Presidential Agendas -NURS 6050 week 1 Discussion

Presidential Agendas -NURS 6050 week 1 Discussion

Initial Discussion Post

This week, we will evaluate how former presidential administrations handled health care and how federal agendas promote healthcare. Healthcare issues are one of the biggest problems in elections. Some believe in universal healthcare, and some think universal healthcare would result in sub-standard healthcare. Whichever side you are on, we can not deny that health care prices and availability need to be improved. Healthcare funding often depends on the political party that is in control of the executive and legislative branches Presidential Agendas -NURS 6050 week 1 Discussion.

The implementation of healthcare coverage has taken on many forms throughout the history of the United States. Until the turn of the century, most healthcare was the states’ responsibility ( Gluck & Huberfield, 2018). The state’s healthcare funding was often not enough to provide healthcare, so the federal government began programs to help cover the elderly and poor. President Johnson created Medicare and Medicaid to ensure healthcare for the elderly and poor ( Gluck & Huberfield, 2018). Medicare and Medicaid are still funding healthcare and have been modified several times to include more people. The Patient Protection and Affordable Care Act (ACA) was the most recent federal government attempt to provide broader healthcare access.

President George W. Bush helped lay the groundwork for future healthcare reform laws. President Bush was the first president to focus on the electronic health record and Health Saving Accounts (HSA) (Bush, 2004). Before 2001, there were very few systems in place to create and maintain patient charts electronically.  Electronic health records have helped with patient safety and quality of care because providers can access prior medical information like allergies and diseases. President Bush passed laws to reduce prescription drug prices, which helped relieve some of the financial burdens on the elderly and poor (Bush, 2014). Overall, President Bush created an environment of future healthcare reform Presidential Agendas -NURS 6050 week 1 Discussion.

President Barrack Obama came into office with the hope of reforming healthcare. President Obama, with the help of congress, passed the  Patient Protection

and Affordable Care Act (ACA).  The ACA expanded Medicaid coverage and created insurance exchanges that offered lower-priced insurance options. The ACA did not see its full potential because some states refused to implement the changes (Oberlanger, 2012). The federal government had to step in to provide insurance options in states that did not participate. The ACA was the most extensive health care reform since the creation of Medicare and Medicaid. The federal government’s involvement in providing healthcare to its citizens is criticized as being socialistic. The United States current healthcare is currently the most expensive globally and does not offer universal healthcare.

President Donald Trump promised to repeal the ACA in his campaign. President Trump offered to replace the ACA with a better plan. The planned replacement for the ACA never materialized. One of the problems in repealing the ACA is that public opinion was split between the government offering healthcare and private insurance coverage (Keckley, 2017).  President Trump tried many avenues to repeal the ACA. His administration has attempted to undermine the ACA by limiting funding and participation (Jones et al., 2018). President Trump successfully streamlined vaccine approvals for COVID-19. The vaccine approval usually would have taken years to be approved by the Food and Drug Administration (FDA). Overall, President Trump’s healthcare policies centered on repealing the ACA, but he never offered a viable replacement plan. One of his only successes in healthcare was streamlining the COVID-19 vaccine Presidential Agendas -NURS 6050 week 1 Discussion.

Universal healthcare is a significant debate. The opinion often depends on political affiliations. I feel like healthcare should be a right instead of a privilege. Many countries have implemented universal healthcare and spend much less than the United States. The argument is that with universal health coverage, you will have low healthcare quality. The reforms and policies to date have attempted to provide access to health for more Americans. If I were to offer more access to Americans, I would try to personalize the uninsured struggle.

Bush, G.W. (2004). Ensuring access to health care: The Bush plan. JAMA, 292(16), 2010-2011. https://doi:10.1001/jama.292.16.2010

Gluck, A.R., & Huberfield, N. (2018). What is federalism in healthcare for?. Stanford Law Review, 70(6), 1689–1803.

Jones, D.K., Gusmano, M.K., Nadash, P., & Miller, E.A. (2018). Undermining the ACA through the executive branch and federalism: what the Trump administration’s approach to health reform means for older Americans. Journal of Aging & Social Policy, 30(3-4), 282-299.

Keckley, P.H. (2017). What’s ahead on healthcare? The new administration favors a state-run, market-driven approach to crafting policy. Healthcare Executive, 32(2), 66-69. Presidential Agendas -NURS 6050 week 1 Discussion

Oberlander, J. (2012). Unfinished journey-a century of health care reform in the United States. The New England Journal of Medicine, 367(7), 585-590. https://doi:10.1056/NEJMp1202111

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 examplePresidential Agendas -NURS 6050 week 1 Discussion.

sample post 2

Healthcare Reform

I chose overall Healthcare Reform as my topic that rises to the presidential level. It’s been a significant issue, often being a cornerstone of presidential campaigns in recent years. The United States spent nearly 18% of the GDP on healthcare, more than any other country (Center for Medicare and Medicaid Services, 2020).


            As the White House pages have been deleted, it has been challenging to find information sources on Trump’s Healthcare plan. While the Trump Administration claimed to repeal and replace the Affordable Care Act, they seemingly only seemed to weaken the ACA throughout the administration. In 2017, Republicans in House and Senate voted in a year-end tax cut that reduced the penalty for failing to have health insurance (one of the underlying tenets of the ACA) to zero.

In October of 2020, Trump announced his “America First Healthcare Vision”. This entailed protecting patients with pre-existing conditions and protecting healthcare consumers from “surprise billing” – an effort to have more transparency in hospital costs and reduce the occurrence of unforeseen hospital bills (Brownstein et al., (2020). It also expanded access to “Association Health Plans”, which small businesses could utilize to have access to health insurance savings typically associated with large group medical coverage seen in larger companies previously.


            Obama enacted the Affordable Care Act in 2010. This provided avenues for more people to gain health insurance, utilizing subsidies for people with household incomes between 100% and 400% of the poverty level (, n.d.). The plan had a focus on individual market coverage, providing subsidies for these plans. He also expanded Medicaid to cover all adults below 138% of the poverty level. Over 20 million Americans gained health insurance from 2010-2018 under this plan (CDC, 2018).


            George W. Bush enacted several specific policy changes rather than one comprehensive healthcare reform, aiming to continue privatized insurance policies but adding options to have more people covered. These included Medicare reforms, including a prescription drug policy which provided more access to better prescription drugs (the Heritage Foundation, 2004). Bush also created Health Savings Accounts; a tax-free savings account for health expenses Presidential Agendas -NURS 6050 week 1 Discussion. He also increased funding for medical research. The president expanded flexibility for states to cover more people under Medicaid and the State Children’s Health Insurance Program (S-CHIP).


I don’t pretend to have a complete understanding of this complex issue. However, I think the success of other countries in implementing centralized, socialized healthcare plans for universal healthcare cannot be ignored. It seems America is spending more on healthcare with the same or even worse results than other first-world countries. Healthcare costs are crippling here. I have been fortunate in not having any major health issues thus far, but even the minor issues I have had have been enormous financial burdens. Taking away the concern over expensive healthcare scenarios would have an immediate positive effect on the overall morale of the entire population.

At the same time, I realize the importance of figuring out policies that gear a population towards more preventative, primary care solutions rather than medical interventions once a health issue is out of hand. The mentality of many in the US needs to change – and the realization that preventative steps can prevent significant health issues down the road; but this begins with people being able to afford basic primary care to nip health issues in the bud before they potentially require expensive solutions like inpatient stays. I also would like to see some of the efforts to provide incentives for good health, like workplace checkups with bonuses for making improvements to health – such as quitting smoking, improving Body Mass Index, etc Presidential Agendas -NURS 6050 week 1 Discussion.


Center for Disease Control, (2018). National Center for Health Statistics. National Health Interview Survey Early Release Program. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January-June, 2018.

Center for Medicare and Medicaid Services, (2020). National Health Expenditure Data – Historical.,spending%20accounted%20for%2017.7%20percent., (n.d.). Affordable Care Act (ACA).

The Heritage Foundation, (2004). An Examination of the Bush Healthcare Agenda.

Brownstein, Hyatt, Farber, and Schrek, (2020). Overview of the Trump Administration’s America First Healthcare Vision’.

sample response

I agree with your statement that healthcare insurance is a complex topic that is hard to grasp a broad understanding of. Our country working towards preventative care versus secondary and tertiary care would drastically decrease the amount of spending on the federal level. “Policymakers and the general public also have little knowledge of the efficacy of primary care, its impact on individual and population health, and its role in today’s healthcare delivery” (Shi, 2012). As registered nurses working towards furthering our education; I agree it is vital for us to be the voice of change to help recognize the importance of primary preventative care Presidential Agendas -NURS 6050 week 1 Discussion.

I think your idea of incorporating more workplace health incentives is great. Most Americans spend a majority of their time at their workplace, often without other daily activities. “Therefore, programs aimed at the workplace have the potential to reach a large segment of the population who might not be exposed to other health promotion initiatives” (Pescud, Teal, Shilton, et. al., 2015). Incorporating incentives for a healthier lifestyle into other mandatory daily activities is a great way for populations to be reached and preventative care to be addressed.


L. Shi. (2012, December 31). The impact of primary care: a focused review. National Institute of Health. Retrieved March 4, 2021 from

M. Pescud, R.Teal, T. Shilton, et. al. (2015, July 11). Employers’ views on the promotion of workplace health and wellbeing: a qualitative study. National Institute of Health. Retrieved March 4, 2021 from Presidential Agendas -NURS 6050 week 1 Discussion

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