only options Americans had to be covered for care was to purchase private insurance plans. The most vulnerable populations were unable to afford private plans and thus lacked access to medical coverage. These populations, similar to today, included the elderly, persons with disabilities, those who were self-employed, those who worked part-time jobs, and employees of small businesses (Kovner & Knickman (Eds.), 2011, p. 29). Talk of universal coverage existed, however was staunchly opposed by conservatives who did not believe free coverage should be given to those who were neither poor nor particularly needy (Kovner & Knickman (Eds.), 2011, p. 29). In 1950 the Social Security Act was amended so that federal funds could be provided to states to be used toward paying health care providers and cover medical care for welfare recipients (Kovner & Knickman (Eds.), 2011, p. 30). Because the responsibility was passed from the federal government to the states, the amendment received bi-partisan support. In 1960, President John F. Kennedy expanded this “welfare medicine program,” known as the Kerr-Mills Program, to cover the elderly as well as persons with disabilities (Kovner & Knickman (Eds.), 2011, p. 30). However, it wasn’t until 1965 that a Democratic President as well as a Democratic House took advantage of their window of opportunity to enact change. President Lyndon B. Johnson envisioned the creation of a “Great Society” where three initiatives became law: hospital insurance for the elderly (Medicare Part A), physician insurance for the elderly (Medicare Part B), and the expansion of the Kerr-Mills Program, which would become Medicaid (Kovner & Knickman (Eds.), 2011, p. 30). Medicaid is an entitlement program that is state-administered and provides health insurance to low-income state residents. States vary in terms of eligibility rules, benefits provided, as well as payment schedules. They are responsible for regulating policies; determining the type, amount, duration and scope of services; setting payment rates, and the
consumer-protection efforts, which include malpractice suits (Sommers & Epstein, 2011). Dating back to the 1920s, states were also in charge of setting capitalization requirements, regulating marketing and enrollment activities, and in some states even setting the rates paid by insurers to providers in hospitals (Kaiser Family Foundation, The Federal Courts' Role In Implementing the Affordable Care Act, 2014). Despite these rules set forth, the relationship among providers, insurers, and regulators was one where everyone benefitted. Providers would charge insurers high rates that would be paid without question, while regulators did little to make sure that insurance companies were capitalizing their profits (Kovner & Knickman (Eds.), 2011, p. 38). Patients were not being treated fairly and many services were not covered. It took two decades for more regulations to be enacted. In 1974, ERISA was passed with the intention of preventing unfair denial of pensions to employees (Kovner & Knickman (Eds.), 2011, p. 38). As part of the law, states could no longer regulate employee benefit programs. This provision was thus used as a loophole for companies that were self-insured. Under this provision, companies would be exempt from state capitalization, state taxes imposed on insurers, and all other state regulations (Kovner & Knickman (Eds.), 2011, p. 38). Self-insured companies therefore did not have to comply with state regulations that promoted patient protection and are only required to adhere to federal regulatory requirements (Longest, 2010, p. 236). Because the federal government prior to 2010 generally did not impose any requirements, most of the companies remained unregulated (Department of Health and Human Services, 2012). As more private firms learned about this loophole, more became self-insured rather than opting to get coverage through private plans. The American public pressured Congress to act against the managed care industry, however, it was not until 2010 with the enactment of the ACA that comprehensive federal oversight was finally imposed over the private health insurance industry.
ACA. These opinions were dependent upon their specialty and which groups they were aligned with. The Physicians for a National Health Program believed that private health insurance options should be eliminated altogether, while the AMA continued to favor tax advantages for health savings accounts (Quadagno, 2011). Overall the ACA has restructured the nation’s entire healthcare system, covered millions more, and has the potential to slow healthcare inflation. However, only time will tell if these changes will have the best interests of America’s public in mind. The Media’s Perspective Partisan ideology will always be an issue when addressing contended political and federal legislation. The media can play a key role in the information they choose to relay to the public. The public may choose to read an entire article, but may be left with only a few words and phrases that resonate in their mind such as an “increase in premiums,” “re-insurance,” or “death panels.” For most Americans, the true concern comes down to dollars and cents – the cost. Given the complexity of the United States health care system as well as the laws that regulate this system, many Americans may interpret health care programs in place differently. When information is spewed out in articles, most of the general public is not interested in the source of this information, but the information itself. Depending on the source, bias can arise as a factor, which can potentially skew the information presented. When dissecting the governor’s Healthy Pennsylvania proposal, the governor did not believe that the taxpayers should be “burdened” with rising costs and that, “Medicaid takes away from other program areas like education” (The Department of Public Welfare, 2013). Repeated words such as “safety-net,” “individual responsibility,” “government bureaucracy,” “easy to
Archembault, J. (2014). Pennsylvania’s ‘healthy pa’ Medicaid expansion will leave taxpayers in the red. Forbes. Retrieved from http://www.cbo.gov/sites/default t/files/cbofiles/attachments/45010-breakout-AppendixC.pdf Congressional Budget Office. (2014). Labor market effects of the affordable care act: updated estimates. Retrieved from http://www.cbo.gov/sites/default/files/cbofiles /attachments/45010-breakout-AppendixC.pdf. Decker, S. (2012). In 2011 nearly one-third of physicians said they would not accept new Medicaid patients, but rising fees may help. Health Affairs. Retrieved from Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2012). Actuarial report on the financial outlook for Medicaid. Retrieved from Department of Public Welfare. (2013). Healthy Pennsylvania: reforming Medicaid. Retrieved from http://www.dpw.state.pa.us/cs/groups/webcontent/documents/doc ument/p_039348.pdf