrieved from http://en.wikipedia.org/wiki/Burwell_v._Hobby_Lobby_Stores,_Inc.

Week 12- Healthcare Financing

Healthcare cost has been the center of controversy, and over the past 30 years national spending on healthcare has doubled. There is arguments that healthcare is in fact, more expensive and does not necessitate that it is of higher quality (Longest, 2010). Many blame the geriatric population with the rising cost of Medicare although many seniors complain of deficiencies in service despite higher cost. In spite of all this, the demand for publicly funded family planning and contraceptive services has also increased.

According to the research by the Guttmacher Institute (2014), there were 20 million women in need of publicly funded services for contraception, because of an income below 250% of the federal poverty level or were younger than 20. The need for publicly funded services increased by more than three million (22%) between 2000 and 2012. Among the 20 million women in need of publicly funded contraceptive care, 73% (15.2 million) were low-income adults, and 24% (4.7 million) were younger than 20 (Guttmacher, 2014).

Publicly funded family planning services totaled $2.37 billion in 2010. Medicaid accounted for 75% of total expenditures, state appropriations for 12% and Title X for 10%. Other sources, such as the maternal and child health block grant, the social services block grant and Temporary Assistance for Needy Families, together accounted for 3% of total funding (Guttmacher, 2014).


Publicly funded Medicaid family planning services in 2012, aided women to evade 1.5 million unintended pregnancies, and 510,000 abortions. Title X contraceptive services prevented 1.1 million unintended pregnancies in 2012, which would have resulted in about 527,000 unintended births and 363,000 abortions.


Research was done on five countries: Canada, France, Sweden, United Kingdom and the United States, in response of their youth’s sexual and reproductive health needs, and availability of services was looked into. The outcome showed that youths in the United States are more likely to meet barriers to availabilities of services than other countries stated above (Hock-Long, 2003).

In regards to the adolescent population in the United States, financial considerations plays a part in reproductive health, and access rest upon insurance coverage (private or public), ability for self-pay, or family planning programs funded by Title X. Because of high cost of prescription drugs, many adolescents may not be able to afford services or the most effective method of contraception (Hock-Long, 2003).

So what does all this mean, well there is a definite need for family planning and contraception services but can the federal budget withstand the increasing cost, and why is cost increasing with demand? Is this the result of free trade in pursuit of the American dream?


Guttmacher Institute (2014). Publicly funded family planning services in the United States. Retrieved from http://www.guttmacher.org/pubs/fb_contraceptive_serv.html

Hock-Long, L., Herceg-Baron, R., Cassidy, A.M., & Whittaker, P. G., (2003). Access to adolescent reproductive health services: Financial and structural barriers to care. Perspectives on Sexual and Reproductive Health, 35 (3).

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Week 11- Characteristics of Innovators and Change Agents in the Healthcare Sector

This week’s blog is on change agents and characteristics of innovators in the healthcare sector. Healthcare technology and innovation is constantly evolving and changing. The organizations or systems that plans to survive in these changing times needs to plan for change and explore changes theories and philosophies of change management.

Change theorist such as John Kotter, recognize that that organized steps must be in place in order to tackle and implement change. The Kotter’s change management model systematically provides 3 phases. The first phase ‘‘creating a climate for change’’, secondly ‘‘engaging and enabling the whole organization’’, and finally ‘‘implementing and sustaining the change’’.

During any period of change, a there are a multitude of emotions that must be dealt with within the organization, such as anxiety, anger, negativity, arrogance to name a few, and can challenge success of any innovative change (Campbell, 2008).

Kotter change

Creating a climate for change involves motivation for all who are involved in order to succeed. This sense of urgency for the change is needed to instill the change all the way through groups or organizations (Campbell, 2008).  Engaging and enabling the whole organization involves identifying key people involved in the change and persuade them to buy in. Communicating the vision and continuous dialog is essential to engaging the organization to change. When changes is finally made, don’t let up. Continuous reinforcement of factors of change is important to maintain the change (Campbell, 2008).   buy in model

Take for example one research to policymaking at the local, state and national level can be complex. Researchers have tried to understand policy decision makers approach for policymaking in order to improve upon the policymaking process.  Over a period of time they engaged legislators in systemic policy educational programs, to examine programs to improve the way policymakers examine the tough, adaptive challenges in today’s society (Minyard et al., 2014). This could be looked at as creating a climate for change. From this, the researchers learned, there was not a cookie cutter way to educate legislators. Specifically, when it comes to educating legislators, it is not realistic to educate all legislators the same way with the same information.

The researchers also found that advocacy from legislative leadership was necessary to gain acceptance of the educational promotable program (Minyard et al., 2014). This incorporated the second phase of Kotter’s change theory in that they needed the support and engaging of key stakeholders to buy into the cause. Lastly, the researchers utilized certification for legislators to sustain and maintain change (Minyard et al., 2014).

From this we see how it is important to have public and private sector advocacy groups and stakeholder support contraceptive issues. The advocates such as in the Hobby Lobby groups proved innovative in their portrayal of their religious rights being imposed upon. Now supporters for the ACA or Obamacare will need to improvise and promote policy change to the Supreme Court judgment.



Campbell, R.J. (2008). Change management in health care. The Health Care Manager, 27 (1), 23–39.

Minyard, K. J., Ferencik, R., Phillips, M. A., & Soderquist, C. (2014, January). Using systems thinking in state health policymaking: An educational initiative. Health Systems, 3(2), 117-123. http://dx.doi.org/10.1057/hs.2013.17

Week 10- Change Theory: Interview with a Policy Maker-Alexander Ritchie Tribal Attorney General (AJ), Esq.

Policy communities are composed of professionals in a given policy area, they are dispersed in and around government (Kingdon, 2010). The interview below was of the AJ of a tribal community, who is certainly a specialist in policy making. It was interesting to see the change agents for policy making in tribal government. The process of tribal government when there is a need in the community and the course the policy goes through as a code provision can be lengthy. Policy windows are given community advocates to voice their concerns over a policy (Kingdon, 2010). In the case of the tribe, when a code provision is drafted and goes to committee selected by the tribal council and then placed before the public for comments. Advocates could also be identified with the police chief and tribal prosecutor who identified the need, can be considered change catalyst.

What does an Attorney General do?

Ritchie: We provide legal counsel to the tribe as an organization not to individual members of the tribe so we assist on all legal transactions which would include contracts, the business of the council. We provide legal counsel to (tribal) departments on legal questions that their programs may confront. We also defend the tribe when it’s been sued, let’s say personal injuries. We also sue other entities on behalf of the tribes, where the tribe has legal interest in the outcome of something. I think that’s it in a nutshellNA art

So you do not represent an individual of the tribe?

Ritchie: No, we represent the tribe as an organization, just like the US attorney represents the United States and no one citizen, unless congress or in this case the council directs or otherwise authorizes us to represent an individual.

So how is a law passed on Sovereign Nations like tribal land?

Ritchie: Laws are passed by any government pretty much the same way. Here, it’s usually in response to a need; and so for example recently the police and the prosecutor wanted to change the way criminals were sentenced, from a the discretion of the court to a series of mandatory sentences, much like the United States, like with joint crimes for example, the court has great discretion on imposing either a fine or jail sentence or probation and so the police chief and prosecutor wanted to have harsher penalties especially for the larger drug dealers, so…the request is made at the department level, it then goes to goes to a committee, the committee makes recommendation to the (tribal) council, the council asked our office to draft a code provision which we do, then we get it back to committee, and the committee approves it, then the committee brings it to the council which then publishes it for public comment, and after a comment period a draft provision comes back to the council, the councils ask if there is any further comments and yes or no, if a yes, the AJ’s office looks at it with the council to see if its sufficient enough to revisions or further concerns, its sent back to committee, otherwise it goes to full council to be acted on (voted on), yes or no and becomes a law.

As far as Women’s Health and Family Planning do laws apply on tribal land, like they would at the state or federal level? Say for example, can teenagers come into a tribal clinic for contraception without parental consent, doe that apply here?

Ritchie: Unless there is state funding tied to the program, the answer would be no, there are federal restrictions and some kinds of planning, so they would apply. An alternative, if the tribe would apply some sort of standard of its own, it would apply, but here I am not aware of any.

In the case of the tribal MCH clinic, where we have 3rd party billing, and are not tied to federal or state grants how does that work?

Ritchie: Well you are tied into rules to third party billing as to whether the services were coverable by insurances like Medicaid or Medicare, or AHCCCS. So that would apply. I do have to research it further. They have tried to change that, multiple times but I can always find out.

Does a teenager become an emancipated minor when she becomes pregnant or has a child?

Ritchie: I don’t know how to answer that question, I’ve never been asked that question to deal with. I can find out.

When a teenager has a baby, who makes the decision for that baby, the teenager or the teenager’s parents?

Ritchie: In the cases we have had here, which are usually state cases, if it’s a dependent minor who has a child, the minor makes the decision in a way, but the parent are still involved. But if the minor is still under the parent’s roof they are still dependents of the parents.

Thank you for your time Mr. Richie.


Kingdon. (2010). Agendas, Alternatives, and Public Policies, Update Edition (2nd ed.). London: Longman Publishing Group.


cloudThe topic of this week’s blog is policy governing access to data and privacy protection in an electronic and genomic age. In regards to contraception management, this would relate to Electronic Health Records (E.H.R.), Health Insurance Portability and Accountability Act (HIPAA) compliance, and confidentiality of health records.

Many organizations are looking at medical cloud computing, in place of data centered central units or servers. Now, patient records can be sent to rented servers such as Amazon, Google or Microsoft (Soyata, 2014).  Clouds are cost efficient because of faster internet speeds and savings of cost for equipment or servers that become obsolete after several years. There is the additional savings of no longer maintaining an IT departments or consultant (Soyata, 2014). The use of clouds can have the benefit of remote accessing of data to specialist or efficient referral capabilities. In spite of these high tech servers, there is still the susceptibility of hackers to patient records

Others argue that cloud computing is not simply internet computing, but instead “a family of computing architectures that offer utility programming” (Schweitzer, 2011).  The National Institute of Standards and Technology (NIST), defines cloud computing with five distinct features before they are classified as cloud computing (Schweitzer, 2011).

cloud computing

The issue with privacy and security of electronic protected health information (ePHI) is controlled by the Health Insurance Portability and Accountability Act (HIPAA). The inspiration behind the HIPAA regulation is comprised by protecting patients’ rights in; access to their medical records, controlling who accesses their records, adeptness of their healthcare delivery and data exchange, and cost efficiency of their healthcare (Schweitzer, 2011).

The Department of Health and Human Services implemented security regulations for ePHI, in 2003, to further safeguard HIPAA regulations. A fine of $1.5 million and up to 10 years in prison are penalties of failure to conform HIPAA regulations (Schweitzer, 2011). There are other regulations and laws that strengthen HIPAA, The Health Information Technology for Economic and Clinical Health (HITECH) Act that is part of the American Recovery and Reinvestment Act of 2009. HITECH reinforces HIPAA by defining levels of culpability and penalties (Schweitzer, 2011).

Utilization of cloud computing, requires movement of the EHR and data outside the healthcare organization, and the need for implementing many of the HIPAA security procedures and regulations. The guidelines of many of the security measures are the same, regardless of who applies them, however there are some issues that are specific to the cloud technology (Schweitzer, 2011).


Schweitzer, E.J. (2011). Reconciliation of the cloud computing model with US federal electronic health record regulations. J Am Med Inform Assoc 2012;19:161e165. doi:10.1136/amiajnl-2011-000162

Soyata, T. (2014). Will medical cloud computing ever be a reality? Retrieved from http://www.researchgate.net/post/Will_medical_cloud_computing_ever_be_a_reality


Private sector involvement is important to policy improvement especially when objectives of a policy are unclear, various or conflicting, making successful operation difficult (Longest, 2010). The private sector is made up of health providers, manufacturer, importers, distributors and retailers. They can be divided into commercial entities, nongovernmental organizations (NGOs), and social marketing organizations (Sharma, 2004).

Commercial entities distribute services to private for profit clinic, solo practitioners, us contraceptionpharmacies, workplace-based clinics, mom and pop shops and other commercial outlets. These commercial entities’ source of funding for contraception supplies are out of pocket spending by consumers and third party payments (Sharma, 2004).

NGOs also provide services for not for profit clinics/outlets, community based distribution networks, outreach workers. Funding and pricing for NGOs varies with some contraceptives sold at affordable prices and others being sold at or slightly above cost. Social marketing organizations provide to commercial outlets, NGO clinics, community based distribution networks and occasionally public sector facilities. They have a range of different products that can be funded and sold at very low prices to low income clients. Others are sold at cost or with a profit margin and are targeted to middle income clients (Sharma, 2004).

contra usGovernment can involve the private sector through joint strategic planning sessions, ongoing public/private stakeholder consultations, government- business roundtables and seminars/forums. These actions can fostering communication and trust with open dialogue (Sharma, 2004).


Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.

Sharma, S., & Dayaratna, V. (2004). Creating Conditions for Greater Private Sector Participation in FP/RH: Benefits for contraceptive Security. Retrieved from http://www.policyproject.com/pubs/policyissues/PF4_eng.pdf


Ever since Medicaid became law in 1965, it has evolved to the entity it is today. It is a joint venture funded by federal and state governments to assist states in providing medical assistance to eligible needy persons (Longest, 2010). Family planning services and supplies are federally mandatory, if federally matching funds are to be received by states. Although title XIX of the Social Security Act allows flexibility within states Medicaid plans, there are some services, such as family planning, that must be offered to low income populations (Longest, 2010).  ACA

Family planning services receive federal funding contributions at a rate of 90 percent, while family planning associated services are matched at the states’ regular federal medical assistance percentage. The Affordable Care Act indicates that family planning related services are considered those medical, diagnosis and treatment services provided in accordance to a family planning visit. The Centers for Medicare & Medicaid Services (CMS) issued earlier guidance on family planning related services in a letter to State Medicaid Directors on July 2, 2010, which indicated that these services were to be provided as part of or as follow up to a family planning visit (DHHS, 2014).

Medicaid has played a dominant and increasing part in funding and providing access to family planning services for low-income women. About two-thirds of women covered by Medicaid are of child-bearing age, and for this group of women, access to family planning services fills a key health need (Kaiser, 2015).


DHHS (2014). Centers for Medicare & Medicaid Services Retrieved from http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SMD-14-003.pdf

Kaiser Family Foundation (2015). State Medicaid Coverage of Family Planning Services: Summary of State Survey Findings. Retrieved from http://kff.org/medicaid/state-medicaid-coverage-of-family-planning-services/

Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL: Health Administration Press.


The government has strived to develop public programs to deal with the problem of poverty in the U.S. Populations such as single mothers, children and poorly educated young people have more issues with poverty (Kraft, 2015). The percentage of children living in poverty has increased, and comprise 35 % of the nation’s poor (Kraft, 2015).

Many research organizations that analyze data for sound public policy decisions (such as the Guttmacher Institute), support the U.S. investment in family planning programs. These organization see public funded family planning services as a prudent use of government funding. Programs such as Title X national family planning program and the national network of safety-net family planning centers, are considered frugal use of preventative programs and thus a need to support the Affordable Care Act’s Medicaid guttenmacherexpansion (Wind, 2015).

Healthy People 2010, designates the significance of family planning services in relations of preventing the social, economic and medical costs of unintended pregnancy.

“Medically, unintended pregnancies are serious in terms of the lost opportunity to prepare for an optimal pregnancy, the increased likelihood of infant and maternal illness, and the likelihood of abortion.…The mother is less likely to seek prenatal care in the first trimester and more likely not to obtain prenatal care at all. She is less likely to breastfeed and more likely to expose the fetus to harmful substances, such as tobacco or alcohol. The child of such a pregnancy is at greater risk of low birth weight, dying in its first year, being abused, and not receiving sufficient resources for healthy development (Sonfield, 2010)”.


Kraft, M. E., & Furlong, S. R. (2015). Public Policy: Politics, Analysis, and Alternatives (5th ed.). Thousand Oaks, CA: CQ Press.

Sonfield, A. (2010). Contraception: An integral component of preventive care for women. Retrieved from https://www.guttmacher.org/pubs/gpr/13/2/gpr130202.html

Wind, R. (2015). Guttmacher Institute U.S. publicly funded family planning effort provides critical preventive care. Retrieved from http://www.guttmacher.org/


This week the discussion will focus on the process of policymaking with agenda setting and the development course of legislation in regards to contraception. Agenda setting in public policymaking include the problem, possible solutions, and political circumstances (Longest, 2010). The activities involved were the initial step of the problem, which was the prevention of pregnancy. Since the early 1900s, women have sought means to prevent unwanted pregnancies. Healthcare has developed means to pregnancy prevention, which to some individuals and groups have found disagreeable. In development of healthcare policymaking the eventual public law for contraception has met with resistance. Legislation is the next step in the development of public healthcare law (Longest, 2010).

Policy formulation of contraception continues with legislation progression of Obamacare, which enforced insurance companies to provide FDA approved contraception to women without a copay (Planned Parenthood, 2014). It has been only recent (June 30, 2014) that the Supreme court ruled with Burwell vs. Hobby Lobby that:

for-profit corporations be exempt from a law its owners religiously object to if there is a less restrictive means of furthering the law’s interest. The decision is an interpretation of the Religious Freedom Restoration Act (RFRA) and does not address whether such corporations are protected by the free-exercise of religion clause of the First Amendment of the Constitution” (Wikipedia,, 2015).

Infographic: Timeline: 100 Years of Birth Control

Courtesy of :

Timeline: 100 Years of Birth Control

– See more at: http://www.plannedparenthoodaction.org/elections-politics/blog/timeline-100-years-birth-control/#sthash.kTODt68o.dpuf


Longest, B.B. Jr. (2010).  Health policymaking in the United States (5th ed.). Chicago, IL:  Health Administration Press.

Planned Parenthood (2014). Timeline, 100 years of Birth Control. Retrieved from http://www.plannedparenthoodaction.org/elections-politics/blog/timeline-100-years-birth-control/

Wikipedia, (2015). Burwell v. Hobby Lobby Stores, Inc. Retrieved from http://en.wikipedia.org/wiki/Burwell_v._Hobby_Lobby_Stores,_Inc.