Healthcare System Reform - USA

Page history last edited by Robert Hackett 1 mo ago

 

Note: please note that this issue brief should (a) link back to the issue overview on this topic, (b) be focused either the local, state, national, or global level, and (c) be neutrally presented, based on facts, and include footnotes for each of the items.  See the Research Guide and Information Sources to assist you. 

 

Issue overview on this topic:  Healthcare System Reform 

 

 

Scope of the Problem  factual statements on the extent of the problem in the past, current, or future

  • Link to PDF of peer-reviewed Harvard Medical School study entitled Health Insurance and Mortality in the U.S., released in the American Journal of Public Health, December 2009 issue (early online access provided in September 2009).   

 

"The United States stands alone among industrialized nations in not providing health coverage to all of its citizens. Currently, 46 million

Americans lack health coverage.1  Despite repeated attempts to expand health insurance, uninsurance remains commonplace among US

adults. Health insurance facilitates access to health care services and helps protect against the high costs of catastrophic illness. Relative to the uninsured, insured Americans are more likely to obtain recommended screening and care for chronic conditions2, and are less likely to suffer undiagnosed chronic

conditions3 or to receive substandard medical care.4  Numerous investigators have found an association between uninsurance and death..." - Wilper, et al., 2009 (there is a link to the full study above). 

 

According to the latest U.S. Census Bureau data (released on September 10, 2009; the data is for 2008): 

  • The number of people without health insurance coverage rose from 45.7 million in 2007 to 46.3 million in 2008.
  • Between 2007 and 2008, the number of people covered by private health insurance decreased from 202.0 million to 201.0 million, while the number covered by government health insurance climbed from 83.0 million to 87.4 million. The number covered by employment-based health insurance declined from 177.4 million to 176.3 million.

 

See http://www.kff.org/uninsured/kcmu091809pkg.cfm for a Kaiser Family Foundation (nonpartisan) issue brief and some basic facts related to the healthcare reform debate. 

 

Past Policy  key legislation and milestones including significant policy and funding shifts, major studies, etc.

Most of the following section is summarized from information available from the Kaiser Family Foundation: 

 

  • July 30, 1965: The creation of Medicare for the elderly and Medicaid for the indigent was signed into law by President Johnson (H.R. 6675 - Public Law 89-97). 

    • Former President Truman was the first person to enroll in Medicare. Medicare coverage began on July 1, 1966 with more than 19 million seniors enrolled. All persons age 65 or older were automatically covered under Part A (essentially hospital insurance). The Part A deductible was $40/year in 1966.  Part B, optional supplemental medical insurance, cost $3/month in 1966. The Social Security Administration selected private insurance companies to perform major administrative functions (such as bill processing and benefit payment functions).  

    • Medicaid became Title 19 of the Social Security Act, expanding the goals of the Kerrs-Mills Act of 1960 and replacing it. States could elect to participate and they would receive federal matching payments based ona formula related to state per capita income with a 50% matching floor and an 83% mayching ceiling on service expenditures. Medicaid was designed primarily for people who were poor, including children, and for persons with intellectual (mental retardation), and other, disabilities.   

 

Medicare - Past Policy 

  • October 30, 1972: President Nixon signed the Social Security Amendments of 1972 (PL 92-603), which extended Medicare eligibility to persons under age 65 with long-term disabilities, covering an additional 2 million people. The bill also encouraged the use of HMO's (Health Maintenance Organizations) and established PSPO's (professional standards review organizations).  
  • 1977: The Secretary of the Dept. of Health, Education, and Welfare (Joe Califano) created the Health Care Financing Administration (HCFA) to administer Medicare and Medicaid.  
  • 1980: Omnibus Budget and Reconciliation Act (OBRA 1980) expanded home health services. Baucus Amendments brought Medicare supplemented insurance ("Medigap") under federal oversight.
  • In 1981: OBRA 1981 included provisions to slow the growth in Medicare spending, including an increase in the inpatient hospital deductible (Part A).
  • 1982: Tax Equity and Fiscal Responsibility Act (TEFRA) increased the Part B premium, and covered hospice services for the terminally ill. Peer-reviewed organizations (PRO's) replaced PSRO's. A ceiling was placed on the amount Medicare would pay for a hospital discharge.
  •  1983: Social Security Amendments established an inpatient hospital Prospective Payment System (PPS). PPS is based on DRG's (Diagnosis-Related Groups), a pre-determined payment for treating a speicifc condition. The PPS system was adopted to replace the cost-based payments.
  • 1984: Deficit Reduction Act of 1984 (DEFRA) froze physicians' fees and established fees for lab services; all designed to slow medicare's spending and constrain the federal deficit. 
  • Bills in 1985 and 1986 (COBRA 1985, the Emergency Extension Act of 1985, OBRA 1986) attemptewd to slow the growth of Medicare.
  • 1987: OBRA 1987 imposed quality standards for Medicare and Medicaid-certified nursing homes. Also in 1987, the Medicare and Medicaid Patient and Program Protection Act was enacted to improve antifraud efforts and strengthen benficiary protection. The Balanced Budget and Emergency Deficit Control Reaffirmation Act of 1987 froze medicare payement rates.  
  • 1988: Medicare Catastrophic Coverage Act added a drug benefit and limited out-of-pocket expenses. The Act was repealed in 1989.  
  • OBRA 1999: Established the R-BRVS (Resource-Based Relative Value Scale) for physicians, which placed limits on physician balance billing, and prohibiting them from referring Medicare patients to cliical labs where they had a financial interest. Also included several provisions to slow the growth in Medicare spending. 
  • December 8, 2003: President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA), providing a new outpatient prescription drug benefit under Medicare beginning in 2006. 
  • November 15, 2005 - May 15, 2006: First open enrollment for the new Part D drug benefit.  
  • 2007: "Medicare Funding Warning" triggered by two consecutive years of Medicare Board of Trustees calculating "the general revenue will exceed 45% of Medicare funding wihtin the succeeding 7 years." 
  • 2008: "Medicare Funding Warning" triggered again, as in the previous year. 

 

Medicaid - Past Policy

  • In 1965, when Medicaid was established, it was placed under the jurisdiction of the Social Rehabilitation Administration, an agency focused on poverty and welfare programs.
  • By 1972, all states except Arizona are participating in Medicaid. (Arizona did not opt in, and only partially did so, until 1982.)
  • 1977: The Carter Administration proposes to expand Medicaid to cover 700,000 children of poor families under the age of 6 (the Child health Assessment Program), but it does not come to a vote in Congress.
  • Also in 1977, the Dept.'s of Labor and HEW (Health, Education,and Welfare) Appropriations Act for FY 1977 passes, which includes the Hyde Amendment, prohibiting federal Medicaid payments for medically necessary abortions except when the life of the mother would be endangered.
  • 1981: The Reagan Administration submits a proposal to convert Medicaid to a block grant to the states. (Fails.)
  • 1995: Congress passes legislation converting medicaid to a bolock grant to the states. President Clinton vetoes it. 
  • 1996: PRWOA (Personal Responsibility and Work Opportunity Act of 1996) repeals AFDC (Aid to Families with Dependent Children, established in 1935 under the New Deal as a federal assistance program for children of families with little or no income) and replaces it with TANF (Temporary Assistance for Needy Families). This ends the link between welfare and Medicaid.  
  • 1997: The Balanced Budget Act of 1997 (BBA 97) established SCHIP, the State Children's Health Insurance Program, allowing states to cover uninsured children in families with incomes below 200% of FPL (the Federal Poverty Limit) who were ineligible for Medicaid.
  • 1999: The Olmstead Act - the Supreme Court rules that the ADA (Americans with Disabilities Act) can, under certan circumstances, require states to provide community-based services to individuals for whom institutional care is inappropriate. 
  •         

 

Current Policy  summary of current policies in the form of legislation, programs, and funding

  • In 2008, there were 44.8 million total Medicare beneficiaries, the Part A deductible had risen to $1,024/year, and the Part B premium had risen to $96.40/month. Total Medicare spending in 2008 reached $444 billion.

  • In 2008, the average premium for the Part D prescription drug benefit was $27.93/month, with 25.4 million people enrolled.     

  • 2005: Congress passes a budget resolution requiring $10 billion in cost savings from the Medicaid program during the 5 following years.      

 

 

Policy Options   

Bills being proposed in the House and Senate are compared in some detail on the following webpage sponsored by the New York Times: Comparing the Health Care Proposals   

 

See Healthcare System Reform for a listing of descriptions of possible models for the U.S. healthcare system reform, including healthcare systems in other industrialized nations or use the following links: 

     Great Britain's National Health Service (NHS)  

 

Congressional bills related to healthcare system reform in the U.S. can be accessed through congress.org

 

See http://www.kff.org/uninsured/kcmu091809pkg.cfm for a Kaiser Family Foundation (nonpartisan) issue brief and some basic facts related to the healthcare reform debate. 

 

See Health Affairs: The Policy Journal of the Health Sphere and its Health Policy Brief section especially (supported by the Robert Wood Johnson Foundation) for more information.

 

Key Organizations/Individuals   contacts for public and private organizations and key individuals

  • Government
    •  White House website on national healthcare reform 
    • Congress.org for information about current legislation and key votes; you can also sign up to receive periodic summaries of how individual legislators (those representing you or others) are voting.   
  • Non-Profit - Service Providing
    •  
  • Non-Profit - Advocacy/Membership/Network
    •  
  • Foundation
  • Other
    • Politifact.com for analyses of the accuracy of comments by policymakers, critics, and others. PolitiFact is a project of the St. Petersburg Times. Reporters and editors from the Times fact-check statements by members of Congress, the White House, lobbyists and interest groups and rate them on their "Truth-O-Meter".  

  

Bibliography   web sites, reports, articles, and other reference material 

  • The Kaiser Family Foundation 

  • The Robert Wood Johnson Foundation 

  • The New York Times

  • www.congress.org

  • American Journal of Public Health 

 

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