Discussion: Government Role
The federal government has played a significant role in health care
since establishing Medicare/ Medicaid which first guaranteed
insurance coverage for a substantial portion of the U.S. population. It
has also been involved in enacting and enforcing legislation for
employer-sponsored health plans and influences private sector
payers by tying healthcare reimbursement to higher quality
outcomes. Regulations include setting quality standards and
processes through conditions of participation (CoPs) or conditions for
coverage (CfCs) and ensuring compliance. Department of Health and
Human Services (DHHS) regulations incentivize and often require
more robust prevention and health promotion programs (Straub,
2013). a
In the U.S., a considerable number of people are still uninsured even
with the passage of the Affordable Care Act (ACA) in 2010. One of
the goals of the ACA was to expand health insurance coverage
through both individual health insurance marketplaces and employer-
provided plans supported by federal subsidies and to reduce
healthcare costs overall by promoting preventative care and early
treatment. However, the U.S. still spends more per capita on health
care than any country in the world and outcomes are not as good as
other developed nations that spend much less. Wide geographic and
socioeconomic variations persist in healthcare quality and costs have
increased over the past few decades, representing the largest share
of GDP than any other sector of the U.S. economy (Tikkanen and
Abrams, 2020). As of 2019, the U.S. spent 16.9 percent of gross
domestic product (GDP) on health care, nearly twice as much as the
average OECD country (Organization for Economic Co-operation and
Development) (Tikkanen and Abrams, 2020). Many states have
chosen not to expand Medicaid under the ACA and there is a gap in
coverage for adults who do not otherwise qualify based on median
household limits and adults who do not have children regardless of
income (KFF, 2021).
Health insurance impacts healthcare delivery with economic
incentives and disincentives. Higher insurance reimbursement for
treatments (drugs and surgery) does not help to promote
preventative care. With Medicare, preventive services are covered
100%. It will be more cost effective to expand this model to all
healthcare plans, whether public or private, and ensure proper
reimbursement for preventative services.
According to a RAND study analyzing data from the most recent
National Health Interview Survey, 42% or all people aged 40 and
older have at least one chronic medical health condition (Buttorff, et.
al, 2017). The CDC estimates the cost of chronic diseases is over 200
billion dollars per year for health care and $147 billion in lost
productivity (2022). To reduce the number of uninsured people while
maximizing quality and access and minimizing costs, the U.S.
Congress and the Centers for Medicare & Medicaid Services (CMS)
should extend Medicare to people aged 55 and over in the next ten
years, then to people 45 and over within the decade after that.
References
Buttorff C, Ruder T, Bauman M. (2017). Multiple Chronic Conditions
in the United States. Rand Corporation. Retrieved July 3, 2022,
https:// www.rand.org/content/dam/rand/pubs/tools
Center for Medicare & Medicaid Services. (2021). National Health
Expenditure Data: Historical. Retrieved July 3, 2022.
https://www.cms.gov/Research-Statistics-Data-and-
Systems/Statistics-Trends-and-
Reports/NationalHealthExpendData/NationalHealthAccountsHistori
cal
Center for Disease Control and Prevention. (2022). Health and
Economic Costs of Chronic Diseases. National Center for Health
Statistics. Retrieved July 3, 2022, from
https://www.cdc.gov/chronicdisease/about/costs/index.htm#
Kaiser Family Foundation. (2021). The Coverage Gap: Uninsured Poor
Adults in States that Do Not Expand Medicaid. Retrieved July 2, 2022
from https://www.kff.org/medicaid/issue-brief/the-coverage-gap-
uninsured-poor-adults-in-states-that-do-not-expand-medicaid
Straub, B. (2013). A Role for Government. An Observation on Federal
Healthcare Efforts in Prevention. American Journal of Preventative
Medicine, 44.
Tikkanen, R. and Abrams, M. (2020). U.S. Health Care from a Global
Perspective, 2019: Higher Spending, Worse Outcomes? The
Commonwealth Fund. Retrieved July 2, 2022, from
https://www.commonwealthfund.org/publications/issue-
briefs/2020/jan/us-health-care-global-perspective-2019
