Week Seven 02/23/15-03/01/15: The Affordable Care Act as an Example of Public Policy Implementation

From what we have read from Kingdon (2011), we learned that the Affordable Care Act (ACA) had to be very strategically done. President Clinton tried to initiate a total health care reform in 1993. However this did not go over well, because there are many interest groups and stakeholders that need and want to be involved when planning a total health care reform. Also, there are many chances to veto a bill in this political culture and the bill has to go through every stage in the voting process. Furthermore, we have learned that when there is a problem and it involves policy and politics, then a window of opportunity opens to where it will be very likely that a bill will pass. This moment has to be acted on or else it may not be addressed again for a very long time (Kingdon, 2011).

The Arizona Medical Marijuana Act passed in 2010 and there is a debate going on now about legalizing marijuana for recreational use. I think that our window of opportunity is still there if nurse practitioners want to be included in the legislative language to certify patients for medical marijuana. The problem is that most physicians will not risk their licenses to certify patients for a federally illegal substance and there is not enough research out there on marijuana to be confident enough to recommend marijuana for therapeutic use (G. Mecagni, telephone interview, February 8, 2015 ). In addition, most patient’s providers are nurse practitioners and we aren’t legalized to certify patients for medical marijuana. Therefore, most patients have to go to certification mills to get certified. Unfortunately the certification mill probably doesn’t know the patient very well. This creates an environment where it is easier to get marijuana and receive protection under the law for substance abuse. If nurse practitioners were included in the legislative language, then we could help regulate medical marijuana more safely and efficiently, as well as decrease the stigma surrounding marijuana as a “dangerous drug.” According to Dr. Mecagni (February 8, 2015), an expert in the field of medical marijuana, the safety profile of marijuana is not as bad as some of our legal prescription drugs. Dr. Mecagni supports that it is not our place to assume that any patient is a drug seeker, but to use our prudent medical judgment to assist patients with finding a therapeutic regimen that works for them, especially if behavioral or other pharmaceuticals have not worked very well for them. Marijuana may be more effective for their condition considering the safety and side effect profile (G. Mecagni, telephone interview, February 8, 2015). For those of you who do not wish to recommend medical marijuana to patients, I want to assure you that in Arizona, physicians reserve the right to not participate in the Arizona Medical Marijuana Program and I believe this right will also be extended to nurse practitioners if we are legally allowed to certify patients for medical marijuana (Arizona Department of Health Services, n.d.).

If we were to initiate an amendment to the law, I believe that our best bet would probably be to contact the Marijuana Policy Project interest group to get in touch with a representative for our state. In this case, it would be Andrew Meyers. We would need to file for a petition with the Arizona Secretary of the State and get 225,962 signatures or 15% of the votes for the most recent gubernatorial election for the Arizona governor to make it onto the ballot (Ballotpedia, n.d.). I believe this would work, because this is how Prop 203 was passed in the first place. Otherwise, Andrew Meyers would probably have to work with a representative in the House or the Senate that is interested in making medical marijuana more readily available to patients such as Arizona House of Representatives, Mark Cardenas. Then we could make our case, however, there is a greater likelihood of it being vetoed. I believe this could work, because it is an incremental change/amendment.

Lastly, I think that nurse practitioners should still be able to certify patients for medical marijuana even if marijuana become legalized for recreational use. Patients still need to be supervised under the guidance and direction of their primary care provider when using marijuana for therapeutic uses. I don’t think that marijuana should be legalized recreationally, because as a health care provider, we are in it to help people, and I do not support the use of marijuana for fun in exchange for increased health risks and tax revenue.

References

Arizona Department of Health Services. (n.d.) FAQs: QP15: Is a licensed physician required to write medical marijuana certifications to a patient who has a chronic or debilitating condition? Retrieved from http://www.azdhs.gov/medicalmarijuana/faqs/index.php?pg=qualifying-patients

BallotPedia. (n.d.). Laws governing the initiative process. Retrieved from http://ballotpedia.org/Laws_governing_the_initiative_process_in_Arizona

Kingdon, J. (2011). Agendas, alternative, and public policies (2nd ed.). Glenview, IL: Pearson Education.

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8 thoughts on “Week Seven 02/23/15-03/01/15: The Affordable Care Act as an Example of Public Policy Implementation

  1. I tend to disagree Lynn with the last paragraph. Lately there has been a large discussion about the possibility of Marijuana
    (MJA) being legalized for recreational use. I think if MJA was legalized then there would be a a shift in drug use from MJA being preferred over alcohol. I would like to see statistical data from states that have legalized to see if crime has lowered, as well as alcohol related deaths. I would prefer alcohol to be illegal rather than MJA. Here are my reasons. First, no one has ever died from a MJA overdose and no one can die from withdrawals if MJA is discontinued. Two, I would rather see MJA legal to decrease the amount of arrests and to focus on violent drug related crimes. Three, I like the idea of the education tax on MJA to fund our schools and the tax that would fund substance abuse programs which are so badly needed in AZ. What do you think?

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    1. You are entitled to your own opinion. I think that preference for marijuana or alcohol is dependent on the individual and their tendencies for addiction and mental health issues. It is too early to know if legalization of marijuana causes a change in crime rates. I wouldn’t want to compare crime rates or marijuana use in the United States to Europe, because of the differences in culture. It is not true that no one has ever died from marijuana. Marijuana has caused deaths while driving under the influence. We also know there are negative side effects from marijuana which are not better or worse than alcohol, they are both bad. I understand that people who are caught with illegal marijuana are criminalized and I think that it is overkill. Arizona’s laws for possession of marijuana are one of the most severe in the U.S. As for violent drug crimes, I believe that it all depends on how you look at the data. Violent drug crimes are not as prevalent as marijuana so it is expected that it is lower and more difficult to find. Lastly, I believe that it would cost our state more to treat patients that are addicted to marijuana or these people may not even come forward for help. I also don’t think parents wouldn’t like the idea that their child or adult child could have access to marijuana as common as alcohol. In addition, marijuana is associated with mental illness, decrease motivation, and job absence. Currently, I think that the risks outweigh the benefits, but I also think that there is not enough data/evidence out there to make a good decision. I think that it is way too soon to be making this decision to legalize marijuana for recreational use. We only just legalized marijuana for medical use in 2010. We should probably give it another 10 years and wait to see what happens to the other states. I would like to hear input from our psych classmates on their thoughts if marijuana could increase behavior problems in children and adolescents and how marijuana impacts our vulnerable population. Like I’ve said before, I don’t think this issue shouldn’t be taken lightly and we shouldn’t rush it.

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  2. I agree that most patients are followed by nurse practitioners, which is what I heard several years ago bothered the State Board of Nursing. Meaning the nursing board was concerned that nurse practitioners were prevented from recommending medical marijuana to their patients they follow, especially the oncology patient population. This has forced patients to go to certification mills where almost everyone is certified, or its very easy to become certified. One card center (certification mill) I spoke to works with a Naturopath and a certain Phoenix Chiropractor that can clear you and forward all of your paperwork back to the green card certification center for quick processing. These mills have made getting certified for medical marijuana a joke and that is the only thing that concerns me about involving nurse practitioners.

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  3. Medical marijuana is such an interesting topic. So much of my knowledge for medical marijuana has to do with pain control, antinausea, or to increase food intake typically realted to the effects of chemotherapy. However, I think more needs to be said about the use of marijuana for psychological issues such as anxiety, anger, etc. The majority of “recreational” users I have been exposed to have what I would consider an appropriate need for marijuary based upon their psychological issues. I also think that if NPs want to be considered as equal in terms of patient care, then NPs need to be automatically considered in the legislature for prescribing medical marijuana. As a side note, I don’t know if you saw the news in the last couple of weeks that talked about the effects of marijuana in relation to performance of tasks such as driving a vehicle. The study showed that a person under the effects of marijuana is only 5% more likely to have an accident than the unimpaired driver. CNN also did an independent test in 2013 and stated “pot smokers are actually pretty good drivers” (CNN, 2013). Quite frankly, marijuana appears to be a safer recreational drug than alcohol.

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  4. Lynn, as you consider the window of opportunity for pursuing NP prescribing, I wonder if you can draw any parallels for NP prescribing of other types of medications, devices, or services that have required a similar policy reform effort? Moreover, I am wondering whether any of the language in the ACA regarding NP services might serve as legislative precedent to allow for NP prescribing (allowing, of course, for the observation that the ACA is a federal law and marijuana is presently not legal at a federal level)? -HMR

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