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The Patient Protection and Affordable Care Act & The Colorado Public Health Act
For District 8 Representatives for the City and County of Denver
Researcher
Mohammed Mrimdate
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Abstract
The analysis of this research provides an investigation into the Patient Protection and Affordable Care Act through a descriptive summary, discussion of support and opposition, the creation of healthcare exchanges and the impact on Colorado. Subsequently, written in a narrative style, The Colorado Public Health Act is discussed and various recommendations are offered. This analysis addresses the Patient Protection and Affordable Care Act (PPACA) and The Colorado Public Health Act (CPHA), with a primary focus on Colorado. The intent of the compilation is to provide data and information regarding the local and national healthcare climate as a result of these Acts. Initially, the researcher investigates PPACA through different discussions of the arguments made from both proponents and opponents. Subsequently, insurance exchanges and the effects of PPACA within Colorado are investigated. Lastly, the researcher examined the CPHA and the PPACA effects are designated and recommendations are presented.
Introduction
Debating Health Care Reform In the USA
It was a privilege as researcher to adapt the time for the learning process to complete this
research as a good topic for discussion in Obama era. Health care reform is a complex process,
and deserves a serious debate. Our nation is struggling to establish health care. Our country is
involved in a debate over healthcare reform. The media focuses only on the strongest voices. But
what you cannot hear and what is often ignored is the voice of millions of the US residents like
me who struggle in silence every day and live with the system that often works better for the
caregiver. There are many people like me who run their own business as independent business
owners and who are looking for health care coverage. In my case, I run a small consulting firm
in the Denver area, but I have a child who has diabetes, and I cannot find the health care that will
cover her fully. Also, as a family we lost our health care coverage when I lost my last job. So, if
I do not have insurance, how can I get high quality and affordable health care coverage for my
family and me?
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This year, our family received countless letters and questions about our health. These
letters are from advocates of reform and can be applied to other citizens. But almost everyone
knows that something must be done. Also, practically every citizen in the US knows that we
need to start working on the reform of the health care. It is necessary for us as residents of the
U.S to create a sense of consistency and certainty about our health.
Therefore, I would like to challenge the health care in our country that leads to an
increase in the cost of the treatment, which means we need a real change for families, businesses
and government savings (state and federal). If truth be told, the 2007 nationwide survey shows
that most of the corporations that provide insurance coverage discriminate against over 12
million citizens in the U.S that have an illness or permanent condition. Moreover, some adults
prefer to stick with their current jobs if the employer provides the health care coverage rather
than changing to a career with more money and no healthcare coverage. The health care system
helps the insurance companies to prohibit, deny, or dilute the health care coverage of the
individuals or group of people. In fact, insurance companies need to understand this irrational
discrimination. As citizens of the U.S, we need to make sure if someone has health care coverage
that no insurance company or government officials can stand between the individual health care
coverage and the care she/he needs.
As a nation, we are closer to achieve health care reform, which has never been done in
the U.S. It’s like a dream. To realize this dream, we need to regulate promises with the
pharmaceutical companies to provide cheaper American products. We need to use the political
force to reinforce the health care reform and enact improvements as a way of sustaining the
country’s health. As well, the 2007 survey exposed that 46 million American live without of
health insurance. Therefore, our country is in the process of losing ground between insured to
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non-insured. 14,000 Americans are now being bereaved and live their daily life without
healthcare. Formerly, the cost of healthcare is increasing rapidly and raising deficits in our
government. Insurance companies continue to enjoy discriminating against the ill. This is not
about political games, but it is about the future of America. Then, the reform will let all the
American people look back years from now and say that it gave our future generations the
opportunity of a lifetime.
The Patient Protection and Affordable Care Act Summary
President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA)
into law on March 23rd 2010. Often referred to as ‘Obama care,’ this Act is one of the most
redoubtable approved attempts, since the 1950’s, to make significant changes nationwide to the
healthcare landscape. Though the ubiquitous discussion of this Act seemingly defeats the
purpose of summarization, a definitive basis of understanding is an important starting point. The
(PPACA) bill was broken down into three illustrative categorical areas of intended change in the
healthcare arena: coverage, cost, and care (U.S. Department of Health & Human Services, 2014).
Broaching the discussion of the PPACA, the efforts toward coverage attempt to soothe
the ills of the many through offering healthcare to all. This coverage is offered through a Health
Insurance Marketplace. Within the PPACA, insurers are disallowed past working procedures that
had encouraged exclusion for pre-existing conditions or refused patient appeal. Within the new
coverage range, employers of more than 50 employees are required to offer employees
insurance, and youth under the age of 26 can still be covered under their parents insurance
(Department of Health & Human Services, 2014). Additionally, the intent is to provide insurance
coverage to the entire nation and as such, those who do not enroll are subject to fines (U.S.
Department of Health & Human Services, 2014).
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In a tenacious interest for not only providing coverage to all, this Act pays reverent
attention to the costs incurred by individuals and families in the attainment of healthcare. The
PPACA provides subsidies for disenfranchised individuals or families and mandates a variety of
healthcare options be provided. Beyond the reduction in costs incurred for families and
individuals, it further bans insurance companies from maintaining lifetime limits on coverage,
which provides more affordable care to those with an on-going illness (CBS, 2013). In a
magnanimous attempt to provide high quality care, the PPACA, provides for preventative care at
no cost and provides patients with the ability to seek their own doctors and emergency care
providers (U.S. Department of Health & Human Services, 2014). Though these changes are
being mandated nationwide, there appears to be no abatement of either the support or opposition
nationally or locally.
Support For The Patient Protection and Affordable Care Act
Supporters of PPACA are some of the most dramatically passionate proponents of any
bill presented locally or nationally. Their nascent arguments were founded in a desire for any
change and their subsequent arguments have been attuned to a non-wavering commitment to
making progress toward healthcare reform for the betterment of all people. Surprisingly, since its
initial passage, polls have continued to show that many people, who say they are opposed to the
PPACA, actually do endorse some of its provisions (Kohn, 2013). Regardless of what sides of
the issues individuals claim to be on, there are a variety of reasons proponents do support this
drastic historical change in our nation’s healthcare system.
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The PPACA has outlined reforms for both the health and insurance industries. This new
law will impact almost every business and individual in America. Supporters argue that the
PPACA is the tool needed to help everyone lead healthier lives, which will be achieved by
making health insurance coverage available to every eligible person in the United States.
Revamping the individual insurance market nationwide will do this. Now, people will be able to
compare and purchase plans based on their own personal situation, which will help improve the
number of people who have healthcare; thus creating a more capitalistic market. They also say
that Medicaid will be expanded, which will allow more low-income Americans to qualify; and
with the goal of cutting the cost of healthcare, the PPACA also includes many rules and
guidelines that will impact the way doctors get paid (Kliff, 2014).
Through our research, there are five basic reasons supporters are most likely to back the
PPACA as Kliff mentioned in his research (2014) and the reasons are: a) Employers must
provide health insurance if they have 50+ employees. b) Insurance companies cannot deny
anyone coverage for pre-existing conditions. c) Young adults can remain on their parents’
insurance plans until they are 26 years old. d) The newly created state-based health insurance
exchanges allows people to compare and purchase plans, via an on-line shopping mall for health
coverage, based on their own personal situation. d) Subsidies will be available to eligible
individuals and families who cannot afford coverage.
According to federal budget forecasters, in the next 10 years, 25 million people will have
health coverage because of the PPACA (The Washington Post, 2014). This formidable change
will likely happen because of three main requirements in the law: a) Medicaid will be expanded,
which will allow more low-income Americans to qualify. b) The individual mandate that
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requires most Americans to obtain health coverage or pay a penalty. This stipulation is to
encourage everyone to take advantage of either option mentioned above. c) The newly created
state-based health insurance exchanges that will allow people to compare and purchase plans
based on their own personal situation, which can take place through online portals like
Healthcare.gov.
Though we have just examined many of the supporters argued axiomatic points about the
subject, The PPACA looks at the various ways that doctors get paid by Medicare. This allows
Medicare to see if a doctor is impacting their patients’ health in a positive way, which can
ultimately impact the money they receive for the services they provide (Kliff, 2014). Under the
PPACA, Medicare will have an Independent Payment Advisory Board (IPAB). It has been given
authorization to cut the rates that Medicare pays (Kliff, 2014). The goal is that the federal
government will be paying for quality care and not unnecessary costs that do not benefit the
patient and in the end this will result in lowering the overall cost of healthcare. At this point, we
must wait and see what standards work and then to see if they are put in place as originally
expected.
Opposing to The Patient Protection and Affordable Care Act
Since it’s passing, the PPACA has been contentious for many reasons. The opposition,
coming mostly from conservatives, tends to focus on the overall expansion of government
regulation and spending (Owcharenko, 2010). In general, the PPACA will expand the
government’s oversight of the healthcare system and many believe that this is an unrealistic way
to go about healthcare reform. Other ideas include allowing consumer driven healthcare plans to
have a more substantial role. This would allow enrolled individuals to receive a certain amount
of money instead of the typical set of ordinary benefits (Miller, 2012). According to research that
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has been done, there is less spending with these types of plans. However, some ask if patients
will avoid the healthcare they need just to save money. In some cases, people are more
vulnerable, which can open them up to being taken advantage of by insurers who get them to buy
health coverage that doesn’t fit their personal situation or cover the benefits they need (Miller,
2012). There are three main ideas of challengers’ arguments. First, many think that the PPACA
is moving America’s healthcare system in the wrong direction (Owcharenko, 2010). They
believe the government is taking over and that we are surrendering our power to Washington
bureaucrats who will control the dollars and decisions that should really be in the hands of
individuals and their families (Owcharenko, 2010). Secondly, the individual mandate that
requires most Americans to obtain healthcare or pay a penalty. Also, it is necessary that the
adversaries believe that forcing individuals to buy healthcare is putting added burdens on
individuals, families and companies (Foster, 2010). Thirdly, the PPACA has also put burdens on
businesses to spend more on healthcare costs and compliance. It’s very likely that these business
owners will be forced to hire part-time workers instead of full-time employees to make up the
extra expenditure (Forbes, 2013).
The Patient Protection and Affordable Care Act & Insurance Exchanges
The creation of state-based health insurance exchanges allows people to compare and
purchase plans, via an on-line shopping mall for health coverage, based on their own personal
situation. This is an unprecedented move toward technological governmental accessibility to the
masses and can take place through online portals like Healthcare.gov. All legal residents in the
United States are eligible to utilize the insurance exchanges, with the exception of those who are
in jail and receiving medical treatment from their incarceration facility. Subsidies are also
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available to eligible individuals who cannot afford coverage on their own. When looking
specifically to the financial assistance portion, only lower and middle-income Americans are
eligible (Foster, 2010).
According to Connect for Health Colorado, even though the federal government site,
Healthcare.gov, can be used nationwide, the District of Columbia along with sixteen other states
have put together specific health insurance exchanges on-line tailored to where they live. Since
its inception, the insurance exchange site, Connect for Health Colorado, has provided insurance
to over 125 thousand Coloradans. Beyond insurance coverage, the site offers access to agents or
brokers, chat capability and a mass of information for individuals, families and employers
(Connect for Health Colorado).
The Patient Protection and Affordable Care Act & Colorado
“Colorado has embraced increased health care quality at a decreased cost for a number of
years making state reform a priority. That means the state already has a framework in place and
infrastructure from which to build an unprecedented system that will result in improved health
outcomes for all Coloradans” (Meinhold, 2010, p. 25). Though the Affordable Healthcare Act
has national precedence in affecting change, looking at Colorado as a state that has shown
interest in progressive health care change, as was seen in the Colorado Public Health Care Act,
prolific change is likely to continue. Colorado is currently experiencing and will likely see
changes are in the areas of economic output, employment creation, tax credits and savings, and
new collaborations. The transition from the CPHCA to PPACA has found on the basis and has
an explanation to transfer the outcome to a new bill that Colorado needs it and a cycle of
research such as Meinhold article written in 2010, before SCOTUS decision on ACA and trying
to show how implementation could be done within context of the Colorado Health Care
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Affordability Act. Her piece only mentions the Colorado Public Health Care Act once, and not
in relation to the ACAE ensuring the implementation of CPHCA? Is in alignment with all
requirements of what—its own language or the ACA? Is and has been a challenge, give
examples. However, remaining focused on employment generation and economic output while
reducing costs is a focus for Colorado. Though the Affordable Healthcare Act is meant to reduce
costs to all American’s, which would seem to reduce revenue output, it is estimated that for
“every additional dollar in new health care spending in Colorado [we] will generate $2.44 in
economic output” (Meinhold, 2010, p. 2). Even more, it is expected that by 2019, the economic
input will reach heights of $8.9 billion, and after including the tax-finance health care; our
expected output will be about $3.8 billion. This, within Colorado’s economy is estimated to
create twenty three thousand new jobs over the next six years (Meinhold, 2010, p. 10). Incipient
of these changes, additional health care workers from a variety of backgrounds will be needed to
implement and maintain the system (Mental Health Association of Colorado, 2012). It is further
postulated that without the overwhelming medical cost burdens, families will be more apt to
spend in other areas creating jobs in additional sectors (Mental Health Association of Colorado,
2012).
Implementing the national reform within Colorado is expected to reduce expenses for not
only families by businesses as well. For families, the reform is expected to reduce Colorado
families premium expenditures by about one thousand five hundred dollars to just over two
thousand dollars (Meinhold, 2010). “On average, each household in Colorado will be $955”
ahead by 2019, with the most impoverished household showing the greatest savings and having
$2,686 more funds annually (Bailey & Stoll, 2011, p.2). Additionally, approximately ninety
thousand businesses may be eligible to receive tax credits in order to further reduce the costs of
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insurance for employees (Meinhold, 2010). Beyond state and family cost reduction, the state is
likely to see savings as well. Currently, much of the state and local funding directed to
impoverished care is shifting to being matched federally by Medicaid (Bailey & Stoll, 2011;
Meinhold, 2010). Additionally, federal increases in funding for in-home and community based
care as well as additional funds for youth, elderly, and disabled populations is expected to
decrease Colorado spending and increase the quality of care (Bailey, 2011; Meinhold, 2010).
The Affordable Care Act also charges state departments and agencies with creating
platforms for collaboration. Within Colorado, the Colorado Department of Health Care Policy
and Financing, Colorado Department of Public Health and Environment, the Colorado Division
of Insurance, and the Governor’s Office of Information and Technology have “identified areas of
responsibility” and started to “ leverage resources and coordinate activities” (Meinhold, 2010, p.
23-24; Department of Health Care Policy and Financing). This forced collaboration is in effect
meant to reduce duplication of services, create coverage for areas not being addressed, and
ensure that the best service is being provided.
The Colorado Public Health Act
The Patient Protection and Affordable Care Act
Since Governor Bill Ritter signed the Colorado Public Health Act (CPHA) in 2008,
public health services with sustainable quality have become available to every person in
Colorado. This Act brought together boards, agencies and public officials to work toward the
development of consistent state and local healthcare plans (Cortiglio & Janssen, 2008). For
example, “The Role of Local Public Health Agencies in Achieving Triple Aim An Exploration
of Local Public Health Services and How They Can Fit Into Broader Delivery and Payment
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Reforms” 2013 one of the authors was from the Colorado Association of Local Public Health
Officials we see the document cited: http://civhc.org/getmedia/66c62833-6f27-4167-8ff4
18e1eb858e4d/LPHA-White-Paper-FINAL-5.13_CIVHC_CALPHO.pdf.aspx/ see pp. 1-2.
Local public health agencies (LPHA) are required to provide or assure the provision of
assessment, planning and communication; vital records and statistics; communicable disease
prevention, investigation and control; prevention and population health promotion; emergency
preparedness and response; environmental health; and administration and governance. LPHAs
provide numerous direct services as well as more traditional, population-focused prevention
services. Under the new Act, each county must establish or be affiliated with a public health
agency (CPHA, 2008 – SB 08-194). These agencies must be organized under a local board of
health, hire effective staff members and meet the requirements of the public health services.
Conversely, Cortiglio & Janssen (2008) stated that “policy makers and the public became aware
of vulnerable and outdated health information systems and technologies” (p.2) They saw these
deficiencies in an “inadequately trained public health workforce, antiquated laboratory capacity,
a lack of real-time surveillance and epidemiological systems”(p.2). They went so far as to say
there was an “ineffective and fragmented communications network, incomplete domestic
preparedness and emergency response capabilities and communities without access to essential
public health services” in Colorado (p.2). Another example of what’s happening now is Denver
Health’s 2015/16 Strategic plan with new and exciting public health opportunities in this shifting
landscape, come several new challenges. The prolonged recession has drained public program
resources for years. Though the economy is improving, the need to fund parts of the Affordable
Care Act – expansions in Medicaid in particular – will likely result in ongoing pressures to divert
ACA-defined public health resources to personal care settings. Public health departments will
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necessarily spend time in the near future defining which services are best provided where, by
whom, and how safety net services will be maintained. For health departments providing clinical
services, as ours does, the need to maximize revenue while maintaining a public health mission
poses additional challenges.
See Denver Public Health, Strategic Plan 2014-2016
http://www.denverhealth.org/Portals/0/Public-Health-and-Wellness/Public-Health/About-Public-
Health/Docs/DPH-2014-2016-DenverPublicHealth-Strategic-Plan-Final.pdf.
The debate on healthcare reform raises many complex issues and problems, including the
coverage availability, cost, accountability and quality of care, especially in Colorado
(Swendimen, 2012). These political issues question the quality and effectiveness of healthcare in
the state of Colorado (CPHA, 2008-SB08-194). There is also a controversy about whether
healthcare should be viewed as constitutional or legal. In this memo, we discuss the
constitutional and legal views regarding healthcare, its effectiveness, and the people’s right to it.
Additionally we discuss, the powers of Congress, the Federal Government and the government
of Colorado’s role in approval of programs and bills concerning healthcare for the people
(Bernadette, 2010; CPHA, 2008-SB08-194; PPACA, 2010). Moreover, the state of Colorado,
along with the United States, does not explicitly grant the people a right to affordable healthcare
and the need to be specific-US Supreme Court and Colorado Supreme Court? Has never
addressed it within the Constitution. Within the Constitution, some could argue, are guarantees
for the people to a right to healthcare provided by the government for those who cannot afford it.
In comparing both Acts to each other, the PPACA addresses a lot of the current
healthcare system’s long-standing problems. The aspects of the current healthcare system are
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unfair, uncertain and unaffordable to many U.S. citizens and the PPACA enacts reforms that help
to curb the cost of insurance, increase the quality of healthcare and expand the consumer’s
protection by justifying their rights (Swendimen, 2012). The new healthcare Act’s priority is to
make healthcare available to more individuals and employees (PPACA, 2010; Bernadette, 2010).
Now, nobody will be excluded from achieving a healthier lifestyle.
According to Kathleen Swendimen (2012), the PPACA includes a strong focus on
improving employee-based healthcare as well as making numerous improvements for minority
groups such as women, senior citizens and those who didn’t qualify for Medicare before. These
improvements allowed the Act to expand Medicare to millions of new Americans the large
expansion, was for Medicaid (income based) that is different from Medicare (age based) and the
US Supreme Court held that forcing states to expand Medicaid was unconstitutional; Colorado
had done it voluntarily. What the PPACA did in Medicare was to deal with seniors who are
eligible for both programs, specifically around care coordination. Furthermore, president Obama
and his administration have made it clear that healthcare should care for all of America’s
citizens. The new healthcare Act aims to build the American healthcare system, so that it can be
beneficial to both the providers and the consumers (PPACA, 2010).
Again, The CPHA no longer works on all counties and districts. Now, it works to connect
small communities to the public health agencies. To start this process, such statutes that concern
county, district and regional health departments as well as local boards of health have been
terminated (Cortiglio & Janssen, 2008). Instead, the repealed sections, concerning the powers
and responsibilities of the county and district health agencies, have been replaced with a priority
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to focus on meeting core public health standards. Cortiglio & Janssen (2008) conclude that
CHPA now requires every county to be a part of the public health agencies. Additionally, they
indicate the Act directs the Department of Public Health and Environment to develop a statewide
public health improvement plan and requires the public health agencies to draft a new plan based
on each community’s needs (Cortiglio & Janssen, 2008). Our assertion suggests that we need to
change the CPHA or to look for substitution and reform with the PPACA.
Changes of the Current Public Health Laws
To create awareness of the phenomena, we adopt Stone’s (2012) views as a helpful
framework to improve our rationality by investigating all the facts toward a solution. Stone
(2012) bases her thoughts on the basic reasoning about political cost and benefit. Stone’s (2012)
framework is founded on three characteristics phenomena of "problem", "solution" and
"objective" that can play a role on the value judgments of the process of policy-making in this
country.
In 2003, the Institute of Medicine of the National Academies (IOM) published a research
document that admits that the healthcare improvements over a 15-year interim (IOM, 2003 and
Cortiglio & Janssen, 2008) have not been effective. Both the analyses (IOM, 2003; Cortiglio &
Janssen, 2008) discuss some persistent problems that still exist. They reflect on the struggle of
our political process to define the problem and solution. According to Cortiglio and Janssen’s
(2008) report, the “statutory framework for public health in most of the nation” is in need of a
serious change (p.2). The IOM (2003) claims the same result. The problem in this case is the
difference between the status quo, where not all Coloradans are covered by current healthcare,
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and the policy goal, where everyone gets covered. This aligns with Stone’s (2012) definition of
the problem as difference between the status quo and the policy objectives (p.155-182).
Recommendations
The change needed is to embrace Stone’s (2012) framework to correlate the rationality of
politics and policy makers’ analysis to understand the resolution from the political conflict. We
also need to relate our healthcare phenomena with the developing model of society because
social model plays a role and supports the model of rational thought (Stone, 2012, p. 9). In turn,
the rational model of the market, which incorporates self-interest and the usefulness value of the
individual’s physical status, can influence the social model.
While acknowledging several operational issues within the healthcare system, Cortiglio
& Janssen (2008) in their analysis state that the “fragmentation and lack of coordination”
between various counties, rural areas and local governments will have “potentially dire
consequences” for the public’s overall health quality (p.2). Accordingly, many of the statutes and
rules relating to public health are obsolete and redundant, which could potentially lead to
difficulty in handling serious situations. As stated in Cortiglio & Janssen’s (2008) analysis,
“these infrastructures of public health information and the local agencies are unable to fully
handle situations in which rapid, clear communication and information transfer are essential ”
(p.2).
Therefore, in order to improve the overall performance of the healthcare system, a change
is required in the public health agencies’ management and coordination skills. Performance
measurement standards designed by the state and local governments are essential to keep the
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agencies in touch with their responsibilities and ensuring quality performance. To meet the
public and private interests, Stone’s (2012) model is determined by the political society in which
corporate groups’ collective action are motivated by loyalty to groups, products or organizations
for social change, rather than simply by achieving material gain. Thus, a new healthcare plan
must show how quality healthcare services will be provided and the local district agencies must
adopt a plan that correlates to the state’s public healthcare. This means that the public officials,
such as the Board of Health and the county commissioners, along with the local public health
directors, are in charge of drafting a plan that will be followed as a model for the local public
health improvement plans without ignoring their responsibilities that must be performed as
written in the Act (Cortiglio & Janssen, 2008). This strategic plan is ultimately ineffective and
inefficient.
The CPHA of 2008 is a fairly new law within Colorado, explaining the fundamental
public health services needed to effectively solve the local communities’ health problems. In
order to tackle health problems, we need to adopt the affirmation of Stone’s (2012) model of
‘social policy’ as the most appropriate model of reflection, policy development and political
criteria. The absence of fixed and definable goals in the current Colorado healthcare policy
makes no sense as an objective because it is not aware of the political problems. Stone (2012)
claims the model of society is the perfect model that can help us to define the problems and to
illustrate a concise plan. To solve these problems, several actions towards improvement need to
be taken: 1)- An investigation of current health problems in the area, education of the citizens of
the health hazards and their solutions (Cortiglio & Janssen, 2008). 2)- Greater collaborations
between the private sectors of each community through drafting plans that connect individuals
with community needs and make healthcare available to more individuals and workforces.
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Additionally, collaboration should be applied broadly within science and research to solve
serious health issues (Cortiglio & Janssen, 2008). 3)- Inclusion of rural areas in Colorado as a
pushing force towards a statewide health plan. This way, every citizen in Colorado would be
included and no one is excluded from achieving a healthier lifestyle that will be passed on to
future generations.
Recently, Colorado has fallen behind on maintaining plans that are approved by the
National Public Health Performance standards. This means that the CPHA of 2008 is not worth
supporting. Colorado needs to draft a model that will meet the health standards and make sure
they are followed by the entire state. Therefore, Colorado needs to terminate statutes that have no
intent with the public health and instead prohibit the rural areas from getting the healthcare
(Cortiglio & Janssen, 2008). Currently, an organized health department only serves 11 of
Colorado’s 47 rural counties and 36 of these counties have public nursing services, 13 only have
one nurse for the entire county, which can’t possibly be sufficient to serve the entire county
(Cortiglio & Janssen, 2008). Similarly, the dental services in Colorado are no different. Only
40% of the counties have dental institutes and the rest of the counties have no dentists at all
(Cortiglio & Janssen, 2008). We need a new policy to transform the State of Colorado to serve
all of the rural areas and counties with the same effectiveness. We can do this by establishing an
information center that will help bring coverage to more citizens in the counties and bring the
latest technology in healthcare to work in Colorado and eliminate laws that don’t contribute to
the improvement of healthcare for everyone.
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References
Bailey, K., & Stoll, K. (2011). The bottom Line: How the Affordable Care Act Helps Colorado
Families[pdf]. Retrieved from http://bethmccann.org/images/ACA.Colorado.pdf
Bernadette, F., (2010). Grandfathered Health Plans under the Patient Protection and Affordable
Care Act
[pdf]. Retrieved from http://www.ncsl.org/documents/health/grandfathered.pdf
Center for American Progress, February 19, 2009. Retrieved date Wednesday 23 April 2014 from the website: http://www.americanprogressaction.org/issues/2009/02/health_in_crisis.html
Colorado. Gov. Frequently Asked Question: Affordable Health Care Act. Retrieved from
http://www.cohealthinfo.com/faqs/affordable-care-act/
CBS. (2013). Brief Overview of the Affordable Care Act. Retrieved from
http://denver.cbslocal.com/2013/07/17/brief-law-overview/
Connect for Health Colorado. (2014). Colorado’s Own Health Insurance Marketplace. Retrieved
from
http://connectforhealthco.com/about-us/
Cortiglio, C., & Jansen, M. (2008). Senate Bill 08-194 Pro/Con Analysis. Retrieved from
http://www.healthdistrict.org/sites/default/files/legislative-analyses/sb08-194.pdf
Denver Health (2014). Affordable Care Act (ACA). Retrieved from
http://www.denverhealth.org/public-health-and-wellness/affordable-care-act
Forbes. (2013). Is the Affordable Care Act Really Bad for Business? Retrieved from
http://www.forbes.com/sites/theyec/2013/04/22/is-the-affordable-care-act-really-bad-for-
business/
Foster, R., (2010). Estimated Financial Effects of the “Patient Protection and Affordable Care
Act. Retrieved from
http://abcnews.go.com/images/Politics/OACT_memo_on_financial_impact_100423.pdf
Health Care Reform: The Perils of Inaction and the Promise of Effective Action; A Report to Business Roundtable by Hewitt Associates LLC; September 2009.
Retrieved date Tuesday 22 April 2014 From the website: http://www.Businessroundtable.org/sites/default/files/brt_hewitt_hcreformreport_Sept2009_finalonline.pdf
20
Kliff, S. (2014). Everything You Need to Know About Obamacare. Retrieved from
http://www.vox.com/cards/obamacare/what-is-obamacare
Kliff, S. (2013). Who Wants to be A Death Panelist? Retrieved from
http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/28/who-wants-to-sit-in-
the-hot-seat-on-a-federal-health-care-panel/
Kocher, R., Emanuel, E.J., DeParle, N. (2010). The Affordable Care Act and the Future of
Clinical
Medicine: The Opportunities and Challenges. Annals of Internal Medicine, 153, 536-539.
Retrieved from http://annals.org/article.aspx?articleid=746295&issueno=8&atab=10
Kohn, S. (2013). Five Reasons Americans Already Love ObamaCare - Plus One Reason Why
They’re
Gonna Love It Even More, Soon. Retrieved from
http://www.foxnews.com/opinion/2013/09/30/five-reasons-americans-already-love-
obamacare-plus-one-reason-why-theyre-gonna/
Meinhold, L. (2010). Implementing Health Care Reform: A Roadmap for Colorado. Retrieved
from
http://www.colorado.gov/GovernorsHealthReform/pdf/QL-4Ex6Fi90.pdf
Mental Health Association of Colorado. (2012). Implications of the Affordable Health Care
ACT (ACA)
FAQ. Retrieved from
http://www.coloradopsychiatric.org/assets/implications%20of%20the%20aca.pdf
Miller, S. (2012). Consumer-Driven Health Plan Participants More Cost-Conscious. Retrieved
from
https://www.shrm.org/hrdisciplines/benefits/Articles/Pages/CDHPs-Cost-Conscious.aspx
National Research Council (2003). The Future of the Public's Health in the 21st Century.
Washington, DC: The National Academies Press
Obama, B. (2009). Why We Need Health Care Reform. The New York Times. August 15, 2009. Retrieved date Wednesday23 April 2014 from the website:http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-at-Town-Hall-on-Health-Insurance-Reform-in-Portsmouth-New-Hampshire.
21
Ouray County. (2014). 2014 Budget Message. Retrieved from
http://ouraycountyco.gov/2014_budget/2014%20Budget%20Message.PDF
Owcharenko, N. The Heritage Foundation (2010). Repealing Obamacare and Getting Health Care Right.
Retrieved from http://www.heritage.org/research/reports/2010/11/repealing-obamacare-and-getting-health-care-right
Public Health Directors of Colorado. (2008). PHDOC Position Paper on the Implementation of
Senate
Bill 08-194. Retrieved from
http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCkQFj
AA&url=http%3A%2F%2Fpublichealthalliance.mediaroom.com%2Ffile.php%2F86%2F
PHDOC%2BPosition%2BPaper%2Bon%2BSB%2B194.pdf&ei=mXxAU9m8IsmzyAGg
z4Bw&usg=AFQjCNHFce1OLpKOK4Hg9SIdh_AiXekpOg&sig2=t_tLmzJ_SSmUCfrt1
Rqn5w&bvm=bv.64125504,d.aWc
Stone, D. (2012). Policy Paradox: The Art of Political Decision Making. Brattlebora: Norton.
Swendiman. K. S., (2012). Health care: Constitutional Rights and Legislative
Powers. Congressional
Research Service July 9, 2012-7-5700 www.crs.gov R40846
The Colorado Trust. (2013). Health Equity and the Affordable Care Act. Retrieved from
http://www.coloradotrust.org/attachments/0001/9399/Health_Equity_Health_Disparities_
Brief_Summary.pdf
The Department of Health Care Policy and Financing. (2014). Health Care Reform Resources.
Retrieved
from http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251616010854
The Heritage Foundation (2010). Repealing Obamacare and Getting Health Care Right. Retrieved from
The Washington Post (2014). Everything You Need to Know About Life Under Obamacare. Retrieved
From http://www.washingtonpost.com/blogs/wonkblog/wp/2014/01/01/everything-you-need-to-know-about-life-under-obamacare-2/
22
The White House (2014). Health Care State Map. Retrieved from
http://www.whitehouse.gov/healthreform/map
U.S. Department of Health & Human Services. (2014). About the Law. Retrieved from
http://www.hhs.gov/healthcare/rights/
