NRS 440 Assignment 2 How a Bill Becomes a Law Essay

NRS 440 Grand Canyon Topic 4 Assignment 2 How a Bill Becomes a Law

NRS 440 Assignment 2 How a Bill Becomes a Law Essay


As you have discovered through this course, nurses are influential members of the community and the political system. Therefore, for the purposes of this assignment you will identify a problem or concern in your community, organization, etc. that has the capacity to be legislated. You will conduct research and state a proposal. Through the legislative process, your proposal for the problem or concern may influence an idea for change into a law.

First, refer to the “How a Bill Becomes a Law” media.

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Then, view the “Bill to Law Process” to watch the scenario.

After viewing the scenario, refer to the “Legislative Assignment.” You will need to save the document first in order to use it.

Submit the assignment to the instructor. You also reserve the right to submit your completed proposal to the respective government official. However, this is optional. If you select to submit your proposal as a

NRS 440 Assignment 2 How a Bill Becomes a Law Essay
NRS 440 Assignment 2 How a Bill Becomes a Law Essay

part of the legislative process, refer to “Find Your Representative” or research the contact information on your own.

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NRS 440 Grand Canyon Topic 5 Discussion 1

Identify the educational preparation and role(s) of the clinical nurse leader (CNL) designation. Give an example of how the CNL influences direct patient care whether in a hospital or out in the community.

NRS 440 Grand Canyon Topic 5 Discussion 2

What you can use to create change in your current workplace.

Legislative Worksheet (SBAR Format) –

How a Bill Becomes a Law


  • Problem: There has been an ongoing debate on policies that can make the American healthcare system more affordable. Even with Medicare and private healthcare programs, many Americans still cannot afford quality medical care. There have been differences in opinion regarding how to improve health care for Americans. Bernie Sanders, Elizabeth Warren, and others support a single-payer Medicare for All system. Joe Biden, Pete Buttigieg, Amy Klobuchar, and others want an incremental approach building on the Affordable Care Act. However, candidates who are battling over plans like Medicare for All (Mr. Sanders) versus Medicare for All Who Want It (Pete Buttigieg) versus Medicare for America (Beto O’Rourke) versus BetterCare (John Delaney) — and many others — are having the wrong debate. Instead, they should be competing to find the best ways to tackle affordability — an issue that has largely remained unaddressed. Changing some existing policies, like harmonizing the income eligibility standards for Medicaid and the insurance exchanges, would enable the government agencies, hospitals, insurers, and other organizations to enroll people in health insurance automatically when they show up for care or other benefits like food stamps. For the other 295 million Americans who have some form of health insurance, the problem is high costs (Emanuel, 2019). Even with health insurance, high premiums, deductibles and co-pays, surprise hospital bills and exorbitant drug prices inhibit people from accessing care and taking their medications, threaten to drain their savings, or even force Americans into bankruptcy. There is a need to have a plan to deal with this problem. This necessitates the introduction of a bill to Congress to address the issue of affordability. The issue of unaffordability is something that can be legislated because addressing it would benefit most stakeholders including the American public and the government. Thus, the present paper proposes the centralization of the insurance system in order to reduce wastage while ensuring the effectiveness of the same. NRS 440 Assignment 2 How a Bill Becomes a Law Essay
  • Proposal/idea: There is a need to have a policy that targets wasteful insurance billing practices. In 2010, the National Academy of Medicine estimated that about 14 percent of health care spending was related to billing and insurance-related administrative activities. Updating those numbers for today, the Center for American Progress estimates that the United States spends nearly $500 billion a year on billing and insurance processing (Pope, 2019). Based on comparisons with other countries, about half of that is classified as “excess” — a polite way of referring to waste. The simplest approach is thus to empower an independent commission to create a clearinghouse for processing all medical bills with uniform standardized electronic formats for all insurers. Both Germany and Japan — countries with hundreds and thousands of insurance companies — have such centralized bill processing systems, generating low billing costs. Health economists suggest this could yield savings that are more than 3 percent of expenditures, about $90 billion annually.



  • A centralized way to handle insurance and billing issues can significantly reduce health care unaffordability problem in the United States. In Japan, the central government regularizes the health care system through the Universal Statutory Health Insurance System (SHIS). The law necessitates local and national administrations to implement a health care structure that expeditiously provides high-quality care (The Commonwealth Fund, 2019). The Japanese central government provides subsidized support to local governments, health care providers, and insurance companies. Similarly, it determines the SHIS fee schedule and sets up and implements elaborate regulations for providers and insurers. Japan’s forty-seven regions or prefectures implement the regulations and have their regional health care delivery systems developed using funds from the national government, as well as their own budgets. This system has effectively implemented health promotion strategies and led to huge cost savings due to price regulation for all services. All stakeholders are involved in negotiations when fees are reviewed, which takes place every year. Such a system can work in the United States to help reduce the cost of healthcare.
  • Similar legislation passed or introduced in other states: Several bills have been introduced in different states to curb the escalating cost of healthcare. Two of these are related to the lack of affordability of quality health care in the United States. In 2018, a bill was introduced in California to impel the state government to set prices for healthcare services such as doctor visits, hospital stays, and others (Mason, 2018). The aim of this bill was to help cut down on healthcare costs. The bill did not pass because of wide opposition. Massachusetts lawmakers, on the other hand, have been discussing a bill to control the pricing of prescription drugs. This bill attempts to moderate expenses on health care that are burdening the state government itself, as well as employers, consumers, providers, and insurers. NRS 440 Assignment 2 How a Bill Becomes a Law Essay


  • Financial Impact: The Center for American Progress Health reports that care providers and payers in the U.S. spend nearly $460 billion on insurance and billing-related costs (Gee & Spiro, 2019). A healthcare policy to address waste can potentially save this cost. The National Academy of Medicine reports that the U.S. spends roughly double of what is needed for billing and costs related to insurance. Currently, this administrative excess adds up to $248 billion every year, which can be saved if healthcare plans can be centralized. Health care providers – hospitals, physicians, and others – can save more and increase their revenue if such a policy is introduced because someone else will handle billing for them. The providers will not have to incur costs related to billing or insurance. NRS 440 Assignment 2 How a Bill Becomes a Law Essay
  • Stakeholder groups that will potentially support this bill: The proposed bill will basically ensure affordability of health care for every American, implying that the public will generally support it. Since duplicative coverage will not be allowed in the proposed system, most legislators are likely to support the bill in the interest of the savings to the government and the majority of people who cannot afford quality medical care currently. Most medical professionals will support the bill because it enables them to focus on treating patients instead of thinking about malpractice liability, carrying out insurance procedures, and other issues. Since the bill will propose free medical services for patients, Americans can engage more in preventive care, which will reduce the cost of treating diseases. The proposed centralized program will also benefit patients with preexisting conditions, implying that they will support the bill as well.
  • Groups/people Likely to oppose this Bill: This proposed bill will seek to cover more people but decrease the cost associated with billing and insurance processing. Such administrative costs amount 15-30% for private insurance companies while the same cost is about 5% for the Medicaid program. The same cost for Medicare is between 1 and 2 percent. Administrative costs, particularly for private insurance companies, include shareholders’ profits and advertising, as well as the collecting and billing costs of doctors’ offices, hospitals, X-ray facilities, and labs. These costs have been a nightmare to patients, who opt to change between insurance companies. Having a centralized system that gets rid of such costs is likely to be opposed by private insurance companies. These players will also oppose the bill because of the potential business closures, as well as loss insurance industry jobs. Some health care providers may oppose the bill because of the complex transition process characterized by the creation of new patient records, as well as the lost opportunity to bill more to patients. Health care organizations in private practice may oppose the bill because of the possibility of closure. Similarly, physicians who intend to get into private practice may choose not to support the bill. NRS 440 Assignment 2 How a Bill Becomes a Law Essay


  • Based on inherent issues with affordability, there is a need to have a more centralized body that can process all insurance claims. This would eliminate the waste associated with billing and insurance processing. Thus, I plan to arrange an appointment with Assemblywoman Aileen M. Gunther of New York District 100. I will first seek her view about the need to control the issue of unaffordability in healthcare. I will ask what I need to do, including whether there is a need to get signatures from New York Residents who support this idea. I will then take the signatures to her, and she will introduce the bill to the House for consideration


Emanuel, E. (2019). Opinion | Democrats Are Having the Wrong Health Care Debate. Retrieved 8 August 2019, from

Gee, E., & Spiro, T. (2019). Excess Administrative Costs Burden the U.S. Health Care System – Center for American Progress. Retrieved 8 August 2019, from

Mason, M. (2018). An ambitious California bill would put the state in charge of controlling prices in the commercial healthcare market. Retrieved 9 August 2019, from

Pope, C. (2019). Issues 2020: Private Health Insurance Saves Americans Money | Manhattan Institute. Retrieved 8 August 2019, from

The Commonwealth Fund. (2019). Japan: International Health Care System Profiles. Retrieved 8 August 2019, from

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