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PubH 6835 Principles of Health Policy

Published : 08-Sep,2021  |  Views : 10


The purpose of this assignment is for you to identify an issue of concern for your role as an advanced practice nurse and to formulate a potential policy change to address that issue. There are many potential issues which can influence your practice setting or other issues which may negatively affect the patients with whom you work. All of the course reading will help you to identify a topic for this assignment. You can think about the issue as related to your health promotion project. The policy you consider may be in reaction to the health promotion issue or something larger that is still related to that issue. There are hundreds of possible issues, but here is a list of a few to consider:

Child and elder care
Civil rights
Domestic violence
Drug abuse/addiction
Native American and migrant workers’ health
Long-term care
Immigration/illegal aliens
Legislative issues affecting advanced practice nursing
Barriers to practice
Access to care



Health care system in the U.S is largely dominated by the private sector since there are many private health institutions and health insurance providers. Every government in the U.S. attempts to increase access to care for the citizens through different health care policies. The government introduces health policies which are implemented by state governments. This paper will develop a health policy for Native American and migrant workers in the state of Florida. Currently, most Native American workers are provided health insurance by their employers through the Affordable Care Act (ACA). Most migrant workers in Florida do not have access to health care serves. However, some migrant workers have access to care through the Community and Migrant Health Centers (C/MHCs). There is a disparity in accessing health care services between Native American and migrant workers. This essay recommends the Bundled-Low Cost Care Act (BLCCA) policy which will increase access to care for Native American and migrant workers in Florida.

Review of the literature

The state of Florida has a large number of migrant workers. In fact, South Florida is ranked number five in the number of migrant workers (Mazzei, 2017). Native American and migrant workers do not have equal access to health care across Florida. Native American workers have better access to care than the migrant workers.  Frank et al. (2013) note that migrant health problems extend beyond injuries to include several illnesses and conditions. The migrant workers and Native American workers seem to experience different health conditions. Most migrant workers are prone to occupational injuries, chronic illnesses, dermatological conditions and oral health issues. They can also experience other health conditions such as mental health and infectious diseases based on their working conditions. Accessing health care for these medical conditions is challenging due to the status of the workers and health reform legislations.

According to Hacker et al. (2015), national policies are the primary barriers that exclude immigrants from accessing health care. Legal barriers mainly health insurance prevent many migrant workers in the state of Florida from accessing care. The health policies maintain that only legal migrants should subscribe to the health insurance plans. As such, Native American workers have access to care because they are legal citizens. For insurance, Affordable Care Act extends insurance to uncovered legal United States residents.

The payment systems in the U.S. further makes care inaccessible to many residents specifically the migrant workers. It is notable that migrant workers are paid poorly and do not have access to health insurance plans. A large percentage of the workers are struggling to access care due to high costs, copayment plans, and fee-for-service programs. The average U.S. citizen spent about $1,074 out-of-pocket on care in 2013. This expenditure was directed towards prescription drugs, and copayments (Squires and Anderson, 2015). Migrant workers fail to access care due to the continuous increase of out-of-pocket payments. The CDC estimated that per capita expenditure on health care in 2014 was $9,523 (CDC, 2017). Chester (2015), notes that state expenditure on Medicaid in the state of Florida is about a fifth or $9.5B of all state expenditure. Workers in the U.S. further have challenges accessing care for specific health conditions due to the gradual increase in cost. Heidenreich et al. (2011) note that the cost of treating cardiovascular disease is expected to rise to about $818 in 2030.

There is a high mortality rate linked to manageable and treatable health conditions in the Florida. North Central Florida is leading in rate of mortality (Lilker, 2016). Minorities in the state of Florida die due to stroke, cardiovascular diseases and cancer (, 2017). The lack of bundled payment system and health policy to increases health care access for migrant workers results in poor outcomes. Jones (2006) argues that American Indians experience disparity in accessing care due to their socioeconomic status. There is a disparity in cholesterol screening in migrants from Mexico.  

Health care providers tend to prescribe more drugs, tests, and drugs for chronically ill patients increasing the costs of care. Some medical institutions tend to encourage these procedures and ask patients to pay out of pocket. For-fee-services cause the costs of care to increase while lowering the quality due to various reasons. The first reason is the wasteful use of the expensive medical services (Calsyn & Oshima, 2012). Second, there is no alignment of incentives among service providers across health care institutions in Florida.  

Health Incidence

There is an urgent need for a policy that will make health care more accessible and affordable to Native American and migrant workers in the state of Florida. Most importantly, migrant workers have been prevented from accessing health care insurance. The health policy is even needed because the state of Florida has a high percent of migrant workers. The workers should be offered equal access to care across the state through a reliable and cost-effective payment system.


There are four possible solutions to the Native American and migrant workers health incidence. The solutions are extending health insurance cover to migrant workers, making care cost-effective, eliminating copayments and for-fee-services in the state of Florida.

Health Policy legislation

The type of legislation is Bundled-Low Cost Care Act (BLCCA) which has a goal of making health care affordable specifically for migrant workers in Florida. Disparities in accessing care in the United States are associated with insufficient to access to health insurance, increasing costs, fee-for-services, and copayments. The BLCCA will extend health insurance to migrant workers, lower the costs of health care, eliminate copayments and fee-for-services across hospitals in Florida. Both Native Americans and migrant workers can have access to equal care if the costs are low and classified according to the health condition of a patient. Besides, this health policy will cause providers to uphold ethics in their practice because they will ask patients to undergo essential medical tests only. Under this health policy, migrant workers who earn low wages and are from low social, economic backgrounds will have access to affordable and efficient care.

Current policy

Currently, Native American and migrant workers are covered by two different health policies. Their employers offer most Native Americans health insurance through the ACA. The ACA urges employers to offer pay insurance premiums for their employees based on the structure and size of the workforce. Employers who have 50 workers or more are eligible to purchase coverage for their employees. The number of employees is determined based on the number of full-time and part-time workers. The Employer Shared Responsibility of the ACA penalizes businesses that do not provide coverage for their employees. These penalties, however, apply to employers who have 50 employees or more (, 2016). The ACA further urges businesses to initiate wellness initiatives that enhance and improve health results. The specific health promotion incentives may not necessarily be provided under the ACA but may include any incentives aimed at promoting health outcome (Rosenbaum, 2011).

Migrant workers mainly have access to care through the Community and Migrant Health Centers (C/MHCs). The C/MHCs use the ideas of coordinated and comprehensive care services. Additionally, they practice continued health care services in a single setting. Most of the services offered at C/MHCs are primary care services and preventive care services. The primary mission of C/MHCs is to offer community-based health care services to enhance the health condition of marginalized and underserved populations (Samuels, et al. 1998). Some migrant workers do not have access to these centers which lower access to health care and increase the prevalence of illnesses.

Proposed Change

The Bundled-Low Cost Care Act (BLCCA) will change the current policy and introduce a system that will make care more accessible and affordable. First, it will lower the cost of varies clinical tests, treatment procedures and drugs. Specifically, the policy will cover workplace injuries, infectious illnesses, and chronic health conditions. These health conditions have been chosen because they are more rampant in workplaces. Second, the BLCCA will introduce a bundled payment model where the workers will pay only once to access care for their illness. The single payment will cover all the tests, treatments and drugs for that particular medical condition. Stakeholders in the medical industry including hospital administrators, doctors, nurses and insurance providers will be involved in categorizing and determining the fair payment for different health conditions. Third, the proposed health policy will eliminate for-fee-services for both Native American and migrant workers. All health conditions will be covered through the existing health insurance plans. The health policy will also terminate copayment systems for workers in the United States. Lastly, the BLCCA will extend health insurance coverage to migrant workers who have previously been prevented from accessing health cover.

Benefit and supporters

Migrant workers will benefit more than Native American workers upon the implementation of the BLCC. Within the migrant workers, individuals with chronic illnesses will benefit more because their conditions will be covered under this health policy. Migrant workers who seek outpatient services will further benefit from the BLCCA because they will not be required to pay for each diagnostic procedure. The BLCCA will be supported and funded by the federal government. The federal government will allocate and distribute funds to the state of Florida. The Congressional Budget Office (CBO) will be tasked with budgeting for the BLCC. The CBO usually budgets and plans federal expenditures in health care (Congressional Budget Office, 2017).

Impact on Nursing

The most significant impact of the BLCCA will be making health care accessible to Native American and migrant workers. Migrant workers and Native American workers will enjoy equal health benefits. This new health policy will also impact nursing practice. Providers will have to focus on accuracy and make sure they use minimal resources. Most unessential tests and treatments will be eliminated. The aspect of test duplication will also be eliminated in health care institutions.  The quality of care will also be improved across facilities in the Florida. Another significant effect will be decreasing the cost of care mainly for migrant workers who earn low wages. Although federal’s expenditure on health care might increase, its expenditure will improve the health outcome for the overall population. Several adverse health outcomes might also arise from this new health policy. For-profit health care facilities might experience low revenues because there will be a decrease in the number of clients. Health care institutions that will subscribe to the BLCCA policy will experience increased workload because many Native American and migrant workers will be seeking health care services. Evidently, the benefits of BLCC Aon health care will be more compared to the adverse impacts.  

Analysis and influence

From my perspective, the BLCCA policy will be more appropriate for high-cost medical procedures only. The BLCCA will make care cost-effective and increase access to care for all Native American and migrant workers in Florida. The stakeholders in the health industry will introduce payment bundles for different chronic health conditions like stroke, heart diseases, and diabetes. However, health insurance providers will have to negotiate with health care institutions before implementing bundled payments for certain health care conditions. Hospitals will get reimbursement from the Florida state government after proving that they offered health care services to a certain number of workers. The BLCCA health policy will impact my practice in several ways. First, there will be a high demand for my services because many migrant workers will demand medical services. The second impact will be increased workload due to a rise in the number of individuals who will be seeking care.


The state of Florida requires an effective health policy that will increase access to care for both Native American and migrant workers. This essay has recommended the Bundled-Low Cost Care Act (BLCCA) policy. This health policy will extend health coverage to migrant workers, eliminate copayments and for-fee-services. Migrant workers will be the major beneficiaries of this policy because they have previously been prevented from accessing health insurance.  Proper coordination of health care stakeholders is needed to ensure the policy is implemented effectively.


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