Chapter 3: Healthcare Reform and in the United States

LEARNING OUTCOMES

By the end of this module, the student will be able to:

· Analyze healthcare policy in the United States.

· Review the impact of policy on the various services and populations.

· Evaluate the efficacy of policy changes implemented by the Affordable Care Act.

· Describe the pros and cons of the ongoing reform.

· Compare and contrast our reform policies with other models in the world.

US Healthcare

Healthcare in the United States is complex and a mixture of private insurance and government programs such as Medicare and Medicaid.  We saw this in the last chapter.  See Table 1 below for a list of government health programs and their department sponsors.

Program	Coverage	Funding
Medicare	65 years or older, certain disabilities or end stage renal disease	Federal
Medicaid	People with limited income (guidelines are established)	Federal and state joint funding
State Children’s Health Insurance Program	Children whose families make too much money for Medicaid but not enough for private insurance	States
Tricare	Military	Department of Defense
Veterans’ Healthcare Administration	Veterans	Department of Veterans Affairs
Indian Health Service	Native American Tribes and Native Alaska people	Department of Health and Human Services

While there are several different ways Americans pay for healthcare many Americans are still uninsured. The battle over how to pay for healthcare has been going on for decades. In 2010 legislation was passed that attempted to increase the number of Americans covered by health insurance and reform our system. This legislation is often called "Obamacare" after the president was in office when it was passed. Its actual name is the Affordable Care Act.

The Affordable Care Act (ACA)

The Affordable Care Act and Reconciliation Act of 2010 included new benefits for patients. Here are some of the important highlights of the act and what it provided to Americans:

· Legal protections against health insurance companies refusing care for “pre-existing conditions”. In other words, if you have diabetes, asthma, or a heart problem that you developed before applying for health insurance, the company cannot refuse to insure you based on this existing health condition.

· Young adult coverage where children can remain on a parent’s policy until age 26.

· Businesses of a certain size need to provide insurance for employees.

· Expanded Medicaid to cover more individuals.

· Penalties are charged if you don't have coverage.

· Rights to appeals.

·  Removal of benefit limits

· Preventive Care coverage

· Established a health insurance marketplace to "shop" for plans.

The debate over healthcare reform still goes on with each political party advocating for different amendments to the current bill. As you probably have heard, the US Congress House of Representatives recently passed the  American Health Care Act of 2017.  

Here are the key elements of the bill:

· Ends the tax penalty against people without coverage.

· Ends the Medicaid expansion funding. 

· Changes Medicaid from an open-ended program to one that gives states fixed amounts of money per person.

· Replaces the ACA's cost-sharing subsidies based mostly on consumers' incomes and premium costs with tax credits that grow with age.

· Repeals taxes on the wealthy, insurers, drug, and medical device makers.

· Consumers who let their coverage lapse for more than 63 days in a year would be charged 30% surcharges to regain insurance. This would include people with pre-existing medical conditions.

· State waivers would allow insurers to charge older customers higher premiums by as much as they'd like.

· States get $8 billion over five years to finance high-risk pools that cover those with pre-existing conditions.

· States get $130 billion over a decade to help people afford coverage.

· Keeps ACA provision that children can remain on their parent’s insurance plans until age 26.

The Senate recently voted on the healthcare bill, however, this failed to pass. Many estimate that enacting this legislation would reduce federal deficits by $420 billion over the coming decade and increase the number of people who are  uninsured by 22 million in 2026 relative to the number under current law.” (CBO, 2017) 

The fight over the best system for American healthcare goes on as does the debate about the best systems and how to create the best model.