Chapter 15 Health and Welfare
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CurrentEvent12.docx
Weekly Current Event
You must look through legitimate online media outlets and locate a news article that relates to the current chapter we are covering. The current event you submit must be a 250+ words summary of the article. It must also include 250+ words answering the question you will find in the chapter current event instructions. In addition, you will need to include a critical thinking question about the article. I do not need to see the article, just insert the http web address that I can click on and it will bring up the article itself . Any quoted material will not count toward the minimum word required for this assignment.
Chapter #:
1. Article Link (Paste full URL to the article):
2. Current Event Summary (250 + words):
3. See related chapter current event instructions for details (250 + words):
4. Submit a critical thinking question regarding the article (1-2 sentence):
Chapter15.pptx
Health and Welfare
Chapter 15
The mayor of Belhaven, NC had a problem. The local hospital shut down in his town. He started a 273 mile walk to Washington, D.C. to bring attention to his towns plight.
The next closest emergency room was 75 miles away. A local resident died 4 days after the hospital closed down because it took an hour for the medivac helicopter to get to her. It was estimated that she would have been to the local hositical in about 25 minutes.
While the mayor was a conservative Republican, his walk to Washington was to promote that North Carolina should accept the benefits of the Affordable Care Act.
The Affordable Care Act was designed to expand access to Health Care by providing more people with health insurance, including millions under medicaid.
What is medicaid?
Nearly half of the states refused to expand Medicaid. While the federal government said it would pick up 100% of the cost for the first 3 years and no less than 90% of the cost after that, many states did not want it.
States already paid a sizable portion of their budget on Medicaid and many Republicans were skeptical that the federal government would renege on paying the 90% at some point in the future, sticking the states with funding the difference.
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Studies have shown in the 4 months after ObamaCare was implemented, uncompensated care for patients without insurance dropped by 30% at 465 hospitals in 30 states that took advantage of the law.
Emergency rooms are required to provide emergency medical attention to anyone who shows up, but if there are not enough insured patients to pay the bills, the hospital can not stay in business.
Just ask Belhaven, NC!
Many states that have fought against Obamacare are starting to come around since their states are still paying the same federal taxes other states are, they are just not getting the medicaid expanded benefits, which does not make sense from a financial standpoint.
Support or resistance to Obamacare is as much to do with culture as it does dollars and cents.
The argument revolves around the best way to help the poor. The Federal program is called Temporary Assistance for Needy Families(TANF)
To many, providing cash payments to people only keeps them in poverty and provides them no motivation to find work.
The Governor of Georgia states his point succinctly:
“I am not interested in growing entitlements, especially through an already broken and unsustainable Medicaid program dictated to the states by Washington”. “I am interested in real economic development where Georginas are better equipped to provide for themselves and their families, rather than having to rely on government welfare programs like Medicaid”
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Government's Role in Health
One of the most important functions of government is protecting public health. Public health is the area of medicine that deals with the protection and improvement of citizens health and hygiene through government agencies.
Most of this responsibility (should not be surprising at this point) to handled by S&L. The best example is the availability of fire and ambulance services.
In 1918, a Flu pandemic hit the world. Over 100 million people died including 600,000 Americans. The government was at the forefront of combating that.
The CDC estimates that 480,000 people die every year from tobacco consumption.
Obesity is another big health concern in this country. Local governments have pushed for increase education programs for parents, restoring physical education classes in schools, and removing soft drinks from school cafeterias.
Each state is different on how much support they provide for public health.
In 1996, Congress got rid of direct welfare payments to people. They then started TANF, which is a block grant to states to decide how to implement their welfare-to-work programs. TANF is $17 billion of the $4 trillion budget.
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The Influence of Culture
How different states deal with public health issues has a lot to do with the regional political culture. While few would argue issues like terrorism, AIDS, flu epidemic, or contaminated water supply are public health concerns, there are other issues many do not agree on.
Is gun violence a public health issue? The CDC thinks so but it is illegal for them to collect data on gun violence due to congressional laws. Gun related deaths are the 2nd leading cause of death in this country. The AMA advises Dr to speak about gun safety with their patients that own guns. Many gun owners reject this premise.
Some cities are providing clean needles to drug users to prevent the spread of disease?
Should schools teach abstinence or to use condoms?
Oregon allows physician assisted suicide while most states still consider it a felony.
Medicaid is also a big issue. As of 2014, medicaid provided health benefits to over 65 million americans. States devote an average of 24% of their general fund to Medicaid.
The Affordable Care Act will cover the cost of Medicaid up to 90% as of 2020. The increase of insured will pump billions of dollars into the state economies though the healthcare system. It is also expected to decrease the number of uninsured visiting emergency rooms.
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States not only need to pay for the medical insurance of the poor, they also need to do it for their current and retired employees.
On top of that, they need to pay for the medical expenses of the people in state prisons.
In 2006, a federal judge estimated that one inmate a week was dying in prison due to poor medical care.
Is this a violation of the 8th Amendment?
In many states, cities and counties provide health clinics to people that make too much for Medicaid but do not make enough to afford health insurance.
How Government Got Into the Health Care Biz
The biggest question here is who pays for what. Historically Democrats wanted the federal government to cover those who could not pay for their own health insurance. Then they somewhat shifted to the states to provide this service. When President Obama got elected, with a Democratic Congress, they wanted it moved back to the federal government.
At the beginning of this country's history, local government actually had the responsibility to maintain those who could not take care of themselves. The setup almshouses to house the aged, the orphaned, the insane, the ill, and the debilitated. By the mid 19th century, physicians started to become more of a established profession and they advocated separating some of these functions into different services. That was the beginning of the hospital.
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The Idea of a Social Safety Net
Health care and welfare remained with the local government well into the 20th century. The only health care the federal government dealt with was a program they established for the merchant marines for sailors to get medical care in almost any port. They also provided medical benefits for military veterans.
In 1883, the conservative German Chancellor created the world's first compulsory sickness and unemployment insurance fund. It required employees and employers to set aside part of their income for medical expenses. Later he also created a compulsory retirement program.
Before this such things were only spoken about by communist and socialist. This chancellor got it to work in a capitalistic society. These programs we then implemented by many other european nations.
These things were not popular in this country until the start of the Great Depression.
The Birth of the American Safety Net
On October 24, 1929, the New York Stock Market Collapsed. By 1933, it was clear the U.S had entered the Great Depression. In response to this, the federal government started to look into the social safety nets that were common in european nations for decades.
In 1935, FDR and Congress passed the Social Security Act where they setup 2 programs. One being unemployment compensation and the other being retirementment benefits for seniors.
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A Multibillion-Dollar Afterthought
After the assassination of President John F. Kennedy, Lyndon Johnson began to push for legislation that would provide medical care for senior citizens. This was how Medicare was created.
What is Medicare?
While the government had momentum, it also created Medicaid. These may sound the same but are very different programs.
Medicare is solely funded by the federal government. It provides medical insurance for senior citizens.
One of the biggest concerns for people that are about to retire is medical coverage until Medicare starts.
Medicaid is a joint venture between the federal government and the states. Its primary goal is to provide medical coverage for the poor. While the service is administered by the states, it is mostly funded by the federal government.
Different states can set different thresholds for Medicaid benefits. For example Arkansas has the highest standard. They set qualification at 13% of the US established poverty level. So a single parent with 2 children that makes more than $2,560 a year would not qualify for Medicaid because they made to much money.
In contrast, Minnesota has the most attractive standards. They allow people earning over 200% of the poverty level to get some kind of Medicaid coverage. So a single parent making $39,500 a year would qualify.
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Oops The Unexpected Cost of Health Insurance
While both programs are very different, they both proved to be very expensive.
As of 2012, Medicaid costs states nearly 415 billion a year.
Also the demographics of medicaid recipients started to change. The AFDC program that was created to help widows taking care of their child started to change to helping young divorced, separated or never married mothers. By 1979, single mothers made up 80% of this service. This did not prove to be popular with the public.
By the 1980’s conservatives like Ronald Reagan painted a picture of welfare queens, driving around in their Cadillacs and paying for steak dinners with a rolls of food stamps. While this may have been an exaggeration, it did bring attention to the fact that the U.S. did create a set of permanent dependants.
The Devolution Revolution
Many S&L were getting sick of the way the federal government was being big brother to the welfare and medicaid programs run by the states.
Many states fought to be more independent and to be able to adapt these programs to meet their states needs.
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Welfare Reform
In 1987, the governor of Wisconsin took office and one of the first things he wanted to do was welfare reform. He was ready to think outside the box. He formed a group of people to discuss the issues. Surprisingly, he did not ask a bunch of political pro and con policy analysts to meet with him, he invited welfare mothers so he could learn first hand the obstacles that made it difficult for them to get and keep jobs.
Past attempts at lowering welfare revolved around providing training and education but they were expensive and not always effective. The governor focuses on getting welfare recipient jobs. Any welfare recipient was required to work. If they were unable to find work, then a subsidized position in community service was made available.
The governor actually increased expenditures for things like child care, health care, and transportation. Welfare recipients were also given one-on-one counseling, training, and support services. They also put a time limit on receiving benefits.
This program disarmed many conservative and liberal critics and pointed to reforms are possible in the welfare system. While expenditures did go up in the short run, it paid off in the long run. State welfare costs fell by 65% over the next decade.
The Feds Falter
When Bill Clinton took office, his administration was ready to let the states take the lead on welfare reform. Even with that, he believed the feds should take the lead on providing health care. In 1994, Clinton introduced the Health Security Act. This would have provided universal healthcare to all Americans. Politics being what it is, Clinton was unable to find common ground with senate republicans so the bill was defeated.
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The Rise of the Health Care State
Since Clinton's healthcare initiative failed to move forward in the 1990’s, That meant the states were going to have to continue to shoulder the burden of medicaid.
In an attempt to stop the increase in cost of medical coverage to the states , managed care was set up. HMO’s formed to try and get people access to preventative maintenance services.
Can you see why the the medical profession would not be all on board with this?
Drs make a lot more money treating illness then they do preventing it!!!
Under managed care, states paid a flat fee to the HMO instead of a pay per service model. It would then be up to the HMO to make the system more efficient.
A Promising Beginning
For a while, the HMO system seemed to work. The increase in costs of medical procedures began to slow. Along with the very good economy of the 1990’s, states sought to provide healthcare for children of families that made too much for medicaid but too little for insurance.
Feds passed CHIP, this was administered by the states but mostly funded by the feds. Almost all states take advantage of CHIP and most allow the family to make 200% over the poverty line to qualify.
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The Safety Net Widens
Unsurprisingly, studies have shown the more people with health care, the more the system gets used. Research has shown that expanding medicaid results in lower death rates and people being in better health.
With the ACA, the number of uninsured people is expected to be cut in half by 2023. As of 2012, 45 million people were uninsured. As of 2032, that number is expected to be 23 million.
We spoke about how uncompensated care is causing hospitals and health clinic to shut their doors. The ACA should actually help with that and keep some of these facilities open.
One of the bigger problems is where are we going to find all the Drs for the new patients?
The Association of Medical Colleges estimates this country could have a shortage of up to 100,000 Dr’s by 2020.
Many of these positions are likely to be filled by nurse practitioners and other health professionals but you can image the Interest Group the represents Dr’s will not be very happy about that.
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Beyond Managed Care
As of 2010, 71% of medicaid patients are in managed care programs. Many states are going to this model including Florida.
The successor to the HMO may be the ACO (Accountable Care Organization)
This program works directly with healthcare providers and hospitals and allows them to share in the profits if patients services cost less than expected. This give Dr and hospital to become better and more efficient.
The ACO model removes the middle man that existed, and was taking much of the profit, in the HMO system. States like Oregon and Minnesota have moved to this ACO model and have seen positive results over the HMO model.
Time for Reform
After The 1990’s, states like Maine and Massachusetts set to enact universal health care laws. In Maine in 2004, 14% of the states population lacked health care coverage, with 80% of the uninsured working for small businesses that could not afford it. After several years, they found the program only reduced the states uninsured population by 10% but it also cost more than was expected.
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Even with that example, Massachusetts moved forward with their own health care initiative.
Residents had to get health care insurance or pay a tax penalty. Also employers that did not offer health insurance had to pay a penalty for each employee every year.
Every residence under the federal poverty line could receive fully subsidized health care.
This program was estimated to cover 95% of state resident with the 5% opting to take the tax penalty.
As of 2008, Massachusetts only had 6% of residents uninsured, the lowest rate in the nation.
The cost of this added $700 million to the states expenditures, with the feds covering half.
This plan in Massachusetts was the model for the federal ACA.
Issues to Watch
Health Information Technology
Have you noticed every time you go to the Dr’s, you have to fill out the same information? How many hoops do you need to jump through to get medical records from one Dr to another.
The feds, states and private insurers are working together to building a health information system database. A 2005 study said the the country could save $77 billion annually in increased efficiencies with such a system in place.
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The federal bailout of 2009 of state and local governments included money to help pay for this. Implementing this records system at the state level was more successful in some states than others.
Vermont was able to pay for an electronic medical records system and the state required insurance companies to pay a fee to maintain it.
In Tennessee, they were less successful. In the end they were not able to find a way to finance the exchange. The initiative shut down in 2011.
Two major healthcare providers in California gave $80 million to establish this records system but there were many technical difficulties with bundling millions of patients records from multiple systems into one.
Long-Term Care
One of the big responsibilities of Medicaid is long term care of elderly people. As the number of elderly people in this country continues to increase, that will cause a dramatic increase in the expense of providing nursing care for the elderly.
The Census Bureau estimates that number of people 85 years and older will increase by 40% by 2020. It is expected to increase by 250% by 2040!
Nursing homes are very expensive. States like Oregon are shifting to less expensive at home care or assisted living facilities. One of the big issues for people to qualify, you have to have almost no assets so people have had to spend hundreds of thousands of dollars of the life savings before medicaid will pay.
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The Return of Public Health
In reality, local government is going to be at the forefront of the response to any public health situation in this country, whether it is a terrorist attack, pandemic, or natural disaster. Of course most local governments are not prepared for something like this. If something happened, it will take a while for the right policies and procedure to be developed to minimize the negative effects on the incident.
Teen pregnancy is also a major concern. 1 in 9 girls between the age of 16 - 19 will become pregnant outside of wedlock.
The argument is whether to provide abstinence only education or extensive sexual education. Both side of this fight can find studies that support their side and go against the other.
Research does show though that students that take either type of class has a lower chance of being sexualy active and thus loweing the rate of teen pregancy.
Due to the money put into both programs, as of 2010, the rate of birth to teenage mothers dropped to the lowest level since the 1940’s.
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What is Good Health Anyway?
Local and States governments also need to try to define what is healthy. Not an easy answer.
Take obesity. Over the past 2 decades, The number of children that are considered obese has tripled. Today 18% of children are obese compared to just 4% in the 1970’s.
Obesity contributes to things like heart disease, cancer, diabetes, stroke, arthritis, breathing problems, and depression, among others.
Research has attributes 112,000 death per years to obesity. In 2003, the cost to deal with the medical issues of obese people was estimated at $92 billion.
With restaurants like McDonalds, Taco Bell, KFC, that are popular and convenient, that has added to the problem
The state of New York passed a law that required restaurants in that city to not serve trans fats, which has been shown to cause many health issues.
States have also considered taxing soft drinks pointing to the success of taxing cigarettes, but strong lobbying groups have fought against it and so far, it has not been successful.
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