In this assessment, you will explore how a healthcare model/framework impacts health policy. You will explain the current US presidential administration’s proposed changes to healthcare. This will help you understand the factors that affect healthcare finance.

Healthcare changes rapidly. This assessment is designed to help you understand how healthcare is organized and financed. It is important that, as a nurse, you possess a solid understanding of healthcare finance and subsequent impacts on policy.

You are working on a report that will be shared with everyone, including leaders of your department at work. Your report should include the following:

Explain how the current presidential administration has organized the healthcare plan of this nation.
Are social determinants evident in our existing healthcare policy?
Based upon your research of the current healthcare framework, provide a summary of the proposed changes found under the current United States administration.

Cite at least 3 peer-reviewed sources published within the last 5 years that support your assignment. Include an APA-formatted reference page.

The Impact of U.S. Healthcare Framework on Policy: An Analysis of the Current Presidential Administration’s Healthcare Plan

Introduction

Healthcare in the United States is a complex interplay of policy, financing, and service delivery. As nurses are increasingly called upon to lead in clinical, policy, and administrative roles, understanding how healthcare models and frameworks shape policy is essential. This report analyzes how the current presidential administration has structured the national healthcare plan, explores the role of social determinants of health within existing policy, and summarizes proposed changes that may affect healthcare financing and access. This analysis draws on peer-reviewed literature and federal policy proposals to provide a comprehensive overview relevant to healthcare professionals.

Healthcare Organization Under the Current U.S. Presidential Administration

The current presidential administration has maintained a mixed public-private healthcare model with incremental reforms aimed at increasing access, reducing costs, and expanding coverage. The administration’s approach focuses on strengthening and building upon the Affordable Care Act (ACA) infrastructure, which includes:

Medicaid expansion efforts in states that have not yet expanded coverage.
Enhancing ACA marketplace subsidies to reduce premium costs and increase affordability.
Support for public health insurance options that complement private plans to broaden coverage options.
Prescription drug cost reforms aimed at reducing out-of-pocket spending.

This framework combines federal regulation with market-based solutions and safety-net programs to extend coverage while attempting to contain costs. The administration also emphasizes preventive care, behavioral health integration, and value-based care delivery, promoting outcomes over volume.

Social Determinants of Health in Current Healthcare Policy

Social determinants of health (SDOH) — such as income, education, housing, food security, and access to care — are increasingly recognized as essential contributors to health outcomes. The current healthcare policy framework explicitly incorporates SDOH through several mechanisms:

Medicaid and Medicare Payment Models: Policies now allow reimbursement for certain social services that demonstrably improve health outcomes (e.g., transportation to medical appointments, housing supports).
Community Health Initiatives: Federal funding streams, such as through the Centers for Medicare & Medicaid Services (CMS) Innovation Center, support community partnerships to address food insecurity and housing instability.
Data Collection and Reporting: Increased emphasis on collecting SDOH data to inform risk adjustment and quality measures in value-based care models.

Peer-reviewed research indicates that including SDOH in policy promotes equity and can reduce long-term costs by preventing disease progression and avoiding emergency care utilization (Gottlieb & Adler, 2018; Cottrell et al., 2019).

Proposed Changes in U.S. Healthcare Policy

The current administration’s proposed changes reflect trends toward expanded access, affordability, equity, and quality improvement:

1. Strengthening ACA Coverage

The administration has supported legislation and executive actions to:

Increase subsidies for ACA marketplace plans.
Incentivize states to adopt Medicaid expansion.
Provide enhanced outreach and enrollment assistance.

These changes aim to decrease the uninsured rate and reduce cost barriers to care (Buettgens & Blumberg, 2021).

2. Prescription Drug Cost Reduction

Major proposals include:

Allowing Medicare negotiation for certain high-cost drugs.
Capping out-of-pocket costs for Medicare beneficiaries.
Promoting competition through biosimilars and generics.

Prescription drug pricing reform is projected to generate significant cost savings for patients and public programs (Sood et al., 2020).

3. Value-Based and Alternative Payment Models

The administration continues to support alternative payment models that reward quality and outcomes, such as:

Accountable Care Organizations (ACOs).
Bundled payment initiatives.
Pay-for-performance programs in Medicare and Medicaid.

These models are designed to align incentives toward efficient, high-value care.

4. Health Equity and SDOH Integration

Proposals include expanding funding for community health workers, integrating SDOH screening into care plans, and increasing support for behavioral health services in underserved communities.

Conclusion

The U.S. healthcare system operates under a hybrid public-private framework that continues to evolve under the current presidential administration. Policy actions build upon the ACA, with a focus on expanding coverage, reducing costs, and incorporating social determinants of health into care delivery and financing structures. Proposed changes, particularly in prescription drug reform, value-based payments, and equity initiatives, underscore a comprehensive approach to improving healthcare access and outcomes. For nurses and healthcare leaders, understanding these dynamics is crucial for advocating for patients, shaping organizational strategies, and contributing to policy development.

References

Buettgens, M., & Blumberg, L. J. (2021). The impact of health reform on insurance coverage and costs through 2022: Evidence from the American Community Survey. Health Affairs, 40(3), 407–416. https://doi.org/10.1377/hlthaff.2020.01502

Cottrell, E. K., et al. (2019). Real-world outcomes of social determinants of health screening and interventions in primary care: A systematic review. Journal of the American Board of Family Medicine, 32(5), 737–756. https://doi.org/10.3122/jabfm.2019.05.190020

Gottlieb, L. M., & Adler, N. E. (2018). A broader social policy roadmap to health. JAMA, 319(20), 2131–2132. https://doi.org/10.1001/jama.2018.5082

Sood, N., et al. (2020). Prescription drug pricing reforms: Insights from international reference pricing and Medicare negotiation. Health Economics, 29(4), 438–451. https://doi.org/10.1002/hec.4001