Question:
Describe the nature of reform in the United States and the goals of healthcare reform Explain policymaking and legal process that underpin the individual health care and public health systems .
Answer:
Introduction
Healthcare adaptations in the United States of America dates back to the 19th Century, the first bill being passed in 1854. Since then, numerous reforms and amendments have been made to make healthcare easily accessible and beneficial to all. Making of the healthcare policies and legal reforms have been influenced largely by Progressivism, the Great Economic Depression, and the World Wars, and by various administrations. (Hoffman, 2003) Even as the crux of healthcare reforms were proposed during the Clinton administration, there have been numerous reformed that were implemented in the Obama administration. The most important issues addressed include providing a cost effective healthcare to all citizens, and focusing on prevention of preventable health issues.
Goals of Healthcare Reforms
The healthcare reforms are aimed at assuring affordable, quality healthcare to all citizens, removing any obstacles to health insurance coverage for individuals with pre-existing conditions, ensuring continuing coverage for individuals despite changes in their occupational status, preventing health expenses related bankruptcy, and investing in good health as a long term plan. This has a high level of significance, as many citizens are unable to avail the complete benefits of healthcare that is provided by the State. (Department of Health & Human Services, 2016)
This essay focuses on the impact of healthcare reforms on the insurance benefits that can be availed by the people of America.
Source of Health Insurance Coverage
In 1965, the Government of the USA came up with the Medicare and Medicaid programs, to ensure financial protection of healthcare to almost all strata of the population, which is one of the significant moves in healthcare. The health insurance coverage to the citizens of USA is managed by the Center for Medicare and Medicaid Services (CMS), which is a federal agency in the United States Department of Health and Human Services. With Medicare, an individual gets financial protection in four parts – Hospital Insurance (covering inpatient admissions up to 90 days of hospitalization), Medical Insurance (covering outpatient services), Medicare Advantage (healthcare coverage even from a non-Medicare networked centre) and Prescription drugs insurance (coverage of pharmacy costs). With Medicaid, the government pays the citizens a fixed monthly premium to cover the insurance costs from their registered program.
Financial Effect on Healthcare costs
Provision for healthcare by the insurance agencies is done by allocating necessary funds in the healthcare budget. Health insurance in the USA, though mandatory, is still unachievable for many people. (Stern, 2003) Around 80% of the population is covered by either an employer sponsored or self-invested health insurance. Yet, over 15% of the population were found un-insured, which meant that any medical expense incurred had to be expended personally. Of them, nearly 20% are “un-insurable”, as they supposedly had a non-insurable pre-existing condition when applying for health insurance.(National Centre for Health Statistics, 2014) Even though the total healthcare expenditure of the USA ranks first in the world, it is still not sufficient to meet the needs of all its citizens; the healthcare quality being low, thus needing a major budget revamp in the years to come.
Factors influencing Health Insurance Eligibility
The major factors influencing the availability of health insurance are
Age – Medicare is made available to the citizens over 65 years of age and any person under 65 with a terminal illness or certified disability. Medicaid is made available to all citizens under 65, who are financially disadvantaged. (Centres for Medicare and Medicaid Services, 2016)
Disability Status – For individuals who are disabled, The Social Security disability insurance and the Supplementary Security Income provide benefits via Medicare and Medicaid respectively (Golosov, 2006)
Ethnicity and Nativity – There is a distinct differentiation in healthcare and insurance between the American citizens and the Native Americans; with the Indian Healthcare Services (IHS) providing for the latter along with Medicaid. (Zuckerman, 2004)
Income – Medicaid focuses on covering the health expenses of individuals less than 65 years of age with a low income, while Medicare has no income restrictions.
The gender of a person and educational status does not have any influence on the eligibility to insurance. There are also some people who are eligible to receive the benefits of both Medicare and Medicaid, and are known as duals.
Conclusion
Health insurance is one of the major factors in the health care, which makes healthcare available to all. The present day healthcare legislations and reforms, however beneficial they might be, have their own shortcomings; and in an attempt to cover a wide range of people, an undeniable compromise on the quality of healthcare is seen. A major legislative reform that would be welcomed is an increased allocation in the healthcare budget, which would help the individuals balance their income levels and the rising costs of healthcare.
References
Centres for Medicare and Medicaid Services. (2016, April 26). Retrieved May 05, 2016, from cms.gov: https://www.cms.gov/
Department of Health & Human Services. (2016, 02 09). U.S. Department of Health & Human Services. Retrieved 08 02, 2016, from HSS.gov: http://www.hhs.gov/about/strategic-plan/strategic-goal-1/
Golosov, M. &. (2006). Designing optimal disability insurance: A case for asset testing. Journal of Political Economy , 257-279.
Hoffman, B. (2003). Health Care Reform and Social Movements in the United States. American Journal of Public Health , 75–85.
National Centre for Health Statistics. (2014). Health, United States. Hyattsville: US Department of Health and Huiman Services.
Stern, A. L. (2003). Labor Rekindles Reform. American Journal of Public Health , 95-98.
Zuckerman, S. H. (2004). Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? American Journal of Public Health , 53-59.
