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

Goal Statement   one sentence that further defines the topic 

•  Healhcare system reform can have many competing goals (for example, covering every person in a system versus bringing the overall costs of healthcare down). For the purposes of this overview, and since this is the goal of the current (Obama) administration in the U.S. where healthcare system reform is the subject of major policy debate this year (2009), the primary goals are to provide  accessible, affordable healthcare to all Americans while also reigning in the escalation of healthcare system costs to government and businesses in the U.S.    

Policy Options / Model Programs   specific policies or program models, grouped by type, that are profiled 

• Great Britain's NHS

• Japan - "Social Insurance"

• Germany's "Sickness Funds"

• Taiwan's Hybrid System

• Swtizerland

• Canada's Healthcare System

• France's Healthcare System 

• Netherlands's Healthcare System

• State of Massachussetts

Local / State / National Information   additional information on this topic at the local, state, national, global level

• Healthcare System Reform - USA 

Glossary of Terms   key words or phrases that the layperson needs to know to understand this issue 

• ADA = Americans with Disabilities Act (originally signed into law in July, 1990 by President George H.W. Bush, was a comprehensive civil rights law for people with disabilites). Under the Olmstead Act (1999), the Supreme Court ruled that the ADA can, under certain circumstances, require states to provide community-based services to individuals for whom institutional care is inappropriate, thus impacting Medicaid.     

• AFDC = Aid to Families with Dependent Children, established by the Social Security Act of 1935, enabled states to provide cash welfare for needy children who had been deprived of parental support or care because their father or mother was absent from home, incapacitated, deceased or unemployed. The PRWROA of 1996 (see below) replaced AFDC and other programs with a cash welfare block grant called the TANF (Temporary Assistance for Needy Families) program, which placed a 5-year limitation on the amount of time a family with an adult can receive assistance funded with federal funds (and other restrictions), and separated "welfare" from Medicaid.

• DRG = Diagnosis-Related Groups: 

• FPL  = Federal Poverty Limit:  (for a detailed discussion of the difference between "federal poverty guidelines", which are sometimes referred to as the FPL, and the "federal poverty threshold", a different measure, please refer to the U.S. Dept. of Health and Human Services webpage on the subject.  

• HMO = Health Maintenance Organization: 

• Medicaid - Signed into law by Pres. Johnson on July 30, 1965, H.R. 6675 (Public Law 89-97) established Medicaid for the indigent (and Medicare for the elderly). The law became Title XIX (19) of the Social Security Act and is currently administered by the Centers for Medicare and Medicaid Services.   

• OBRA = Omnibus Budget Reconciliation Act (there are multiple OBRAs, each occurring in a different year)

• PPS = Prospective Payment System: 

• PRO's = Peer Review Organizations: (this term replaced the older PSRO's, Professional Standards Review Organizations)

• PRWROA = Personal Responsiblity and Work Opportunity Act of 1996, which repealed the AFDC and replaced it with TANF.  The PRWROA ended the link between Welfare and Medicaid. It also prohibited extending Medicaid coverage for non-emergency services to otherwise eligible legal immigrants entering the U.S. on or after 8/22/96 for five years. Coverage after the 5-year ban is at state option.

• SCHIP = State Children's Health Insurance Program was established under the Balanced Budget Act of 1997 (BBA 97), allowing states to cover uninsured children in families with incomes below 200% of FPL who were ineligible for Medicaid.

• Single-Payer System - 

• "Socialized medicine" and "social health insurance" -   

• SSA = Social Security Administration: 

• QMB's = Qualified Medicare Beneficiaries (usually low-income):    

• TANF = Temporary Assistance for Needy Families (please see AFDC and PRWROA): 

• TMA = Transitional Medical Assistance:  

• UPL's = Upper Payment Limits:  

Bibliography    

• White House website on national healthcare reform