HLTH - 556 DB 5 - Urgently Required. 12-16 Hours. Need A + Work

In reviewing the political environment during the Clinton healthcare legislative failure and then comparing it to the Obama healthcare legislative success, one will find some of their experiences quite similar.  Both environments were facing many challenges including increased uninsured, pre-existing conditions, rising health care costs, and medical bankruptcies to name just a few (Godfrey, 2014).  Both Clinton and Obama made healthcare promises during their campaign trail.  When Bill Clinton was in office, he formed a task force on Health Care Reform and had his wife, Hillary Rodham Clinton as the chair (McLaughlin & McLaughlin, 2015).  This task force was not very transparent as it focused on several issues. They included:

· mandating employee coverage through an employer-based system,

· providing subsidies for small businesses and low wage employees,

· capping annual premiums,

· providing payments for the poor to cover premiums and out of pocket expenses, and

· creating regional alliances (McLaughlin & McLaughlin, 2015).

One of the functions of the alliances was to collectively bargain with insurance companies.  This was not attractive to insurance companies.  As a result, Bill Clinton found one of his biggest opponents the Health Insurance Association of America (HIAA).  In contrast, when Obama was launching his healthcare campaign, he actually included the health care insurance companies as primary stakeholders (Godfrey, 2014).  One of Obama’s main focuses was to change the way healthcare insurance was regulated.  He had a mandate for people who could afford health insurance and they were forced to purchase or pay a penalty.  Obama also had a “play or pay” mechanism similar to the Clinton plan that required businesses with 50 or more employees to offer health care coverage to their employees or pay a penalty (Gottlieb, 2015).  In addition, both plans set up exchanges.  Clinton’s plan had fewer exchanges as it covered multi-states.  Obama’s plan allowed each state to set up their own exchange or have a federally managed system (Gottlieb, 2015).

            While Clinton appeared to have great support for healthcare change, his plan ended up failing for several reasons.  First, the “Health Security Act” had major competition when it went to Congress.  There were other healthcare bills from Democrats and Republicans being presented (McLaughlin & McLaughlin, 2015).  Second, the Republicans were united together in an effort to defeat the Clinton bill.  Third, the Democrats did not have a clear strategy as other Democrat healthcare bills had been proposed.  Finally, the Congressional Budget Office (CBO) was unable to support Clinton’s budget assumption and did not agree that the healthcare plan would be budget neutral.  Ultimately, public opinion was lost and the bill died in September 1994.  For Obama, the Democratic Party was much more united and they had several interest groups that were unified to support the legislation moving forward.  In 2010, the Affordable Care Act (ACA) was passed with very slim margins in Congress and would be phased in over the next four years (Camillo, 2016).

In reference to the state agencies listed in 10-1 and 10-2, many of these are involved in the healthcare debate each having their own strengths and weaknesses.  Their strengths are based on the fact that each agency has a specific area of concern that it addresses.  After each agency, I have listed a description of where their strength is focused.  For example, the Agency for Healthcare Research and Quality (AHRQ) is focused on supporting research that studies outcomes, patient safety, and other qualities of healthcare ("HHS Agencies & Others," 2018).  The Agency for Toxic Substances and Disease Registry (ATSDR) focuses on hazardous substances that may affect quality of life.  The Centers for Disease Control and Prevention (CDC) has many different roles.  One role is to prevent and control diseases and injuries that affect quality of life.  A second role is to conduct research and provide leadership training.  The CDC is also involved in protecting people from biological and chemical terrorism.  The Food and Drug Administration (FDA) focuses on the safety and efficacy of pharmaceuticals and medical devices.  Health Resources and Service Administration (HRSA) is involved in national health programs.  It focuses on people living with HIV/AIDS, the underserved, and women and children through different state programs.  Centers for Medicare and Medicaid Services (CMS) are home to our two largest Federal healthcare programs, Medicare and Medicaid.  CMS is also involved in other programs such as SCHIP, HIPAA, etc.  Indian Health Services (IHS) is the Federal program that supports American Indians and Alaska natives by providing comprehensive health services.  The National Institute of Health (NIH) is our nation’s medical research industry and supports researchers in every state (website HHS offices).  Substance Abuse and Mental Health Services Administration (SAMHSA) focuses on prevention, treatment, and rehabilitative services encompassing substance abuse and mental illness. 

            Then there are Federal agencies outside HHS that also have health-related responsibilities.  In our text they are listed under Table 10-2.  Some examples include the Environmental Protection Agency (EPA) which is focused on protecting our air, water, and soil from pollution ("Non-HHS Agencies and Programs," 2018).  The Federal Bureau of Prisoner’s (BOP) protects citizens by keeping offenders confined.  They also work for the Health Services Division to provide physical and mental health services.  The U.S. Department of Agriculture (USDA) focuses on providing citizens safe, affordable, nutritious supply of food and prevents foodborne illnesses from spreading.  The U.S. Department of Defense (DOD), in addition to providing our military, is also focused on behavioral health and traumatic brain injury.  The U.S. Department of Homeland Security (DHS) focuses on providing safe and secure borders and looks after the well-being of people on U.S. soil.  The weaknesses of these organizations centers on the fact that they are government programs supported mostly with our tax dollars.  There are three categories of spending:  mandatory, discretionary, and interest on debt.  For all the agencies listed, they fall under mandatory and discretionary and account for over 90% of government spending (National Priorities).  For example, in 2015 discretionary spending was $1.11 trillion and mandatory spending was $2.45 trillion for a total of $3.56 trillion dollars.  A majority of our tax revenue is used to fund these federal programs.  This to me is a major weakness as much waste occurs within the government.  As I write this discussion post, the current U.S. debt is over $20 trillion dollars ("U.S. Debt Clock," 2018).  We have seen our Federal spending increase 138%.  One of my favorite bible verses in regards to financial stewardship is “the rich rules over the poor, and the borrower is slave to the lender” Prov 22:7 (English Standard Version).  I would prefer to see our country rely less on government support and more on one another.  “Bear one another’s burdens, and so fulfill the law of Christ” Gal 6:2 (The Reformation Study Bible). 

References

Camillo, C. A. (2016). The US healthcare system: Complex and unequal. Global Social Welfare, 3, 151-160. https://doi.org/10.1007/s40609-016-0075-z

Godfrey, M. (2014). What is the difference between the health care proposal once advocated by President Clinton (often called “Hillarycare”) and the now-enacted Affordable Care Act (often called “Obamacare”)? Retrieved from https://www.quora.com/What-is-the-difference-between-the-health-care-proposal-once-advocated-by-President-Clinton-often-called-Hillarycare-and-the-now-enacted-Affordable-Care-Act-often-called-Obamacare

Gottlieb, S. (2015). The clintonian roots of obamacare. Retrieved from http://www.aei.org/publication/the-clintonian-roots-of-obamacare/

HHS agencies & others. (2018). Retrieved from https://www.hhs.gov/about/agencies/hhs-agencies-and-offices/index.html

McLaughlin, C. P., & McLaughlin, C. D. (2015). Health policy analysis (2nd ed.). [VitalSource Bookshelf].

Non-HHS agencies and programs. (2018). Retrieved from https://www.usphs.gov/aboutus/agencies/non-hhs.aspx

U.S. debt clock. (2018). Retrieved from http://www.usdebtclock.org/