The Health Care Bill Of US
Environments Influencing the Health Policy Issue. 4
2.1 Historical Environment. 4
2.2 Sociocultural environment. 5
2.3 Ethical issues. 6
2.4 Economic issues. 7
2.5 Political environment. 8
3.0 History of the Bill (or Law). 10
6.0 Evaluation. 13
7.0 Recommendations for Improvement of the Policy. 15
Health is an important aspect of human life and should be treated with great care; it’s a basic commodity and a human right. Various people in a community should be considered for any health care initiative that is established, the old, the young, the poor and the sick should all be taken care of in any health plans.
The United States government has for many years tried to come up with a Health Care Act that could be acceptable to all and cover all Americans, however this has not been always acceptable by everyone and some resistance has resulted to various bills being passed in parliament. Different stakeholders have had varying opinions on passed bills and why they were for or against the bills.
Since time immemorial different bills have been enacted in to law this paper looks at the various bills that have been passed their effects to the society and the impact they have had politically, socially, and economically to the people. The paper traces a history of several bills that have been passed and the impact they have brought in to the society, it highlights different categories of people who have opposed bills and their ground for opposing them.
It later looks at the most current bill and the effect it has brought to the society and later highlights the recommendation for improving the welfare of the stakeholders
The US health care system was described as “broken” a decade ago and had not improved, and fixes promised by managed care had not materialized, premiums were rising and around 45 million Americans had not been insured (Garson, 2000). Basing on these figures policymakers and other stakeholders were quick to predict that the problems would worsen and new challenges crop up. Such predictions were made in the full realization that the ever emerging technological innovations would increase efficiency in service delivery and therefore cost would be far above the savings. The increased costs would not be accepted by employees and would mean hiring new employees while others would quit the insurance business and this would result to more people being uninsured as well as remaining unemployed.
Cutler (2010) emphasizes this as he observes that as much as 10% of Americans are unemployed. Needless to say, this has resulted to slow economic recovery particularly in the face of the recent global financial crisis. In this regard, many measures have been put in place to enhance efficient and timely service delivery Dealing with unemployment has been at the top of the list of US current President Barrack Obama and Congress leaders. Cutler observes that one way to deal with unemployment is to slow the growth of medical spending; he argues that if health care cost increase slows down, it will be more profitable for businesses to expand employment and workers will readily join the new jobs. High health care costs have a double effect on employment this can be illustrated as: on the side of the employer, employer paid-health premiums are a cost to the business just like other operational costs such as salaries and wages, electricity and water bills among other expenses and a reduction in health insurance premiums will enable employers to hire more workers other factors held constant. On the side of the worker most of them are ready to give up salaries and wages to receive employer’s paid-health insurance.
According to the Presidents Health Care Bill (2010) small families and small business owners should be in control of their own health care. The Health Care Bill makes insurance more affordable by providing a large middle class tax cut for health care and reducing premium cost, it therefore helps in providing an afford health care. The bill further introduces a new competitive health insurance market and brings a greater accountability to health care by laying out rules to keep premium down and prevent insurance industries abuse that existed such as refusing to cover people with pre-existing medical conditions and denial of care.
The passing of the bill in the House of Representative though by the Democrats only owing to the Republicans unanimously voting against the bill, led to another stage for The Patient Protection and Affordable Care Act (PPACA) that was signed by President Barrack Obama on March 23 2010, the Act will ensure that workforce health and wellness efforts will remain critical with expanded wellness incentives, in addition employers will need to prepare for generally increased oversight and interaction with the federal government regarding employees’ health benefits (Watson 2010).
Environments Influencing the Health Policy Issue
2.1 Historical Environment
According to Economic History Association (2010), due to medical technologies very little could be done to patients and most patients were treated from home prior to 1920, therefore most people had very little or no medical expenditures. In 1919 state of Illinois study report showed that the amount of lost wages due to sickness was four times larger than that off the medical expenditure associated with treating the illness (Cited in health insurance in the United States). Reinhardt (2001) emphasizes this by stating that though the Americans economy prospered during the 1990s the number of Americans under the age of 65 without any form of insurance coverage experienced a dramatic rise from about 35 million Americans to around 40 to 44 million Americans, this was a very high rise. The situation was expected to rise if economic growth remained low and as more Americans would lose their job which tied their insurance coverage through the employer-paid premium. He further observes that though they are those with insurance coverage, a significant proportion of them have shallow coverage due to very high deductibles and co-insurance on the total covered by the insurance or even exclusion of important and desired coverage from the insurance package the situation left many Americans vulnerable to worsening medical problems.
In addition in the late 1980 and early 1990s actual real health spending began to rise noticeably and the premiums that private employers paid for on behalf of their employees rose both for larger employer and even smaller employers, consequently most companies would not manage employing many workers as this would increase the cost of premiums while others strategized on laying off some employees.
2.2 Sociocultural environment
The social cultural aspect deals with all members of a community, The Social Security Act Amendment Bill signed On 30th July 1965 by President Lyndon Johnson established Medicare which is an insurance program for the elderly and also established Medicaid which a health insurance program for the poor, this shows there was concern for wider members of the society and later in 1997, The State Children’s Health Insurance Program (SCHIP) was enacted which gives grants to states to provide health insurance coverage to uninsured children up to 200% of the Federal Poverty Level (FPL) (Work World Inc., 2010).
Waymack (n.d.) emphasizes that health can be regarded as a social good, the author continues to elaborate that it’s not in any nation’s interest to have a populace wracked and consumed by diseases therefore a nation’s will is to have a health population that is productive; he observes that sick people do little to contribute to economic production and income taxes, and that a healthy workforce is more productive than a sick workforce.
A healthy nation is more productive and matters of health should not be discriminated on any ground, be it gender, race, religion or age. Jeffries (2010) observes that in the past women argued that their premiums were higher than those for their male counterparts; however this issue has been addressed by the new health care reform that made it illegal for insurance companies to charge higher premiums based on gender.
2.3 Ethical issues
Ethics is concerned with determining what is right and what is wrong on how human relate to one another, under the American Medical Association(AMA) a patient has a right to make decision regarding the health care that is recommended by the physician, this right was not upheld during the managed care era, this was in a period of about five years from 1992 to 1997 when the demand for the America health introduced managed care, a program which gave private employers ability to force upon their employees employer-sponsored health insurance products. The employer-sponsored health insurance products limited the employee’s choice of medical providers to define networks, as a result this limited direct access to medical specialist and at times limited patients access to new and expensive medical technology like new and expensive brand name medicine, this was unethical treatment to the employees (Reinhardt, 2001).
There are members of the public who believe that health is an individual responsibility, they believe that the well being of once health is a personal issue, in this regard they do not support a system that requires them to contribute tax dollars to support fellow citizens who they feel do not act responsibly in protecting and promotion of personal health. Their argument is that the government cannot establish what is right for them and therefore people should be allowed to choose their own physician and treatment (Waymack n.d.).
Ethics in health care can be regarded as a positive Moral Right, this is described by Waymack (n d.) who further explains that individuals have a right to health care and if a person has limited economic resources to cater for such care the society has an obligation to see that poverty does not act as an obstacle to receiving health care. Health care can also be regarded in the Business Ethics and health care has never been a completely charitable endeavor, physicians have always felt some professional moral obligation to provide care to the indigent.
2.4 Economic issues
In the period between 1992 to 1997, the demand for the America health sector boosted employers through managed care, this is a system which gave private employers ability to force upon their employees employer-sponsored health insurance products, consequently this limited the employees choice of providers of medical services to define networks, hence limited direct access to medical specialist and at times limited patients access to new and expensive medical technology (Reinhardt, 2001). This effect was mainly felt by those employed in the private sector, but its worth noting that a nations population is much more than just the employed people, therefore a nation’s government should take care of all parts of a nation and all citizens.
A country’s economic welfare should take care of every part of a country, the rural economy is in America is characterized by underinsurance and un-insurance as observed by Bailey (2009) he continues to add that the rural areas have witnessed significant decline in manufacturing jobs and a rise in service sector employment, as a result this has lend to losing jobs and a decrease in rates of employer-sponsored health insurance as well as gaining jobs with lower rates of employers–sponsored coverage. This is rampant for low-skilled jobs that are more common in rural areas. The rural economy has a very large number of self-employed and small businesses which are generally less insured, more underinsured and more dependants on the individual insurance market. Putting this in to consideration a health care reform that relies exclusively on maintaining the current employer-sponsored health insurance system will be of little relevance for rural areas due to the lower rates of employer-sponsored insurance as well as the rural economy composition. A health care reform that is viable should strengthen public programs currently depended upon by majority of the rural people.
As observed earlier everyone’s interest should be put in to consideration while drafting a bill, a bill should cater for both the employee and the employers, if the employer-sponsored insurance is seen as putting unfair constraint on the employee by deciding where the employee should get medical attention, then the government should also consider that the employer-sponsored insurance premiums are an additional cost to the employer and they result in reduced profits hence the need to decide where an employee should attend for medical attention.
2.5 Political environment
There are major political opportunities that have been lost in the US as observed by Starr (1994), to this category of great political opportunities lost in America; he adds the collapse of health care reforms in the first two years of Clinton’s administration. It was an idea endorsed and co-sponsored by republicans, democrats and key interest groups, it came out as a strategic mismanagement on the president’s part and his advisors, this move was to end the season of opportunity for President Bill Clinton and by 1994 the press would undermine trust in the president, those opposing the reforms were organizing their forces and first concentrated on groups with ideological affinities and as a result the chambers of commerce that had endorsed the mandate reversed and other business organizations followed suit.
The health care bill has been used to weigh political abilities of many in US as Malone (2010) points out; when the congressional passed the health care reform bill it was a major political boost for President Barrack Obama and the Democrats. This was a major gamble with the democrats, with the opposition republicans vowing to exact revenge. Additionally, Malone asserts that compared to his predecessors, President Obama scored a political success on health care, this sets a history for the Americans as the process was initiated a century ago when a national health insurance was initiated by President Theodore Roosevelt. Since its initiation by Roosevelt, successive presidents mainly the Democrats were in its favor, this show that since the initial stages the health care reform was a thing for the Democrats and its success was a success for the Democrats politically despite being a success to the Americans. When President Barrack Obama was elected in 2008 his top domestic priorities were change and quick made health care and therefore with the passing of the bill which he later signed in to law, this was a major achievement in his political career and a fulfillment of his promise to the public.
Though the health care bill is historic, it’s a gigantic political gamble, in response to this most Americans oppose the Obama plan which resulted to all republicans voting against the bill, the bill has also fueled the rise of Tea-party movements, loosely organized groups of grass root conservatives, liberation and anti-tax activists who opposed the health care plan on grounds that it had resulted to too much government involvement in the economy.
3.0 History of the Bill (or Law)
On 30th July 1965 President Lyndon Johnson signed the Social Security Act Amendment into law, it established Medicare which is an insurance program for the elderly and also established Medicaid which a health insurance program for the poor. The program was funded by a tax on the earnings of the employees matched by contribution by the employers and was positively received. The program had been initiated by President Harry S. Truman two decades prior to the enactment by asking the congress to establish a legislation establishing a national health insurance plan as established by the government document information. In 1985 The Consolidated Omnibus Budget Reconciliation Act (COBRA), amended the Employee Retirement Income Security Act of 1974 (ERISA). The Act requires most employers to provide continuing health insurance coverage to employees and their dependants who are no longer eligible for the company’s health insurance program; the law was later revised in 1999. The law applies to nearly all businesses that have more than twenty employees and offers a group health care plan (Lenore, 1999).
A health plan that would guarantee health insurance for all Americans was presented to the US congress in 1993 by President Bill Clinton but was opposed by congress leaders on grounds of being too expensive and excessively regulated, but a year later members of congress introduced alternative proposals though no compromise was reached. In 1994 president Bill Clinton introduced the Health Security Act that was defeated, president Clinton proposed to achieve universal coverage in the US by mandating that all employers privately provide health insurance to their employees and also giving small businesses and the unemployed Americans subsidies to purchase insurance, the move was supported by his wife Hillary as explained by Oberlander (2002).
In 1996 Congress passed the Mental Health Parity Act to require some employers to offer health plans with psychiatric benefits. In the same year Health Insurance Portability and Accountability Act was passed by congress, this bill was introduced to protect individuals from losing their health insurance in case one changed from one job to another or moved from private employment to self-employed (NCNMG Inc, 2007). In 1997 The State Children’s Health Insurance Program (SCHIP) was enacted and it gives grants to states to provide health insurance coverage to uninsured children up to 200% of the Federal Poverty Level (FPL) (Work World Inc. 2010).
The President Bush administration proposed to adopt tax credits that would help the uninsured purchase private insurance, due to the appeal of tax cuts the approach seemed attractive and also due to expanded coverage with minimal government involvement, but these two factors do not control medical care spending.
In the year 2010 The Patient Protection and Affordable Care Act (PPACA) was signed by president barrack Obama, the law will ensure that workforce health and wellness efforts will remain critical with expanded wellness incentives and will require employees to prepare for generally increased oversight and interaction with the federal government regarding employees’ health benefits (Watson, 2010).
4.0 Supporting Stakeholders
The American Medical Association and Health Insurance Association of America had previously opposed compulsory health insurance but later changed their stand in support of an employer mandate and universal coverage. Their move was followed by the US Chamber of Commerce and other equally large public corporations who also endorsed an employer’s mandate (Starr, 1994).
A large potion of the public agreed with the bill, they felt that health care reforms were an issue of high priority. Even so, the republicans opposed it. Ferraro (2010) observes that the democrats rejected the claims by the republicans by contending that once the people come to realize about the benefits (short and long term) of the bill, public support would ultimately grow. Ideally, these can be observed as conscious efforts on the part of the democrats in trying to pass the message across to the people in a bid to gain support from them.
For instance, Dennis Kucinich who had previously opposed the bill announced that he had at long last decided to vote for the bill. Interestingly, his change of decision was after a careful consultation with his wife, speaker, president and close friends. This move from opposing to supporting the bill gave a boost to President Obama, the Congressional leaders as well as the entire pro-reform group (Alan, 2010).
Alan further observes that further support also emanated the Catholic Bishops who were previously opposing the bill had organized a group of nuns and leaders and sent a letter to House of members urging them to pass the Senate Health Care Reform Bill.
5.0 Opposing Stakeholders
Oberlander (2002) analyses the situation and observes that in the year 1994 the then President Bill Clinton had a plan that would see all Americans benefiting from health insurance, he wanted to achieve universal coverage in the United States by making it mandatory for all employers to provide private health insurance to their employees and also by giving small businesses and unemployed Americans subsidies with which to purchase insurance. This plan experienced fierce opposition from a number of stakeholders notably the insurance industry which was not happy with the proposed regulations. They opposed the abolishment of experience rating which enabled them to charge high premiums for patients and as a result the business community also disliked the mandate put on the employer.
The plan was also objected by Ideological Conservatives’ as viewed the plan as a warranted nationalization of the health care systems. A large segment of the community also disapproved this and was anxious about the plan’s emphasis on moving patients into Health Maintenance Organization (HMOs), in addition to these the move also lacked support from a majority in the congress and was therefore defeated.
Ferraro (2010) further explains that the legislation would expand the governments health plan for the poor, this would be through imposing new taxes on the rich and bar insurance industries abuse such as refusing to cover people with pre-existing medical conditions. These issues had been denounced by the republicans and termed as costly and misguided federal takeover. Although the bill was passed, all the republicans voted against the bill.
Litvan and Armstrong (2010) shows that though President Barrack Obama signed the bill in to law the Congressional Republicans pledged to repeal it, the House and Senate Republicans have already written at least 30 bills to roll back provisions in the law.
The BBC news reported that immediately after signing the bill, there were 13 states attorney generals who composed of 12 Republicans and one Democrat who began legal proceedings against the federal government seeking an injunction on the reforms on grounds that they were unconstitutional and very costly.
There has been enactment of several bills that deal with the medical practitioner for a period of close to five decades; each bill has led to enactment of a different bill with mixed reactions on the bill. Different parties have supported it while others have opposed it but all bills have left an impact on the society. Appleby and Steadman (2010) points out a number of parties who will be affected by the legislation both positively and negatively. These are children, aged, poor, those who had previous medical issues, the insurance companies and the employees.
The people who have been left uninsured due to their medical conditions may be able to enroll in a new federally subsidized insurance program; the legislation appropriated $5 billion for the program though it may not be enough to cover everyone that applies. They are also discounts and free Medicare for approximately four million beneficiaries who hit the doughnut hole in the program’s drug plan, this is due to plans to see the cost of drugs in the coverage gap go down by 50% while preventive care like some types of cancer screening will being provided free of co-payment or deductibles.
The kids will also benefit from the program as the parents will be allowed to keep their on their health insurance plan until the age of 26 years unless the child is eligible for coverage through a job. Apart from taking care of children up to the age of 26, the insurance plan is barred from excluding pre-existing medical conditions from coverage for children under the age of 19 years but a slight loophole still exists because insurers could still reject these children outright for coverage in the individual market until 2014.
The Health Care Reform also introduces tax credits for businesses in that those with less than 25 employees and an average wage of $50,000 could qualify for a tax credit of up to 35% of employees cost of premiums this is a major boost for the business fraternity.
Insurance companies will experience changes in that they can no longer cancel insurance retroactively for things other than outright fraud and all existing insurance plans will be barred from imposing life time caps on coverage and the plan will also place restrictions on annual limits on coverage.
According to the insurance plan the government will also require insurers to report on how much they spend on medical care versus administrative costs, this will be followed by tighter government reviews of premium increase, this move was not welcomed positively by the business community as they felt the government had so much influence in the business transactions.
7.0 Recommendations for Improvement of the Policy
Bernard (2010) explains that most Americans would be required to have health insurance or face federal penalties on failure to buy but it; this means that the government would require all American to have a health insurance cover. The political and economical experts question on how strict the enforcement of that penalty could be; consequently the government should expound on how it will enforce this.
It common for business to pass an increase in cost of production to the consumers, and with increased government intervention its likely the business community will pass costs to the consumers. The legislation should clearly state the effect if any the legislation would have if the cost of medical premium went high and the levels in which these premiums should be considered high or considerable for the Americans, putting in to consideration that all Americans are obliged to have a health insurance.
Wilson(2010) observes that insurance companies will be required to spend no less than 80-85 % of their premiums directly on reimbursement for clinical services or on activities that improves health care quality but the bill does not explain what happens to the remaining 15-20% neither does it explain who determines what constitutes an activity that improves health care activity the bill should be clear on these issues, though the 15-20% may be for covering the operation cost of the insurance firms this will eat in to their profits and they should be consulted to reach an agreement on best percentage ratios.
The bill should have considered the number of staffs who are employed in insurance firms, this is because once the government has control of the company’s finances, its most likely that the insurers will be forced to either lay off thousand of workers due to low profits or be forced to abandon their ant fraud programs.
The legislation will impose some tax changes through introducing an annual fee imposed on the pharmaceuticals/ manufacturing sector and health insurance sector, these costs will be passed on to the consumers of these products so that the organization can maintain their profit margin, the bill should be clear on how the manufacturing sector will recover their expenses without passing it on to the consumers.
Carney (2010) describes the future of the Health Care Reform as hanging on a balance since its effects are already being felt with rising insurance premiums and doctors denying to take on additional patients, the government should put measures in place to ensure that all stakeholders involved in the medical field do not suffer unjustifiably from the bill.
The bill also requires that from 2014 all Americans will be legally obliged to have a health insurance cover, this may exert a strain on many Americans if they will be required to pay penalties for lack of insurance, the bill should omit this clause.
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