Medicaid Policy Process Part 1


Healthcare is an issue that stirs up a discussion in the United States. Several steps and measures have been taken to make medical services affordable to all Americans (Marmor, 2000). Since the reign of President Franklin D. Roosevelt and during the ruling of the present administration led by President Obama, healthcare has remained a burning issue. Policy formulation and the respective procedures are essential in solving problems connected with this field. During the past elections, healthcare was one of the main topics debated upon extensively. Medicaid and Medicare were some of the issues that dominated campaign discussions. Most families, workers, and citizens across America think and discuss healthcare on a daily basis (Dye, 1976). Those, who are lucky enough to have some form of health coverage, are worried about paying premiums and co-pays incurred during costly procedures. However, many Americans lack any kind of insurance. It increases the likelihood of financial losses in the event of a catastrophic emergency.

The healthcare system has too many holes that make it difficult to deal with a specific problem. These are interconnected in such a manner that they either benefit someone or leave a person without healthcare services. Professionals in this sector have become protagonists in helping their patients influence changes in the current policies. It means that doctors and nurses have also joined forces responsible for policy formulation through stepping out of their normal duties of practicing medicine. The Congress also plays a powerful role in public policy formulation. This process requires determination, pure dedication, time and energy to successfully put forward and implement new policies. This paper will discuss the introduction or changing of policies by looking at the essential steps involved. They include the formulation, legislative, and implementation stages. The aim is to streamline the healthcare system in order for every American to have access to better healthcare services.

Formulation Stage

At this stage, proposals of solutions regarding the agenda issue are floated. It provides policymakers with several options to solve the latter. The effectiveness of the policy formulation process will depend on analysis that will identify the most effective policies and political regulations (Nakamura, 1987). Health professionals and other policy analysts may influence this process. However, members of the Congress have the ultimate say on what solutions form part of the proposal that will move to the next phase of policy formulation.

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Policymakers determine the course of action in addressing the healthcare issue. At the formulation stage, proposals may involve ideas taken from a variety of fields ranging from open to closed systems. The former may welcome possible solutions provided by public and medical professionals, while the latter involve just a few actors.

The ultimate policy selected for the next phase of the policy formulation process is dependent on two factors. Firstly, it is essential to provide a valid way of solving the healthcare issue at hand. The solution must be efficient and feasible. Therefore, the formulation stage gives an opportunity of choosing from alternatives that can be used to solve the issue in case the first priority fails. Secondly, it is important for the selected policies to be feasible politically. It is because the acceptable formulation will be scrutinized in the phase, which will entail the authorization of policies by members of the Congress.

Proposals usually follow the bargaining process that involves supporting the legislation. Therefore, the formulation stage comprises analysis aimed at identifying the most effective policies and political authorizations.

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Legislative Stage

The legislative stage is very crucial for the final adoption and implementation of policies. It can be influenced by factors eminent during policy formulation. These include intense lobbying to gather interest groups, the possibility of crisis, and public attention aggravated by the media.

Healthcare policies adopted by governors and mayors bring about a change in the healthcare system at the state or local level. On the other hand, the Congress has little influence on policy adoption, since the sole responsibility of initiating new national policies lies with the president.

Formulated policies need to be enacted by relevant government institutions to become effective. Healthcare regulations that address cases that can bring about crises are likely to be adopted immediately. These address essential issues that are important for every citizen, such as basic healthcare. On the other hand, some policies may be affected by powerful interests that determine their adoption. Therefore, politicians can utilize their influence to determine policies that will be adopted (Marmor, 2000).

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The media also play a vital role at the legislation stage. If reports and commentaries are unbiased, it provides a platform for debates over various cases (Dye, 1976). Favorable bias by the media enhances chances of the enactment of proposals. On the other hand, negative publicity may undermine any policy. For instance, the Obamacare policy received a boost in the media leading to its enactment into a law.

Although the president has the sole responsibility of determining what policies are enacted into laws at the national level, the Congress still has some influence. It is because the latter approves actions of the president. However, it does not initiate a policy. The function of the Congress is to serve local communities, who have varied interests. This function is a hindrance to reaching consensus over what policies should be enacted into laws. After the latter process has taken place, the next stage of the policy process begins, which is policy implementation.

Implementation Stage

The implementation stage should include the three key elements for it to be effective. They are broadly categorized into organization, interpretation, and application. The first element involves the engagement of appropriate governmental agencies in the implementation of policies. Interpretation entails the translation of the legislation into operating rules and guidelines. Effective application implies that new laws do not cause conflicts with ongoing operations. The implementation phase is usually very difficult to achieve. In most instances, policies take a long time before getting off the ground or fail the implementation process altogether.

Due to the policy implementation stage entails putting adopted policies into practice, success is pegged on the three elements mentioned above. Firstly, healthcare regulations must pass down from the president’s office to health agencies for implementation. In case of the incapability of the latter, a new agency is formed and staffed. Secondly, clear interpretation of a policy is essential for effective implementation. The failure to translate the legislative intent may lead to the involvement of the judiciary. The latter will ask legislators to clarify any ambiguity. In addition, the judiciary has the authority to overrule the implementation of policies, in case the legislative intent cannot be translated effectively.

The last element necessary for effective implementation may prove to be difficult to attain. The resources needed for this process must not interfere with ongoing operations. It means that any initiatives or new agencies established for implementation purposes must not cause intensive competition or disagreement with the existing ones (Nakamura, 1987).

The healthcare industry needs to have a great deal of directions in order not to complicate the policy implementation process. Since the formulation stage is often influenced by politics, it is subject to compromises. Therefore, the implementation phase is often difficult, due to it leads to discretion and confusion in agencies responsible for policies. Furthermore, other factors, such as ineptitude, bureaucratic incompetence, and scandals, negatively influence the policy implementation process (Marmor, 2000).


The policy process is very tasking, due to it involves various elements. Medicare policies are essential for efficient running of the healthcare system. It ensures that all medical needs are taken into consideration. The policy process follows the three major steps. They are the formulation, legislative, and implementation stages. The first one is concerned with policy proposals. It may engage all stakeholders affected by the agenda issue or just a few decision-makers. The legislative stage entails the enactment of policies into laws. It paves way for the implementation of the latter by the respective agencies. The last stage is influenced by the effective organization, interpretation, and application of policies.

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