User:ShayeandSarah/AP Gov: Health Care Policy in the United States

Brief Overview of Health Care Policy
Health Care Policy in the United States has a long and rocky history, both locally and federally. However, questions of reform would not truly take off until the 20th century, and large-scale reform would not take place until the latter half of the era. Today, debate over health care reform still exists, many dissatisfied with the most recent “Obamacare.”

The United States' health-care system contrasts greatly with other health-care systems throughout the globe. It is more expensive, Americans spending $2.8 trillion per year, or about ⅕ of their GDP, on the policy area. It is also often obtained through private insurance companies and employment, rather than the government.

Of note is also America’s history with conflict between the ideas of Capitalism and Communism, and the fact that this conflict played a major role in health-care policy. There have been many organizations, such as the AMA, as well as many politicians and citizens, that were staunchly positioned against Medicare and other forms of federal health-care; they saw these types of reforms as Socialistic and Communistic movements which is a controversial subject because of the mentioned conflict.

Brief timeline of major events in the area of health-care in the United States, including movements, failed policy, and passed policy:
•1798- The Act for the Relief of Sick and Disabled Seamen marked the beginning of federal involvement in health care.

•1854- President Franklin Pierce vetoed a national mental health bill

•1912- President Theodore Roosevelt campaigns as a Progressive Party candidate with platform on single national health service

•1920- The Snyder Act is the first federal legislation to deal with health care for Native Americans

•1921- The Maternity and Infancy Act provided grants to states to provide health services to mothers and children

•1924- The Veterans Act codified and extended federal responsibilities for health care services to veterans who were injured in the line of service

•1932- The Committee on the Costs of Medical Care report was published and raised concerns about the costs of health care and the number of people lacking medical aid

•1935- The Social Security Act provided pensions to the elderly; signed by FDR

•1937- The Technical Committee on Medical Care is convened to advance health care

•1938- A national health conference proposed federal aid to the states to expand public health, maternal, and children’s services

•1939- The Wagner National Health Act of 1939, FDR’s second push for national health insurances, failed

•1943- The National War Labor Board declared employer contributions to health insurance as tax free; the Wagner-Murray-Dingell bill called for additions to the Social Security Act but was never voted on

•1945-President Truman recommended a national health insurance program

•1946- The National Health Policy Hospital Survey and Construction Act provided grants to states to inventory and survey existing health care facilities

•Truman’s National Health INsurance Initiative failed

•1951- Truman created the President’s Commission on the Health Needs of the Nation by executive order

•1954- Eisenhower proposed a plan of federal reinsurance for any private company as protection against heavy losses resulting from health insurance; rejected

•1959- Bill introduced to provide benefits for elderly and survivors using Social Security; the bill is rejected

•1960- Legislation enacted to establish Social Security program for elderly but state participation is optional

•1965- President Johnson signed Landmark programs Medicare and Medicaid

•1974- Nixon proposed Comprehensive Health Insurance Plan to replace Medicaid; plan rejected

•1977- The Health Care Financing Administration created to manage Medicare and Medicaid apart from Social Security

•1985- COBRA signed by Reagan to mandate post-work insurance and solidify hospice care as a part of Medicare

•1988- The Medicare Catastrophic Coverage Act provided largest expansion of benefits since the creation of the program but repealed; McKinney Act is signed, providing health-care to the homeless

•1990- The Americans with Disabilities Act

•1996- The Health Insurance Portability and Accountability Act improved continuity of health insurance coverage in group and individual markets

•1997- State Children’s Health Insurance Program provided medical care to children whose families were low-income but did not qualify for Medicaid

•2003- Bush signed to add prescription drugs to Medicare

•2010- Patient Protection and Affordable Care Act enacted under Obama

Interrelated Activity Between the Three Branches
All three branches of government play an important role in establishing health care policy, just as they do in other areas of policy construction. In general, the Judicial Branch acts as an enforcer or establisher, taking cases in which the constitutionality of certain health care issues are debated and then providing a ruling that is meant to apply to national policy. This branch enforces policy through its ability to declare certain actions unconstitutional on a private health sector basis(i.e. Can a privately run insurance policy discriminate against those with health issues?) and establishes laws on discrimination, economics, and basic rights on a national level as well. Judicial action can be seen throughout history, as well as in recent cases related to Obamacare: the newest health-care plan was upheld in the 2012 ruling of NIFB v. Seleblius and subsidies were declared legal through Healthcare.gov in the 2015 case of King v. Burwell.

In contrast, the Legislative Branch is primarily in charge of creating policy, and of creating agencies to watch over the regulation of established policy. It also acts to check the Executive Branch, and to follow the wishes of constituents- whether that be to expand national health care or reduce it. In addition, they are capable of performing extensive research through the construction of advising commissions, commissions who can help the legislature make educated decisions on issues related to epidemics, pandemics, global health, the economy, bioethics, etc. It is the Legislature who hears the concerns of its constituents, the complaints of interest groups, and the information from advising committees, and then uses this data to try to create educated and helpful policy. One example of this is the creation of the Americans with Disabilities Act(ADA); the Legislative branch was contacted by interest groups who fought for the equality of those with disabilities, and was able to respond to these concerns with a change in policy.

The Executive Branch, on the other hand, is tasked with both leading the country to new reform as well as gathering data on health care issues to an extent that the other branches can/do not. While the Legislative Branch is capable of performing research through its commissions for data from outside groups, the Executive Branch is in charge of departments such as the U.S. Department of Health and Human Services, a department that is unrivaled in its capacity to obtain data on health related issues in the United States. This branch is also capable of creating new projects- such as the Human Genome Initiative- and the power of the president to pass executive orders gives this branch substantial sway over health care policy aside from its general influence through open meetings and political ties.

Looking specifically at Obamacare/The Affordable Care Act, one can even trace the impact of the three branches on a specific area of health-care:

•Executive-The ACA was signed into law to reform the health-care industry by President Barack Obama on March 23, 2010 •Judicial-The Supreme Court upheld the act’s legality on June 28, 2012 and allowed subsidies in 2015.

•Legislative- Authorized, clarified, and adjusted the ACA since its enactment in 2010. A summary of enacted legislation on The Affordable Care Act can be found through this link: https://www.fas.org/sgp/crs/misc/R43289.pdf ; it is a direct link to a paper consructed by the Congressional Research Service. Through 2015, 18 Acts have been passed in relation to Obamacare policy and its programs, 41 bills have been passed by the House in relation to the ACA, and 23 ACA provisions were passed by both House and Senate.

Groups Outside of Government Involved in Health-Care Policy
Many groups have an interest in health-care policy, from the poor to the wealthy, and from the government to private health or insurance agencies. Historically, the AMA has played a prominent role in the establishment of national health-care, the organization taking a fierce stance against a national form of policy. Other groups have also been involved, such as the Academy of General Dentistry, AIDS United , Alzheimer’s Impact Movement , American Nurses Association , Citizens for Health , National Union of Healthcare Workers , The American Geriatrics Society , and many others. Interests range from receiving equal care in hospitals to covering insurance to protecting the elderly, low-income households, or children. Health-care is not a single issue but a broad and complex one with many incorporated factor, its policies affecting anything from how hospitals are run to who runs the hospitals and who provides insurance. Interest groups provide a way for different citizens’ concerns to be seen by the government and dealt with accordingly.

Sec. 3506 Program to Facilitate Shared Decision Making
This ensures that that the Secretary of Department of Health and Human Resources will create programs designed to educate patients and their guardian/caregiver. It is meant to help people make informed decisions when dealing with health insurances along with making sure the patient understands all options and reasons for the care or treatment available to them. But, while this was authorized, it has not been funded, so it is unlikely for it to come into effect soon.

Sec. 3022 Accountable Care Organizations and Medicare Shared Savings Program
This created ACOs (accountable care organizations) which are intended to let health care providers better cooperate and coordinate with patients through Medicare. It is implementing incentive for providers and help reduce overcost of care to the population.

Sec. 3021 Center for Medicare and Medicaid Innovation
This is made to give formats and examples of how to “assist individuals in making informed health care choices by paying providers for services and suppliers for using patient decision support tools". It gives initiative to help start the idea to fall into place.

Sec. 6301 Patient Centered Outcomes Research Institute
PCORI is a non profit organization to set priorities for national clinical comparative effectiveness research and will give complete information for decision making.

Analysis and Recommendations for Health-Care/Impact on American Public
There is not a health-care system in another country that parallels the US's. Although, the health-care debate about whether the system being used and put in place is effective is something that has caused problems in the past and is still currently causing problems for politicians trying to initiate reform. This debate has been around for a long time, and with all the time comes many different aspects and details of the government that much of the general population lacks the information of (although it is not that they do not have access, rather just being uninformed). Because of scandals that occur, it is hard for the public to have complete trust in the government. Consequently, reforms with health-care are hard to even get off the ground, let alone get the support that is needed. Many people agree health-care should be a right not a privilege, however with the way the system is being carried out in current times, it is unable to be said with confidence that the entire country has their "right" to health-care being protected and carried out.

Health-care reform coupled with our recently improving although still wobbly economy makes even clearer and more defined sides of the debate because people are unsure if the government can make a health-care reform that works, and if it would put the economy through more turbulence. There have been many polls about the general public's opinion and opportunity for equal health-care, and these polls sometimes have very different results from one another. Some may say that the majority of Americans are satisfied with the care given to them and the way the system works, while others may say that the general public sees an evident problem in way health-care policy is being handled. These opposite results may be because of the demographics of those being questioned are different. It is thought that perhaps a way to find a result that is most true to what the majority of all Americans and constituents believe is to target all the groups of people from every aspect of living in the country and having those groups being equal in number with each other.