Health care reform in the United States

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Medicare health care reform[edit]

Medicare is a government health care program that will no longer fully be able to fund care in 2028.[1]

Veterans administration health care system[edit]

The Veterans Health Administration scandal of 2014 was a serious failure by a government health care program.

Medicaid health care system[edit]

Medicaid was expanded under ObamaCare providing health care to many that had less access to health care prior. ObamaCare’s Medicaid expansion expanded Medicaid to our nation’s poorest in order cover nearly half of uninsured Americans.[2] 24 States have not expanded Medicaid, so 5.7 million people are uninsured.[3]

The poor are ineligible for subsidized health care insurance on the exchanges.[4] Many doctors won’t take the Medicaid, and the care patients do receive may be inferior.[5]

History of national reform efforts[edit]

Here is a summary of reform achievements at the national level in the United States. For failed efforts, state-based efforts, native tribes services and more details generally, see the main article History of health care reform in the United States.

  • 1965 President Lyndon Johnson enacted legislation that introduced Medicare, covering both hospital (Part A) and supplemental medical (Part B) insurance for senior citizens. The legislation also introduced Medicaid, which permitted the Federal government to partially fund a program for the poor, with the program managed and co-financed by the individual states.[6][7]
  • 1985 The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.[8]
  • 1996 The Health Insurance Portability and Accountability Act (HIPAA) not only protects health insurance coverage for workers and their families when they change or lose their jobs, it also made health insurance companies cover pre-existing conditions. If such condition had been diagnosed before purchasing insurance, insurance companies are required to cover it after patient has one year of continuous coverage. If such condition was already covered on their current policy, new insurance policies due to changing jobs, etc... have to cover the condition immediately.[9]
  • 1997 The Balanced Budget Act of 1997 introduced two new major Federal healthcare insurance programs, Part C of Medicare and the State Children's Health Insurance Program, or SCHIP. Part C formalized longstanding "Managed Medicare" (HMO, etc.) demonstration projects and SCHIP was established to provide health insurance to children in families at or below 200 percent of the federal poverty line. Many other "entitlement" changes and additions were made to Parts A and B of fee for service (FFS) Medicare and to Medicaid within an omnibus law that also made changes to the Food Stamp and other Federal programs.[10]
  • 2000 The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) effectively reversed some of the cuts to the three named programs in the Balanced Budget Act of 1997 because of Congressional concern that providers would stop providing services.
  • 2003 The Medicare Prescription Drug, Improvement and Modernization Act (also known as the Medicare Modernization Act or MMA) introduced supplementary optional coverage within Medicare for self-administered prescription drugs and as the name suggests also changed the other three existing Parts of Medicare law.
  • 2010 The Patient Protection and Affordable Care Act, called PPACA or ACA but also known as Obamacare, was enacted, providing for the phased introduction over multiple years of a comprehensive system of mandated health insurance reforms designed to eliminate "some of the worst practices of the insurance companies"—pre-existing condition screening and premium loadings, policy cancellations on technicalities when illness seems imminent, annual and lifetime coverage caps. It also sets a minimum ratio of direct health care spending to premium income, and creates price competition bolstered by the creation of three standard insurance coverage levels to enable like-for-like comparisons by consumers, and a web-based health insurance exchange where consumers can compare prices and purchase plans. The system preserves private insurance and private health care providers and provides subsidies in the form of income tax reductions to enable lower income Americans to buy insurance. PPACA also made many changes to the 1997, 2000 and 2003 laws that had previously changed Medicare and further expanded eligibility for Medicaid (that expansion was later ruled by the Supreme Court to be at the discretion of the states)
  • 2015 The Medicare Access & CHIP Reauthorization Act (MACRA) made significant changes to the process by which many Medicare Part B services are reimbursed and also extended SCHIP

Quality of care[edit]

There is significant debate regarding the quality of the U.S. healthcare system relative to those of other countries.


The Patient Protection and Affordable Care Act popularly known as ObamaCarewas a major reform passed in 2010. See the main articles for a full history.

Repeal and Replacement of ObamaCare[edit]

President Trump made the repeal and replacement of ObamaCare a major issue in his 2016 campaign.

Alternatives and research directions[edit]

There are alternatives to the exchange-based market system which was enacted by the Patient Protection and Affordable Care Act which have been proposed in the past and continue to be proposed, such as a single-payer system and allowing health insurance to be regulated at the federal level.

In addition, the Patient Protection and Affordable Health Care Act of 2010 contained provisions which allows the Centers for Medicare and Medicaid Services (CMS) to undertake pilot projects which, if they are successful could be implemented in future.

Single-payer health care[edit]

A number of proposals have been made for a universal single-payer healthcare system in the United States, most recently the United States National Health Care Act, (popularly known as H.R. 676 or "Medicare for All") but none have achieved more political support than 20% congressional co-sponsorship. Advocates argue that preventative health care expenditures can save several hundreds of billions of dollars per year because publicly funded universal health care would benefit employers and consumers, that employers would benefit from a bigger pool of potential customers and that employers would likely pay less, and would be spared administrative costs of health care benefits. It is also argued that inequities between employers would be reduced.[11][12][13] Also, for example, cancer patients are more likely to be diagnosed at Stage I where curative treatment is typically a few outpatient visits, instead of at Stage III or later in an emergency room where treatment can involve years of hospitalization and is often terminal.[14][15] Others have estimated a long-term savings amounting to 40% of all national health expenditures due to preventative health care,[16] although estimates from the Congressional Budget Office and The New England Journal of Medicine have found that preventative care is more expensive.[17]

Any national system would be paid for in part through taxes replacing insurance premiums, but advocates also believe savings would be realized through preventative care and the elimination of insurance company overhead and hospital billing costs.[18] An analysis of a single-payer bill by Physicians for a National Health Program estimated the immediate savings at $350 billion per year.[19] The Commonwealth Fund believes that, if the United States adopted a universal health care system, the mortality rate would improve and the country would save approximately $570 billion a year.[20]

Recent enactments of single-payer systems within individual states, such as in Vermont in 2011, may serve as living models supporting federal single-payer coverage.[21] The plan in Vermont, however, has failed.[22]

Public option[edit]

In January 2013, Representative Jan Schakowsky and 44 other U.S. House of Representatives Democrats introduced H.R. 261, the "Public Option Deficit Reduction Act" which would amend the 2010 Affordable Care Act to create a public option. The bill would set up a government-run health insurance plan with premiums 5% to 7% percent lower than private insurance. The Congressional Budget Office estimated it would reduce the United States public debt by $104 billion over 10 years.[23]

Balancing doctor supply and demand[edit]

The Medicare Graduate Medical Education program regulates the supply of medical doctors in the U.S.[24] By adjusting the reimbursement rates to establish more income equality among the medical professions, the effective cost of medical care can be lowered.

See also[edit]


  2. ^ "ObamaCare's Medicaid Expansion Could Insure 21.3 Million Americans in the Next Decade. So Why Did Some States Opt-Out Of Expanding Medicaid?". ObamaCare Facts. Retrieved 5 December 2016. 
  3. ^ "ObamaCare's Medicaid Expansion Could Insure 21.3 Million Americans in the Next Decade. So Why Did Some States Opt-Out Of Expanding Medicaid?". ObamaCare Facts. Retrieved 5 December 2016. 
  4. ^ Young, Jeffery (14 Jan 2014). "Millions Are Now Realizing They're Too Poor For Obamacare". Huffington Post. Retrieved 5 December 2016. 
  5. ^ Atlas, Scott W. (15 March 2016). "How to Fix the Scandal of Medicaid and the Poor". Wall Street Journal. Retrieved 5 December 2016. 
  6. ^ "Brief history of the Medicare program". San Antonio, Tex.: New Tech Media. 2010. Retrieved August 31, 2010. 
  7. ^ Ball, Robert M. (October 24, 1961). "The role of social insurance in preventing economic dependency (address at the Second National Conference on the Churches and Social Welfare, Cleveland, Ohio)". Washington, D.C.: U.S. Social Security Administration. Retrieved August 31, 2010. 
    • Robert M. Ball, the then Deputy Director of the Bureau of Old-Age and Survivors Insurance in the Social Security Administration, had defined the major obstacle to financing health insurance for the elderly several years earlier: the high cost of care for the aged and the generally low incomes of retired people. Because retired older people use much more medical care than younger, employed people, an insurance premium related to the risk for older people needed to be high, but if the high premium had to be paid after retirement, when incomes are low, it was an almost impossible burden for the average person. The only feasible approach, he said, was to finance health insurance in the same way as cash benefits for retirement, by contributions paid while at work, when the payments are least burdensome, with the protection furnished in retirement without further payment.
  8. ^ "An employee's guide to health benefits under COBRA – The Consolidated Omnibus Budget Reconciliation Act of 1986" (PDF). Washington, D.C.: Employee Benefits Security Administration, U.S. Department of Labor. 2010. Retrieved November 8, 2009. 
  9. ^
  10. ^ "What is SCHIP?". Washington, D.C.: National Center for Public Policy Research. 2007. Retrieved September 1, 2010. 
  11. ^ Institute of Medicine, Committee on the Consequences of Uninsurance; Board on Health Care Services (2003). Hidden Costs, Value Lost: Uninsurance in America. Washington, DC: The National Academies Press. 
  12. ^ Lincoln, Taylor (April 8, 2014). "Severing the Tie That Binds: Why a Publicly Funded, Universal Health Care System Would Be a Boon to U.S. Businesses" (PDF). Public Citizen. Retrieved May 20, 2014. 
  13. ^ Ungar, Rick (April 6, 2012). "A Dose Of Socialism Could Save Our States - State Sponsored, Single Payer Healthcare Would Bring In Business & Jobs". Forbes. Retrieved May 20, 2014. 
  14. ^ Hogg, W.; Baskerville, N.; Lemelin, J. (2005). "Cost savings associated with improving appropriate and reducing inappropriate preventive care: Cost-consequences analysis" (PDF). BMC Health Services Research. 5: 20. doi:10.1186/1472-6963-5-20. PMC 1079830Freely accessible. PMID 15755330. 
  15. ^ Kao-Ping Chua; Flávio Casoy (June 16, 2007). "Single Payer 101". American Medical Student Association. Retrieved May 20, 2014. 
  16. ^ Hogg, W.; Baskerville, N; Lemelin, J (2005). "Cost savings associated with improving appropriate and reducing inappropriate preventive care: cost-consequences analysis". BMC Health Services Research. 5 (1): 20. doi:10.1186/1472-6963-5-20. PMC 1079830Freely accessible. PMID 15755330. 
  17. ^ PolitiFact: Barack Obama says preventive care 'saves money'. February 10, 2012.
  18. ^ Krugman, Paul (June 13, 2005). "One Nation, Uninsured". The New York Times. Retrieved December 4, 2011. 
  19. ^ Physicians for a National Health Program (2008) "Single Payer System Cost?"
  20. ^ Friedman, Gerald. "Funding a National Single-Payer System "Medicare for All" Would save Billions, and Could Be Redistributive.". Dollars & Sense. 
  21. ^ "State-Based Single-Payer Health Care — A Solution for the United States?" New England Journal of Medicine 364;13:1188-90, March 31, 2011
  22. ^ [1] Politico (20 Dec 2014). Accessed 20 May 2015.
  23. ^ "House Dems push again for creation of government-run health insurance option" The Hill, January 16, 2013
  24. ^ "Graduate Medical Education Funding Is Not Helping Solve Primary Care, Rural Provider Shortages, Study Finds". Robert Wood Johnson Foundation. June 19, 2013. 

Further reading[edit]

External links[edit]