History and Process of Health Policy-Making in US

Subject: Healthcare Research
Pages: 4
Words: 1219
Reading time:
5 min
Study level: Bachelor


Healthcare policies have been a sensational factor that determines the welfare of the people of the US for a long while. Although policymaking takes a long process due to legal implications, the execution of various clauses of law changes terms that help boost the provision of medical services. The government of the US is the foundational element that plays a key role in changing health policies in a move to ensure that there is efficacy in universal health coverage (Gordon, 2004). Various levels of government, such as the State and Federal administration, must be consulted before embarking on any health policy process. For instance, the Federal government has been given powers to create and execute laws passed in judicial branches across the country.

Three Phases of Policy Making in Federal Government

Any policymaking must pass through the main stages in the federal government. The phases include formulation, implementation and modification stages, as shown in Figure. These phases form a core model when it comes to public policymaking procedures. Thus, incorporating various stakeholders and requirements in each phase is vital for legalizing a policy in the Federal government (Longest, 2016). The important aspect mentioned in these phases is that they are designed to allow decisions to be made concerning a given agenda. Health policymaking follows these phases because of the nature in which the field is at the heart of the people of the US. Below is a description of the three phases of policymaking at the country’s federal level of government.

Three Phases in the Policymaking process in the US
Figure 1: Three Phases in the Policymaking process in the US (Longest, 2016).

Formulation Phase

At the federal level, health policymaking consists of two unique and sequential sections: agenda-setting and legislation development. The policymakers in each section must conduct activities that determine the end game of the matter (Longest, 2016). During this phase, the outcome is embracing or intention to create new laws. The public laws created in this stage mostly probe legislators to amend the existing laws in healthcare. That process catalyzes the formation of new regulations that allow judicial decisions to get initiated in the entire process. The agenda-setting involves the amendment of laws that concern health. In this process, the commencement of amendment is through interactions of wide health-centric issues, the probable remedies, and the dynamism in political perspective that relates to the challenges.

The key stakeholders in the formulation phase include the legislators, such as members of parliament and senators, and health policymakers through representative groups. These parties usually lead to the development of legislation to address the problems raised. During the process, the problems and solutions stimulate the development of laws as the opportunity nears backing by the majority in the House of Representatives (Longest, 2016). Bills are presented in the respective houses and are addressed through debate to create public laws that combat health problems that the people of the US face. The bill is drafted, referred to the committee and reviewed before hearing (Niknamian, 2018). The end process involves a series of processes such as voting and referral to the House of Senate before final actions. Issues that may develop in this case include instruction of bills that may help the US citizens rather than the policymakers (Gordon, 2004). Additionally, there might be flexibility to adjust to the pressure of formulating the laws, which means the parties involved might desperately agree to form a consensus.

Implementation Phase

After the health policy is amended or introduced as new public law, there follows the enactment of legislation that starts the execution of the policy. This phase involves a bridge that connects the formulation and implementation through interrelated steps such as designing, rulemaking, operating and evaluation (Gordon, 2004). The key stakeholders in the implementation stage include departments and agencies within the US executive federal government. The people concerned with this matter are hired to start the intention to act as per the amendments of public law by the legislation. Health policies in a stage must be executed effectively to measure whether or not they are to help or change lives for Americans (Niknamian, 2018). Designing must have the means to administer the policy and management of social and political issues that come along the way.

Rulemaking involves setting legislative actions that shall be followed whenever there is a breach of the policy when administering health at the federal level of government. In this section, stakeholders such as members of the judiciary become part of the phase as they assist in prosecution during the process, as shown in Figure 2 (Longest, 2016). Operation means actualizing the plan, such as medical enrollment, and inclusion of people with clinical expertise to leverage challenges that may come with the implementation. Issues that may be present in this phase are a limitation of the rule of law whereby policymakers drive changes that the people absorb by force (Niknamian, 2018). Additionally, consent, in this case, may not be guaranteed as the top-level stakeholders usually agree on the health policies without involving the target beneficiaries.

The implementation phase
Figure 2: The implementation phase (Longest, 2016).

Modification Phase

Due to the loopholes observed in health policy, there is room to modify the mistakes adjustment of changes that might change circumstances. The modification is essential to avoid adverse effects that might be felt if a law is applied in its original form (Niknamian, 2018). The key stakeholders in this phase are the interest groups, individuals, health organizations and any other party affected by the new law. There is concurrence to modify the law to avoid possible liabilities of bias to given parties. The modification phase is meant to finalize health policy by weighing possible outcomes on the target sides. During this phase, some policies may be discarded while others give a chance for the development of new laws to enhance the existing matter. Issues that might be present include disregard for a phenomenal policy that may positively change the welfare of US nationals when it comes to healthcare provision (Longest, 2016). The reason is that many parties may have a conflict of interest while protecting specific issues.

How the Stages are Inter-related

The three phases discussed above are interrelated in that without the formulation stage, implementation will not be there. Similarly, when the policies are not implemented, there would be nothing to change in the modification stage. All the phases require collaborative measures between policymakers, interest groups, civilized individuals, legislators and judicial members at the federal level of government in the US (Patel & Rushefsky, 2019). All the phases require political perspectives before competing to the next stage. For example, during formulation, the legislators will try to understand how the proposed amendments will benefit the people of the US in terms of matters of healthcare.

Under that perception, the stakeholders will be working hard to set a legacy that will aid in building their political milestones. Similarly, the implementation and modification stages involve a series of political differences. In this case, the Democrats will base their arguments in a given direction, and the Republicans have the same ideology. The implementation of a given health policy depends on the majority in the government (Gordon, 2004). Thus, all the phases are interrelated due to the extent to which they apply political metrics in efforts to build an environment where the people of the US are protected health-wise.


Gordon, C. (2004). Dead on arrival: The political economy of American health care. Princeton University Press.

Longest, B. (2016). Health policymaking in the United States: The context of health policymaking (6th ed.). Health Administration Press.

Niknamian, S. (2018). Designing a model to investigate the role of the factors formulation of public policies in the implementation of the administrative system health policy. SSRN Electronic Journal, 9(2), 11-18.

Patel, K., & Rushefsky, M. (2019). Healthcare politics and policy in America (5th ed.). Routledge.