Mental Health in Healthcare Policy and Presidential Agendas

The rising importance of mental health to both the general population’s well-being and the nation’s economic growth has propelled it to the forefront of the presidential agenda in recent years. Recent worldwide occurrences, such the COVID-19 epidemic, have intensified mental health illnesses, which impact millions of Americans. Federal policymaking and health problem priority can be illuminated by examining how past and present presidents have dealt with mental health.

Policy on Mental Health at the Presidential Level

The importance of mental health as a public health issue has been recognized by both the Trump and Biden administrations. As part of their larger approach to the opioid problem, President Trump’s administration prioritized mental health. Provisions to enhance mental health services were a part of the 21st Century Cures Act, which was signed into law in December 2016. These included measures to increase access to treatment for those with severe mental illness and to integrate mental health care with primary care. Certified Community Behavioral Health Clinics (CCBHCs) receive more money from the Trump administration so they may treat substance abuse and mental health issues more comprehensively (U.S. Department of Health and Human Services, 2020).

The effects of the COVID-19 epidemic on mental health have not diminished President Joe Biden’s commitment to improving people’s mental health. Increasing availability of mental health treatments, decreasing stigma, and incorporating mental health into general health care are all areas that the Biden administration has prioritized as part of its public health strategy. Mental health services, especially in areas hit hard by the epidemic, received substantial financing under the American Rescue Plan Act of 2021. Substance Abuse and Mental Health Services Administration [SAMHSA], 2021, states that among Biden’s mental health agenda items are more mental health experts, more telehealth services, and funding for community-based mental health programs.

Possible Policy Changes and Suggestions

Although there have been some positive developments in mental health policy throughout both regimes, there is still need for improvement in a number of key areas. To begin, improving people’s mental health must be the first step in achieving better health for all Americans. This can only be achieved by a more thorough and coordinated national approach. Treatment, early intervention, and prevention should be the pillars of this approach. Reducing the strain on specialized mental health services might be achieved by increasing the availability of mental health services within primary care settings. This would encourage the early identification and treatment of mental health issues (Patel et al., 2021).

A second piece of advice for policymakers is to zero in on issues like poverty, housing instability, and educational opportunities as they relate to people’s mental health. To tackle these antecedent issues, we need a multi-sectoral strategy that brings together health, education, housing, and social services to build communities that are mentally healthy (Marmot, 2020). Increased funding for mental health research is also necessary to provide new, effective therapies and interventions that can reach a wide range of people.

References

Marmot, M. (2020). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104. https://doi.org/10.1016/S0140-6736(05)74234-3Links to an external site.Links to an external site.

Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., … & UnÜtzer, J. (2021). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553-1598. https://doi.org/10.1016/S0140-6736(18)31612-XLinks to an external site.Links to an external site.

Substance Abuse and Mental Health Services Administration (SAMHSA). (2021). Biden-Harris administration’s investments in behavioral health and substance use disorder services in the American Rescue Plan. Retrieved from https://www.samhsa.gov/newsroom/press-announcements/20210329Links to an external site.Links to an external site.

U.S. Department of Health and Human Services. (2020). 21st Century Cures Act. Retrieved from https://www.hhs.gov/about/news/2020/12/01/hhs-announces-grants-200-million-expand-mental-health-substance-abuse-treatment.htmlLinks to an external site.Links to an external site.

​One population health topic that remains relevant to the presidential agenda currently is healthcare access and healthcare costs, with an emphasis on mental health. This brings us to the final stage of the social determinants of health model, which is access to healthcare services. Mental Health care is still a concern to millions of Americans, especially those in rural and other under-served areas (Crowley et al., 2020). President Joe Biden’s administration attempted to address mental health by investing in formal behaviouralhealth services using COVID-19 relief programs and signing the American Rescue Program, which increases mental health and substance utilization funding. The administration also played a role in expanding telehealth services, which also benefitted the delivery of mental health services to vulnerable populations (McBain et al., 2023).

​President Donald Trump also paid a lot of attention to this area of health, primarily through his attention to the opioid crisis. His administration also introduced the Opioid Initiative, which involved augmenting the funds for treatment services. Furthermore, in 2018, Trump enacted the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act,seeking to enhance mental health in the frame of substance use prevention and treatment (Fishbein & Sloboda, 2023). Despite these efforts, a significant barrier remains: many Americans still lack easy and cost-effective access to professional, timely, and extensive psychiatric services.
​I would address the challenge differently by advocating for mental health benefits to be included under the health insurance regime to the same extent as primary health benefits. In addition, I will propose to expand the care providers in mental health professions through measures like offering student loan forgiveness to practitioners in the mental health field. Further, I would encourage the provision of mental health services not only in the schools, the workplace and other community-based services but also in taking preventive measures to ensure that individuals do not reach the point where they require this service. Telehealth will also continue to be expanded, particularly for rural patients, and these will have to be made available at an affordable cost to the patient under insurance schemes (McBain et al., 2023).

References

Crowley, R., Daniel, H., Cooney, T. G., Engel, L. S., & Health and Public Policy Committee of the American College of Physicians*. (2020). Envisioning a better US health care system for all: coverage and cost of care. Annals of internal medicine, 172(2_Supplement), S7-S32.https://www.acpjournals.org/doi/full/10.7326/M19-2415Links to an external site.

Fishbein, D. H., & Sloboda, Z. (2023). A national strategy for preventing substance and opioid use disorders through evidence-based prevention programming that fosters healthy outcomes in our youth. Clinical Child AndFamily Psychology Review, 26(1), 1-16.https://link.springer.com/article/10.1007/s10567-022-00420-5Links to an external site.

McBain, R. K., Schuler, M. S., Qureshi, N., Matthews, S., Kofner, A., Breslau, J., & Cantor, J. H. (2023). Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022. JAMA Network Open, 6(6), e2318045. https://doi.org/10.1001/jamanetworkopen.2023.18045Links to an external site.

Mental health has been a recurring issue in presidential agendas for years, due to rising rates of suicides and shootings in the U.S. There has been a growing demand from Americans for improved mental health services, and we believe that current resources are not enough or available for those in need. “The social determinants of mental health such as income inequality and poor education are understood as being underpinned by unequal distribution of opportunity and more deeply by public policies” (Trump White House 2020). Raising awareness is crucial because many people lack proper education about mental health. Financial stress can be significant for families with the increasing inflation and insufficient income to support their needs can contribute to depression.

The last two Presidents have each emphasized mental health and made significant contributions to support it. President Biden allocated “nearly $300 million in September for new and existing certified community behavioral health clinics, with an additional $15 million in grants to be awarded early next year.” (SAMHSA, 2022). This funding is vital for providing the resources necessary to make an impact for this patient population. During his term, President Trump signed an executive order aimed at mitigating the negative effects of prolonged shutdowns on mental and behavioral health, and at enhancing suicide prevention efforts” (Trump White House, 2020). The pandemic had a major effect on the mental health of millions of Americans, including children, who experienced depression due to lack of social interaction and the struggle with adapting to return to social settings. These children require support to help them adapt and learn to lead normal lives.

I believe both Presidents have made great efforts in addressing mental health by discussing it and implementing supportive policies. However, I would advocate for ensuring that a portion of the funding is also directed toward educating healthcare providers on the treatment and detection of mental illness. Especially in the inpatient setting where doctors fail to continue the patients home medications, specifically for mental health. Far too often, I’ve seen that providers are focusing on one issue and don’t address continued mental health needs in the acute setting.

Patients can also feel or overtly be judged by their healthcare providers, which can discourage them from seeking help. Although there are beliefs that mental illness still has a stigma, I feel as if the oversharing nature of social media has somewhat caused cracks in the barriers. There is more information being shared for the people who have access that could potentially be of assistance to others. Utilizing the social platforms has given access to information we didn’t otherwise have prior. It’s essential for healthcare professionals to improve their understanding and approach to mental health to better support and care for these individuals.

References

Compton, M & Shim, R (2015) The Social Determinants of Mental Health. Psychiatry Online. https://focus.psychiatryonline.org/doi/pdf/10.1176/appi.focus.20150017Links to an external site.Links to an external site.

SAMHSA. (2022) Biden-Harris Administration Announces Millions of Dollars in New Funds for States to Tackle Mental Health Crisis. https://www.samhsa.gov/newsroom/press-announcements/20221018/biden-harris-administration-announces-funding-states-tackle-mental-health-crisisLinks to an external site.Links to an external site.

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/Links to an external site.

Obesity is a chronic condition in which there is an excessive amount of fat in the body, and is considered when an individual’s BMI is greater than 30 (Body Mass Index, BMI Calculator, Healthy BMI, n.d.). This chronic condition is able to be prevented by changing one’s lifestyle and managing their weight through diet and exercise. The recent data indicates that 39.6% of the people in the United States of America are obese. Rates of obesity prevalence was the highest in African American and hispanic populations (Obesity in the U.S. – Food Research &Amp; Action Center, 2019). Obesity increases the risk for patients to experience various heart diseases, diabetes, sleep apnea, and high blood pressure (Obesity – Symptoms and Causes – Mayo Clinic, 2023). All this can be prevented if the population has better and affordable options to eat and exercise regularly. Social determinants that are associated with obesity include education, income, and occupation (Pcna, 2023). Populations that come from low economic areas are at the highest risk for obesity.

President Biden has issued an Executive order to renew the President’s Council on  Sports, Fitness, and Nutrition until 2025 (President’s Council | Health.gov, n.d.). This allows various populations to become aware of healthy eating and benefits of physical activity. This council motivates and brings awareness to the less economical areas about how increasing physical activity and healthy eating will prevent diseases such as heart disease, diabetes and also helps alleviate anxiety.Also, this council promotes youth sports participation,which is vital for the youth to get outside and become active (President’s Council | Health.gov, n.d.). This council will also educate the public about what exactly is healthy eating, and the affordable option they have in their surroundings. NURS 6050 Week 1 Discussion Answers

The Obama administration acknowledged the growing rates of obesity, and routed the problem to processed foods and a sedentary lifestyle. In order to do something about this, the Obama administration has drastically improved the standards for school meals in 2012. They released a program called, “The Healthy, Hunger-Free Kids Act”, which required schools to increase the proportions for fruits, vegetables, whole grains, and low fat milk (Obama-era School Nutrition Policy Led to Better Diets for Students but Faces Changes | UW School of Public Health, 2020). This was very different from the previous lunches that the schools would provide for the children which included foods high in sodium and fat (Obama-era School Nutrition Policy Led to Better Diets for Students but Faces Changes | UW School of Public Health, 2020). This shift from unhealthy lunches to much more healthier lunches have displayed positive changes in the health of children since 2012.

If I was in a position of power, after realizing the massive population of obesity that is prevalent in the United States, I would do various actions. I would start off by screening populations that are at the greatest risk for obesity, and after screening them I would educate the population about how obesity puts them at a higher risk for various chronic conditions. Then I would educate those populations about how they will be able to conquer obesity, I would suggest they exercise 30 minutes every day even if it’s just walking. I would also tell them various recipes that they are able to make with the vegetables and fruits that are already in their homes, to make them realize that healthy eating is not always expensive. I would also do something about how expensive healthy options are, and make sure to have affordable options surrounding the community.

References:

Week 1 Discussion Post – Policy & Advocacy for Pop Health-Fall 2024 – 6050N

Post your response to the discussion question: Consider a population health topic that rises to the presidential agenda level.

As health care workers, the COVID-19 pandemic is something we still going through in 2024, even though the lock down and media coverage has died down. We are still seeing surges and new strains all the time, and with long-COVID, there are just so many unknowns.

In my opinion, this is a good discussion topic since this was worldwide issue for extended period of time, and continues to be a topic of debate and discussion worldwide. We are not sure if the virus is causing complications or the vaccine itself, or some combination?  One thing we do know is that there is still ongoing research to clarify the long term effects. Huge amounts of national funding was dedicated to stopping the spread, and now additional funds are being spend on root cause analysis type studies to determine if what was done was correct, and what we can expect to be long term effects, if any.

Which social determinant most affects this health issue?

Social determinants of health (SDOH) “are organized into 5 place-based domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context (Social Determinants of Health Workgroup, 2024).” Most commonly we consider this homelessness, food insecurity, healthcare insecurity, drug and alcohol abuse and other negatively mitigating factors for health issues. All of these 5 played some role in the COVID-19 pandemic issues in the US and across the world.  The poorer people had less access to supplies, medications and vaccinations. Less educated people had a poorer understanding and comprehension of hygiene and universal precautions. Limited healthcare access needed to be overcome to provide care to these groups, especially in impoverished areas of the US, and even more so in  underdeveloped nations. It cannot be said that there was any one SDOH that had no impact on the spread and management of the COVID-19 pandemic.

How did two recent presidents handle the problem?

During COVID, the world had to start from scratch to figure out the type of illness, methods of contagion, prevention, and cure. Each day we had new health care policies and recommended implementation as research was updated day to day, often with just anecdotal evidence. In the early stages of the pandemic, partisan politics were a major deciding factor in how policies were implemented, and it does not appear in retrospect that much of what was mandated was rooted in scientific evidence, but more politics and mass hysteria (Gadarian et al., 2021).  We still have not eradiated this pandemic, as they are identifying more viruses like alpha, delta, omicron and sub variants which continue to create more suffering in our society. These new variants are not effective with previous vaccines approved by FDA, and it appears as this is no longer a headlining news topic, science is once again the determining factor for policy rather than politics.  This contagious virus forced us to shut down schools, businesses and even many doctors’ offices that were both good and harmful to the community at the same time. In initial months, we observed many hospitalizations, and deaths, but eventually the world was able to unite and develop new policies to overcome rising COVID numbers. As this was nothing we had even seen before in our lifetimes, this was something we were ill-equipped to manage (Glied, 2020).

During last two presidential terms, President Trump and President Biden were forced to establish many new policies and implement them in the public health emergency.

During the Trump administration is when COVID initially was identified, and the Trump administration initiated travel restrictions, and lock downs which helped us to stop further spread both domestically and internationally. The COVID 19 rapid tests were developed, and the CDC approved guidelines to treat patients. Hand hygiene, masking, and social distancing became the norm for those few years. Those policies were based the best evidences of the time on infection control specifically to protect the most vulnerable populations. Vaccinations were a controversial topic, but were developed in record time, and the health emergency allowed populations to get minimally tested drugs during that time in hopes of serving the greater good. President Trump’s team was able to provide free vaccinations, free testing centers, and even free at- home tests to everyone. The research, development and manufacturing of multiple different types of vaccines started during Trump administration world-wide.

During the Biden administration, the COVID public health emergency officially ended. As of May 11^th 2023, the administration was still giving significant importance to the pandemic by continuation of the development of new variant vaccinations, and continuing free at home test accessible to the general public (Jaffe, 2021). Although the pandemic has officially ended, it is safe to say COVID has become endemic to the world.

During the Biden-Harris administration, the largest adult vaccination program in U.S history was developed. Tele-health availabilities are still in place, which offered access to healthcare to those in the most remote and rural areas, typically underserved by healthcare. At this time the Centers for Disease Control (CDC) also launched the National Wastewater Surveillance System (NWSS) to track SARS-COV-2 in sewage across the country. The administration has also successfully built a robust emergency response infrastructure. Our surge response – led by the Federal Emergency Management Agency (FEMA) and the US Department of Health and Human Services (HHS) – developed over 100 federal mass vaccination sites and surge testing sites and the capability to distribute essential supplies to those in need.  Since July 2021, the federal government deployed over 4,000 military and non-military personnel including doctors, nurses, and paramedics; sent over 3,400 ventilators, ambulances, and other critical supplies; and shipped over 115 million pieces of PPE. And over the last year, FEMA has invested $300 million in state hospital preparedness to expand hospital capacity in 38 states (National COVID-19 Preparedness Plan, 2024).

What would you do differently?

What I would do differently would be educating our society that illness still exists, continuing masking, and that hand hygiene is still needed. Increasing awareness about at home tests, rather than emergency room visits with minor symptoms is another thing I would advocate. As an ER nurse, I see still hoards of people just coming to the ER to just test for COVID, which creates a crowded ER, and less resources available to those who present with truly severe and acute illnesses. Another recommendation I have would be opening more COVID one stop test and vaccine clinics, open free to the public, which help people to seek help as they need it. Advertising those services on TV and social media would be a great way to spread information. Creating websites where the public can get status updates and find local areas at risk, or even text alerts when travelling to higher risk areas. I also recommend helping people with disabilities and the elderly to get prompt care, as well as offering paid sick leave to care your loved ones who contracted serious illness or complications as a result of COVID. All of these help reduce the SDOH that are limiting our fight against COVID.

References:

• Gadarian, S. K., Goodman, S. W., & Pepinsky, T. B. (2021). Partisanship, health behavior, and policy attitudes in the early stages of the COVID-19 pandemic. PloS one, 16(4), e0249596. https://doi.org/10.1371/journal.pone.0249596Links to an external site.
• Glied S. (2020). Health Policy in a Biden Administration. The New England journal of medicine, 383(16), 1501–1503. https://doi.org/10.1056/NEJMp2029546
• Greer, S. L., Dubin, K. A., Falkenbach, M., Jarman, H., & Trump, B. D. (2023). Alignment and authority: Federalism, social policy, and COVID-19 response. Health policy (Amsterdam, Netherlands), 127, 12–18. https://doi.org/10.1016/j.healthpol.2022.11.007Links to an external site.
• Jaffe S. (2021). Legal challenges threaten Biden’s COVID-19 vaccine rule. Lancet (London, England), 398(10314), 1863–1864. https://doi.org/10.1016/S0140-6736(21)02537-XLinks to an external site.
• National COVID-19 Preparedness Plan. (2024, 8). Retrieved 8 2024, from The White House: https://www.whitehouse.gov/covidplan/
• Office of Disease Prevention and Health Promotion. Explore Resources Related to the Social Determinants of Health. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resourcesLinks to an external site.
• Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide(7th ed.). Jones & Bartlett Learning (pg 12)
• Social Determinants of Health Workgroup. (2024). Retrieved 8 2024, from Healthy People 2030: https://health.gov/healthypeople/about/workgroups/social-determinants-health-workgroup#cit5
• O’Rourke, N. C., Crawford, S. L., Morris, N. S., & Pulcini, J. (2017). Political efficacy and participation of nurse practitionersLinks to an external site.. Policy, Politics, and Nursing Practice, 18(3), 135–148.
• Short, N. M. (2022). Milstead’s health policy and politics: A nurse’s guide(7th ed.). Jones & Bartlett Learning

                                                                         WEEK 1 Discussion

Nursing 6050N-27

Tiffany R. Peron

August 27^th, 2024

Mental health is so often talked about and noted to have such a huge need but we are still leaps and bounds behind where we should be in 2024. Many are now suffering from anxiety and depression, Post-traumatic stress disorder, and a rising instance of self-harm and suicide. There is still such a huge stigma around mental health. Many are afraid to seek help as they fear they will be labeled as something is wrong with them. Post COVID-19 many youths have been noted to be struggling with these issues being stuck in homes where they were not nurtured or exposed to more violence, drug use, and neglect. Many governments are working to adopt new laws and regulations, working with organizations to get new policies in place but the demand is still so high.

                                   Current and Previous President’s Approaches to Mental Health

President Joe Biden and former President Donald J Trump called to action and noted the need for more! There is a need for more educated doctors, nurses, and counselors to provide care to many of these individuals. A need to reduce the Stigma around mental health. A need for insurance providers to open up their networking and allow more services to be provided. According to Mezuk (October 2022) “Among the multiple factors that contribute to poor availability of mental health care, the White House plan did not address inadequate reimbursement by private health insurance and public payers, including Medicaid.” This is such a huge issue even in the school setting when a child has private insurance they are often placed on a sliding scale fee which is way too steep or practical or are told to find an outside therapist for services. We are failing our youth by telling them we cannot help with their needs and this is leading to more and more children falling through the cracks.

President Joe Biden

According to the fact sheet in 2023, President Joe Biden and his administration planned to increase new resources for school-based health services which would include an increase in school counselors, psychologists, as well as social workers. They also plan to expand peer support where someone who has lived with mental health issues could become a person to talk to others. Increasing crisis response such as Mobile Response Services and the use of 988 as a crisis line to assist youth and adults in need of crisis are getting rapid response to their needs. There are so many areas that still need to be covered and is a work in progress to incorporate all of these initiatives.

President Donald J. Trump

After the COVID-19 pandemic, Donald J. Trump noted that “40.9% of Americans reported at least one adverse mental health condition and 10.7% reported seriously considering suicide”. He also signed legislation to put in place more services for mental health as well as substance abuse. We need to focus on vulnerable populations who have been affected the most children, veterans, elderly and so many more.

As of now, both presidents have not succeeded in assisting with the mental health crisis. So many people are suffering and need reliable care that is affordable and easily accessible. Ensuring that there is a team of qualified mental health experts to assist with developing more care and reducing the stigma would allow more advancements in research. Nurses need to become more aware of current legislation and active in political issues by ensuring that their knowledge is heard and seen by political leaders (Milstead’s health policy and politics). As nurses, we need to advocate for the care of our patients and ensure that there are receiving all the care that they need. When there is a shortage of services or insurance denies patient care they are not receiving the best care possible.

What Would I Do Differently

More services:

Looking into providing more counselors, therapists, and social workers in a school-based setting and underserved areas. Adding a mental health provider to all primary care settings such as pediatric offices, family practices, and even OBGYN offices. Offering counseling services for anyone interested the more it is seen and talked about the more willing people would be.

Reducing the Stigma:

The biggest way to make this happen is education for those with mental health disorders and for those who do not understand mental health issues. If someone is worried about what their friends and family might think if they open up to them or a provider oftentimes they go untreated. Often people describe mental health as living with a secret feeling of decreased self-worth (Strategies to Reduce Mental Illness Stigma).

Technology

Since COVID-19 telehealth has made such huge strides and has become a huge industry offering more and more opportunities for convenience as well as a sense of private counseling to build relationships for those who need that confidentiality.

.                                                                         References

Institute of Medicine (US) Committee on Enhancing Environmental Health Content in Nursing Practice,      Pope, A. M., Snyder, M. A., & Mood, L. H. (Eds.). (n.d.). Nursing health, & environmentLinks to an external site.Links to an external site.: Strengthening the relationship to improve the public’s health.

Mezuk, B., Maust, D., & Zivin, K. (2022, October). A response to the president’s call to support Public Mental Health. American journal of preventive medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9516693/?scrlybrkr=e6c8d9d3

National Archives and Records Administration. (n.d.). National Archives and Records Administration. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

Shahwan, S., Goh, C. M. J., Tan, G. T. H., Ong, W. J., Chong, S. A., & Subramaniam, M. (2022, January 31). Strategies to reduce mental illness stigma: Perspectives of people with lived experience and caregivers. International journal of environmental research and public health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835394/

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

• Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 2–23 only)

The United States Government. (2023, May 18). Fact sheet: Biden-Harris Administration announces new actions to tackle nation’s mental health crisis. The White House. 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/

                  Mental health is a topic of health that routinely makes it to the Political Agenda and is often a discussion point in presidential debates. There are many detriments as it pertains to mental health, with access to mental health care being the most substantial. Nurses often can play a key role in policy making as they bring power in numbers, not only through individual numbers, but also through professional organizations that so many nurses affiliate themselves with (Short, Nancy, 2022 pp17). The following will provide an overview of the last two presidents and their policy on mental health and access to much needed care.

Biden Administration

President Joe Biden has served as president of the United States from 2020-2024, and prior to this he served as vice president under the Obama Administration who was most famous for his Affordable Care Act. The Biden Administration believes that mental health is healthcare and has thus set forth a list of requirements that insurers and providers must adhere to (The White House, 2023). One of the first conditions is that insurances must conduct an analysis of their care and costs compared to other insurances, along with in network and out of network pricing to ensure care is equal and in accordance with the Mental Health Parity and Addiction Equity Act; which was put into law in 2020 (The White House, 2023). The Biden administration also put forth more strict policies on what insurance companies can and cannot do, as it pertains to prior authorizations and care; in short, they must make the same effort to cover mental health care as they do physical health care (The White House, 2023). The last major change that the Biden Administration did thus far was “closing the loophole” making state and private insurances abide by the MHPAEA, which previously was only enforced in federal insurances (The White House, 2023).  There are three other areas of focus as well, and these include mental health care in schools, enhancing crisis response resources, and allowing more expanded payment for mental health with those who have Medicare (The White House, 2023).

Trump Administration

President Donald J. Trump served as president of the United States from 2016-2020. The former president’s policy on mental health focused on three major areas: Improving Mental Health, Protecting Americans, and Promoting Physical and Mental Health (Trump White House Archives, 2020). The biggest impact that former Pres. Trump had was Improving Mental Health policies, regarding access, as during COVID, previously video access for mental health was not covered under insurances, this policy made it so video was an acceptable form of delivery of care mandating insurances to cover video appointments (Trump White House Archives, 2020). This change in policy opened a door allowing millions of people to continue access to mental health care during COVID, of which many in person appointments were not being had. Former Pres. Trump’s administration recognized that during COVID there was a negative impact on mental health through isolation and shutdowns that were mandated, this prompted the administration to produce $425 million dollars in emergency mental health resources (Trump White House Archives, 2020).

What Would I Change?

The single most important thing I would change if possible, would be to put providers and patients back in the driver’s seat for care.  I cannot fathom how a physician can say that a certain medication is needed, or treatment is needed, but an insurance company can deny coverage until other avenues are tried. Especially when the companies who are directing this approval and denial often do not hold medical degrees themselves. I struggle with the thought process of allowing a company who has never met a patient to override the care plan that a provider believes is best for the patient, creating ultimately a delay in care, and this delay in mental health can often cause someone their life.

The other thing I would change is that I would mandate mental health professionals in all schools, or medical organizations, with the requirement that routine suicide and depressions screenings be conducted in order to provide preventive therapy and care, decreasing inpatient hospitalizations and hence health care spending.

Resources:

Short, Nancy M. (2022). Health Policy and Politics A Nurse’s Guide. (7th Edition).
Jones and Bartlett Learning.

The White House. (2023). FACT SHEET: Biden- Harris Administration Takes Action to Access
In-Network Mental Health Care. Retrieved on Aug 27th, 2024. 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/Links to an external site.

Trump White House Archives. (2020). President Donald J. Trump is safeguarding American’s Mental Health and Preventing the Tragedy of Suicide. Retrieved on Aug 28th, 2024. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trump-safeguarding-americans-mental-health-preventing-tragedy-suicide/

Prescription drug prices have been a major topic of conversation and will continue to be until the U.S. is able to find a solution to the insane prices we are subject to. Based on the amount of drug research and healthcare intuition in the U.S., one would expect the U.S. to compete fairly well in prescription drug pricing ranges with other countries. However, in 2019, per capita, the United States spent $1,126 on prescription medications while other countries in similar economic and social statuses only spent $552 (Kurani et al., 2022). In truth, there are many factors that play in to this and there is not a simple solution. Additionally, both the Republican and Democratic Parties have different views on what it takes to solve this financial problem which means fighting each other tooth and nail until one side finally cracks the code.

During Trump’s time in office, he worked with the U.S. Department of Health and Human Services (HHS) to create “The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs.” By identifyingseveral factors that caused the increase in prescription drug prices such as the 1990s business model, Medicare and Medicaid evolutions, ACA taxes and rebates, international price controls, and lack of pharmaceutical competition, a plan was created to enforce lower drug prices (The U.S. Department of Health & Human Services [HHS], 2018). Trump’s plan included four main sectors: increasing competition, better negotiation, creating incentives to lower list prices, and reducing patient out-of-pocket spending (HHS, 2018). Each section had an immediate action that HHS may take and a second phase that HHS could consider and still give and receive feedback on. From my understanding, the blueprint did not make it far legally.

Biden’s administration recently announced that agreements have been made to lower prices for 10 select prescription drugs. These drugs are some of the most common medications in the Medicare program, with the savings estimated at $3.7 billion in the first year (HHS biden). CMS states that by February 1, 2025, 15 more drugs will be selected for negotiation in the coming years (HHS, 2024). While this is great progress, these savings only apply to Medicare Part D prescription coverage.

Overall, I think I would want to combine efforts from both former presidents so that negotiation can be used when competition cannot. Additionally, I think the U.S. should be allowed to cap prices on certain medications. Many European countries regulate the price of medications. And as much as I hate to say it, the economy has to change. The rate of inflation simply does not match the rising cost of living, including the cost of prescription drugs. Rate of inflation on average from January 2022 to January 2023 was 6.6%, while the average increase for drugs was 15.2% (U.S. Bureau of Labor Statistics, 2023; Bosworth et al., 2023). This is a seriously complicated problem we have gotten ourselves into, and I will not pretend to know all the answers, but I think these ideas would move us in the right direction.

References

Bosworth, A., Sheingold, S., Finegold, K., Sayed, B. A., De Lew, N., & Sommers, B. D. (2023, October 6). Changes in the List Prices of Prescription Drugs, 2017-2023. U.S. Department of Health and Human Services. https://aspe.hhs.gov/reports/changes-list-prices-prescription-drugsLinks to an external site.

Kurani, N., Cotliar, D., & Cox, C. (2022, February 8). How Do Prescription Drug Costs in the United States Compare to Other Countries? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/chart-collection/how-do-prescription-drug-costs-in-the-united-states-compare-to-other-countries/#Per%20capita%20prescribed%20medicine%20spending,%20U.S.%20dollars,%202004-2019Links to an external site.

U.S Bureau of Labor Statistics. (2023). Chained Consumer Price Index for All Urban Consumers [Table]. https://www.bls.gov/cpi/tables/supplemental-files/c-cpi-u-202301.xlsxLinks to an external site.

The U.S. Department of Health & Human Services. (2018, May). American Patients First: The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-pocket Costs. https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdfLinks to an external site.

The U.S. Department of Health & Human Services. (2024, August 150. Negotiation for Lower Drug Prices Works, Saves Billions. https://www.hhs.gov/about/news/2024/08/15/historic-first-biden-harris-administration-successfully-negotiates-medicare-drug-prices-delivers-promise-lower-prescription-drug-costs-american-seniors.htmlLinks to an external site.

Main Question Post

Discussion Response

The opioid crisis is a major public health issue that has made its way onto the presidential agenda. The opioid crisis has become a major public health concern in the United States, resulting in severe morbidity, mortality, and societal implications. One of the most important social variables influencing this health concern is socioeconomic position, which includes income, employment, education, and the local environment. These variables significantly influence healthcare access, mental health services, and drug abuse risk (Dasgupta et al., 2018).

Social Determinant Impact: Socioeconomic Status

Socioeconomic status (SES) is a crucial socioeconomic factor that contributes to the opioid problem. People from lower socioeconomic backgrounds are more likely to be stressed, have restricted access to healthcare and mental health services, and participate in more drug-related occurrences. Opioids are more likely to be prescribed to people with chronic pain who are also at a higher risk of abuse and addiction (Dasgupta et al., 2018). Compounding the problem is the fact that regions with high rates of unemployment and poverty typically lack the funding necessary to establish all-encompassing addiction treatment programs (Kolodny et al., 2015).

Presidential Approaches: Obama and Trump Administrations

After declaring the opioid problem, a public health emergency, both the Obama and Trump administrations took action to address it. After the Affordable Care Act (ACA) was established, the Obama administration prioritized making treatment more accessible. The ACA makes substance use disorder therapy a mandatory health benefit. This made it possible for more people to get addiction treatment. To enhance pain management and lower the number of opioid prescriptions written, the administration also introduced the National Pain Strategy (Davis et al., 2017).

In 2017, the Trump administration designated the opioid crisis as a public health emergency, allowing for some leeway in the distribution of government funding for the fight against the epidemic. Apart from encouraging the creation of non-addictive substitutes for approved drugs, the government placed emphasis on employing law enforcement techniques to limit the availability of illicit substances. However, some experts in public health have expressed disapproval of the focus on punitive measures as opposed to all-encompassing solutions for public health (Gollust et al., 2020).

Alternative Approaches

If I were taking a different stance on this matter, I would support a more holistic strategy that prioritizes the basic socioeconomic determinants of health, such extending educational possibilities, preserving the status quo in the economy, and enhancing access to mental health treatments. By enlarging community-based initiatives, drug use problems would be supported, educated, and prevented. In addition, I would place a higher priority on funding research into non-opioid drugs and the creation of easily accessible, reasonably priced, and well-thought-out addiction treatment programs for certain groups of individuals. In addition, I will prioritize funding for research into non-opioid pain management and the creation of addiction treatment options that are accessible, inexpensive, and customized to the needs of various groups. My approach would also include a focus on harm reduction methods such as increased access to naloxone and safe injection places. This holistic policy intends to address not only opioid usage and overdose mortality, but also the underlying socioeconomic problems that contribute to the crisis.

References

Davis, C. S., Green, T. C., & Case, P. (2017). Availability of naloxone in the United States: A new era in opioid overdose prevention? Drug and Alcohol Dependence, 182, 379-381. https://doi.org/10.1016/j.drugalcdep.2017.01.018

Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: No easy fix to its social and economic determinants. American Journal of Public Health, 108(2), 182-186. https://doi.org/10.2105/AJPH.2017.304187

Gollust, S. E., Barry, C. L., & Niederdeppe, J. (2020). Partisan responses to public health messages: Motivated reasoning and sugar-sweetened beverage taxes. Journal of Health Politics, Policy and Law, 45(1), 37-74. https://doi.org/10.1215/03616878-7952151

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner, P., Eadie, J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574. https://doi.org/10.1146/annurev-publhealth-031914-122957

Main Post

Presidential Agendas

Access to medical care is a fundamental component of public health, yet it remains a persistent challenge in the United States, particularly for individuals with lower socioeconomic status (SES) (McMaughan et al., 2020). This issue has consistently risen to the forefront of the presidential agenda, with recent administrations taking varied approaches to address it.

One of the most important social determinants influencing this issue is socioeconomic status (SES). SES includes income, education, and job, and it is an important factor in influencing an individual’s ability to obtain healthcare services. Individuals with lower socioeconomic status frequently face difficulties such as a lack of health insurance, limited access to healthcare facilities, and financial restraints, preventing them from receiving timely and effective medical care. These barriers exacerbate health disparities, resulting in lower health outcomes for economically disadvantaged people (McMaughan et al., 2020).

In recent years, two US presidents have approached the subject of medical access in different ways, reflecting their administrations’ divergent objectives and political beliefs. The Affordable Care Act (ACA), signed into law by President Barack Obama in 2010, marked a significant step forward. The Affordable Care Act aims to improve access to healthcare by extending Medicaid, establishing health insurance exchanges, and mandating that individuals purchase health insurance. It also provided subsidies to help low- and middle-income people purchase insurance and barred insurance companies from refusing coverage because of pre-existing diseases (Healthcare.gov, 2022). These measures were particularly beneficial for people with low socioeconomic status, and as a result, millions of previously uninsured Americans got access to health insurance, leading to an increase in preventative care and early treatment, which critical in managing chronic conditions and improving overall health outcomes.

President Joe Biden’s administration has also made a good contribution to healthcare access in recent years by expanding and enhancing the Affordable Care Act. In March 2021, Biden signed the American Rescue Plan Act, which included provisions to increase health insurance premium subsidies, making coverage more accessible for millions of Americans (The White House, 2024). These increased subsidies considerably reduced the cost of insurance for low- and middle-income individuals and families, especially during the COVID-19 pandemic, when healthcare access was vital. Biden’s administration also worked to increase membership in the ACA marketplaces by extending open enrollment periods and investing in outreach and education programs, which benefited more individuals. Additionally, Biden’s efforts to persuade states to extend Medicaid along with financial incentives provided in the American Rescue Plan, aimed to increase coverage for low-income individuals who had previously fallen into the coverage gap (Corallo, 2021).

If I were to address the issue of medical access differently, I would prioritize strengthening and expanding the existing healthcare framework to ensure that it better addresses the needs of those most affected by socioeconomic disparities. One critical step would be to advocate for the implementation of a public option, which would provide a government-run health insurance plan that competes with private insurers. This could help lower premiums and increase coverage options for individuals who do not qualify for Medicaid but still struggle to afford private insurance.

In addition, I would emphasize the importance of addressing the root causes of SES-related disparities, such as education and employment opportunities. By investing in education and job training programs, we could help lift individuals out of poverty, thereby reducing the long-term need for government-funded healthcare (Saputra, 2024).

Conclusion

Access to healthcare remains a critical public health issue influenced heavily by socioeconomic status, necessitating targeted interventions at the federal level. While recent presidents like Barack Obama and Joe Biden have made significant strides through the Affordable Care Act and the American Rescue Plan, continued efforts are essential to address the persistent disparities faced by lower SES populations. By expanding existing frameworks and addressing root causes, a more equitable healthcare system can be achieved, ensuring better access for all Americans.

References

Corallo, B. (2021). New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending. KFF. https://www.kff.org/medicaid/issue-brief/new-incentive-for-states-to-adopt-the-aca-medicaid-expansion-implications-for-state-spending/Links to an external site.

Healthcare.gov. (2022). Affordable care act (ACA) . Healthcare.gov; U.S. Centers for Medicare & Medicaid Services. https://www.healthcare.gov/glossary/affordable-care-act/Links to an external site.

McMaughan, D. J., Oloruntoba, O., & Smith, M. L. (2020). Socioeconomic status and access to healthcare: interrelated drivers for healthy aging. Frontiers in public health, 8, 231. https://doi.org/10.3389/fpubh.2020.00231Links to an external site.

Saputra, G. R. (2024). Analyzing the Impact of Government Policy on Poverty Alleviation: Evaluating Social Protection Programs, Healthcare Access, and Economic Reforms. Inspirasi & Strategi (INSPIRAT): Jurnal Kebijakan Publik & Bisnis, 15(1), 27-36. https://ejournal.isha.or.id/index.php/Inspirat/article/view/339Links to an external site.

The White House. (2024). 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. 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/Links to an external site.

Presidential Agendas

It is beneficial to create policies that influence population health by emphasizing prevention and wellness. The government makes various policies regarding the reduction and elimination of waste eradication of health disparities based on various factors such as ethnicity, language, income, gender disability, race and sexual orientation. Good policies enhance public health, improving the community health status as a whole, not just an individual. Therefore, regardless of political affiliation or the president in power, every citizen has to enjoy the benefits of a good healthcare policy. Healthcare is part of every president’s agenda; therefore, each president must fulfill the agenda by creating healthcare policies that benefit the citizens.

One of the critical aspects that require effective policy-making is mental health, which continues to affect society. Depression, anxiety and stress, among other mental health challenges, affect millions of American citizens and result in other healthcare challenges; therefore, it is paramount to ensure adequate policies on the social location to enhance mental health treatment to improve productivity, quality of life and overall health status (World Health Organization, 2022). Mental health has a critical adverse impact on the economy, as the mentally ill population cannot increase productivity, which negatively affects GDP. Effective measures to ensure access to mental health treatment for timely and quality psychiatrist services such as telepsychiatry resulting in improved mental health and increased productivity. The mental health policy also includes discrimination and stigmatization reduction policies, including diversity and inclusivity policies that ensure all people, regardless of their race or ethnicity, have access to quality life. The president must read in allocating resources to implement comprehensive strategies and create long-term health outcomes.

During the President Obama era, he created the Affordable Care Act (ACA), (Obamacare), which ensured that mental health and behavioral services were incorporated into insurance coverage to ensure mental health treatment for all. Obamacare included mental health insurance in private insurance plans and tele-visits are available to everyone and covered by employer insurance coverage. Mental health was incorporated into essential health benefits that the Affordable Care Act ensured citizens could receive quality treatment services. Mental health and behavioral health services, are incorporated in Medicaid programs that ensure the low premium insurance coverage policies cover effective behavioral health treatment such as counseling, mental health and behavioral health inpatient services, and substance use disorder treatment (Stewart et al., 2018). Therefore, the inclusion of mental health as an essential health benefit means health insurance plans cover mental health treatment, enhancing access to quality care. The expanded Medicaid that was issued to most of the low-income earners who were uninsured and insurance policies were critical to ensuring mental health access to most of the poor people who are vulnerable to mental health challenges. The inclusion of telehealth under the support of ACA ensured increased access to mental health treatment processes for people living remotely. Therefore, President Obama made significant policies, including the Affordable Care Act that ensured mental health treatment services were available to Americans, thus increasing the quality of life and overall health care.

Under President Trump, the ACA was not successful, but there were critical improvements in telehealth policies that improved health treatment virtually due to covid-19 pandemic that limited inpatient treatment. Under the current administration, President Biden introduced the American Rescue Plan, which increased funding for mental health treatment plans and telehealth, improving access to mental health treatment. The funding has also been allocated to education and awareness campaigns that will ensure healthcare professionals educate the public on the dangers of mental challenges and substance use (Randi, 2021). The policy to increase budgeted allocation to the mental health statement process is timely and critical after the coronavirus, which increases mental health challenges. There has been increased access to healthcare treatment services for both in-person and virtual services. Therefore, each president has been critical in highlighting the Presidential agenda, with each increasing access to mental health treatment through creating quality policies.

On what I would do differently, I would ensure mental health policies are well developed under universal mental health coverage that will ensure individuals with mental health challenges have mental health access regardless of the type of insurance coverage they have. This policy, building on Obama care and the American rescue plan act by the Biden administration, will significantly reduce mental health challenges. All insurance policies, including Medicaid and private programs, will cover mental health treatment. I would prioritize the increased budget allocation to infrastructure development and telehealth services, which ensure mental health services, are accessible to every part of the country, even in rural areas where resources are limited. Infrastructure development in rural areas to ensure there is an adequate network is critical to support virtual health care and mental medication apps that increase mental health access. The funding was also largely awareness campaigns to reduce factors that increase mental health challenges such as stigmatization. This will be critical in addressing the gaps left by the policies of the two presidents.

References

Randi, O. (2021, August 2). American Rescue Plan Act Presents Opportunities for States to Support School Mental Health Systems. NASHP. https://nashp.org/american-rescue-plan-act-presents-opportunities-for-states-to-support-school-mental-health-systems/

Stewart, M. T., Horgan, C. M., Hodgkin, D., Creedon, T. B., Quinn, A., Garito, L., Reif, S., & Garnick, D. W. (2018). Behavioral Health Coverage Under the Affordable Care Act: What Can We Learn From Marketplace Products? Psychiatric Services, 69(3), 315–321. https://doi.org/10.1176/appi.ps.201700098

World Health Organization. (2022, June 17). Mental health. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response

Access to health services plays a vital role in shaping mental health outcomes within our society; factors like the availability of mental health professionals and the financial accessibility of services are key elements in this determinant alongside the presence of a supportive infrastructure to uphold these services effectively and efficiently for individuals in need (referencing Pincu et al., 2007). Various obstacles that hinder access to health services—such as limited insurance coverage and societal stigma attached to seeking help for mental health concerns along, with challenges related to geographical distance—significantly affect individuals’ mental well-being and holistic wellness.

President Obama’s administration implemented measures to tackle mental health concerns through laws and policy actions. His Affordable Care Act (ACA) broadened health coverage by incorporating mental health and substance abuse treatment services as crucial health benefits to bridge the gap in healthcare accessibility (Obama 2010). This extension played a role in enhancing the provision of mental health support, for numerous Americans. During his time in office the Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted. This law mandated that mental health services should receive the coverage as physical health services in order, for treatment fairness (accordingly stated by Bachbach & Sacks in 2014).

Throughout Donald Trump’s time as President of the United States, mental health received attention through various legislative initiatives and responses to the opioid crisis. His administration endorsed the 21st Century Cures Act; which aimed to secure funding for bolstering mental health services and enhancing the coordination of mental health care within broader healthcare frameworks (Trump 2016). Nevertheless, there were apprehensions regarding suggested reductions, in Medicaid funding and other programs that could potentially weaken health services (Lavis and Robles 2019). Although the steps taken by the government to tackle the crisis were commendable, some critics believe that these actions did not adequately target the underlying problems related to mental health care accessibility.

When it comes to taking care of mental well-being, in advance I’d put these plans into action;

Support the development of care models that bring together mental health services and primary care in a unified approach to enhance accessibility and reduce stigma, around mental health treatment while making it a regular part of overall healthcare management (as discussed by Pincus and colleagues in 2007). Let’s allocate resources to community-based initiatives by funding mental health programs in areas that lack adequate services and by enhancing support for community mental health centers and projects targeting factors, like housing and job assistance that contribute to mental well-being (source. Jorm 2014). Let’s improve health education and training by introducing training programs, for primary care providers and first responders to better recognize and address mental health conditions early on while also spreading awareness and reducing stigma through public education initiatives (Corrigan & Watson).

By implementing these tactics, we can establish a health care system that is more inclusive and efficient, in catering to both accessibility and quality of services.

References:

Bachrach, L. L., & Sacks, V. (2014). The Affordable Care Act and Mental Health Parity: A Health Policy Perspective. Health Affairs, 33(5), 836-843.

Corrigan, P. W., & Watson, A. C. (2007). The Stigma of Psychiatric Disorders and the Role of Mental Health Literacy. Journal of Social Work Education, 43(1), 29-40.

Jorm, A. F. (2014). Mental Health Literacy: Empowering the Community to Take Action for Better Mental Health. American Psychologist, 69(7), 481-491.

Lavis, N., & Robles, R. (2019). Evaluating the Impact of the Trump Administration’s Policies on Mental Health Services. Journal of Policy Analysis and Management, 38(4), 944-959.

Obama, B. (2010). Remarks on the Affordable Care Act.

Opioid Epidemic

Between 2002 and 2022, deaths caused by opioid overdoses have skyrocketed. According to the latest data available from the CDC, in 2022 synthetic opioids had the highest rate of drug overdose deaths compared to heroin, methadone, and natural/semisynthetic opioids combined (Spencer et al., 2024). The total deaths in 2002 for males and females combined topped out at 23,518, while the total deaths for males and females combined in 2022 topped out at 107,941 (Spencer et al., 2024, data table for figure 4 PDF). This is almost a five-fold increase in deaths since 2002. While easier accessibility to healthcare has been on the rise and our more rural areas are seeing the benefits of having easier access to healthcare in their community, this also could have inadvertently contributed to the rising opioid epidemic that we are currently battling in our country. Lack of continuing education, experience, knowledge of pain management using best practice standards, and poor staff ratios also could be considered contributing factors for the growing opioid crisis.

Obama Administration

In 2010, Former President Obama released his first National Drug Control Strategy that stressed the importance to address the opioid crisis while also ensuring patients received adequate and effective treatment for pain management (Office of the Press Secretary, 2015). During his first term, he placed more than $300 million in funding for drug abuse prevention, improving prescribers’ education regarding opioids and adequate pain relief, increasing treatment access, and offering support for recovery and rehabilitation.

In 2015, Former President Obama announced federal, state, local, and private sector efforts aimed at addressing the prescription drug abuse and heroin epidemic (Office of the Press Secretary, 2015). This effort stresses the importance of proper training for prescribers and educators (such as doctors, dentists, advanced practice registered nurses, physician assistants, etc.), improving access to treatment of drug abuse for patients, and providing easier access to opioid reversal agents such as naloxone.

Trump Administration

In 2018, Former President Trump approved more than $1 billion in funding to state and local entities for prevention, treatment, recovery, and education for opioid addiction and secured $6 billion in new funding over two years to fight the opioid crisis (National Archives and Records Administration, 2018). Former President Trump also implemented a Safer Prescribing Plan that reduced the demand for over-the-counter prescriptions, helped states transition to Prescription Drug Monitoring Programs, and helped healthcare providers adopt best practices for opioid prescribing (National Archives and Records Administration, 2018)

Biden Administration

In 2018, President Biden signed the Mainstreaming Addiction Treatment (MAT) Act of 2023 that eliminated the “X-waiver” that prescribing providers needed to prescribe buprenorphine, a medication that curbs opioid cravings, reduces drug use, and prevents opioid related deaths (The United States Government, 2023). In 2023, President Biden made Naloxone (Narcan) more accessible by working with the U.S. Food and Drug Administration (FDA) to approve the use of Naloxone as an over-the-counter nasal spray, eliminating the need for a prescription. President Biden also deemed August 25^th – 31^st as national Overdose Awareness Week in an attempt to acknowledge the numerous lives that have been negatively affected by the opioid crisis.

What I Would Do Differently

While I understand the limitations our policymakers face in the big picture, whether it be time constraints, lack of knowledge, or lack of resources, I do believe there are things that can be done to improve the opioid epidemic at a local and state level. I would continue to dive deeper into promoting continuing education for prescribing providers, specifically those who prescribe medications in a hospital, surgical, pain management, and psychiatric settings. In my experience after talking to patients about their personal experience with opioids, those healthcare settings mentioned are some of the most common places that my patients have stated “that’s where my addiction started”. Promoting alternative methods of pain relief can also be an option for decreasing the overall opioids prescribed, such as (but not limited to) homeopathic approaches, non-addictive pain relievers, physical therapy, guided imagery, gentle exercises, and nutritional supplementation.

Another area I would focus on would be to put in place stricter guidelines, rules, and regulations for our rehabilitation centers and “halfway homes”. Unfortunately, many of these facilities are not properly regulated due to lack of education, funding, and poor staffing ratios. Staffing and funding are two big areas that, on a local and state level, need to be reviewed and addressed for overall efficiency. While many financial representatives try and cut costs where they can to increase profit for their company, I do not believe healthcare is an area where “corners can be cut” to save a dime. Too often facilities are understaffed due to budgeting issues or “census issues”, which results in little to no time that proper education can be provided. I personally believe that this is a major contributor to the lack of education and resources for opioid rehabilitation in our rural areas. I would do my best to ensure that the budget is not an issue so in return, staffing needs can be properly met.

References

Spencer, M., Garnett, M., & Minino, A. (2024, March 21). Drug Overdose Deaths in the United States, 2002-2022. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db491.htm#ref1

Office of the Press Secretary. (2015, October 21). Fact sheet: Obama Administration announces public and private sector efforts to address prescription drug abuse and heroin use. Obama White House Archives. https://obamawhitehouse.archives.gov/the-press-office/2015/10/21/fact-sheet-obama-administration-announces-public-and-private-sector

National Archives and Records Administration. (2018, October 24). President Donald J. Trump’s Initiative to Stop Opioid Abuse and Reduce Drug Supply and Demand. Trump White House Archives. https://trumpwhitehouse.archives.gov/briefings-statements/president-donald-j-trumps-initiative-stop-opioid-abuse-reduce-drug-supply-demand-2/

Presidential Agendas

The opioid crisis has developed into one of the most acute social problems affecting the population in the United States, causing thousands of deaths every year and putting pressure on the healthcare industry and society in general. Like all the other previous administrations, both the Trump and Biden administrations have realized the severity of the epidemic and have adopted multiple measures towards it. These approaches encompass their overall health care philosophies, but they are methodologically and aims distinct; Trump twists in Public health emergency declarations and funding endeavours, while Biden put in public health-centered approach. This essay will analyze the measures taken by these administrations and identify the other measures that could help to increase the impact of the federal response to this on-going problem.

Donald Trump’s Approach

Trump’s strategy on the opioid problem was characterized by tremendous early steps such as declaring the opioid use a public health emergency in October 2017. This was aimed at centralizing the federal response to the epidemic and coordinate the flow of resources at the national level; the epidemic was strongly affecting the country and 2017 alone recorded over 42, 000 opioid related deaths (Mann, 2020). It also ensured massive funding to address the crisis with $6 billion on two years on the initiative to Stop Opioid Abuse. This include half billion U.S dollars in 2017 and another five billion U.S dollars in 2018 dedicated to improve prevention, treatment and recovery (Wen & Sadeghi, 2020). The Trump administration was also keen on medication-assisted treatment (MAT) and formed the President’s Commission on Combating Drug Addiction and the Opioid Crisis, which offered more guidelines on how to progress. Such activities were demonstrative of severe efforts toward the management of the crisis despite an evident lack of coordination and continuity.

Despite the Trump administration’s initiatives, its approach faced criticism for being inconsistent and insufficiently coordinated. Although the provision of the public health emergency and the allocation of considerable funds for this purpose were quite relevant and meaningful steps, the overall approach was seen as uncoordinated. The Office of National Drug Control Policy (ONDCP) suffered from Budget reductions at first, which were then restored; however, the absence of a coherent leadership system led to the poor organization of the opioid response (Mann, 2020). Moreover, conserving law enforcement also became the goal of the administration, such as increasing the penalties for drug traffickers and other types of criminals, where some critics said that the administration could care less about the development of appropriate public health strategies. This is because after having recorded a modest improvement in the number of overdose deaths in 2018, there was a spike in the number of deaths in the following years, thereby pointing to the partial nature of the Trump administration’s approach to the problem, indicating that much more ambitious and long-term interventions were in order.

Joe Biden’s Approach

The Biden administration has taken a more comprehensive and public health-focused approach to addressing the opioid crisis. Acknowledging the fact that the epidemic is severe, the administration has focused on increasing funding for and supporting efforts undertaken by states and communities. In 2022, President Biden unveiled $1.5 billion in funding to improve treatment and recovery programs; the president also stressed eliminating silos to other public health solutions and increasing the availability of treatment services (The White House, 2022). He has also ensured adequate funding for the drug control programs in his administration through advocacy for appropriate funding to address substance use disorders instead of punishing the individuals. This strategy comprises activities such as the promotion of recovery-oriented workplaces, the promotion of harm reduction programs, and the use of financial tools against international drug trafficking, especially networks involved in the supply of synthetic opioids, particularly fentanyl. In this way, the Biden administration proposed a comprehensive approach to tackle the opioid crisis in order to change the current punitive and oppressive model, helping the thousands of people struggling with opioid addiction.

Biden’s approach also reflects a broader shift towards a more holistic understanding of addiction and its impact on individuals and communities. Such an approach contrasts sharply with previous governments’ efforts to combat drug problems and aims to address them as a public health issue rather than a law enforcement one, using compassionate and treatment-based methods. Biden reported actions to weaken sources of synthetic opioids by rimming international cooperation and leveraging the Finances of the affected nations together with the practice of educational campaigns and increasing the availability of naloxone, an antidote to opioid overdose (The White House, 2022). The administration has also supported an expansion of such programs as the provision of syringes to drug users as well as the elimination of prejudice when it comes to addiction. The Biden administration is incorporating these various components as one comprehensive approach to respond to the opioid crisis in the short term as well as the long term in order to help as many people as possible in recovery and to decrease the social cost of addiction.

What You Would Do Differently

To strengthen the federal response to the opioid crisis more, I would concentrate on enhancing the national approach to response with the efforts of Federal, State, and local governments. This strategy entails charging a direct management team in the ONDCP with the responsibility of coordinating all the opioid initiatives so as to avoid duplication and hence guarantee efficient use of the available resources. Also, I would promote embracing long-term funding models rather than short-term grants to offer proper funding strategies by the treatment centers and the community programs in the long run. Another appropriate component of this approach would also be to create a unique register containing information on trends in opioid use in members, for example, overdose rates and treatment outcomes. In this way, it would be possible to identify the necessary measures as soon as possible, given the rapid increase in the newly arising needs of members.

Another essential component would be the extension of efforts in preventive and early action, more specifically in schools and neighborhoods. Increased availability of educational programs that would help the youthful population learn about the potential dangers of consumption of opioids and encouraging organizations to find strategies that can help manage the country’s pain without resorting to opioids would be another effective way of preventing the problem before it actually starts. I would also aim to increase the engagement of the community in ity involvement in developing and implementing opioid response strategies that should reflect the specific cultures of the needy cultures. Also, I would enhance collaboration with medical facilities to increase enrollment in medication-assisted treatment (MAT) and obtain the availability of harm-reduction resources like naloxone and syringes. When these prevention-centered strategies are integrated with thorough treatment and recovery services, this is the kind of federal response that could tackle the complex causes of the opioid epidemic and promote recovery for people affected.

References

The White House. (2022, September 23). FACT SHEET:  Biden-Harris Administration Announces New Actions and Funding to Address the Overdose Epidemic and Support Recovery | The White House. The White House; The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2022/09/23/fact-sheet-biden-harris-administration-announces-new-actions-and-funding-to-address-the-overdose-epidemic-and-support-recovery/Links to an external site.

Mann, B. (2020, October 29). Opioid Crisis: Critics Say Trump Fumbled Response To Another Deadly Epidemic. NPR. https://www.npr.org/2020/10/29/927859091/opioid-crisis-critics-say-trump-fumbled-response-to-another-deadly-epidemicLinks to an external site.

Wen, L. S., & Sadeghi, N. B. (2020). The opioid crisis and the 2020 US election: crossroads for a national epidemic. The Lancet, 396(10259), 1316–1318. https://doi.org/10.1016/s0140-6736(20)32113-9Links to an external site.

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The opioid crisis is still a significant problem in the public health sector, and it has become a national concern because of its prevalence. Economic disparities, lack of access to healthcare, and scarcity of mental health services are still driving this problem, especially among marginalized communities. These factors have been focal in presidential agendas over the past years, though with different strategies in terms of coverage and efficiency.

During the Trump administration, the opioid crisis was declared a public health emergency, which saw an increase in federal funding and efforts in the prevention and treatment of the disease. The administration focused on law enforcement measures, tighter prescription policies, and the availability of treatment methods like MAT (Phillips et al., 2020). However, the approach was often criticized for adopting a punitive approach rather than a public health approach, with insufficient focus on addressing the causes associated with social determinants. Despite the increased funding, unequal distribution of resources across the different states, especially in rural and hard-to-reach areas, hampered the implementation of these interventions.

The Biden administration moved the focus to a more comprehensive approach to a public health crisis, focusing on prevention and access to fair treatment. Biden’s American Rescue Plan plan focuses on increasing funding for harm reduction services and mental health services and addressing the racial and economic disparities that worsen the crisis(Affairs (ASPA), 2022). For instance, Biden has advocated for community-based interventions and treatment services for populations that have limited access to such services, acknowledging that social factors such as poverty, homelessness, and literacy levels are critical drivers of SUD.

Therefore, a more effective response would entail improving the implementation of social determinants in policymaking. Instead of relying mainly on the police to solve the problem, I would recommend policies that address the root causes of the opioid epidemic. For example, enhanced funding for community-based initiatives that encompass preventive education and socioeconomic services can help decrease substance abuse rates. Also, the policies should address the issue of parity for mental health and treatment in different communities, especially in minority groups.

In conclusion, although the recent administrations have made some efforts to counter the opioid epidemic, there is a dire need to enact policies that directly address the social determinants that fuel the epidemic. A combined approach of population-level interventions and targeted approaches aimed at addressing economic and racial inequalities would lead to more sustainable impacts, providing the basis for the community to protect itself against substance misuse in the long term.

References

Affairs (ASPA), A. S. for P. (2022, January 20). Biden-Harris Administration Awards $103 Million in American Rescue Plan Funds to Reduce Burnout and Promote Mental Health and Wellness Among Health Care Workforce. HHS.gov. https://www.hhs.gov/about/news/2022/01/20/biden-harris-administration-awards-103-million-american-rescue-plan-funds-reduce-burnout-promote-mental-health-wellness-among-health-care-workforce.htmlLinks to an external site.

Phillips, J. K., Ford, M. A., & Bonnie, R. J. (2020). Evidence on Strategies for Addressing the Opioid Epidemic. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK458653/Links to an external site.

Discussion 1 

NURS 6050 

Brianna Cole 

August 28, 2024 

Reproductive Rights

Abortion, one of the biggest topics that is on the forefront of every presidential agenda, has caused a major uproar across the country over the past two years. Women’s reproductive rights in general has been a sensitive political topic for decades. With the recent overturn of Roe vs Wade in 2022, millions of women are struggling to get the care that they need. This can be dangerous to many and cause bigger issues like before “Roe” won in 1973 when women who were desperate enough were finding ways to have an illegal abortion which ended up taking some of their lives. (Roe V. Wade: Behind the Case That Established the Legal Right to Abortion, n.d.) 

As a nurse who is extremely passionate about women’s health and currently working in that area there have already been moments since the overturn of Roe where doctors have been needed but scared to perform the medically necessary abortions with all the possible legal trouble. It has caused a prominent level of uncertainty to many providers and nurses caring for them. 

From the overturn of Roe vs Wade, there are many states with restrictions all the way to full bans on abortions, leaving women in unimaginable dilemmas. One of the main social determinants of health affecting this topic is economic stability. (Girardi et al., 2023) Those who are in trouble financially now must find the finances and resources to get to another state where abortions are still legal, and it is not that easy for a lot of women. 

Trump Administration

• Title X funding- Title X funding was created to help lower income families gain access to contraceptive services, supplies, and information about family planning. Former president Trump created a rule that barred providers that were in the Title X network from discussing abortion care to patients, even if they mentioned it first. It forced providers to drop out of the network if they wanted to continue to counsel patients on the topic. 

• Teen Pregnancy Prevention- Trump cut more than $200 million in programs that were made to help prevent teen pregnancy. 

• Global Gag Rule- Shortly after coming into office Trump reinstated and expanded on the global gag rule which prevents recipients of U.S. foreign aid from offering any information, referrals, services, or advocacy regarding abortion care. 

• Abortion Coverage- Trump passed a bill that denies abortion coverage on private insurance. 

• Supreme Court Justice- Trump appointed three new justices that replaced longstanding policymakers causing a dramatic change and contributed to the overturn of Roe vs Wade. (Short, 2021) 

Biden Administration

• Title X Funding- In 2021, President Biden reversed the rule created by Donald Trump which allowed providers to continue to counsel their patients as needed and refer them to abortion clinics.  

• Right To Travel- President Biden reaffirmed the right to travel to another state to have a legal abortion performed without penalty. 

• Contraception Coverage- Proposed a rule that will help women have access to contraception at no cost. 

• Reproductive Healthcare Privacy HIPAA- Biden issued a new rule to protect any reproductive health sought by an individual regardless of where you receive it. (House, 2023) 

What I Would Do Differently

I would continue to expand on the changes taken place during the Biden-Harris Administration. The nation needs more funding to help with reproductive rights now more than ever. Giving funding back to teen pregnancy programs and Planned Parenthood is so vital. I would continue to work to make sure contraception is something that is more easily assessable to all who acquire it without it being a struggle. I would also work hard to have Roe vs Wade reinstated, as it is one’s personal right to make decisions about their bodies. Doing so, I would continue to make sure the privacy of one’s personal decisions remains private.  

References

Girardi, G., Longo, M., & Bremer, A. A. (2023). Social determinants of health in pregnant individuals from underrepresented, understudied, and underreported populations in the United States. International journal for equity in health, 22(1), 186. https://doi.org/10.1186/s12939-023-01963-xLinks to an external site. 

Roe v. Wade: Behind the Case That Established the Legal Right to Abortion. (n.d.). Www.plannedparenthoodaction.org. https://www.plannedparenthoodaction.org/issues/abortion/roe-v-wade/roe-v-wade-behind-case-established-legal-right-abortion#:~:text=Road%20to%20Roe-Links to an external site. 

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

The White House. (2023, June 23). FACT SHEET: President Biden Issues Executive Order on Strengthening Access to Contraception. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2023/06/23/fact-sheet-president-biden-issues-executive-order-on-strengthening-access-to-contraception/Links to an external site. 

Prescription Drug Cost Reforms

Healthcare costs in the United States of America are growing exponentially, and lifesaving medications are still unaffordable for many Americans. The Republican Party and the Democratic Party have both different approaches to solving the issues. One side believes allowing competition will bring the price down. The other side argues that capping the cost of prescription drugs will make them less accessible to more Americans. Unfortunately, in the post-COVID-19 era, we have seen a rise in the cost of living, and some citizens had to choose between groceries and medication.

The Trump Administration has been successful at speeding up the Food and Drug Administration (FDA) approval rate for processing new drugs, which led to the early introduction of generic drugs (Dabbous et al., 2019). Normally, the FDA review process takes 6-8 years for a generic drug, shortening the time allows more competition and drives the cost down. During, the pandemic, for example, the fast approval of the vaccine and other competitors allowed more people to get vaccinated and helped prevent more deaths. In addition, former President Donald J. Trump’s executive order promoted healthcare and competition across the state lines. This action was estimated to save $200 billion towards the federal deficit in 10 years (Dabbous et al., 2019). Admittedly, competition alone cannot solve the issue of prescription costs rising, the government should have more regulatory power to considerably drive the cost.

The Biden Administration reached an agreement with drug manufacturers to lower the price of life-saving medication used in the treatment of chronic diseases such as Farxiga, Entresto, insulin, and others for the treatment of diabetes, heart failure, and chronic kidney disease. Moreover, crucial medication for stroke prevention and the treatment of blood clots Medicare enrolled almost 4 million Americans who used the medication they were able to negotiate the price down to 56% (House, 2024). Working as a nurse on the cardiac floor we hear anecdotes about seniors not being able to afford their medication and going months without it because they are not able to afford it or take less than was prescribed to make their supply last longer (i.e. rationing). Finally, the Biden Administration is planning to expand the list of medications they will plan on negotiating the price which will help beneficiaries of Part D Medicare recipients at least $400 yearly (House, 2024).

Among other industrialized nations, the US prices persistently remain high despite progress to reduce the cost. What I would do is have the government implement policies to further lower the cost of prescription drugs, because in the senior community, for example, there are seniors that have multiple comorbidities. Some of my patients have to deal with diabetes, hypertension, heart failure, coronary artery disease, COPD, and others. Most of them have 10-plus medications to take daily, which can easily go over $500 monthly (Kesselheim et al., 2016). I will advocate for affordable prescription drugs for all not just a specific population. Neglecting to care for the younger population will lead to a sicker senior population. For example, in France Lantus costs $46.6 compared to $186 which is almost 4 times less (Kesselheim et al., 2016). Lastly, promoting a healthy lifestyle needs to be incorporated at every level. Some solutions like portion reduction, better choices of ingredients, and an active lifestyle.

In summation, there is still a long way to address the healthcare crisis in this country, from health coverage to prescription affordability. Politician have to set their differences apart and work to serve their citizen. Management of chronic disease should be accessible to all because complications, frequent hospitalization, and worst death can happen prematurely. Undoing progress from the previous administration is not a solution but building on and ameliorating what is not working will set the nation forward rather than going back.

References

Dabbous, M., François, C., Chachoua, L., & Toumi, M. (2019). President Trump’s prescription to reduce drug prices: From the campaign trail to American Patients First. Journal of Market Access & Health Policy, 7(1), 1579597. https://doi.org/10.1080/20016689.2019.1579597

House, T. W. (2024, August 15). FACT SHEET: Biden-Harris Administration Announces New, Lower Prices for First Ten Drugs Selected for Medicare Price Negotiation to Lower Costs for Millions of Americans. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2024/08/15/fact-sheet-biden-harris-administration-announces-new-lower-prices-for-first-ten-drugs-selected-for-medicare-price-negotiation-to-lower-costs-for-millions-of-americans/

Kesselheim, A. S., Avorn, J., & Sarpatwari, A. (2016). The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform. JAMA, 316(8), 858. https://doi.org/10.1001/jama.2016.11237

Week1 Discussion

Main Post

The opioid crisis is still a significant health problem in the United States of America, affecting the lives of many individuals, communities, and business entities. Fighting this crisis has become one of the major concerns of the recent presidential terms. According to Lombardi et al. (2023), Obama and Trump, and the recently elected Biden, had their policies regarding the opioid crisis, although the strategies differed and the effectiveness was also different.

Obama’s administration began concentrating on increasing the availability of treatment, as seen through the Comprehensive Addiction and Recovery Act (CARA) of 2016, which sought to help improve prevention, treatment, and recovery support. However, even when these programs were in place, opioid deaths persisted, which was an indication that there was a need for more elaborate action (Roberts, 2024). The Obama Administration released the opioid declaration in 2017 and expanded funding of programs and policing to arrest the supply and demand of illicit substances. Nevertheless, it was considered to be neglected in identifying the fundamental issues of addiction. The Biden administration has moved to the Health and Well Being approach, where the administration highlights the need to meet the Quadruple Aim of healthcare, improve physical and mental health, decrease health disparities, improve the healthcare practitioner experience, and reduce the cost of healthcare. These are what the American Rescue Plan covers, which are significant in such areas, recognizing that substance use disorders are also multidimensional with social and economic determinants (Chhatwal et al., 2023).

What I would have done differently

To continue and strengthen these changes, I would continue to further the preventable measures by continuing education that targets substance abuse among students and enhancing the availability of mental health services in communities. In the same regard, the application of informational technology, like applications of artificial intelligence, could promptly improve the patterns of mitigating incidences among high-risk individuals. A lifespan, prevention-oriented approach should be used to address the deadly consequences of the opioid cris

References

Roberts, D. L. (2024). Reframing the response to the opioid crisis: The critical role of resilience in public health. Open Health, 5(1), 20230006.

Chhatwal, J., Mueller, P. P., Chen, Q., Kulkarni, N., Adee, M., Zarkin, G., … & Barbosa, C. (2023). Estimated reductions in opioid overdose deaths with sustainment of public health interventions in 4 US States. JAMA network open, 6(6), e2314925-e2314925.

Lombardi, A. R., Arya, R., Rosen, J. G., Thompson, E., Welwean, R., Tardif, J., … & Park, J. N. (2023). Overdose detection technologies to reduce solitary overdose deaths: a literature review. International journal of environmental research and public health, 20(2), 1230.

Past presidents have approached the important problem of marginalized people’s access to healthcare in different ways. Former President Barack Obama enacted the Affordable Care Act (ACA) in an effort to provide millions of Americans with greater access to healthcare, but it has since encountered difficulties and undergone modifications (Obama, 2010). Opponents argue that President Trump’s administration’s policies and attempts to dismantle the Affordable Care Act have exacerbated disparities in healthcare access. A more thorough and diverse approach is required to solve this problem.

Increasing funding for community health centers, enacting laws to combat systematic racism and discrimination, funding initiatives to combat poverty and increase access to opportunities for education and employment, fortifying Medicaid and other public health insurance programs, and endorsing community-based projects to improve health outcomes and tackle social determinants of health are a few potential solutions (CDC, 2020).

In conclusion, resolving health disparities and guaranteeing underprivileged populations’ access to healthcare necessitates an all-encompassing strategy that tackles the underlying causes of these problems.

                                                                                   References

Centers for Disease Control and Prevention. (2020). Social determinants of health

Obama, B. (2010). The Affordable Care Act. Retrieved from

https://www.healthcare.gov/about-the-aca/Links to an external site.

Jasmine Daniels

August 27, 2024

Reproductive Rights: A Nurse’s Approach

Reproductive rights have been one of the hottest topics on the ballot for the last several election terms.  From contraception to abortion to sex education, the topic of reproductive rights—or lack thereof—has created an immense amount of discourse, both on and off the podium.  Legislation began in the 1970s with Title X, a program established to provide accessible and affordable family planning and reproductive health resources for low-income families within the United States (Department of Health and Human Services, 2022).  The Roe v. Wade decision would follow, creating a landscape for discourse on sexual health, sex education, abortion, and reproductive rights as a whole.

The Roe v. Wade decision of 1973 set a precedent for the right to choose whether to have children.   By extension, abortion was considered a fundamental right (Wilson, 2020).  From the time of the ruling to today, many bills have been introduced to amend parts or all of the Roe v. Wade decision, threatening access to reproductive care and women’s health resources across the United States (Baden et al., 2024).

The last three presidential administrations have had vastly different approaches to the topic of reproductive rights.

Obama Administration

• 2010 – Affordable Care Act – Prevented insurance companies from denying coverage based on gender and pre-existing conditions. Expanded access to preventative care, including contraceptives (Fact sheet: Obama administration record for women and girls 2014).
• Defended Title X (2014).
• 2015 – Budgeted for funding programs geared at sex education and teen pregnancy prevention (2014).

Trump Administration

• 2018 – Trump administration announces plan to cut funding for Title X.
• 2019 – Domestic Gag Rule – revisions to Title X imposing restrictions on abortion providers and facilities. (Hasstedt & Dawson, 2022)

Biden Administration

• 2021- Proposal to restore Title X provisions cut by domestic gag rule during Trump Administration (Title X program handbook (July 2022).
• 2022 – Executive Order 14076 – Protecting Access to Reproductive Health Services. Provided guidance to healthcare providers and allied health professionals regarding roles, responsibilities, and legal coverage when providing abortion-related services through the Emergency Medical Treatment and Labor Act (EMTLA) (2022).
• 2022 – Clarification on Affordable Care Act coverage of contraceptives (2024).

What would I have done differently?

The topic of reproductive rights is very nuanced and tends to incite enthusiastic discourse. Regardless of personal beliefs or opinions, we must advocate for our patients.  That said, I do believe more funding needs to be allocated to real sex education.   Access to quality healthcare for preventative care and family planning is also critical. As a healthcare provider in a rural area, I have seen the negative impact that limited access to reproductive health resources and education can create.  I certainly don’t have all of the answers, but I am eager to learn how to better advocate for my patients beyond the bedside.

References

Baden, K., Dreweke, J., & Gibson, C. (2024, August 22). Clear and growing evidence that Dobbs is harming reproductive health and freedom. Guttmacher Institute. https://www.guttmacher.org/2024/05/clear-and-growing-evidence-dobbs-harming-reproductive-health-and-freedom

Department of Health and Human Services : Office of population affairs. (2022, July). Title X program handbook (July 2022). Title X Program Handbook. https://opa.hhs.gov/sites/default/files/2022-08/title-x-program-handbook-july-2022-508-updated.pdf

Hasstedt, K., & Dawson, R. (2022, August 30). Title X under attack-our comprehensive guide. Guttmacher Institute. https://www.guttmacher.org/article/2019/03/title-x-under-attack-our-comprehensive-guide

National Archives and Records Administration. (2014, August 26). Fact sheet: Obama administration record for women and girls. National Archives and Records Administration. https://obamawhitehouse.archives.gov/the-press-office/2014/08/26/fact-sheet-obama-administration-record-women-and-girls

The United States Government. (2022, August 5). Executive order on securing access to reproductive and other healthcare services. The White House. https://www.whitehouse.gov/briefing-room/presidential-actions/2022/08/03/executive-order-on-securing-access-to-reproductive-and-other-healthcare-services/

The United States Government. (2024, March 7). Fact sheet: Biden-Harris Administration continues the fight for Reproductive Freedom. The White House. https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/07/fact-sheet-biden-harris-administration-continues-the-fight-for-reproductive-freedom/

Wilson, J. C. (2020). Striving to rollback or protect Roe: State legislation and the trump-era politics of abortion. Publius: The Journal of Federalism, 50(3), 370–397. https://doi.org/10.1093/publius/pjaa015 NURS 6050 Week 1 Discussion Answers