Description
This week, students will create a Policy Memo PPT outline advocating for ACA preventive health services and screenings.There are three main ways to advocate for or against a law or policy: 1) a policy analysis paper, 2) a policy brief, and 3) a policy memo. As healthcare leaders, it is not likely that you will have the time to develop a policy analysis paper or a policy brief. However, as a community leader with ties to the political environment, you could be called upon to advocate for or against a proposed law or policy that impacts your healthcare organization. A well written policy memo should effectively address: Introduction: a compelling, high level summary of what the policy will or will not do Statement of the Problem: a summary of the problem that the policy will or will not solve Financial Implications and Solutions for Stakeholders: identify stakeholder groups and delineate how the policy will or will not impact their personal or organizational finances and a statement of why the policy is or is not a viable solution for the stakeholders Supporters and Opponents of the Proposed Policy: Identify political and organizational supporters and opponents and tell why your position (advocating for or against) is important to them Conclusion: a brief recap of your most salient points (for or against) followed by a compelling, persuasive statement of why your position is the right position For your reference a sample policy memo is attached so that you have a reference document
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Health Administration Program
Healthcare Policy and Politics for Health Leaders
Week 7 Assignment – Policy Memo PPT Outline Instructions and Sample Policy MemoPolicy memos can be used to offer one’s position on a subject in either the affirmative or the negative. A wellwritten memo requires an introductory paragraph that will capture the interest of the reader, and extensive
research on the subject. It also requires a comprehensive understanding of who will be impacted by the policy,
and the financial implications of implementing or not implementing the policy on different stakeholder groups.
Additionally, knowledge of who the proponents and opponents of the policy are, and the political atmosphere
that exists around the issue are critical to gauging the chances of your position being adopted. In the end, a
policy memo is simply a persuasive argument for or against something backed up by problem research, policy
impact and financial justifications. A persuasive argument starts with an outline of WHAT should be
addressed. There are 5 main components to a policy memo shown by the bullet points below. For this
assignment, you will use these 5 components as a template to determine what you would include in a policy
memo that advocates for the continuation of preventive services and screenings under the ACA.
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Introduction: a compelling, high level summary of what the policy will or will not do
Statement of the Problem: a summary of the problem that the policy will or will not solve
Financial Implications and Solutions for Stakeholders: identify stakeholder groups and delineate
how the policy will or will not impact their personal or organizational finances and a statement of why
the policy is or is not a viable solution for the stakeholders
Supporters and Opponents of the Proposed Policy: Identify political and organizational supporters
and opponents and tell why your position (advocating for or against) is important to them
Conclusion: a brief recap of your most salient points (for or against) followed by a compelling,
persuasive statement of why your position is the right position.
The Assignment Instructions
For this assignment, you are on the legal team of a major health system that will create a policy memo that
advocates for continuation of the preventative services and screenings provided by the ACA. You should
access a short summary of the court case that presents this challenge to the law which is referenced below .
You will create a MACRO level -PPT presentation to be shared with the team which will outline what each
component of the policy memo will focus on/address. Your PPT presentation should contain a maximum of
5 information slides, one for each component. Your title and reference slides are separate. Use APA format
for any references and citations. Read the Sample Policy Memo provided so that you have an idea of how the
5 components are presented in a final memo. This will help you decide the kind of information you want to
include in your outline.
Case Background
Braidwood v Becerra is a case in the Northern District of Texas that argues the constitutional validity of
recommending bodies, mainly the United States Preventive Services Task Force (USPSTF) and their
processes for determining which preventive care services and screenings should be required under the ACA.
The plaintiffs allege that such recommending bodies represent “… violations of the Appointments and Vesting
Clauses of the US Constitution and the Non-Delegation Doctrine…:”. The partial ruling by Judge O’Connor “
…holds that the Appointments Clause of the US Constitution is violated by [the law’s] reliance on the
USPSTF in setting preventive services coverage requirements …”. (1) The case also challenges
recommendations for other health related services. If the plaintiffs prevail such recommending bodies and
their recommendations could be declared unconstitutional. However, your outline will only address the
potential for some of the services and screenings required under the ACA to be declared unconstitutional
should this challenge reach the current SCOTUS given its political composition.
(1) Hughes, R., Chappel, N., Walters, W. (2022). Will The US Supreme Court Strike Down The ACA’s Preventive Services
Coverage Requirement? Health Affairs, Health Affairs Forefront. September 23, 2022. 2210.1377/forefront.20220922.150344
Retrieved from: https://www.healthaffairs.org/content/forefront/us-supreme-court-strike-down-aca-s-preventive-servicescoverage-requirement
(2) Sample Policy Memo
Introduction
For more than a century, the US has sought to find a way to provide comprehensive health care for all
Americans. The Patient Protection and Affordable Care Act of 2010 (PPACA or ACA) has finally given all
legal US citizens the right to healthcare, making it no longer a privilege to be able to have good health. This
act, along with policy subsequent to the passage of the act, now makes it possible for more than 40 million
uninsured Americans to have health care coverage. This includes the 1.9 million uninsured residents in our
state (1). Foregoing the expansion of the state’s Medicaid Program will have a severe impact on our uninsured
citizens, our hospitals and health care providers, and our economy. The purpose of this memo is to outline the
implications of a recent decision not to offer a Medicaid Expansion program in our state. Continued
reconsideration of this decision is recommended as more information becomes available from the White
House, the Department of Health and Human Services, and trusted independent health research organizations.
Continued reconsideration would allow for the best possible final decision and is highly recommended.
Statement of the Problem
There are approximately 1.9 million individuals in the State of Georgia who have no healthcare coverage.
However, a lack of insurance coverage does not mean that these individuals do not seek healthcare services
when needed. With a lack of access to primary and preventive care services they seek health care services in
the most expensive healthcare venue that we have today, the emergency room. The state bears a significant
portion of the uncompensated care that is provided through our hospital emergency rooms for uninsured
patients. A Kaiser Family Foundation report calculates that with the implementation of a Medicaid Expansion
program Georgia could save $726 million dollars in uncompensated care payments over a 10 year period (3).
This savings cannot be realized without the implementation of a Medicaid Expansion program. Additionally, a
decision not to implement Medicaid Expansion in Georgia means that the state will lose $33 billion dollars
over 10 years, its estimated share of the $808 billion dollars in federal funding that has been allocated for state
Medicaid Expansion programs (3).
The PPACA gives the State of Georgia the opportunity to expand its Medicaid program to cover all newly
eligible Medicaid enrollees. For Georgia, this could mean more than 700,000 newly insured Georgians (2,4).
According to the Kaiser Family Foundation, in 2014 the ACA will increase Medicaid eligibility up to 138% of
the federal poverty level, which will offer coverage to adults under the age of 65 with an income up to
$15,415, and a family of four with an income up to $31,810 (3). On a national level, Medicaid expansion
programs will provide health care coverage for almost 22 million eligible Americans including the more than
700,000 residing in Georgia. Without offering a Medicaid Expansion program here in Georgia, the
implications for our citizens, our health care delivery system, and our economy will be grave. A few of the
major implications are presented below.
Financial Implications and Solutions for Stakeholders
Implications for Uninsured Georgians
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Georgia will continue to have almost 1.9 million uninsured individuals and that number will likely
grow as our state population continues to grow.
With a Medicaid Expansion program, an estimated 42% of the state’s uninsured residents who are
eligible to have insurance coverage will be able to take advantage of the health care services offered
through an expanded Medicaid program. (2,4,9)
Implications for Georgia Hospitals
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In anticipation of Medicaid expansion programs under the ACA, Grady Hospital the state’s largest
provider of health care for the poor and uninsured could lose as much as 50% of its federal
Disproportionate Share Hospital (DSH) funds starting in 2014. (5) Other hospitals around the State
could experience the same reduction in federal DSH payments.
Georgia’s FY 2011 federal allotment of DSH funds totaled $269 million dollars. Georgia hospitals
could lose as much as $135 million dollars in federal DSH funding. (6)
Without an expanded Medicaid program Georgia hospitals and clinics would likely provide $36
million dollars in uncompensated care over the next10 years. (9)
Medicaid expansion would allow that loss to be recovered through new revenues from uninsured
individuals covered under the new Medicaid Expansion program.
Implications for Georgia Providers
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With its emphasis on primary and preventive care, without an expanded Medicaid program Georgia’s
primary care providers would not be able to take advantage of new Medicaid payment rules under the
ACA that would increase Medicaid payments to Medicare levels in 2013 and 2014. (9)
With an expanded Medicaid program, Georgia’s providers can bill for Medicaid at the Medicare levels
and providers will not have to use cost shifting as a means of covering the cost of care for uninsured
patients. (9)
Implications for the Georgia Economy
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The expansion of Medicaid would likely mean more jobs in the healthcare sector of most every state
that implements a Medicaid Expansion program. Without implementation of an expanded Medicaid
program, Georgia will likely lose billions of dollars that could boost its economy not only in the
healthcare sector but in every sector that contributes to the delivery of goods and services used in
healthcare. (10)
We could also lose a portion of our healthcare workforce to states whose health care economy has
grown, which would increase our current shortage of healthcare providers in the state.
With a Medicaid Expansion program, Georgia’s economy would likely grow and could result in
increased levels of employment as hospitals and providers attempt to receive payments to cover the
cost of uninsured patients.
Supporters and Opponents of this Policy
In the current Georgia legislature, there are both supporters and opponents to implementing Medicaid
Expansion in the state. Work should continue to bring to the attention of all Georgia legislators the benefits of
ME to the state’s economy, as well as the potential for a ME program to improve the health status of hundreds
of thousands of Georgia residents.
• Georgia will forego almost $33 billion dollars, being made available by the federal government for
State Medicaid Expansion programs (7).
• Without a Medicaid expansion program, our state will be faced with covering new Medicaid enrollees
in its regular Medicaid program with a federal match rate lower than that offered for a Medicaid
expansion program. In 2011, Georgia’s original Federal Medicaid Assistance Percentage (FMAP)
match was 65.3%. As a result of the American Recovery and Reinvestment Act (ARRA) our State
enjoyed an enhanced FMAP of up to 75.3%, which has since expired, reducing our current match rate
to 66.2% (8). This is substantially lower than the 100% funding that we could expect for a recipient
enrolled in a Medicaid Expansion program from 2014 through 2016, and the 90% expected from 2020
going forward. Thus, Georgia will lose between a 33.8% and 23.8% match for each individual
enrolled in its regular Medicaid program starting in 2014.
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Without a Medicaid Expansion program, Georgia would not be able to cover more than 700,000
uninsured residents at no cost to the State from 2014 through 2016 and with modest cost increases
from 2017 to 2019, not exceeding 10% from 2020 forward.
ME has the potential to reduce the amount of uncompensated care that the State of Georgia pays out,
in particular to rural hospitals, to provide health services to uninsured Georgians.
Conclusion
The estimated cost of a Medicaid Expansion program to the State would be approximately $2.5 billion dollars
over 10 years, with some estimates as low as $1.8 billion and as high as $3.7 billion over ten years (2,7). The
$2.5 billion dollars represents a 1% increase in total state spending over the same time period but does not
include offsets for savings in other areas. This is calculated to be approximately $300 per new Medicaid
enrollee per year, and would represent a significant savings over the yearly cost of enrolling new recipients
into the state’s current Medicaid program (4). Overall, Kaiser reports that the additional state costs to
implement Medicaid expansion will be small compared to total state Medicaid spending and new federal
spending Additionally, they project that once all factors that reduce the cost of a state’s Medicaid program are
considered, some states could see net savings (3). Even without a Medicaid Expansion program, it is
estimated that Georgia will have approximately 157,000 new enrollees in Medicaid based on other provisions
of the ACA (2). Georgia will have to cover the cost of care for these new recipients without the benefit of
additional federal funding.
In summary, not implementing a Medicaid Expansion program in Georgia will severely impact our uninsured
citizens, our hospitals and providers, and our state’s economy. In contrast, implementing a Medicaid
Expansion program will improve the health of our citizens, grow Georgia’s economy, and ensure that our
hospitals and healthcare providers can continue to provide the best care that the ACA dollars will buy.
Additionally, the public interest of our citizens will best be served by implementing a health care program that
maximizes the overall social welfare of our state.
Information on the cost of a Medicaid expansion program for our state is still evolving. A recent letter to the
President from Republican Governors seeks an opportunity to expand Medicaid in a “much more modest way
than envisioned in the law” (11). I urge the Governor to evaluate the President’s response to this request for
the possibility of reconsidering the recent decision on Medicaid expansion for our state.
References
1. Kaiser Family Foundation. State health facts. Health Coverage and Uninsured-Georgia 2011.
Retrieved from: http://www.statehealthfacts.org. Access date: 12/8/2012
2. Miller, A. Report takes a new look at Medicaid expansion costs. Georgia Health News. November 26,
2012. Retrieved from www.georgiahealthnews.com. Access date: 12/9/2012
3. Kaiser Family Foundation. The Cost and Coverage Implications of the ACA Medicaid Expansion:
National and State-by-State Analysis. Kaiser Commission on Medicaid and the Uninsured.
Washington, D.C. November 2012. Retrieved from: www.kff.org/kcmu
Access date: 12/8/2012
4. Sweeney, T. More evidence that expanding Medicaid is an offer Georgia shouldn’t refuse. Georgia
Budget and Policy Institute. November 27, 2012. Retrieved from: http://www.gbpi.org/moreevidence-that-expanding-medicaid/ Access date: 12/9/2012
5. Williams, M. Grady could have big loss in Medicaid stand-off. Atlanta Journal Constitution, November
21, 32012. Retrieved from: http://www.ajc.com/;news/news/grady. Access date: 12/9/2012.
6. Kaiser Family Foundation. Federal DSH Allotments. Kaiser State Health Facts. 2011. Retrieved from:
http://www.statehelthfacts.org/comparetable.jsp/ Access Date: 12/9/2012.
7. Williams, M. Report: Medicaid expansion would bring state more than $30 billion. Atlanta Journal
Constitution, November 27, 2012. Retrieved from: http://www.ajc.com/news/news/medicaidexpansion-would-bring. Access Date: 12/9/2012
8. Kaiser Family Foundation. Enhanced Medicaid Match Rates Expire in June 2011. Kaiser Commission on
Medicaid and the Uninsured. Publication # 8205. Washington, D.C. June 2011. Retrieved from:
www.kff.org/kcmu. Access date: 12/8/2012.
9. GA Internal Medicine Physicians. A Report from Georgia’s Internal Medicine Physician Specialists: How
Will the Medicaid Expansion Benefit Georgia? August 20, 2012. Retrieved from:
http://www.acponline.org/about_acp/chapters/ga/ga_medicaid_report.pdf
Access Date: 12/8/2012.
10. Georgians for a Healthy Future. Healthy Debate GA. Cover Georgia: implement the
Medicaid expansion. July, 2012. Retrieved from:
http://www.healthyfuturega.org/archives/3238. Access Date: 12/9/2012.
11. Aizenman, N.C. GOP governors seek leeway on Medicaid expansion. The Washington
Post.
December 8, 2012. Retrieved from: http://www.washingtonpost.com/national/health-science/gop-gov.
Access date:
12/09/2012.
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