This document discusses the evolution of Medicaid managed care in the United States from 1965 to 2005. It summarizes that initially, only a few states experimented with Medicaid managed care, with California's efforts leading to calls for reform due to low quality of care. In response, federal policymakers independently enacted laws in the 1970s and 1980s to regulate quality in Medicaid managed care arrangements, asserting more control over this growing part of the healthcare system. The document argues that despite Medicaid's design emphasizing state control, federal actors played a decisive role similar to their role in Medicare, displaying independence in shaping Medicaid managed care policy.
Observations on the needs for, the contents of, and many of the practical effects of the Affordable care Act or Obamacare. Understanding its benefits and shortcomings
Republican politicians overwhelmingly oppose action on climate change and reject the scientific consensus. The top .01% earn on average $23.8 million per year, while the top 1% earn over $352,000. A study found that the stock wealth of the richest 12,000 households has surpassed the housing wealth of 108 million households. Paul Singer will get back $2.28 billion, 369% of his original $617 million investment, from Argentina's debt repayment. Close to half of all super-PAC money comes from just 50 mega-donors and their relatives who are trying to influence elections.
Higher incomes are associated with longer life expectancy in the United States. This study analyzed tax and mortality data from 1999-2014 to examine the relationship between income and life expectancy. The key findings were:
1) The gap in life expectancy between the richest and poorest was 14.6 years for men and 10.1 years for women.
2) Income inequality in life expectancy increased over time, with those in the top 5% of incomes seeing larger gains in life expectancy than those in the bottom 5%.
3) Life expectancy varied substantially across local areas for low-income individuals, differing by up to 4.5 years between areas.
4) Differences in life expectancy across areas were correlated with
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
This document summarizes New Mexico's behavioral healthcare crisis and proposes reforms. Key points:
- New Mexico faces high rates of substance abuse and mental illness that burden the state financially and socially.
- Previous reforms failed to create an effective, coordinated system, and a 2013 scandal further divided stakeholders.
- The summary argues that simply increasing funding will not solve problems and that New Mexico must reform its system through more effective policies rather than looking to the dysfunctional US federal system for guidance or funds.
Latest nationwide health report shows i.a. some improvements in infant mortalityΔρ. Γιώργος K. Κασάπης
The latest national health report is out from the CDC. Here’s what you need to know:
•Infant mortality: Overall, the infant mortality rate in 2017 was 14% lower than in 2007. At the same time, the rate was 170% higher among black infants than infants born to Asian or Pacific Islander mothers.
•Use of cigarettes: Although the number of high schoolers who used tobacco cigarettes decreased between 2011-2018, the use of e-cigarettes increased by nearly 20%.
•Prescription drugs: The proportion of Americans taking five or more prescription drugs nearly doubled between 1999-2016. In 2017, some 12% of adults who were 100%-200% below the federal poverty level reported not getting prescribed medicines due to cost.
The document discusses the complex legal infrastructure for public health in the United States across federal, state, and local levels of government. While states have the primary legal responsibility for public health, the federal government has grown in influence through powers like the Commerce Clause, funding provided by taxing authority, and agenda-setting on national issues. Local governments are dependent on and limited by state authority based on Dillon's Rule. Overall, while legal authority is dispersed, informal powers from funding, politics, and national prioritization have increased the federal government's dominance in shaping public health policy despite public health primarily being implemented locally.
Observations on the needs for, the contents of, and many of the practical effects of the Affordable care Act or Obamacare. Understanding its benefits and shortcomings
Republican politicians overwhelmingly oppose action on climate change and reject the scientific consensus. The top .01% earn on average $23.8 million per year, while the top 1% earn over $352,000. A study found that the stock wealth of the richest 12,000 households has surpassed the housing wealth of 108 million households. Paul Singer will get back $2.28 billion, 369% of his original $617 million investment, from Argentina's debt repayment. Close to half of all super-PAC money comes from just 50 mega-donors and their relatives who are trying to influence elections.
Higher incomes are associated with longer life expectancy in the United States. This study analyzed tax and mortality data from 1999-2014 to examine the relationship between income and life expectancy. The key findings were:
1) The gap in life expectancy between the richest and poorest was 14.6 years for men and 10.1 years for women.
2) Income inequality in life expectancy increased over time, with those in the top 5% of incomes seeing larger gains in life expectancy than those in the bottom 5%.
3) Life expectancy varied substantially across local areas for low-income individuals, differing by up to 4.5 years between areas.
4) Differences in life expectancy across areas were correlated with
Used for Medical Grand Rounds at several hospitals, this is data based comprehensive review of the shortcomings of the American Medical System and dysfunctional political attempts at reform. Single payer, Medicare for all, with elimination of for profit insurance companies is the best answer.
This document summarizes New Mexico's behavioral healthcare crisis and proposes reforms. Key points:
- New Mexico faces high rates of substance abuse and mental illness that burden the state financially and socially.
- Previous reforms failed to create an effective, coordinated system, and a 2013 scandal further divided stakeholders.
- The summary argues that simply increasing funding will not solve problems and that New Mexico must reform its system through more effective policies rather than looking to the dysfunctional US federal system for guidance or funds.
Latest nationwide health report shows i.a. some improvements in infant mortalityΔρ. Γιώργος K. Κασάπης
The latest national health report is out from the CDC. Here’s what you need to know:
•Infant mortality: Overall, the infant mortality rate in 2017 was 14% lower than in 2007. At the same time, the rate was 170% higher among black infants than infants born to Asian or Pacific Islander mothers.
•Use of cigarettes: Although the number of high schoolers who used tobacco cigarettes decreased between 2011-2018, the use of e-cigarettes increased by nearly 20%.
•Prescription drugs: The proportion of Americans taking five or more prescription drugs nearly doubled between 1999-2016. In 2017, some 12% of adults who were 100%-200% below the federal poverty level reported not getting prescribed medicines due to cost.
The document discusses the complex legal infrastructure for public health in the United States across federal, state, and local levels of government. While states have the primary legal responsibility for public health, the federal government has grown in influence through powers like the Commerce Clause, funding provided by taxing authority, and agenda-setting on national issues. Local governments are dependent on and limited by state authority based on Dillon's Rule. Overall, while legal authority is dispersed, informal powers from funding, politics, and national prioritization have increased the federal government's dominance in shaping public health policy despite public health primarily being implemented locally.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
The document discusses 6 reasons why 2009 will be a pivotal year for health care reform in Connecticut: 1) People are desperate for change in health care due to rising costs, 2) The economic crisis has increased demand for reform but also creates opportunities, 3) A comprehensive reform plan could expand access and control costs, 4) Campaign and grassroots organizing efforts are growing support for reform, 5) Polls show strong public support for government action on health care access and affordability, even if it raises taxes. The economic downturn has increased medical hardships and made reform more urgently needed.
Essay 4, excellent effort realizing full credit of 10 of 10 possible pts.jcarlson1
The document discusses how the US government is transitioning from a democratic to a democratic socialist form of government. This can be seen through violations of constitutional principles within several institutions:
1) The political system - elected officials are influenced by donations, and homeless citizens cannot vote due to residency requirements.
2) The economic institution - higher taxes undermine liberty and happiness, and government intervention in private industries like auto companies undermines free enterprise.
3) The educational institution - public education limits private options, and school searches violate privacy rights per the 4th Amendment.
4) The religious institution - [no summary provided as document ends abruptly]
Independent study -danika tynes--analysis of indicator well-being gapDanika Tynes, Ph.D.
This document summarizes and analyzes a research paper that explores whether shifting the focus of institutions from economic growth to individual well-being and happiness could provide a more sustainable way to create global stability. The document reviews literature on factors that influence development and analyzes the role of institutions. It discusses how institutions set priorities and influence healthcare systems. Results from comparing global happiness, GDP, and UN Millennium Development Goals reveal that individual well-being is a significant predictor of development outcomes, pointing to the need to re-evaluate priorities in institutional policies.
This study analyzed the effects of alcohol tax increases in Alaska from 1976-2004 on alcohol-related mortality rates. The results showed statistically significant reductions in alcohol-caused and alcohol-related deaths following tax increases in 1983 and 2002. However, the decreases were temporary as multiple variables like population and frequency of tax increases influenced outcomes. Additionally, lessons from the prohibition era suggest that punitive measures like sin taxes may not be the most effective long-term strategy and positive reinforcement may work better.
Health care policy in the United States, Canada and ChinaYuzhou Sun
This document compares the health care systems of the United States, Canada, and China. It finds that while the US spends the most on health care as a percentage of GDP, it has a lower life expectancy than Canada. China spends the least but has increased funding for reform. Key factors discussed include pharmaceutical costs, administration costs, income levels, the uninsured population, lifestyle/obesity rates, and recent reforms in the US and China. Excessive medical treatment and fraud are also noted as increasing costs without improving health outcomes.
Liberal Democracy in America and Socialism in Vietnam Impact on Health Insura...LongHienLe
This article compares two political theories, namely liberal democracy, and socialism, on health insurance and services in America and Vietnam. More specifically, it dives deeper into the relationship between the different types of economy in each social formation and the quality of the health care system development as expressed in specific policies.
This document provides an overview of the 2019 World Happiness Report, which focuses on happiness and community. It discusses three topics: links between government and happiness, the importance of prosocial behavior, and the impact of digital technology on communities and interactions. The overview previews the subsequent chapters, which will analyze relationships between governance and life evaluations, the connection between voter happiness and political participation, evidence on the link between generosity and well-being, and the effects of digital media and internet addiction on American happiness.
This document is the introduction chapter of the World Happiness Report 2019. It summarizes the focus of the report, which examines how happiness has changed over time and how factors like government, community, and technology influence happiness. The chapter specifically discusses three topics: 1) links between government and happiness, 2) the impact of prosocial behavior, and 3) changes in information technology. It provides examples from Mexican survey data to illustrate how dissatisfaction with government can influence voting behavior and how happiness increased after a change in leadership.
This document discusses approaches to controlling health care costs in the United States. It compares free market and socialized healthcare systems. A free market system leaves many uninsured and has high administrative costs, while socialized healthcare extends care to all citizens but may increase taxes and wait times. An analysis shows that US healthcare costs have risen much more sharply than in countries with single-payer systems like Canada, where administrative costs are about half of those in the US. Adopting aspects of more efficient single-payer systems could help control costs and improve health outcomes in the US.
From Politics to Parity: Using a Health Disparitiies Index to Guide Legislati...Jim Bloyd, DrPH, MPH
This document discusses the creation of a health disparities index (HDI) to quantify racial health disparities in states over time. The researchers analyzed mortality rates for various diseases in Black and White populations in states from 1999-2005. They calculated disparity values and compiled HDI scores for states. States with the lowest average HDI scores, indicating fewer health disparities, were Massachusetts, Oklahoma, and Washington. The HDI scores correlated with social determinants of health like income inequality and rates of uninsured individuals. The researchers aim to use the HDI to guide legislative efforts to reduce health disparities.
The document discusses the problems with the current US healthcare system, including the large number of uninsured and underinsured Americans, high costs, and lower quality of care compared to other developed nations. It argues for a universal single-payer healthcare system that would provide comprehensive coverage to all Americans with no out-of-pocket costs, funded through taxes and savings from reduced administrative overhead. A single-payer system could save over $200 billion per year currently spent on private health insurance bureaucracy and lower drug and care costs through collective bargaining.
1. The document outlines 5 reasons why 2009 will be Connecticut's time to win on health care reform: people are desperate for change on health care; the economic crisis has strengthened this feeling; the crisis creates opportunities; a proposed health care plan has benefits; and their campaign is well organized.
2. Polls show health care is a top issue for voters, especially rising costs and losing insurance. Nearly two-thirds support a federal role in ensuring affordable, quality health care.
3. The economic crisis means the debate on the government's role in the economy is settled, and now it's a question of how it gets involved and what it does. Health care needs to be addressed at the state level.
This document discusses churning (involuntary movement between health insurance programs) under the Affordable Care Act. It aims to identify the characteristics of individuals likely to churn between Medicaid and Qualified Health Plans (QHPs), and the health plans best able to serve churning populations. The document introduces different types of health plans and examines their presence in several states' insurance exchanges. It outlines how churning will occur under the ACA and analyzes the experiences of Hawaii, New York, and Maryland to identify policies that can reduce churning, such as market alignment of insurers and strong data tools. The key findings are that market alignment dramatically reduces churning problems, data-driven health plans can help states address churning
Running Head POLITICS AND HEALTH CASE SYSTEMS IN USPOLITICS AND.docxcharisellington63520
Running Head: POLITICS AND HEALTH CASE SYSTEMS IN US
POLITICS AND HEALTH CARE SYSTEM IN US. 5
Politics and Healthcare System in USComment by James A Love: This is a good first outline. Please read the comments I have inserted below, and let me know if you have questions.
Name
School/College
September 11, 2015
Outline
Title: Politics and Healthcare System in US
Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector.
I. Introduction
A. Politics started intervening in the healthcare sector between the years 1930 and 1960.Comment by James A Love: Were politics not involved in healthcare prior to the 1930s and 1960s? Be prepared to cite this assertion. What changed in the 1930s?
B. Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector.Comment by James A Love: This claim will need citing for support.Comment by James A Love: This claim will need to supported with specific citations.
II. Background Comment by James A Love: The ‘background’ is appropriate here. It is essentially your ‘literature review’. I think you can use either section title, but you should include multiple citations of articles that discuss “politics in healthcare” spanning history.
A. The aim is to discuss the association between politics and healthcare and to try and find out the roles politics has played in reforming the healthcare sector.
III. Formation of acts to offer medical securityComment by James A Love: Section III, IV, and V seem like they should be the major subsections within section II.
A. Formation of social security act of 1935
a. Provide unemployment compensationComment by James A Love:
b. Provide old-age pensions
c. Other benefits
1. Provision of federal funds for hospital construction
B. Kerr-mills act of 1960
a. Federal matching payments
b. Elderly disabled and poor
IV. The election of some prominent leaders in the US
A. Kennedy, 1961
a. Kennedy kept the issue of elderly healthcare needs alive
B. Lyndon Johnson 1963
a. Initiated the Great Society’s War on Poverty Program
b. Medicare
C. Nixon
a. He signed various acts to extend community mental health centers
b. National Health Insurance Partnership Act
1. Family Health Insurance Plan
i. Offers health insurance to low income families
2. National Health Insurance Standards Act
i. Developing Health Maintenance Organizations
D. Jimmy carter
a. Supported national health insurance program
E. Clinton
a. He made changes in health insurance cove.
Universal Health Care in the United StatesShantanu Basu
The document discusses the current US healthcare system and theories of policy change. It analyzes how multiple problem streams, political conditions, and policy alternatives could converge to place healthcare reform on the policy agenda. Specifically, rising costs, decreased coverage, and poor outcomes have highlighted issues with the current system. Shifting public opinion and the upcoming presidential election may open a policy window to address universal healthcare.
Healthcare Policy and Advocacy for Improving Population Health.pdfbkbk37
This document provides instructions for students to respond to two discussion posts by other students on the topic of the Affordable Care Act. Students are asked to analyze how cost-benefit analysis affected efforts to repeal/replace the ACA and how voter analysis may impact legislative decisions on policies like Medicare and Medicaid. Students must post an original discussion by day 3 and respond to two other students' posts with expansions or challenges to their explanations and examples.
Running Head POLITICS AND HEALTH CASE SYSTEMS IN USPOLITICS A.docxcharisellington63520
Running Head: POLITICS AND HEALTH CASE SYSTEMS IN US
POLITICS AND HEALTH CARE SYSTEM IN US. 12
Politics and Healthcare System in US
Student’s Name
Institution
Date
Abstract
It should be noted that the U.S health care delivery system is constantly undergoing transformation through new legislation or improvement and amendments of the existing legislations. Some of the most common areas that are often improved concern the financing sector, insurance sector, delivery sector and quality sector. New laws are often introduced in these sectors with the purpose of ensuring that the resultant health care is of high quality and that it is cheaper and accessible to many. Affordability is another crucial component of health care delivery system. The four basic functional components of the U.S. health care delivery system include financing, insurance, delivery and quality would be discussed.
The paper will explore and analyze the association between the politics and the health care reforms in the United States. The analysis will try to find out the role of politics in the key healthcare reforms such as Medicare, Medicaid, Managed care and even the most current act called Affordable Care Act. The paper will demonstrate that politicians have been using gaps in the healthcare system to campaign for their consideration for being elected as Congress or senetors. It will also demonstrate that some politicians such as Clinton plan to initiate reforms to suit their political interest. The paper will conclude by indicating how the politics and politicians manipulate the health care reform as their campaign strategies of winning voters.
Politics and healthcare system in USA
A closer look at the health care reform in United States reveals that any reform is politically orchestrated. In fact it is as if one of the campaign strategies of most of the politicians is to come up with a reform that can improve cost of care, quality of care and access to care. A closer look at the history of the United States reveals that politics started intervening in health care between 1930s and 1960s (Patel & Rushefsky, 1999). During this time, there was depression, unemployment insurance and hence the government was in pressure to provide cheaper if not free medical care or reimbursement for its cost (Patel & Rushefsky, 1999).
In 1935, the Social Security Act of 1935 was formed to provide for unemployment compensation, old-age pensions and other benefits (Patel & Rushefsky, 1999). It should be noted that the political party in leadership had to be careful on how it handles the issue of health care lest it lose the confidence in people. Before the idea of insurance was introduced, the American Medical Association was strongly opposing it. On the other hand, the politicians and the ruling political government had to force it happen because that was the only option in which politicians could help its citizens and p.
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
This document discusses health care reform in the United States. It provides background on universal health care systems originating in Germany and Britain in the late 19th/early 20th centuries. It then discusses the Patient Protection and Affordable Care Act passed in 2010 in the US, which aimed to expand health insurance coverage. The document notes criticisms of both the German and US healthcare systems. It argues the German system distributes care fairly through government involvement, unlike the US approach of developing mass assistance programs and stating government should not control them.
The document discusses health care reform in the United States, known as the Affordable Care Act or Obamacare. It was signed into law in 2010 with the main goal of ensuring affordable health insurance is available to all US citizens. Key aspects of the law include prohibiting denial of coverage due to pre-existing conditions for those under 19 and allowing coverage for children under parents' plans until age 26. The law also expanded Medicare and added new benefits while fighting fraud and improving care. Both positives and criticisms of the law are discussed.
The document criticizes the U.S. medical system as being the most ineffective, unjust, inequitable and unethical among wealthy nations. It argues that the 2009 health reforms made the system worse. It provides examples showing racial and socioeconomic disparities in access to healthcare and health outcomes. It also discusses issues like the high costs of the system, medical bankruptcy, and how viewing patients as consumers is problematic.
The document discusses 6 reasons why 2009 will be a pivotal year for health care reform in Connecticut: 1) People are desperate for change in health care due to rising costs, 2) The economic crisis has increased demand for reform but also creates opportunities, 3) A comprehensive reform plan could expand access and control costs, 4) Campaign and grassroots organizing efforts are growing support for reform, 5) Polls show strong public support for government action on health care access and affordability, even if it raises taxes. The economic downturn has increased medical hardships and made reform more urgently needed.
Essay 4, excellent effort realizing full credit of 10 of 10 possible pts.jcarlson1
The document discusses how the US government is transitioning from a democratic to a democratic socialist form of government. This can be seen through violations of constitutional principles within several institutions:
1) The political system - elected officials are influenced by donations, and homeless citizens cannot vote due to residency requirements.
2) The economic institution - higher taxes undermine liberty and happiness, and government intervention in private industries like auto companies undermines free enterprise.
3) The educational institution - public education limits private options, and school searches violate privacy rights per the 4th Amendment.
4) The religious institution - [no summary provided as document ends abruptly]
Independent study -danika tynes--analysis of indicator well-being gapDanika Tynes, Ph.D.
This document summarizes and analyzes a research paper that explores whether shifting the focus of institutions from economic growth to individual well-being and happiness could provide a more sustainable way to create global stability. The document reviews literature on factors that influence development and analyzes the role of institutions. It discusses how institutions set priorities and influence healthcare systems. Results from comparing global happiness, GDP, and UN Millennium Development Goals reveal that individual well-being is a significant predictor of development outcomes, pointing to the need to re-evaluate priorities in institutional policies.
This study analyzed the effects of alcohol tax increases in Alaska from 1976-2004 on alcohol-related mortality rates. The results showed statistically significant reductions in alcohol-caused and alcohol-related deaths following tax increases in 1983 and 2002. However, the decreases were temporary as multiple variables like population and frequency of tax increases influenced outcomes. Additionally, lessons from the prohibition era suggest that punitive measures like sin taxes may not be the most effective long-term strategy and positive reinforcement may work better.
Health care policy in the United States, Canada and ChinaYuzhou Sun
This document compares the health care systems of the United States, Canada, and China. It finds that while the US spends the most on health care as a percentage of GDP, it has a lower life expectancy than Canada. China spends the least but has increased funding for reform. Key factors discussed include pharmaceutical costs, administration costs, income levels, the uninsured population, lifestyle/obesity rates, and recent reforms in the US and China. Excessive medical treatment and fraud are also noted as increasing costs without improving health outcomes.
Liberal Democracy in America and Socialism in Vietnam Impact on Health Insura...LongHienLe
This article compares two political theories, namely liberal democracy, and socialism, on health insurance and services in America and Vietnam. More specifically, it dives deeper into the relationship between the different types of economy in each social formation and the quality of the health care system development as expressed in specific policies.
This document provides an overview of the 2019 World Happiness Report, which focuses on happiness and community. It discusses three topics: links between government and happiness, the importance of prosocial behavior, and the impact of digital technology on communities and interactions. The overview previews the subsequent chapters, which will analyze relationships between governance and life evaluations, the connection between voter happiness and political participation, evidence on the link between generosity and well-being, and the effects of digital media and internet addiction on American happiness.
This document is the introduction chapter of the World Happiness Report 2019. It summarizes the focus of the report, which examines how happiness has changed over time and how factors like government, community, and technology influence happiness. The chapter specifically discusses three topics: 1) links between government and happiness, 2) the impact of prosocial behavior, and 3) changes in information technology. It provides examples from Mexican survey data to illustrate how dissatisfaction with government can influence voting behavior and how happiness increased after a change in leadership.
This document discusses approaches to controlling health care costs in the United States. It compares free market and socialized healthcare systems. A free market system leaves many uninsured and has high administrative costs, while socialized healthcare extends care to all citizens but may increase taxes and wait times. An analysis shows that US healthcare costs have risen much more sharply than in countries with single-payer systems like Canada, where administrative costs are about half of those in the US. Adopting aspects of more efficient single-payer systems could help control costs and improve health outcomes in the US.
From Politics to Parity: Using a Health Disparitiies Index to Guide Legislati...Jim Bloyd, DrPH, MPH
This document discusses the creation of a health disparities index (HDI) to quantify racial health disparities in states over time. The researchers analyzed mortality rates for various diseases in Black and White populations in states from 1999-2005. They calculated disparity values and compiled HDI scores for states. States with the lowest average HDI scores, indicating fewer health disparities, were Massachusetts, Oklahoma, and Washington. The HDI scores correlated with social determinants of health like income inequality and rates of uninsured individuals. The researchers aim to use the HDI to guide legislative efforts to reduce health disparities.
The document discusses the problems with the current US healthcare system, including the large number of uninsured and underinsured Americans, high costs, and lower quality of care compared to other developed nations. It argues for a universal single-payer healthcare system that would provide comprehensive coverage to all Americans with no out-of-pocket costs, funded through taxes and savings from reduced administrative overhead. A single-payer system could save over $200 billion per year currently spent on private health insurance bureaucracy and lower drug and care costs through collective bargaining.
1. The document outlines 5 reasons why 2009 will be Connecticut's time to win on health care reform: people are desperate for change on health care; the economic crisis has strengthened this feeling; the crisis creates opportunities; a proposed health care plan has benefits; and their campaign is well organized.
2. Polls show health care is a top issue for voters, especially rising costs and losing insurance. Nearly two-thirds support a federal role in ensuring affordable, quality health care.
3. The economic crisis means the debate on the government's role in the economy is settled, and now it's a question of how it gets involved and what it does. Health care needs to be addressed at the state level.
This document discusses churning (involuntary movement between health insurance programs) under the Affordable Care Act. It aims to identify the characteristics of individuals likely to churn between Medicaid and Qualified Health Plans (QHPs), and the health plans best able to serve churning populations. The document introduces different types of health plans and examines their presence in several states' insurance exchanges. It outlines how churning will occur under the ACA and analyzes the experiences of Hawaii, New York, and Maryland to identify policies that can reduce churning, such as market alignment of insurers and strong data tools. The key findings are that market alignment dramatically reduces churning problems, data-driven health plans can help states address churning
Running Head POLITICS AND HEALTH CASE SYSTEMS IN USPOLITICS AND.docxcharisellington63520
Running Head: POLITICS AND HEALTH CASE SYSTEMS IN US
POLITICS AND HEALTH CARE SYSTEM IN US. 5
Politics and Healthcare System in USComment by James A Love: This is a good first outline. Please read the comments I have inserted below, and let me know if you have questions.
Name
School/College
September 11, 2015
Outline
Title: Politics and Healthcare System in US
Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector.
I. Introduction
A. Politics started intervening in the healthcare sector between the years 1930 and 1960.Comment by James A Love: Were politics not involved in healthcare prior to the 1930s and 1960s? Be prepared to cite this assertion. What changed in the 1930s?
B. Thesis: The healthcare delivery system in the US has undergone noticeable gradual improvements from the financing sector, insurance sector, delivery and quality sector even though many politicians politicize the gaps in healthcare for their own benefits with the pretense of initiating reforms to the sector.Comment by James A Love: This claim will need citing for support.Comment by James A Love: This claim will need to supported with specific citations.
II. Background Comment by James A Love: The ‘background’ is appropriate here. It is essentially your ‘literature review’. I think you can use either section title, but you should include multiple citations of articles that discuss “politics in healthcare” spanning history.
A. The aim is to discuss the association between politics and healthcare and to try and find out the roles politics has played in reforming the healthcare sector.
III. Formation of acts to offer medical securityComment by James A Love: Section III, IV, and V seem like they should be the major subsections within section II.
A. Formation of social security act of 1935
a. Provide unemployment compensationComment by James A Love:
b. Provide old-age pensions
c. Other benefits
1. Provision of federal funds for hospital construction
B. Kerr-mills act of 1960
a. Federal matching payments
b. Elderly disabled and poor
IV. The election of some prominent leaders in the US
A. Kennedy, 1961
a. Kennedy kept the issue of elderly healthcare needs alive
B. Lyndon Johnson 1963
a. Initiated the Great Society’s War on Poverty Program
b. Medicare
C. Nixon
a. He signed various acts to extend community mental health centers
b. National Health Insurance Partnership Act
1. Family Health Insurance Plan
i. Offers health insurance to low income families
2. National Health Insurance Standards Act
i. Developing Health Maintenance Organizations
D. Jimmy carter
a. Supported national health insurance program
E. Clinton
a. He made changes in health insurance cove.
Universal Health Care in the United StatesShantanu Basu
The document discusses the current US healthcare system and theories of policy change. It analyzes how multiple problem streams, political conditions, and policy alternatives could converge to place healthcare reform on the policy agenda. Specifically, rising costs, decreased coverage, and poor outcomes have highlighted issues with the current system. Shifting public opinion and the upcoming presidential election may open a policy window to address universal healthcare.
Healthcare Policy and Advocacy for Improving Population Health.pdfbkbk37
This document provides instructions for students to respond to two discussion posts by other students on the topic of the Affordable Care Act. Students are asked to analyze how cost-benefit analysis affected efforts to repeal/replace the ACA and how voter analysis may impact legislative decisions on policies like Medicare and Medicaid. Students must post an original discussion by day 3 and respond to two other students' posts with expansions or challenges to their explanations and examples.
Running Head POLITICS AND HEALTH CASE SYSTEMS IN USPOLITICS A.docxcharisellington63520
Running Head: POLITICS AND HEALTH CASE SYSTEMS IN US
POLITICS AND HEALTH CARE SYSTEM IN US. 12
Politics and Healthcare System in US
Student’s Name
Institution
Date
Abstract
It should be noted that the U.S health care delivery system is constantly undergoing transformation through new legislation or improvement and amendments of the existing legislations. Some of the most common areas that are often improved concern the financing sector, insurance sector, delivery sector and quality sector. New laws are often introduced in these sectors with the purpose of ensuring that the resultant health care is of high quality and that it is cheaper and accessible to many. Affordability is another crucial component of health care delivery system. The four basic functional components of the U.S. health care delivery system include financing, insurance, delivery and quality would be discussed.
The paper will explore and analyze the association between the politics and the health care reforms in the United States. The analysis will try to find out the role of politics in the key healthcare reforms such as Medicare, Medicaid, Managed care and even the most current act called Affordable Care Act. The paper will demonstrate that politicians have been using gaps in the healthcare system to campaign for their consideration for being elected as Congress or senetors. It will also demonstrate that some politicians such as Clinton plan to initiate reforms to suit their political interest. The paper will conclude by indicating how the politics and politicians manipulate the health care reform as their campaign strategies of winning voters.
Politics and healthcare system in USA
A closer look at the health care reform in United States reveals that any reform is politically orchestrated. In fact it is as if one of the campaign strategies of most of the politicians is to come up with a reform that can improve cost of care, quality of care and access to care. A closer look at the history of the United States reveals that politics started intervening in health care between 1930s and 1960s (Patel & Rushefsky, 1999). During this time, there was depression, unemployment insurance and hence the government was in pressure to provide cheaper if not free medical care or reimbursement for its cost (Patel & Rushefsky, 1999).
In 1935, the Social Security Act of 1935 was formed to provide for unemployment compensation, old-age pensions and other benefits (Patel & Rushefsky, 1999). It should be noted that the political party in leadership had to be careful on how it handles the issue of health care lest it lose the confidence in people. Before the idea of insurance was introduced, the American Medical Association was strongly opposing it. On the other hand, the politicians and the ruling political government had to force it happen because that was the only option in which politicians could help its citizens and p.
Health Care and Medicare Corporate Culture and the Three-Legged StoolLillian Rosenthal
This document discusses the history and current state of Medicare spending in the United States. It notes that while Medicare was originally intended to provide healthcare access for seniors, costs have risen significantly due to an aging population living longer and advancing medical technology. The document analyzes newly released data on payments made to individual physicians by the Centers for Medicare and Medicaid Services to determine if and how healthcare providers may respond to financial incentives.
This document discusses health care reform in the United States. It provides background on universal health care systems originating in Germany and Britain in the late 19th/early 20th centuries. It then discusses the Patient Protection and Affordable Care Act passed in 2010 in the US, which aimed to expand health insurance coverage. The document notes criticisms of both the German and US healthcare systems. It argues the German system distributes care fairly through government involvement, unlike the US approach of developing mass assistance programs and stating government should not control them.
The document discusses health care reform in the United States, known as the Affordable Care Act or Obamacare. It was signed into law in 2010 with the main goal of ensuring affordable health insurance is available to all US citizens. Key aspects of the law include prohibiting denial of coverage due to pre-existing conditions for those under 19 and allowing coverage for children under parents' plans until age 26. The law also expanded Medicare and added new benefits while fighting fraud and improving care. Both positives and criticisms of the law are discussed.
Agenda Comparison Grid Template
Agenda Comparison Grid and Fact Sheet or Talking Points Brief Assignment Template for Part 1 and Part 2
Part 1: Agenda Comparison Grid
Use this Agenda Comparison Grid to document information about the population health/healthcare issue your selected and the presidential agendas. By completing this grid, you will develop a more in depth understanding of your selected issue and how you might position it politically based on the presidential agendas.
You will use the information in the Part 1: Agenda Comparison Grid to complete the remaining Part 2 and Part 3 of your Assignment.
Identify the Population Health concern you selected.
Mental Health Issue (Depression)
Describe the Population Health concern you selected and the factors that contribute to it.
Depression is the foremost cause leading young population to death in the USA. According to Cockerham, depression is a mental disorder, which is caused by psychological, persistent social and biological pain. This leads to disinterest of social life and committing suicide. Yet, if depression is not treated, it may lead to dementia, stroke and heart attack. In the past six to ten years, researchers such as Disease Control and Prevention found that youngsters at the age of 18 to 24 years, experience depression and going through suicidal thoughts. Unlike citizens 45 to 65 years of age, reports have reported that deaths among these particular group have been significantly rising. Mental health illnesses have brought many US presidents attention, which most of them have taken various steps allowing easy access to treatments and medicines.
Administration (President Name)
(Current President)
Donald Trump
(Previous President)
Barack Obama
(Previous President)
George W. Bush
Describe the administrative agenda focus related to this issue for the current and two previous presidents.
- To renovate the Patient Protection and Affordable Care Act, president Donald Trump came up with a different strategy, a new healthcare bill.
- Diminishing the amount of Medicaid is one of the undertaken steps of Donald Trump’s administration. This way, insurance plan will only cover substance use and mental issues meanwhile majority of them depend on low income.
- Obama signed an act, the Patient Protection and Affordable Care Act. It is also known to be Obamacare, allowing the extension of federal mental parity to Medicaid.
- The purpose of the act is to support people with mental illnesses and people who are disable. In 2010, president Obama signed the Frank Melville Supportive Housing Investment Act.
- In 2002, George W Bush shaped a commission, which involved experts in the mental health field.
- President George W Bush wanted to bring the anguishes undergone by mentally ill citizens to an end. President George W Bush signed the Pete Domenici Mental Health Parity and Addictions Equity Act in 2008. An all-inclusive law that covers health insurance. The act states .
Respond by Day 5 to at least two colleagues in one of the follmickietanger
Respond by Day 5
to at least two colleagues in one of the following ways:
Describe two factors that might make minority groups especially vulnerable in the Medicaid policy your colleague cited. Explain why these groups may not have a voice in the policy-making process.
Offer examples of organized self-help and citizens’ groups as both support mechanisms and potentially powerful lobbies. Describe how these lobbying bodies can help in amending the policy your colleague described.
Colleague 1
Chana Smith
RE: Discussion - Week 9
COLLAPSE
How the evolution of health care policy has influenced programs such as Medicaid and Medicare.
America health policy shifted from environmental concerns to individual. Over time we have moved from dispensaries, to marine hospitals, to focusing on check ups. "The federal government entered briefly into health provision during Franklin Roosevelt's New Deal with the Resettlement Administration's medical cooperatives" (Popple & Leighninger, 2019). The Depression led way for prepaid programs such as, Blue Cross and Blue Shield, due to hospitals being left with unpaid hospital bills. The government stepped back in when those who were less healthy, retired, unemployed, underemployed or self employed suffered. This is when both the Democratic and Republican parties worked together to put forth proposals that would protect the senior population that was getting left out of the employer based health plans (Popple & Leighninger 2019). Hospitals were reimbursed by Medicare however, continuously rising hospital costs, resulted in the Reagan administration developing a standardized payment based on diagnosis. Medicare became their cash cow because congress was able to take advantage of the cost reduction by transferring savings in Medicare into the general deficit reduction (Popple & Leighninger, 2019).
Specific Medicaid policy in your state that should be amended, and explain how you would amend it and why.
The Medicaid policy in North Carolina that should be amended is the policy that prohibits payment for diet programs in weight loss centers. Helping recipients with their goal towards weight loss could help reduce Medicaid costs. Medicaid paying for weight loss programs could result in lowered expenses towards weight related health issues such as high blood pressure, and diabeties (dhhs.gov, 2018).
The stakeholders involved in the Medicaid and Medicare health care policy in your state, and explain the role of these stakeholders in policy development for this issue.
The stakeholders involved in the Medicaid and Medicare health care policy include ombudsmen, providers, and consumer health advocacy groups. The provide expertise and knowledge to contribute towards identifying solutions to meet the needs the people. They then work together towards developing the policy (Nguyen, & Miller, 2018).
Colleague 2
Tameka Sutton
RE: Discussion - Week 9
COLLAPSE
In this week’s discussion, we are to communicate the devel ...
Medicare was signed into law in 1965 by President Johnson to protect vulnerable populations like the elderly and poor. Originally intended to passively protect these groups, Medicare has since emerged as a key driver of the US healthcare system due to rising costs. While Medicare still faces significant financial challenges, the Affordable Care Act has established Medicare as the dominant player in healthcare reform efforts.
1 3Defining the ProblemRigina CochranMPA593August 1.docxsmithhedwards48727
1
3Defining the Problem
Rigina CochranMPA/593
August 19, 2019
Peter ReevesDefining the Problem
The health care system in Colorado is a composition of medical professionals providing services such as diagnosis, treatment, as well as preventive measures to mental illness and injuries ("Healthcare policy in Colorado - Ballotpedia," 2019). Health care policy involves the establishment and implementation of legislation and other regulations that the states use to manage its health care system effectively. Further, this sector consists of other participants, such as insurance and health information technology. The cost citizens pay for medical care and also the access to quality care influence the overall health care providers in Colorado. Therefore, the need for the creation and implementation of laws that help the state maintain efficiency in the health sector in Colorado.
Problem Statement
The declining standards of medical care within the United States has caused significant concern in the world. Due to these rising concerns, there have been various policies implemented, leading to mixed reactions among the different states. Some of the active policies implemented offer a long-term solution to this problem including Medicaid and Medicare. After acquiring state control, the Republicans dismissed the idea to expand and create medical insurance for Medicaid in Colorado. Sustaining the structure of the health care payroll calls for the deductions from the employees and the employers, which may lead to loss of jobs and increased burden of expenditure (Garcia, 2019).
Identify the Methodology
The main objective of this policy plan is to investigate the role of legislation in the management of the health care sector in the United States. Due to the need for achieving in-depth exploration, this paper uses a combination of both qualitative and quantitative methods of data collection by addressing both practical and theoretical aspects of the research. Based on the answers that the policy requires, choosing survey as the research design. This method involves collecting and analyzing data from a few people who represent the principal group within health care. However, the survey method faces some challenges such as attitudes and perception of the health workers leading to the delimitation of the study. The target population for the study includes the nurses within the health sectors in Colorado. The selection of the participants involved in the use of stratified random sampling.
Identify your Stakeholders
The major stakeholders in the creation and implementation of the policy plan include the legislatures, local government, patients, and other private parties such as the insurance companies. Collectively, these bodies are involved in the making of thousands of decisions, overseeing hospitals, making budgetary appropriations, assisting the health workers to acquire licenses, determination of services that the insurers cover, and the management of.
Lesson 6: Mental Healthcare Financing
Readings:
Frank, R, Glied, S. (2006). Changes in mental health financing since 1971: Implications for policymakers and patients. Health Affairs 25(3): 601-613.
Garland, R.I., Lave, J.R. & Donohue, J.M. (2010). Health reform and the scope of benefits for mental health and substance use disorder services. Psychiatric Services 61(11): 1081 – 1086.
Druss, B (2006). Rising mental health costs: What are we getting for our money? Health Affairs 25(3): 614-622.
Scheffler, RM, Eisenberg, D (2004). How money makes its way through the mental health system. Family Therapy Magazine March/April 2004: 12-19.
Insurance Market Reforms in the Patient Protection & Affordable Care Act and the Health Care & Education Reconciliation Act, Bazelon Mental Health Law Center http://www.bazelon.org/LinkClick.aspx?fileticket=rLF-G4_8dbw%3d&tabid=137.
Scan:
Barry, C.L., Huskamp, H.A. & Goldman, H.H. (2010). A Political History of Federal Mental Health and Addiction Insurance Parity. Milbank Quarterly 88(3): pp. 404-433.
Readings also of interest:
Honberg, R., Diehl, S., Kimball A., Gruttadaro, D., & Fitzpatrick, M. (2011). State mental health cuts: A national crisis. NAMI. http://www.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=126233
Kliff, S. (December 17, 2012). Seven facts about America’s mental healthcare system. Washington Post. Retrieve at: http://www.washingtonpost.com/blogs/wonkblog/wp/2012/12/17/seven-facts-about-americas-mental-health-care-system/
Introduction
There are many sources of financing for mental health care in both the private and public sectors. Private sector financing includes private insurance, out-of-pocket payment and a modest amount of charitable and philanthropic sources (Garfield, 2011). In addition, the Patient Protection and Affordable Care Act (ACA) passed in 2010, which was discussed last week, will have a substantial impact on behavioral health financing.
The amount of funding for behavioral health care is substantial. Including those for the Affordable Care Act, private and public expenditures for mental health and substance abuse treatment are expected to be around $280.5 billion by 2020, an increase in spending from $171.7 billion in 2009. Growth in expenditures, however, will trail behind that of health care in general. This lesson will briefly discuss financing of the public mental health system.
Public sector financing includes Medicaid, Medicare and other sources of funding support at the federal, state and local level. The largest amount of funding from other public sources is primarily from the federal level, the Community Mental Health Services Block Grant. On the substance abuse side, the Substance Abuse Prevention and Treatment Block Grant is also a large source of financing.
Why examine the public mental health system? Garfield (2011) notes that there are differences in financing between general health and behavioral health in that “public s ...
This document is a letter from Republican physicians in Congress providing 10 facts about the challenges facing the Medicare program. It summarizes that Medicare costs have grown unsustainably, the program will face insolvency in the near future, and reforms are needed to strengthen and protect Medicare for current and future seniors. The letter aims to further an informed discussion about adopting bipartisan solutions to these issues.
The document discusses Medicare spending in the United States. It reports that Medicare spending was reduced to 0.2% in 2013 compared to 1.8% between 2009-2012. This decrease may have resulted from the recession limiting spending, delivery system reforms to improve quality while reducing local costs, or a focus on patient-centered care. Statistical data from Medicare budget reports is cited to support the claims around reduced spending.
ANALYTIC APPROACH IN ACCESSING TRENDS AND IMPACTS OF MEDICAID-MEDICARE DUAL E...ijsc
The landscape of Medicaid and Medicare enrollment in the United States is undergoing dynamic changes,
driven by intricate policies, shifting demographic trends, and evolving healthcare access criteria. This
publication serves as a beacon, illuminating the multifaceted terrain of Medicaid and Medicare dual
enrollment and offering a comprehensive understanding of its complexities and challenges. The primary
objective is to advocate for the adoption of a centralized data-driven decision support system, recognizing
its transformative potential. By harnessing the power of data, we can revolutionize enrollment
management, streamline administrative processes, and facilitate the timely adjustment of policies, ensuring
more efficient and effective healthcare access. Empowerment is at the heart of our mission. We aim to
equip all healthcare stakeholders, from government agencies and insurance providers to healthcare
institutions and enrollees, with knowledge and insights. Informed decisions driven by data will lead to
improved healthcare access, ultimately catalyzing positive change within the Medicaid and Medicare
landscape. This publication represents a call to action, urging all players in the healthcare ecosystem to
embrace data-driven solutions, adapt to the evolving landscape, and work collaboratively to advance the
cause of accessible and effective healthcare for all.
ANALYTIC APPROACH IN ACCESSING TRENDS AND IMPACTS OF MEDICAID-MEDICARE DUAL E...ijsc
The landscape of Medicaid and Medicare enrollment in the United States is undergoing dynamic changes,
driven by intricate policies, shifting demographic trends, and evolving healthcare access criteria. This
publication serves as a beacon, illuminating the multifaceted terrain of Medicaid and Medicare dual
enrollment and offering a comprehensive understanding of its complexities and challenges. The primary
objective is to advocate for the adoption of a centralized data-driven decision support system, recognizing
its transformative potential. By harnessing the power of data, we can revolutionize enrollment
management, streamline administrative processes, and facilitate the timely adjustment of policies, ensuring
more efficient and effective healthcare access. Empowerment is at the heart of our mission. We aim to
equip all healthcare stakeholders, from government agencies and insurance providers to healthcare
institutions and enrollees, with knowledge and insights. Informed decisions driven by data will lead to
improved healthcare access, ultimately catalyzing positive change within the Medicaid and Medicare
landscape. This publication represents a call to action, urging all players in the healthcare ecosystem to
embrace data-driven solutions, adapt to the evolving landscape, and work collaboratively to advance the
cause of accessible and effective healthcare for all.
This document discusses a data analysis task involving childhood obesity rates in different regions of the United States. The analysis will use data on the percentage of overweight and obese children ages 10-17 in each state. The states will be categorized into regions - East, South, Midwest, and West. A cluster analysis technique will be used to determine if there are trends in childhood obesity rates between different regions. If trends are found, government and healthcare organizations can focus obesity prevention programs on specific regions. The document provides background on the situation, data sources, and analysis methodology to be used.
1. The document discusses the growth of the American welfare state from FDR's New Deal programs through modern social welfare policies under various presidents.
2. It examines debates around reforms to welfare, Social Security, Medicare, and the school choice movement. Key issues include funding entitlement programs and the appropriate role of government versus private industry.
3. Stakeholders disagree on the best approaches to designing and funding social welfare programs to help those in need while reducing risks and costs.
PUH 5301, Public Health Concepts 1 Course Learning.docxShiraPrater50
PUH 5301, Public Health Concepts 1
Course Learning Outcomes for Unit VIII
Upon completion of this unit, students should be able to:
1. Assess current public health developments in the community.
2. Analyze key public health concepts and principles.
3. Discuss the different public health disciplines’ impact on population health.
4. Explain the role of government regarding public health practice and policy.
5. Evaluate the impact of social determinants of health on population health.
5.1 Identify ways to reduce medical costs in your community.
Course/Unit
Learning Outcomes
Learning Activity
1 Unit VIII Reflection Paper
2 Unit VIII Reflection Paper
3 Unit VIII Reflection Paper
4
Unit Lesson
Chapter 26: Is the Medical Care System a Public Health Issue?
Unit VIII Reflection Paper
5.1
Unit Lesson
Chapter 27: Why the U.S. Medical System Needs Reform
Unit VIII Reflection Paper
Reading Assignment
Chapter 26: Is the Medical Care System a Public Health Issue?
Chapter 27: Why the U.S. Medical System Needs Reform
Unit Lesson
Balancing Public Health and the Medical System
Medicine is a crucial part of public health in that individuals are taken care of as opposed to the community in
general. For example, public health officials could educate the community about immunizations and wellness
exams to avoid chronic diseases, but it is up to the individual to use that education and visit his or her
physician.
Medical care is expensive, and the costs have risen over time in the United States. More money is spent
every year on medical bills than public health preventive measures. There is always the debate of who is
superior in the health sector—medical care or public health measures (Schneider, 2017). The government, in
this situation, makes it a point of duty to set boundaries, discipline unethical behavior, and establish
standards. While public health is important, the government needs to safeguard individuals’ privacy as well as
religious and personal beliefs while healthcare providers are providing good care for their patients without
being biased or providing improper diagnoses.
UNIT VIII STUDY GUIDE
The Healthcare System
PUH 5301, Public Health Concepts 2
UNIT x STUDY GUIDE
Title
Certain types of medical care are necessary for the community’s overall health, including the prevention and
treatment of infectious diseases. Public health officials try to contain certain infectious diseases by providing
immunization programs and free medical treatments or testing for those without insurance.
Another way public health officials try to be responsible for medical care is through emergency services. In
the late 1960s, the federal government encouraged communities to provide emergency care through the
assistance of public health officials, particularly in the wake of the Highway Safety Act of 1966 where it was
necessary to get immediate care (Schneider, ...
PUH 5301, Public Health Concepts 1 Course Learning.docx
Managing-Quality
1. 1
Isaac Lederman 4/11/14
WWS 333 Starr
Managing Quality: The Politics of Medicaid Managed Care
Word Count: 3144
In the last four decades a revolution has occurred in American medicine.1
This
revolution has fundamentally transformed the provision of healthcare in the United
States. Even the Patient Protection and Affordable Care Act (PPACA), the most
significant healthcare reform effort since the passage of Medicare and Medicaid in 1965,
relies on what grew out of this revolution.2
This seismic change is what scholars refer to as the “managed care” revolution.3
In essence, it has involved the integration of two previously separate functions: the
payment for and provision of medical services, as states give a certain amount of money
per enrollee per month to managed care plans that limit clients to a network of providers.4
Though managed care has risen to prominence in both Medicare and Medicaid, this paper
will focus on Medicaid.5
In particular, this paper will depart from previous work on the
1
Paul Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care
Reform (New Haven: Yale University Press, 2013), 66.
2
Caroline F. Pearson, "Analysis: Medicaid Plans Expected to Grow 20% This Year
Under ACA Expansion," Avalere Health LLC, January 15, 2014,
http://avalerehealth.net/expertise/managed-care/insights/analysis-medicaid-plans-
expected-to-grow-20-this-year-under-aca-expansion.
See also Peter Baker, "For Obama Presidency, Lyndon Johnson Looms Large," New
York Times, April 8, 2014, http://www.nytimes.com/2014/04/09/us/politics/for-obama-
presidency-lyndon-b-johnson-looms-large.html?_r=0.
3
Starr, 66.
4
Jacob S. Hacker and Theodore R. Marmor, "The Misleading Language of Managed
Care," Journal of Health Politics, Policy and Law 24, no. 5 (October 1999): 1036.
See also Leslie Clement, Medicaid Managed Care: What This Means for Idaho, PDF,
Boise: Idaho Department of Health and Welfare, 2011.
5
Carlos Zarabozo, "Milestones in Medicare Managed Care," Health Care Financing
Review 22, no. 1 (Fall 2000): 65.
2. 2
politics of Medicaid managed care by examining action on the federal, not state, level.6
Beyond that, it will bring the sparse scholarship on this topic up to date.7
In accomplishing these goals, this paper will show that though Medicaid differs a
great deal from its much beloved twin, Medicare, the politics of Medicaid managed care
mirror those of Medicare, as state actors play a decisive role in both. This is evident in
the evolution of the laws governing the quality of care in managed care arrangements, an
evolution that underscores the nature of the institution that is Medicaid managed care.
Scholars have proposed a number of theories to explain institutional patterns.8
Some contend that elections drive policy change.9
In other words, politicians will either
adjust policy to win reelection or act on the basis of a mandate from the public to alter
policy.10
Popular influence could enter policymaking through other channels. Another
school of thought argues that politicians respond to either established or anticipated
6
David J. Randall, "The Politics of Medicaid Contracting and Privatization" (diss., Kent
State University, 2012), 3.
See also Etienne E. Pracht, "State Medicaid Managed Care Enrollment: Understanding
the Political Calculus That Drives Medicaid Managed Care Reforms," Journal of Health
Politics, Policy and Law 32, no. 4 (August 2007): 686.
Also see Ethan M. Bernick, "The Politics of States’ Medicaid Managed Care: 1981-
1998" (diss., The Florida State University, 2002), ix.
See as well Thomas R. Oliver, "The Collision of Economics and Politics in Medicaid
Managed Care: Reflections on the Course of Reform in Maryland," The Milbank
Quarterly 76, no. 1 (January 1998): 61.
7
James W. Fossett and Frank J. Thompson, "Back-Off Not Backlash in Medicaid
Managed Care," Journal of Health Politics, Policy and Law 24, no. 5 (October 1999):
1170.
8
The term “institution” is used here to mean a set of rules and practices that regulate
social interaction.
9
Jonathan Oberlander, The Political Life of Medicare (Chicago: University of Chicago
Press, 2003), 137.
10
Ibid., 137-138.
3. 3
public opinion.11
That is to say, political actors will craft policy that is consistent with the
wishes of the people.
Others are less sanguine about the democratic nature of policymaking. According
to one group of theorists, politicians bow to well-organized interest groups with a stake in
policy change.12
Furthermore, there are those who assert that state actors are independent
of both interest groups and public opinion.13
In short, policymakers do as they please.
Moreover, yet another set of scholars maintains that past decisions constrain future
choices.14
In this view, seemingly small decisions about institutional design and
development have significant ramifications later on. Lastly, others stress the importance
of ideas.15
Policymakers in their opinion cannot escape the influence of ideas about the
character of either their nation or the particular program they oversee.16
Though all these theories do to some degree explain the politics of Medicare, state
actors play a particularly decisive role. As Jonathan Oberlander notes about the period
from Medicare’s inception in 1965 to 1994, there is “substantial evidence” indicating
that policymakers act independently.17
Nevertheless, Oberlander does not dismiss the
other theories discussed above. For him, they too are key to understanding Medicare.18
Though less has been written about the period after 1994 and the politics of the program
11
Ibid., 140.
12
Ibid., 145.
13
Ibid., 148.
14
Ibid., 151.
See also Paul Starr, The Creation of the Media: Political Origins of Modern
Communications (New York: Basic Books, 2004), 4-5.
See as well Daron Acemoglu and James A. Robinson, Why Nations Fail: The Origins
of Power, Prosperity, and Poverty (New York: Crown Publishers, 2012), 106-107.
15
Oberlander, 155.
16
Ibid., 155-156.
17
Ibid., 148.
18
Ibid., 156.
4. 4
changed after that date, it seems reasonable to conclude that government actors will
continue to be instrumental in understanding the institutional patterns of Medicare.19
It is unclear, however, whether the same can be said of Medicaid, in general, and
Medicaid managed care, in particular.20
Though Medicare and Medicaid arose out of the
same legislation in 1965, the two could not be more different. In particular, Medicaid has
a rather unique design and serves a similarly unique set of constituencies. The history that
follows tells not only of Medicaid’s beginnings but also of its adoption of managed care
and the evolution of laws governing the quality of care in managed care arrangements
between 1965 and 2005.
Medicaid’s institutional framework provides good reason to believe that its
politics should stand in stark contrast to those of Medicare. Medicaid’s architects built it
to provide health insurance to the “deserving poor.” 21
Though this meant that Medicaid
provided health insurance to a small subset of low-income individuals deemed eligible
for public assistance, it acquired a different significance in the public imagination. While
Medicare served “worthy” Americans at the end of their careers, Medicaid amounted to
welfare for the deadbeats destined to live on the public dole.22
Medicaid’s architects also differentiated it from Medicare by making the program
a joint federal-state partnership. While states have no say in the running of Medicare,
19
Ibid.
20
Medicaid in general is beyond the scope of this paper, as I am focusing exclusively on
the institutional patterns of Medicaid managed care.
21
Nicole Huberfield, "Federalizing Medicaid," Journal of Constitutional Law 14, no. 2
(December 2011): 445.
22
Carolyn L. Engelhard, "The Politics of Medicaid," Inquiry, The Journal of Health Care
Organization Provision and Financing 48, no. 4 (Winter 2011/2012): 340.
5. 5
they do have a great deal of say in the running of Medicaid.23
Though the federal
government sets some requirements and attaches some conditions to the funds it allocates
to states, states, for the most part, have the right to administer Medicaid as they please.24
This feature of Medicaid’s institutional architecture also results in a different sort of
program politics than is evident in Medicare, as states continue to assert their right to run
the program free of federal control.25
Thus on the basis of design alone it seems
reasonable to expect that the politics of Medicaid should differ significantly from those
present in its much beloved twin, Medicare.
The history of Medicaid managed care does not appear to bear out this
expectation. At least with respect to the laws governing the quality of care in managed
care arrangements, Medicaid resembles its twin. In all three phases of Medicaid’s
relationship with managed care, policymakers on the federal level exercised a tremendous
degree of independence. That is not to say that the numerous explanations described
above are bunk, but rather that they pale in comparison to state-centered theories.
Though policymakers at first struggled to ensure that managed care arrangements
delivered quality care to Medicaid beneficiaries, by 1981 they had begun to assert their
control over this new and somewhat frightening part of the American healthcare
ecosystem. In the sixteen years after the passage of Medicaid, managed care did not enjoy
23
Karl Kronebusch, "Medicaid and the Politics of Groups: Recipients, Providers and
Policy Making," Journal of Health Politics, Policy and Law 22, no. 3 (June 1997): 841.
24
Huberfield, 445-447.
25
567 U. S. ____ (2012)
6. 6
great popularity. Only a few states, most notably California, dared to experiment with this
novel institution.26
After California’s blunders with Medicaid managed care led to calls for reforms,
policymakers on the federal level acted independently. In 1971, Ronald Reagan, then
governor of California, signed legislation into law that aimed to stimulate the growth of
prepaid medical plans (PHPs).27
Because California would only give a certain amount of
money to the plans per Medicaid beneficiary per month (thus “prepaid”), the PHPs would
have an incentive to provide high quality care at low cost.28
As the legislation’s author
explained, this was “an attempt to provide quality care to the needy while at the same
time tightening controls to prevent runaway costs.”29
This legislation failed in that PHPs did not deliver quality care. A “gold rush” in
the words of the Los Angeles Times ensued, because no regulations governed the quality
of care provided by the PHPs.30
That is to say, plans were reaping huge profits, because
they were skimping on quality while lowering costs dramatically. In some instances, the
care was so shoddy it was no longer even care. Thus a Medicaid beneficiary could go to a
24-hour emergency clinic at night only to find it closed.31
26
Michael Sparer, Medicaid Managed Care: Costs, Access, and Quality of Care, report
no. 23, Research Synthesis (Princeton, NJ: Robert Wood Johnson Foundation, 2012), 3.
27
William Endicott, "Assembly Passes New Medi-Cal Measure, Sends It to
Governor," Los Angeles Times, August 13, 1971.
28
In addition, the plans would limit their enrollees to a network of providers.
National Council on Disability, "Appendix A. Glossary of Terms," National Council
on Disability, Prepaid Health Plan,
http://www.ncd.gov/publications/2013/20130315/20130513_AppendixA.
29
Endicott.
30
Robert Fairbanks, "New Gold Rush---Prepaid Medi-Cal Franchises Sought: Prepaid
Medi-Cal Stirs Sacramento Gold Rush," Los Angeles Times, December 10, 1972.
31
Endicott.
7. 7
In 1973 and 1976 policymakers on the federal level displayed their independence
in their response to these worrisome reports. In 1973 interest groups neither mobilized
nor defined in any substantial way the first requirements for Medicaid managed care
plans.32
The key players really were Senator Edward Kennedy (D-MA) and Congressman
William Roy (D-KS), who pushed these requirements for what were then known as
health maintenance organizations (HMOs) through Congress.33
In 1976 Congress passed even more stringent requirements, most notably the
“50/50 rule.” This rule stipulated that Medicaid and/or Medicare beneficiaries could
constitute no more than half of the enrollees in a Medicaid plan.34
The idea was that
private purchasers, mainly employers, would ensure plans provided high quality care to
the privately insured.35
As before, state actors were decisive in the passage of these regulations. Interest
groups representing various constituencies, especially managed care organizations
(MCOs), however, won nearly all of the provisions they sought.36
Nevertheless, the very
32
David Strang and Ellen M. Bradburn, "Theorizing Legitimacy or Legitimating Theory?
Institutional Analysis, ed. John L. Campbell and Ove K. Pedersen (Princeton, NJ:
Princeton University Press, 2001), 135.
See also Medicaid and CHIP Payment and Access Commission, Report to the
Congress: The Evolution of Managed Care in Medicaid, report (Washington D.C.:
Medicaid and CHIP Payment and Access Commission, 2011), 18.
33
Joseph L. Dorsey, "The Health Maintenance Organization Act of 1973 (P.L. 93-222)
and Prepaid Group Practice Plans," Medical Care 13, no. 1 (January 1975): 8.
34
Medicaid and CHIP Payment and Access Commission, 18.
35
Prospective Payment Assessment Commission, Report to the Congress: Medicare and
the American Health Care System (Washington, D.C.: Prospective Payment Assessment
Commission, 1997), 42.
36
Lawrence D. Brown, Politics and Health Care Organization: HMOs as Federal
Policy (Washington, D.C.: Brookings Institution, 1983), 356-357.
See also Jan Coombs, The Rise and Fall of HMOs: An American Health Care
Revolution (Madison, WI: University of Wisconsin Press, 2005), 55.
8. 8
fact that MCOs agreed to even more regulation by the federal government underscores
the state-driven nature of reform.
Between 1981 and 1997 policymakers on the federal level, now more comfortable
with managed care arrangements, encouraged experimentation and competition on the
state level in the hope that together these would lead to quality care. Just as he had done
as governor of California, Reagan as president in 1981 evinced great faith in the power of
MCOs. Under the direction of his administration, Congress in 1981 rolled back a large
number of the regulations on MCOs it had put in place only a few years earlier.37
The
50/50 rule, for instance, became the 75/25 rule in 1981, as Medicaid and/or Medicare
beneficiaries could now constitute three quarters of the enrollees in a Medicaid plan.38
Medicaid MCOs, in other words, did not require much oversight at all, as the market
provided incentive enough for them to deliver quality care.
Though these changes did, to some degree, reflect new understandings of the
market, they bore Reagan’s imprint. As Daniel Rodgers notes, “In an age when words
took on magical properties, no word flew higher or assumed a greater aura of
enchantment than ‘market.’”39
While Rodgers is certainly correct that ideas about the
power of markets were gaining currency at this time, ideas alone cannot account for all
shifts in policy. After all, as explained above, in 1971, well before the rise of free market
thinking, Reagan was pursuing policy along these lines in California. And Reagan
37
Sparer, 3.
38
Ibid.
See also Medicaid and CHIP Payment and Access Commission, 18.
39
Daniel T. Rodgers, Age of Fracture (Cambridge, MA: Belknap Press of Harvard
University Press, 2011), 41.
9. 9
continued to pursue policy along these lines as president a decade later, despite strong
objections from various interest groups.40
While these policies led to experimentation and arguably higher quality care, they
were not responsible for the tremendous growth of enrollment in managed care
enrollment in the late 1980s and 1990s. Of all the states, Arizona engaged in the most
ambitious experimentation due to Reagan’s urging.41
In 1982 Arizona had the unique
distinction of being the last state to create a Medicaid program and the first state to enroll
all of its Medicaid beneficiaries in managed care arrangements.42
Though the program
initially faced difficulties, clients of MCOs were soon receiving care that was of similar
or even greater quality than they had before.43
Reagan’s policies, however, did not result in the enrollment surge in managed
care arrangements in the late 1980s and 1990s. Two developments made managed care
particularly appealing to states. First, the federal government expanded eligibility for
Medicaid beyond the small subset of the “deserving poor” it originally served.44
At the
same time it increased Medicaid benefits.45
States, in other words, faced rising costs due
to growth in Medicaid enrollment and benefits. The situation only became untenable,
however, when a recession in 1990 and 1991 swelled states’ Medicaid rolls and deprived
states of tax revenue.46
States turned to managed care in the hope that it would deliver
40
Harry Nelson, "Reagan Plan Would Hike Health Care Competition," Los Angeles
Times, April 5, 1981.
41
Sparer, 3.
42
National Health Policy Forum, Managed Medicaid: Arizona's AHCCCS Experience,
report, Site Visit Report (Washington, D.C.: National Health Policy Forum, 2000), 1.
43
Sparer, 3.
44
Ibid., 3-4.
45
Ibid., 4.
46
Ibid.
10. 10
quality care at a low price.47
By 1997, almost half of all Medicaid beneficiaries were
enrolled in managed care arrangements.48
Between 1997 and 2005 policymakers on the federal level sought new ways to
ensure that Medicaid beneficiaries received quality care from MCOs. In breaking with
previous regulation of these arrangements, legislators demonstrated their independence,
especially from the heavy hand of the past. These thirteen years saw policymakers
innovate largely unconstrained by the decisions of their predecessors. As explained
above, legislators instituted the 50/50 rule in 1976 and five years later, tweaked it slightly
to make the 75/25 rule. For more than a decade and a half, the 75/25 rule had reigned
supreme. This seemingly small regulatory choice had acquired significance and appeared
to weigh heavily on policymakers’ minds by 1997. Fears about the rise of Medicaid only
MCOs due to the elimination of this rule were bluntly summarized by a policy broker
who said, “I think All-Medicaid HMOs are a terrible thing.”49
This institutional inertia, however, did not prevent the elimination of the rule and
the rise of a new regulatory framework. Congress scrapped the 75/25 rule in 1997 and
replaced it with both a requirement that states develop strategies to assess and improve
the quality of care delivered by managed care arrangements and quality assurance
See also Jennifer M. Gardner, "The 1990-91 Recession: How Bad Was the Labor
Market?," Monthly Labor Review, June 1994, 3.
47
Ibid.
48
Alina Salganicoff and Suzanne F. Delbanco, "Medicaid and Managed Care: Meeting
the Reproductive Health Needs of Low-Income Women," Journal of Public Health
Management and Practice 4, no. 6 (November 1998): 13.
49
Gloria N. Elridge, The Medicaid Evolution: The Political Economy of Medicaid
Federalism, PhD diss., The University of Texas at Austin, 2007 (Austin: University of
Texas at Austin, 2007), 299.
11. 11
standards.50
In doing so, Congress responded to states’ concern that the 75/25 rule made
contracting with MCOs difficult.51
And in 2005 legislators gave states even more tools to
improve the quality of care delivered by MCOs.52
Among other things, states could
expand access to managed care and put beneficiaries in disease management programs.53
Thus it is clear that state actors were decisive in the evolution of the laws
governing the quality of care in managed care arrangements in Medicaid in the four
decades after its inception. This finding is in line with previous scholarship. As James
Fossett and Frank Thompson wrote in 1999, the politics of Medicaid managed care
“tends to be a less visible and more technical kind of politics that plays out in
administrative forums well off the main political stage.”54
In short, when it comes to
managing quality in Medicaid managed care, policymakers hold the stage.
50
Medicaid and CHIP Payment and Access Commission, 18.
In addition, Congress put in place additional safeguards. For more information, see
Elicia J. Hertz, Medicaid Managed Care: An Overview and Key Issues for Congress,
report (Washington, D.C.: Congressional Research Service, 2005).
Also Starr, Remedy and Reaction: The Peculiar American Struggle over Health Care
Reform, 142.
51
Charles A. Bowsher, Medicaid: Spending Pressures Drive States Toward Program
Reinvention (Washington, D.C.: U.S. General Accounting Office, 1996), 3.
52
Medicaid and CHIP Payment and Access Commission, 18.
53
Centers for Medicare and Medicaid Services, Roadmap to Medicaid Reform, report
(Washington, D.C.: Centers for Medicare and Medicaid Services, 2005), 5.
54
Fossett and Thompson, 1170.
12. 12
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