Health+Care


 * History of Health Care Policy **

1945: Harry S. Truman was the first president to call for national health insurance. His 10-year plan proposes compulsory coverage, increased hospital construction, and doubling the number of doctors and nurses nationwide. His attempt of reform is abandoned with the outbreak of the Korean War.

1946: Recognizing a growing gap in access to medical care between urban and rural areas, Congress passes the Hill-Burton Act to finance a vast wave of hospital construction aimed particularly at rural areas. It requires hospitals to provide charity care and prohibits discrimination based on race, religion, or nationality (but allows for “separate but equal” facilities).

1965: President Lyndon B. Johnson signs legislation creating the Medicare and Medicaid programs, which provide comprehensive health care coverage for people 65 and older, as well as the poor, blind, and disabled.

1971: Senator Edward Kennedy proposes the Health Security Act, a universal single-payer health reform plan. Kennedy considered health care reform to be "the cause" of his life.

1974: Congress passes the Employee Retirement Income Security Act (ERISA), which exempts large corporations’ self-insured health plans from state regulations.

1986: Congress passes the Emergency Medical Treatment and Active Labor Act, which requires hospitals to screen and stabilize all emergency room patients. The Consolidated Omnibus Budget Reconciliation Act (Cobra) allows employees to continue their group health plan up to 18 months after losing their jobs.

1988: Medicare Catastrophic Coverage Act is created to protect older Americans from financial ruin because of illness, and its benefits include setting limits on a Medicare patient’s payments for hospitals, doctors and prescription drugs. The law calls for the program to be financed entirely by the 33 million Medicare beneficiaries.

1989: The Medicare Catastrophic Coverage Act is repealed.

1993: President Clinton starts his reform effort, which would provide universal coverage based on the idea of “managed competition” in which private insurers compete in a tightly regulated market. Clinton’s Health Security Act fails to pass in Congress as a result of fierce partisan politics, powerful lobbying by interest groups, Congressional distraction by other major issues, and the news media’s failure to successfully explain the plan to Americans.

1996: The Health Insurance Portability and Accountability Act establishes standards for medical record privacy, protects people in group health insurance plans from being barred for pre-existing conditions, and prohibits employment discrimination based on health status.

1997: President Clinton signs legislation to create the State Children’s Health Insurance Program (S-Chip). The program covers more than seven million children by 2008.

2002: The cost of health care, which had stabilized in the mid-1990s, climbs rapidly again.



2003: Bush signs the Medicare Modernization Act, which expands Medicare to include prescription drug coverage.

2006: National health care spending totals $2.2 trillion, or $7,421 per person and 16.2% of the economy.

2010: After intense, yearlong debate, President Obama signs legislation into law that will remake the nation’s health care system.



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Executive
 * Policy Making Actions of the Three Branches**
 * The executive branch essentially steers the direction in which healthcare policy will go during the president's administration
 * Recent presidents often introduce healthcare packages that are aimed at some type of reform, but they vary drastically
 * Clinton
 * 5 lb, 1300 page healthcare bill
 * Main goal was guaranteeing healthcare for all, but also extend coverage to all those that are under-covered
 * Plan would have required companies to provide health insurance or pay into a pool that would cover Medicaid and Medicare
 * Also taxes on the tobacco industry and other smaller taxes on large companies
 * Labeled by opponents as a government take over of healthcare
 * Bush
 * Health savings accounts
 * Save money tax free in order to pay for healthcare coverage
 * Based on free market principles
 * Medicare Part D
 * Provide coverage for prescription drugs for beneficiaries of the Medicare system
 * Plan was expensive - most likely $530 billion over the first decade

[] Legislative Judicial []
 * Presidents have varied strategies for attacking the problem, and so far not many have passed due to lobbying and partisan politics
 * The president will often propose the healthcare plan and use political maneuvers in order to pass it
 * The main job of the legislature is to refine the president's bill in order so that it can pass, determine costs with the CBO, and eventually vote on the bill
 * The largest problem for Clinton's healthcare plan was that he had a Republican controlled Congress and was unable to get his bill passed
 * In subcommittees and committees, the fine points of the bill are ironed out with the help of interest groups
 * Interest groups are very influential in the healthcare arena, especially ones for senior citizens like AARP
 * The growing baby boomer generation will depend on Medicare for care late into their years, and as average life expectancy increases, the government will need to pay more in order to support them
 * Interest groups have a large influence due to their large voter base and ability to make campaign contributions
 * Eventually the bill will get enough votes to pass if Congress and the president belong to the same party; however, this isn't always true
 * The Senate and House will usually have to pass two different versions and them merge them and have another vote before it ends up on the president's desk
 * The courts may not decide on the constitutionality of specific bills (although they will soon), there are many other healthcare related topics in the courts
 * Assisted suicide
 * In //Vacco v. Quill// the Supreme Court ruled that state bans of assisted suicide are constitutional and they don't violate the Ninth of Fourteenth Amendments
 * Implications over whether or not people can be required to kill someone else, and for the cost of keeping people alive
 * Can nurses and doctors be forced to participate in assisted suicides if they are requested?
 * Will assisted suicide remove some economic strain from the healthcare system by allowing people to not fight to the last?
 * Stem cell research
 * In 2001, George Bush issued a ban on federal funding of new embryonic stem cell lines, but it could be used on existing ones
 * Was recently removed by Barack Obama
 * Stem cell research has a lot of potential, but is it okay to end the life of a blastocyst?
 * The Supreme Court as well as lower courts will have to determine the constitutionality of many new medical practicies that are about to come onto the scene such as PGD. The future of medical lies in the courts

//Government in America.// Edwards, Wattenberg, and Lineberry. Thirteenth Edition. []

Executive Branch Legislative Branch Judicial Branch
 * Interrelated Activity Among the Branches - Tracking the Recent Healthcare Bill**
 * Barack Obama's major platform during his campaign was healthcare reform, specifically a government run option
 * The Obama administration proposed a bill, along with several congress members, in mid 2009, some of which passed through committees
 * There was a large fight in the House about whether or not the bill should include abortions, President Obama cut a deal saying that he would issue an executive order banning federal funding on abortions in order to get the bill passed
 * Obama also held a summit on healthcare for members of Congress to voice their opinions over the current bill
 * The Patient Protection and Affordable Care Act was eventually signed March 30, 2010
 * Congress begins looking at bills in committees and subcommittees around July 2009
 * The House then passed the Affordable Healthcare for America Act in November 2009, and the bill then went to the Senate
 * The Senate then passed it's version of the bill on Christmas Eve, which included a provision about federally funded abortions
 * Bart Stupak of the House then leads a revolt against the Senate version of the bill because of the abortion language, and attempts to convince enough House Democrats to not vote for the bill so that it will not pass
 * President Obama talks to the legislators and promises his executive decision, so Stupak's party is appeased
 * The House finally passes the reconciliation bill on March 21, 2010.
 * Several other healthcare plans were proposed, but none were ever voted upon
 * The judicial branch will now be involved as several states have challenged the constitutionality of the Patient Protection and Affordable Care Act
 * Two separate lawsuits have been filed
 * One by Florida Attorney General Bill McCollum which represents multiple states and another by Virginia Attorney General Ken Cuccinelli
 * This essentially a federalism issue over whether or not the federal government can require healthcare coverage, but there are also other arguments that could make this law unconstitutional such as the Slaughter House Rule
 * The outcome of these cases over the next several months should be very interesting as the Roberts Court may be defining federalsim in the twenty-first century

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**Role of non-governmental groups on the policy process:** Insurance Companies: They have been making it more difficult for doctors and hospitals to pass along the cost of others’ unpaid bills to them, creating problems for some institutions such as inner-city hospitals and trauma centers that serve the poor. The health insurance industry has a huge stake in the outcome of the debate on national health insurance, because a program funded and run by the national government would leave insurance companies without a function or a profit. Insurance companies played a major role in the defeat of President Clinton’s health care reform plan.



Private employers: As private insurance rates increase, employers complain that they are paying inflated premiums for their workers to cover the costs of those who cannot pay or whose insurance provides only partial reimbursement for medical care. Employers may attempt to reduce their burden by cutting out benefits that are covered by government programs.

According to [], the new legislation will:
 * Health Care Reform 2010**


 * Rein in the worst excesses and abuses of the insurance industry with some of the toughest consumer protections this country has ever known.
 * Hold insurance companies accountable to keep premiums down and prevent denials of care and coverage, including for pre-existing conditions.
 * Make health insurance affordable for middle class families and small businesses with one of largest tax cuts for health care in history – reducing premiums and out-of-pocket costs.
 * Provide the security of knowing that if you lose your job, change your job, or start that new business, you’ll always be able to purchase quality, affordable care in a new competitive health insurance market that keeps costs down.
 * Strengthen Medicare benefits with lower prescription drug costs for those in the ‘donut hole,’ chronic care, free preventive care, and nearly a decade more of solvency for Medicare.
 * Improve our nation’s fiscal health by reducing our deficit by more than $100 billion over the next decade, and more than $1 trillion in the decade after that.


 * Healthcare Reform - The GOP Point of View (aka...the right one)**

The recently passed healthcare bill claims to lower the nation's deficit by more than $1.1 trillion over the next 20 years. How can increasing spending on government run healthcare options like Medicare and Medicaid reduce the national defecit? Does the Congressional Budget Office know that the number of people that will be on this program for the next 20 years will be ever increasing and that the number of workers supporting each person on Medicare/Medicaid is decreasing. Taxing the middle class and upper class in order to pay for everyone's healthcare will essentially tax the middle class out of existence. There are many other affordable options and reforms that do not require much, if any, government spending and can still have a positive impact on the healthcare status of America. For example: These ideas will not cost the government a cent. These ideas are based on capitalistic, free market principles that will lower the cost of healthcare for all Americans. Before we spend billions of dollars, we should be trying approaches that do not involve spending money when our nation is $13 trillion in debt due to recent economic "bailouts." All I am asking for is sensability before we jump off into the deep end and cannot return to shore. [] [] []
 * Focus on lowering premiums for small businesses and families
 * Ending junk malpractice lawsuits
 * Preventing insurers from cancelling policies unfairly
 * Only terminate policies when customer commits fraud or conceals facts about a medical condition
 * Encourage small businesses to pool together in order to buy health insurance at the rate that large corporations do
 * Encourage innovative state programs to reach the uninsured
 * Allow Americans to buy health insurance across state lines
 * Promote healthy lifestyles
 * Enhance the idea of Health Savings Accounts

**Health Care Reform-The Liberal Perspective** As a nation, we spend a far larger share of our national income on health than any other industrialized country (18% of the GDP and that number is rising), yet we are far from being the healthiest. The World Health Organization ranked the United States twenty-fourth among the world’s nations using a measure of healthy longevity. The chance in the US of a baby dying in the first year of life is over 50% higher than that of a baby born in Japan. The United States was (until recently) the only industrial nation in the world without any form of national health insurance. Obviously, the US health care system is in need of reform, not just because it is ineffective, but also because it is unfair. One of the biggest weaknesses is that patients with a past or current medical condition are often unable to obtain affordable health coverage, and some insurance companies flat out deny coverage to those with pre-existing conditions. This leaves people with pre-existing conditions the option of using up much of their own money, or leaving the condition untreated. Fixing this problem is extremely complex. New York Times columnist Paul Krugman addresses this in the article “Why We Reform.” "So what’s the answer? Americans overwhelmingly favor guaranteeing coverage to those with pre-existing conditions — but you can’t do that without pursuing broad-based reform. To make insurance affordable, you have to keep currently healthy people in the risk pool, which means requiring that everyone or almost everyone buy coverage. You can’t do that without financial aid to lower-income Americans so that they can pay the premiums. So you end up with a tripartite policy: elimination of medical discrimination, mandated coverage, and premium subsidies."

Which is essentially what this new health care reform provides. More Arguments: -The gap in the quality of health care between the rich and the poor is huge. -According to the Congressional Budget Office, the reform will actually reduce the deficit. Read this. “How Health Care Reform Reduces the Deficit in 5 Not-So Easy Steps” [] -If not now, when? [] []
 * -Health care is a basic human right that should not be denied to the poor or to people who lose their jobs.**