Presidential Agendas Discussion

Presidential Agendas Discussion

Initial Post

Healthcare reform has been a major political topic over the past two decades. Policies have been debated on and implemented over the past ten to fifteen years that has changed the way healthcare works in America.


George W. Bush

George W. Bush stated in his state of the union address, that he proposed an agenda to make health care more affordable, transparent, portable, and efficient. In 2003, President Bush signed a bill into law that started the healthcare savings account. He also implemented policies changes that helped pave the way to bring more generic medication to pharmacies to lower the cost of prescription drugs. In 2004, President Bush started the initiative that all medical records would be electronic and available to the American people over the next 10 years (Reforming Health Care for the 21st Century, 2006). There is a significant reduction in cost for the consumer when buying generic prescriptions. This plan signed by President Bush was a gamechanger for consumers, especially the “baby boomers” that have many prescription medications that they rely on for their healthcare. The consumer can take advantage of the tax-free healthcare savings account putting money aside for expected costs of healthcare each year.  This lowers the taxable income each year and essentially saves the consumers at tax time.  Electronic medical records streamline the process of access to your medical record so any healthcare facility can get your records quickly in the case of any emergency Presidential Agendas Discussion.


Barack Obama

 President Obama is most known for the passage of the Affordable Care Act, or Obamacare.  In this legislation, he started a National Health Insurance Exchange (NIE), savings for preventative coverage, prescription drug coverage savings for generic medications (Ventola, 2009).  The National Health Insurance Exchange offers private insurance options for those that are not offered insurance by their employers, those who are self-contractors, and those whose employers offer insurance that is too costly. These plans have specific tiers of coverage ranging from low-cost premium to low deductibles. The plan for Obama to lower cost of prescription drugs were to make it legal to have them imported from other countries at a discounted cost to the consumers Presidential Agendas Discussion. 

Donald J. Trump

President Trump on day one of his term started trying to dismantle Obamacare. One of the changes he made was to get rid of the individual mandate for coverage. Another change was the federal government stopped paying the cost sharing reduction subsidies. He also expanded access to short term plans (Simmons-Duffin, 2019). The individual mandate was a penalty for those who did not have insurance and did not apply on the national insurance database.  The whole reasoning behind Affordable Healthcare Act was to ensure that most Americans had an opportunity to have health coverage which would lower the cost of healthcare because Americans could become healthier by having some health coverage. By taking away this mandate, there would be no penalty enforced to those who did not sign up for healthcare. Cost sharing subsidies were a way to keep insurance cost down by the government payments sent to the insurers to stay in the national database. Apparently, President Trump decided he did not want the government to pay this any longer, so they stopped paying. “What ended up happening is, insurers, by and large, addressed this by increasing the price of the silver plan on the health insurance exchanges.” (Simmons-Duffin, 2019) Presidential Agendas Discussion.

What Would I do Differently?

I would fist start by not entirely changing the healthcare system, like President Obama did. The ideas he had, some of them were good, but this type of healthcare system does not work in a democracy that is America. The point of a reduced option for healthcare is a great idea for those that are unemployed and self-contractors that can not afford the cost on their own.  I would have, instead of making a penalty for those that did not sign up for healthcare, make a tax break for those that did sign up. I would also not limit this tax break to income limitations.  The problem with Obamacare is that a family of 4 may not pay a high premium, but the deductible is high. I would change the plans in the national database to preventative care only plans. This would cover any primary care visits, preventative care, wellness visits, lab work, and so on.  There would be a copay, but everything would be 100% covered after your copay.


Reforming Health Care for the 21st Century. (2006, February 15). Https://Georgewbush-Whitehouse.Archives.Gov/.,world%20in%20cutting%20edge%20medicine.


Ventola C. L. (2009). President Obama’s health care reform policies: Issues of interest to P&T committees. P & T: a peer-reviewed journal for formulary management34(6), 296–308 Presidential Agendas Discussion.

Simmons-Duffin, S. (2019, October 14). Trumps Five Big Changes to Obamacare: Shots. WWW.NPR.ORG.

Discussion: Presidential Agendas

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

To Prepare:

  • Review the Resources and reflect on the importance of agenda setting.
  • Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example Presidential Agendas Discussion.


Topic that Rises to the Presidential Level

Health care policies and plans have been an important issue and topic that our presidents have had to discuss during and prior to elections, this is primarily due to the size of the health care system in America, and how it budgets a large sector in our economy (Lambrew, 2018). That being said, Americans are monitoring every move of our presidential candidates with their health care policies, because the American voting citizens can affect the election outcomes regarding how our presidential candidates discuss health care plans (Lambrew, 2018). Although, our recent presidents; George W. Bush, Barack Obama, and Donald Trump have been modifying ideas and making improvements in our health care system to benefit the needs of American citizens, we have been struggling with this reform since the 1940’s according to Milstead and Short (2019).

Former President George W Bush, Republican party, had a similar style as to the now former President Donald Trump regarding health care priorities. The Bush administration put their focus on private plans, primarily in Medicare. The idea of this is great because you participate more in your health care and be treated ‘fairly’ for your prices (premiums, deductibles, etc.) since it would be based off your annual income (Reinhardt, 2006), but there are several pitfalls that come along with this idea. Such as some of the financial burdens, which would greatly impact those individuals with co-morbidities that are causing them to be chronically ill. Although, former president Bush did recommend and encourage individuals to enroll into Health Savings Account (HSA) which is tax deductible and in theory should decrease some of the financial burden on some individuals’/families (Reinhardt, 2006).

After an eight-year term from Republican George W. Bush, Former Democratic President Barack Obama was elected, and his administration had a different approach with our health care policy. During his eight-year term he was able to make several changes such as making health care available for everyone even if there were pre-existing health conditions and attempt to lower costs for all. For in the past, insurance companies had the opportunity to deny individuals/families for pre-existing conditions (Lambrew, 2018). This is how the Affordable Care Act (ACA) was created and implemented. Although, many great movements occurred within this program, one of the biggest downfalls was that individuals that declined this or still could not afford this, would be taxed on their yearly taxes because they did not participate in this program. Basically, a loophole to have all Americans have health care to bring money into our economy, but also receive money from those who do not participate in the ACA, making it an equal playing field on participating within our growing economy Presidential Agendas Discussion.

Lastly, our most recent former Republican President, Donald Trump, sought very similar ideas as George W. Bush as I previously mentioned. Near the beginning of his term the Trump foundation eliminated the mandate that required individuals under the ACA have health coverage, meaning individuals will not be taxed additional if they do not have health care coverage. Trumps ultimate goal was to repeal the ACA completely, but approximately halfway through his four-year term had been engulfed with the current pandemic and was trying to maintain calmness while our health care facilities where becoming overwhelmed and millions of Americans were having astronomically high medical bills due to COVID-19 (Melillo, 2020). While dealing with the pandemic he continued to work on similar items are George W. Bush, such as “expand access to health care, lower Americans health coverage costs, negotiate lower prescription drug prices… Medicaid expansion (Melillo, 2020, para. 9).”

All three of our former presidents had great intentions to reform our health care system and I agree that our system does need to be reformed. My belief is health care should be readily available for everyone (previously chronic/acute health issues), rates that are reasonable (monthly premium and affordable deductibles), education to the general public for what they are being charged for with a standard price across all health care facilities, and to look at the foundation of the use of ICD10 codes. The fact that one ICD10 code could cover the cost for a test that is required, but a different ICD10 will charge the patient and their insurance more, does not make sense. I do not have all the answers on the ‘best’ way to reform our health care system or even that bad ways, but I know we have to learn from the plans that did pan as anticipated and to consider what is happening in the current day within the health care society. As I mentioned we have been struggling with this issue since the 1940’s with our health care system and I am sure we will continue to until we can figure out what works best for the largest number of Americans (Milstead & Short, 2019) Presidential Agendas Discussion.


Lambrew, J. M. (2018, June). Getting ready for health reform 2020: What past Presidential campaigns can teach us (Rep.). Retrieved March 1, 2021, from The Commonwealth Fund website:

Melillo, G. (2020, June 25). Trump administration, republican attorneys general ask supreme court to repeal ACA. The American Journal of Managed Care.                    

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed., pp 11-13). Burlington, MA: Jones & Bartlett Learning.

Reinhardt U. (2006). President Bush’s proposals for healthcare reform. BMJ (Clinical research ed.)332(7537), 314–315.                                                      Presidential Agendas Discussion

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