Agenda Comparison

It may seem to you that healthcare has been a national topic of debate among political leaders for as long as you can remember.
Healthcare has been a policy item and a topic of debate not only in recent times but as far back as the administration of the second U.S. president, John Adams. In 1798, Adams signed legislation requiring that 20 cents per month of a sailor’s paycheck be set aside for covering their medical bills. This represented the first major piece of U.S. healthcare legislation, and the topic of healthcare has been woven into presidential agendas and political debate ever since.
As a healthcare professional, you may be called upon to provide expertise, guidance and/or opinions on healthcare matters as they are debated for inclusion into new policy. You may also be involved in planning new organizational policy and responses to changes in legislation. For all of these reasons you should be prepared to speak to national healthcare issues making the news.
In this Assignment, you will analyze recent presidential healthcare agendas. You also will prepare a fact sheet to communicate the importance of a healthcare issue and the impact on this issue of recent or proposed policy.
To Prepare:
• Review the agenda priorities of the current/sitting U.S. president and the two previous presidential administrations.
• Select an issue related to healthcare that was addressed by each of the last three U.S. presidential administrations.
• Reflect on the focus of their respective agendas, including the allocation of financial resources for addressing the healthcare issue you selected.
• Consider how you would communicate the importance of a healthcare issue to a legislator/policymaker or a member of their staff for inclusion on an agenda.
The Assignment: (1- to 2-page Comparison Grid, 1-Page Analysis, and 1-page Fact Sheet)
Part 1: Agenda Comparison Grid
Use the Agenda Comparison Grid Template found in the Learning Resources and complete the Part 1: Agenda Comparison Grid based on the current/sitting U.S. president and the two previous presidential administrations and their agendas related to the public health concern you selected. Be sure to address the following:
• Identify and provide a brief description of the population health concern you selected and the factors that contribute to it.
• Describe the administrative agenda focus related to the issue you selected.
• Identify the allocations of financial and other resources that the current and two previous presidents dedicated to this issue.
• Explain how each of the presidential administrations approached the issue.
Part 2: Agenda Comparison Grid Analysis
Using the information you recorded in Part 1: Agenda Comparison Grid on the template, complete the Part 2: Agenda Comparison Grid Analysis portion of the template, by addressing the following:
• Which administrative agency would most likely be responsible for helping you address the healthcare issue you selected?
• How do you think your selected healthcare issue might get on the agenda for the current and two previous presidents? How does it stay there?
• Who would you choose to be the entrepreneur/ champion/sponsor of the healthcare issue you selected for the current and two previous presidents?
Part 3: Fact Sheet or Talking Points Brief
Using the information recorded on the template in Parts 1 and 2, develop a 1-page narrative that you could use to communicate with a policymaker/legislator or a member of their staff for this healthcare issue. Be sure to address the following:
• Summarize why this healthcare issue is important and should be included in the agenda for legislation.
• Justify the role of the nurse in agenda setting for healthcare issues.
By Day 7 of Week 2
Submit your final version of Part 1: Agenda Comparison Grid, Part 2: Agenda Comparison Grid Analysis, and Part 3: Fact Sheet or Talking Points Brief.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.
• Chapter 1, “Informing Public Policy: An Important Role for Registered Nurses” (pp. 11–13 only)
• Chapter 2, “Agenda Setting: What Rises to a Policymaker’s Attention?” (pp. 17–36)
• Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 171–180)
• Chapter 12, “An Insider’s Guide to Engaging in Policy Activities”
o “Creating a Fact Sheet” (pp. 217-221)

Page 218 ▶ Creating a Fact Sheet page 218
You must be prepared when you visit a congressional or state legislative office. Novices to the policy and politics world often visit their representative with others as an activity related to a conference or convention. At conferences, you may be handed materials to take with you to a legislative meet-and-greet. These materials are intended to be left with the member or staff to serve as a reminder or give a nudge to action after you leave the office. This kind of fact sheet (also known as a “leave-behind”) is a reasonable way to get introduced to the process but is not a highly effective way to share a message. The most effective meeting is one-to-one (e.g., face-to-face) with the member or health staff (legislative aide).
You should prepare a fact sheet that is customized to your message. Criteria for a fact sheet are as follows:
 Keep the document to one page; you may use both the front and the back.
 Use attractive, easily readable font (of at least 12), and eliminate all typos and spelling errors.
 Title your issue at the top of the page. Use plain English—no medical terms.
 State your “ask,” succinctly at the top of the page directly under the title.
 Do not use citations or references. This is not an academic document.
 Bullets, lists, tables, and text boxes must be clearly readable (never use a tiny map or graph).
 List organizations in support of your position (state-level organizations for state issues).
 Know who opposes your “ask,” and be ready to address this opposition verbally.
 Your full contact information (name, credentials, phone, email) must be readable. Unless you have permission to represent your place of work, do not give the impressions that you are speaking on your employer’s behalf.
For more information about how to construct a fact sheet, visit http://cthealthpolicy.org/wp-content/uploads/2018/04/FACT-SHEETS-AND-ACTION-ALERTS.pdf.

Page 219
Example of a Fact Sheet for Folic Acid
Supplementation for the Prevention of
Neural Tube Defects
Asking That You:
• ✓ Expand the Women, Infants, and Children (WIC) program to allow the purchase of over-the-counter folic acid supplements
• ✓ Increase funding for the WIC program to allow the program to cover these supplements for pregnant women already enrolled in WIC
Fast Facts About Neural Tube Defects
• ➢ The neural tube is present in early fetal development and develops into the infant brain and spinal cord
• ➢ Neural tube defects (NTDs) result when the fetal neural tube doesn’t close properly, resulting in spinal cord or brain defects
• ➢ NTDs are among the most common congenital defects in the United States
 3,000 pregnancies are affected by NTDs in the United States every year
 840 infants die of NTDs in the United States every year
• ➢ Types of NTDs:
 Spina bifida is the most common NTD involving the spinal cord
 ○ Infants with spina bifida have disabilities that range widely in severity
 ○ Disabilities related to spina bifida are permanent and lifelong, resulting in significant economic impacts
Lifetime Costs for an Infant With Spina Bifida
Medical costs $513,500
Special education and developmental services $63,500
Estimated lost parental economic output $214,900
Total anticipated lifetime costs $791,900
 Anencephaly is the most common NTD related to the brain and results in the death of nearly all afflicted infants
CONTACT: I. M. Involved, BS, BSN, RN, CCRN
[email protected] 512-555-1100
Facts About NTDs and Folic Acid
• ➢ Folate is required for proper DNA synthesis and function
• ➢ Folic acid supplementation is associated with a decreased risk for NTDs
• ➢ Folic acid supplementation provides maximum benefit for NTD prevention when started 1 month before conception and continued through the first 2–3 months of pregnancy
• ➢ The U.S. Preventative Services Task Force (USPSTF) has determined that the net benefit of supplementation is substantial and the risks are minimal
• ➢ USPSTF recommends that all women who are pregnant or may become pregnant take a daily supplement containing 0.4 to 0.8 mg of folic acid
Projected Costs of Proposed WIC Expansion
North Carolina WIC Participation Totals (2012 data)
Total number of WIC participants in N.C. 284,995
Total number of pregnant women participating in WIC in N.C. 27,052

North Carolina WIC Expansion Anticipated Costs (2014 dollars)
Annual current food costs for WIC program in N.C. $127,920,051.00
Folic acid supplement cost, per pregnant WIC participant $1.94
Estimated annual cost of proposed WIC expansion in N.C. $52,480.88

Summary
• ➢ Addition of folic acid supplement coverage would expand WIC program food costs by less than 0.04%
• ➢ Folic acid supplementation has the potential to prevent 2–3 cases of spina bifida per year among infants born to WIC program participants in N.C.
• ➢ Potential taxpayer cost savings could exceed $1.1 million annually
Supporting Organizations
Centers for Disease Control and Prevention
Flour Fortification Initiative
U.S. Preventative Services Task Force
International Clearinghouse for Birth Defects Surveillance
World Health Organization
American College of Obstetrics and Gynecology
U.S. Food and Drug Administration
International Federation for Spina Bifida and Hydrocephalus

Page 220
▶ What to Expect When You Visit Your Policymaker

1. Make an appointment—don’t just show up.
2. You may visit in pairs, but if there are many of you, make sure the staff know in advance so that they can arrange a place large enough to accommodate all of you.
3. Dress professionally. Do not show up in jeans or clothing with offensive logos.
4. Don’t expect to see the policymaker in person; you probably will talk with a staff member. Staff are very important. Depending on the prestige and length of time in the position, a policymaker may have a small or large staff; each staffer will have one or more specific areas to cover, such as health, agriculture, economic development, or transportation. Staff are responsible for filtering information that is presented to the policymaker.
5. Research the person you are visiting. If it is a legislator, go to the relevant website—you probably will find information about his or her education, family, interests, and community service, as well as current service on committees. There may be a picture.
6. Know the district or constituency that the policymaker represents. This will give you clues about the person’s interests and background. Note any leadership positions the person has held. It is best to visit your own representative, but if you have a particular area of interest, you can choose a person who is the chair or an officer of a relevant committee.
7. Expect your visit to last no more than 5 to 10 minutes—so be focused with your message.
8. Shake hands and look the people you meet in the eye. Speak clearly and with authority.
9. Do not spend much time in “pleasantries”—get to the point of your visit.
10. State why you are there—the specific issue/bill number, your position (“for” or “against”), and why.
11. Be prepared to defend your position. Use evidence-based research (translated into ordinary language), best practice, and other supports.
12. Focus on only one issue per visit. You may be tempted to interject several issues, but you have a very limited amount of time, so do not undercut yourself.
13. Have one or two 1-page documents that support your issue ready for the staff after you leave. For example, you may have “talking points” that summarize your issue. If you are representing an organization, make sure its logo appears on the documents.
14. Leave your business card so that the staff can contact you.
15. Hand-write a thank-you note within two weeks after your visit.

Page 221
▶ Preparing to Testify
You may be asked to testify at a hearing about an issue in which you are involved. A hearing is an official meeting of a committee or group of policymakers (i.e., legislators) in which they “hear” arguments for and against an issue. You must follow protocols about who and when and how long you testify.

1. Know where the hearing room is located. Be there before the hearing begins.
2. You may be required to sign in as a witness. You will be called in the order in which you sign in.
3. Know the name of the committee chair and who will be attending the hearing.
4. Provide copies of your testimony to each member of the committee. Distribute these copies to their staffs.
5. Have with you a one- to two-page testimony document in a font large enough to read without glasses. If your issue demands a longer response, provide copies to the committee staff.
6. Dress as a professional (e.g., no jeans or hoodies). You are representing your organization or issue. Look credible.
   Tips on Testifying
7. Always address the chair first, then any particular members. For example, if a member asks a question, you respond by saying, “Mr. Chairman, Representative (or Senator) XXX, . . . Do this every time you speak. You may want to practice with a colleague.
8. Do not read your testimony. You have provided written copies to each member of the committee, so now is your time to have a “conversation” with them.
9. Make a single point. Now is not the time to bring up all the issues relevant to your case.
10. Provide a personal story that emphasizes your point; state it quickly.
11. You have only a very short time to testify (3–5 minutes),* but you may be able to extend this window if there are questions from committee members. To make best use of the opportunity, have your rationale in your head so you do not hem and haw and waste time.
12. Speak clearly and loudly. Stand up straight. Dress conservatively and appropriately. Act as a professional. Do not slouch. Do not say “Uh . . .” during your precious speaking time.
13. Do not use medical terminology or other confusing language. For example, do not use abbreviations or acronyms (e.g., CABG, IV, MI).
14. If you refer to research or evidence, summarize it.
15. Speak positively and with conviction. Use “power” words (e.g., expertise, overwhelming evidence, significance).
16. Do not equivocate; that is, do not say “kinda,” “sorta,” “maybe,” or “like.”
17. Do not threaten anyone or become violent. You are there as a guest.
18. Always close the loop—that is, bring your remarks back to how this issue will affect the constituents of the policymakers and your patients. Otherwise, you are likely to be seen as self-serving.
19. Be prepared to answer any questions from those who oppose part or all of the bill. Again, have a response in your head that you can pull out for a 30-second reply.
20. If you cannot think of a response to a question, go back to your original position and restate your argument. Remember: Just because you are asked a question does not mean you have to answer it. If you get nervous and the question stumps you, keep to your point.
21. If you are asked a question that you cannot answer immediately, tell the questioner that you will get back to him or her with a solid answer promptly.
22. Thank the chair and committee for hearing your testimony. Tell them you are available for comments or questions.
    Providing Testimony for a Regulatory Hearing
    Jacqueline Loversidge
    When providing comments in writing or as written/oral testimony at a hearing, it is important to follow these guidelines:
     Be transparent about your identity, background, and representation status; that is, be clear about whether comments/testimony represent an organization’s position or your own.
     Be specific regarding whether the position you are representing is in support of or in opposition to the regulation. Give examples using brief scenarios or experiences when possible.
     Assure there is a body of credible evidence to back up your position. Explain major points using common language; avoid nursing/medical jargon.
     Know the agency’s position and respond to those concerns.
     Know the opposition’s position and respond to those concerns.
     Convey a willingness to negotiate or compromise toward mutually acceptable resolutions.
     Demonstrate concern for the public good rather than self-interest.
     Be brief and succinct. Limit your remarks to one or two pages. Regulatory agencies may limit the number of minutes for oral testimony; 5 minutes is average.
    Regulatory agencies charged with public protection are more likely to address concerns that deal with how the public may be harmed or benefited rather than concerns that give the impression of turf protection and professional jealousy. Demonstrate support for your position by asking colleagues who represent a variety of organizations, professions, and interests to submit comments; interprofessional solidarity projects a powerful message. When a significant number and variety of professionals and organizations form a coalition around a single issue, their collaboration demonstrates an elevated degree of concern and a high level of commitment toward finding a solution. In this way, the volume and breadth of interest expressed in a proposed regulation can serve as the deciding factor in assisting an agency to assess support or nonsupport for the proposed regulation.

• There may be a three-light bulb system used for keeping time. As one U.S. senator said, “Talk when the light is green, talk fast when the light is yell

Sample Solution