Health Care Reform Research Paper
Shanna Bennett
September 8, 2013
AL420 Current Issues in Allied Health
Health Care Reform: Past, Present, and Future
Introduction
Health care, and the lack thereof, in the United States have always been and will continue to be an issue. Currently, the United States does not have Universal Healthcare and those that do have health care coverage should feel privileged. The purpose of this paper is to discuss the: a) way healthcare is currently delivered, b) the history of health care reform, c) the current healthcare reform act, and d) what healthcare will be like in the future.
Current Health Care Delivery System
The United States health care system is complex. It is not centrally controlled and has …show more content…
a variety of payment, insurance, and delivery mechanisms. The U.S. health system is mostly privately owned, either you have private health insurance, Medicare, Medicaid, or you are uninsured. In 2010, private financing, which is predominately through employers, accounted for approximately 34 percent of total health expenditures- 14 percent were out-of- pocket costs, 23 percent were paid by Medicare, 17 percent by Medicaid, and the remaining 12 percent by other insurance, payers, and programs (National Center for Health Statistics, 2012). An individual must have health insurance to receive primary health services or pay out-of-pocket.
Health care in the U.S.
is not inexpensive. According to the Centers for Medicare & Medicaid Service, U.S. health care spending reached $2.7 trillion in 2011, or $8,680 per person. This is 17.9 percent of the Gross Domestic Product. Health spending grew by 3.9 percent which was the same growth rate as in 2009 and 2010 (Center for Medicare and Medicaid Services [CMS], 2011). Because health care is so expensive it makes it difficult for those without health insurance to access primary care services. Health insurance is the primary means of accessing health care. The current health care delivery system is technology-driven with the newest medical technology being highly sought out. Patients assume that current technologies offer the best care and physician’s want to try the latest gadgets. Hospitals also compete on the basis of having the most modern equipment. This, in effect, drives up health care costs making it more difficult for individuals to obtain health …show more content…
insurance.
Private Health Insurance
Private insurance is either obtained through an employer or purchased from a private insurance company. Millions of Americans have private health insurance coverage through a managed care system. Managed care is defined as a system of providing health care (as by an HMO or PPO) that is designed to control costs through managed programs in which the physician accepts constraints on the amount charged for medical care and the patient is limited in the choice of a physician (Merriam-Webster). Managed care is the most dominant health care delivery system in the United States and is available to most Americans that can pay for it. With managed care insured’s have a select group of providers to choose from and will pay a higher rate when care is provided by someone not on the list.
Medicare and Medicaid Medicare and Medicaid are both large health care sources in the United States. Medicare is available to those 65 years of age and older, those under the age of 65 designated as having certain disabilities, and persons of any age with End-Stage Renal Disease (Medicare.gov). There is a Part A, Part B, and a Part D (prescription drug plan). Part A is used for most hospital stays, nursing facilities, and hospice care. Part B is mainly for physicians’ services and outpatient care and there is a premium associated with Part B. There are millions of disabled and elderly on Medicare. Medicaid provides coverage for low-income families, children, elderly people, and those with disabilities. Families that make under a certain income can also receive Medicaid for their children.
Uninsured
There are about 45 million uninsured Americans today. These individuals have access to care, but must pay expenses out-of- pocket. Since paying out-of- pocket may not be an option for many uninsured individuals, Emergency departments are often used as a safety net. With the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1996, stating that all U.S. hospitals receiving Medicare funds are required to evaluate and stabilize patients seeking care in hospital emergency rooms, many self-pay individuals have the mentality that they will always be treated in an emergency room. This clogs up the emergency department for those that truly have an emergency. With the passage of Universal Health Care, more people will become insured and will have access to primary care physicians to receive recommended preventative services which will subsequently lead to fewer emergency department visits.
History of Health Care Reform
Health care reform did not start when Obama became president. Health care reform goes back as far as 1854, when President Franklin Pierce vetoed a national mental health bill because he believed that personal health was not a government matter. In 1912, President Theodore Roosevelt called for national health care and in 1935, when President Franklin D. Roosevelt signed the Social Security Act into law he left out national health insurance because he feared attacks for the American Medical Association (American Journal of Public Health, 2003). President Bill Clinton proposed reworking the health care system with universal coverage in 1993 but the Republicans voted against it. President George W. Bush did succeed in signing a law adding prescription drug coverage to Medicare (Part D). A few other Presidents suggested national health care but it never actually went anywhere or was opposed by the Senate.
Current Health Care Reform Act The Affordable Care Act (ACA) is the U.S. health care reform law that was enacted in 2010 by President Obama and was upheld by the U.S. Supreme Court in 2012. The ACA is expected to directly affect every American citizen by 2014 and will require every American citizen to obtain health insurance or pay a penalty. There will be an employer mandate, federal subsidies for the poor, expanded access to Medicaid and will provide regulations for insurance companies to cover everyone, regardless of pre-existing conditions. Individuals that currently have health insurance through their employer will most likely not see a huge change.
Essentials of the Affordable Care Act With the mandate every American citizen and legal resident will have health insurance or pay a penalty. The penalty will most likely be applied through a tax. There will be subsidies available to those that have trouble meeting the obligation. For instance, Medicaid will be expanded to include every American whose income is under 138 percent of poverty (Congressional Budget Office). According to the CBO, the number of Medicaid recipients will increase to 17 million in 2021 and will increase federal spending for those programs by $627 billion over the 2012-2021 periods. Another subsidy is health care exchanges, which may possibly be determined by each individual state or they can let the federal government control it. These exchanges allow individuals who don’t have employer-based coverage, and are not eligible for Medicaid, to obtain coverage.
Health Care in 2023 By the year 2023, the majority of American citizens and legal residents will be insured with some type health insurance. According to the CBO estimates, the ACA will still leave 23 million citizens without health insurance after full implementation in 2019. Some citizens may not elect to accept coverage and just pay the penalty.
Private Sector
Universal Healthcare should be run as a single-payer system so that the costs can be afforded by all and everyone can benefit from a life time of health care. Shi, Et.Al, suggests a variation on comprehensive health reform, which would allow patients to “purchase additional health care coverage to supplement a core benefits package provided by the government”. Employers would receive incentives for providing insurance for their employees, and small businesses would receive a huge tax break or be exempt. Patients would receive free preventative service services and will strengthen the nation’s primary care foundation. The CBO estimates $3.5 billion will be available to primary care providers depending on the percentage of Medicare patients they see.
Medicare and Medicaid In 2010, President Obama stated that the ACA is expected to keep Medicare strong and solvent- today and tomorrow. The CMS projects that with implementation of the ACA, the life of the Medicare Hospital Insurance Trust Fund is increased by 12 years from 2017 to 2029, more than doubling the time before the exhaustion of the trust fund (CMS). The CMS believes Medicare recipients will receive a higher quality of care and lower Part B premiums by 2019. As stated previously, Medicaid will expand to include millions of Americans that are not currently eligible because the income poverty level will be increased to 138%.
Summary
Health Care reform did not start in 2010 when Obama became President.
Obama just happened to get further than past Presidents. Even though by 2019 millions of Americans will still be uninsured, the Affordable Care Act is still considered Universal Health Care. This is evident by the fact that it will be available to all U.S. citizens and legal residents. Whether an individual chooses to participate is fully up to them. Insurance companies will not be able to deny individuals on pre-existing conditions nor be able to increase insurance rates and premiums. Employers will benefit from receiving incentives to providing health insurance coverage for
employees.
Conclusion
In a best-case scenario, the quality of care, access to care and the outcome of U.S. health care will increase with the completion of the already-implemented policy changes. At the very least, emergency department overcrowding and easily prevented illnesses should decrease. There is still a long way to go, but any movement is progress. Health Care will undoubtly continue to be a hot topic for discussion in the political realm, but one can certainly hope that it is always the best interest of the general public that will prevail.
References
Affordable Care Act update: Implementing Medicare cost savings. CMS Office of the Actuary, 2010. www.cms.gov/apps/docs/AVA-Update-Implementing-Medicare -Cost-Savings.pdf
Centers for Medicare and Medicaid Services. National Health Expenditures, 2011. Retrieved from http://www.cms.gov/Research-Statisitics-Data-and -Systems/Statistics-Trends-and-Reports
Congressional Budget Office. Letter to the Honorable Nancy Pelosi. Washington: Congressional Budget Office: 2010. Retrieved at http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf
Hoffman, Beatrice, (2003). Health Care Reform and Social Movements in the U.S. American Journal of Public Health, 93, 75-85. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/
Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights. www.healthcare.gov/law/provisions/billofright/patient_bill_of_rights.html.
Medicare Eligibility. www.medicare.gov/MedicareEligibility/Home.asp
National Centers for Health Statistics. Health, United States, 2012. Hyattsville, MD. Dept of Health and Human Services. Retrieved from http://www.cdc.gov/nchs/data/hus/hus12.pdf
September 8, 2013
AL420 Current Issues in Allied Health
Health Care Reform: Past, Present, and Future
Introduction
Health care, and the lack thereof, in the United States have always been and will continue to be an issue. Currently, the United States does not have Universal Healthcare and those that do have health care coverage should feel privileged. The purpose of this paper is to discuss the: a) way healthcare is currently delivered, b) the history of health care reform, c) the current healthcare reform act, and d) what healthcare will be like in the future.
Current Health Care Delivery System
The United States health care system is complex. It is not centrally controlled and has …show more content…
a variety of payment, insurance, and delivery mechanisms. The U.S. health system is mostly privately owned, either you have private health insurance, Medicare, Medicaid, or you are uninsured. In 2010, private financing, which is predominately through employers, accounted for approximately 34 percent of total health expenditures- 14 percent were out-of- pocket costs, 23 percent were paid by Medicare, 17 percent by Medicaid, and the remaining 12 percent by other insurance, payers, and programs (National Center for Health Statistics, 2012). An individual must have health insurance to receive primary health services or pay out-of-pocket.
Health care in the U.S.
is not inexpensive. According to the Centers for Medicare & Medicaid Service, U.S. health care spending reached $2.7 trillion in 2011, or $8,680 per person. This is 17.9 percent of the Gross Domestic Product. Health spending grew by 3.9 percent which was the same growth rate as in 2009 and 2010 (Center for Medicare and Medicaid Services [CMS], 2011). Because health care is so expensive it makes it difficult for those without health insurance to access primary care services. Health insurance is the primary means of accessing health care. The current health care delivery system is technology-driven with the newest medical technology being highly sought out. Patients assume that current technologies offer the best care and physician’s want to try the latest gadgets. Hospitals also compete on the basis of having the most modern equipment. This, in effect, drives up health care costs making it more difficult for individuals to obtain health …show more content…
insurance.
Private Health Insurance
Private insurance is either obtained through an employer or purchased from a private insurance company. Millions of Americans have private health insurance coverage through a managed care system. Managed care is defined as a system of providing health care (as by an HMO or PPO) that is designed to control costs through managed programs in which the physician accepts constraints on the amount charged for medical care and the patient is limited in the choice of a physician (Merriam-Webster). Managed care is the most dominant health care delivery system in the United States and is available to most Americans that can pay for it. With managed care insured’s have a select group of providers to choose from and will pay a higher rate when care is provided by someone not on the list.
Medicare and Medicaid Medicare and Medicaid are both large health care sources in the United States. Medicare is available to those 65 years of age and older, those under the age of 65 designated as having certain disabilities, and persons of any age with End-Stage Renal Disease (Medicare.gov). There is a Part A, Part B, and a Part D (prescription drug plan). Part A is used for most hospital stays, nursing facilities, and hospice care. Part B is mainly for physicians’ services and outpatient care and there is a premium associated with Part B. There are millions of disabled and elderly on Medicare. Medicaid provides coverage for low-income families, children, elderly people, and those with disabilities. Families that make under a certain income can also receive Medicaid for their children.
Uninsured
There are about 45 million uninsured Americans today. These individuals have access to care, but must pay expenses out-of- pocket. Since paying out-of- pocket may not be an option for many uninsured individuals, Emergency departments are often used as a safety net. With the passage of the Emergency Medical Treatment and Active Labor Act (EMTALA) in 1996, stating that all U.S. hospitals receiving Medicare funds are required to evaluate and stabilize patients seeking care in hospital emergency rooms, many self-pay individuals have the mentality that they will always be treated in an emergency room. This clogs up the emergency department for those that truly have an emergency. With the passage of Universal Health Care, more people will become insured and will have access to primary care physicians to receive recommended preventative services which will subsequently lead to fewer emergency department visits.
History of Health Care Reform
Health care reform did not start when Obama became president. Health care reform goes back as far as 1854, when President Franklin Pierce vetoed a national mental health bill because he believed that personal health was not a government matter. In 1912, President Theodore Roosevelt called for national health care and in 1935, when President Franklin D. Roosevelt signed the Social Security Act into law he left out national health insurance because he feared attacks for the American Medical Association (American Journal of Public Health, 2003). President Bill Clinton proposed reworking the health care system with universal coverage in 1993 but the Republicans voted against it. President George W. Bush did succeed in signing a law adding prescription drug coverage to Medicare (Part D). A few other Presidents suggested national health care but it never actually went anywhere or was opposed by the Senate.
Current Health Care Reform Act The Affordable Care Act (ACA) is the U.S. health care reform law that was enacted in 2010 by President Obama and was upheld by the U.S. Supreme Court in 2012. The ACA is expected to directly affect every American citizen by 2014 and will require every American citizen to obtain health insurance or pay a penalty. There will be an employer mandate, federal subsidies for the poor, expanded access to Medicaid and will provide regulations for insurance companies to cover everyone, regardless of pre-existing conditions. Individuals that currently have health insurance through their employer will most likely not see a huge change.
Essentials of the Affordable Care Act With the mandate every American citizen and legal resident will have health insurance or pay a penalty. The penalty will most likely be applied through a tax. There will be subsidies available to those that have trouble meeting the obligation. For instance, Medicaid will be expanded to include every American whose income is under 138 percent of poverty (Congressional Budget Office). According to the CBO, the number of Medicaid recipients will increase to 17 million in 2021 and will increase federal spending for those programs by $627 billion over the 2012-2021 periods. Another subsidy is health care exchanges, which may possibly be determined by each individual state or they can let the federal government control it. These exchanges allow individuals who don’t have employer-based coverage, and are not eligible for Medicaid, to obtain coverage.
Health Care in 2023 By the year 2023, the majority of American citizens and legal residents will be insured with some type health insurance. According to the CBO estimates, the ACA will still leave 23 million citizens without health insurance after full implementation in 2019. Some citizens may not elect to accept coverage and just pay the penalty.
Private Sector
Universal Healthcare should be run as a single-payer system so that the costs can be afforded by all and everyone can benefit from a life time of health care. Shi, Et.Al, suggests a variation on comprehensive health reform, which would allow patients to “purchase additional health care coverage to supplement a core benefits package provided by the government”. Employers would receive incentives for providing insurance for their employees, and small businesses would receive a huge tax break or be exempt. Patients would receive free preventative service services and will strengthen the nation’s primary care foundation. The CBO estimates $3.5 billion will be available to primary care providers depending on the percentage of Medicare patients they see.
Medicare and Medicaid In 2010, President Obama stated that the ACA is expected to keep Medicare strong and solvent- today and tomorrow. The CMS projects that with implementation of the ACA, the life of the Medicare Hospital Insurance Trust Fund is increased by 12 years from 2017 to 2029, more than doubling the time before the exhaustion of the trust fund (CMS). The CMS believes Medicare recipients will receive a higher quality of care and lower Part B premiums by 2019. As stated previously, Medicaid will expand to include millions of Americans that are not currently eligible because the income poverty level will be increased to 138%.
Summary
Health Care reform did not start in 2010 when Obama became President.
Obama just happened to get further than past Presidents. Even though by 2019 millions of Americans will still be uninsured, the Affordable Care Act is still considered Universal Health Care. This is evident by the fact that it will be available to all U.S. citizens and legal residents. Whether an individual chooses to participate is fully up to them. Insurance companies will not be able to deny individuals on pre-existing conditions nor be able to increase insurance rates and premiums. Employers will benefit from receiving incentives to providing health insurance coverage for
employees.
Conclusion
In a best-case scenario, the quality of care, access to care and the outcome of U.S. health care will increase with the completion of the already-implemented policy changes. At the very least, emergency department overcrowding and easily prevented illnesses should decrease. There is still a long way to go, but any movement is progress. Health Care will undoubtly continue to be a hot topic for discussion in the political realm, but one can certainly hope that it is always the best interest of the general public that will prevail.
References
Affordable Care Act update: Implementing Medicare cost savings. CMS Office of the Actuary, 2010. www.cms.gov/apps/docs/AVA-Update-Implementing-Medicare -Cost-Savings.pdf
Centers for Medicare and Medicaid Services. National Health Expenditures, 2011. Retrieved from http://www.cms.gov/Research-Statisitics-Data-and -Systems/Statistics-Trends-and-Reports
Congressional Budget Office. Letter to the Honorable Nancy Pelosi. Washington: Congressional Budget Office: 2010. Retrieved at http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/113xx/doc11379/amendreconprop.pdf
Hoffman, Beatrice, (2003). Health Care Reform and Social Movements in the U.S. American Journal of Public Health, 93, 75-85. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447696/
Fact Sheet: The Affordable Care Act’s New Patient’s Bill of Rights. www.healthcare.gov/law/provisions/billofright/patient_bill_of_rights.html.
Medicare Eligibility. www.medicare.gov/MedicareEligibility/Home.asp
National Centers for Health Statistics. Health, United States, 2012. Hyattsville, MD. Dept of Health and Human Services. Retrieved from http://www.cdc.gov/nchs/data/hus/hus12.pdf