One of the main points that reflects the level of development of any country is its health care policy. The health of citizens may be a crucial factor that leads to harmony within a country. The United States tends to be a leader in today’s system of international relations and, thus, might be an example of implementing its domestic policies, particularly in the sphere of medical care. However, the US has faced some contradictions within the topic discussed.
The primary legal source that regulates public relations in the sphere of medical care is the Affordable Care Act (ACA), passed in 2010. It is claimed to be an effective mechanism that deals with uncompensated care and provides transparent terms of medical insurance. Nevertheless, the Act has some limitations that encouraged Donald Trump and the Republicans to attempt to repeal the law and change the health care policy. Thus, the US medical care system, through the prism of straights and limitations of the ACA, its evolution, and suggested options might be relevant themes to discuss.
The Scope and Nature of the Healthcare Problem
The problem of compensated health care has always been essential for the US government and citizens. From the second half of the 20th century to 2010, the United States adopted many crucial legal acts dictating the policy in the field of medical care (Theodoulou & Kofinis, 2012).
The leaders of the states wanted to figure out and implement the best appropriate option. As always, critical governmental decisions had their supporters and opponents within society. The sound reform of 2010 meant to alleviate the burden of uncompensated health care. To the exact extent, it was successful but required serious funding from the budget and had some gaps and contradictions within its articles.
For instance, Section 1332 Obamacare permitted states to waive federal subsidies and buy state health insurance from private insurance companies. However, the Obama administration imposed restrictions on the ability of states to use section 1332. The Trump administration has abolished these restrictions and expanded the rights of states to attract private insurance companies to the insurance market. Moreover, the ability of states to provide financial assistance to low-income people and those who expect high medical expenses has been expanded. Such action resulted in sustainable shifts in the US medical care system. It might be suggested that the scope of the issue covers both the national and federal levels.
How the Problem Came to Public and Political Awareness
As mentioned above, the Act has some aspects that might be controversial. For instance, Theodoulou and Kofinis (2012) state, “the act establishes a health-care system that continues to rely mainly on private insurance and private healthcare providers” (p. 368). It means that the public sector is involved to a lesser extent. Then, it forced all citizens to purchase the insurance or meet a penalty in another case.
Moreover, the ACA obliges hospitals to provide charity health care but gives no detailed mechanism for this. It occurs that “not-for-profit hospitals sometimes behave more like economic entities … instead of charity operations” (Valdovinos, Le, & Hsia, 2015, p. 1302). Sometimes, hospital policies of free healthcare are the only way to get treatment for poor citizens. And when the founding legal act provides no specific details of who can get the charity healthcare and what payments should be waived, many problems, such as turning charity systems into business models, may occur. The citizens and authorities, keeping in mind the considerable burden on the budget, became aware of the limitations of the policy as they realized the total expenses on Obama’s healthcare reform of 2010.
The Evolution of the US Healthcare Policy
The medical care system of the United States was founded upon market-oriented principles. According to Theodoulou and Kofinis (2012), “the U.S. Public Health Service [in 1798], originally meant to provide health care for merchant seamen” (p. 361). The others had to look for treatment provided by charitable organizations. The expansion of services took place in the first half of the 20th century during World War I, when religious communities created about 4000 medical establishments (Theodoulou & Kofinis, 2012). A significant increase in public involvement and legislation development was in the 1960s.
During this period, the Medicare and Medicaid programs were introduced. Both of them are single-payer systems, “which means they fund medical care from a single insurance pool run by the state” (Theodoulou & Kofinis, 2012, p. 363). The main aim of the programs was to function as private insurance. Hospitals and doctors would get compensation for necessary expenses on healthcare needs with little governmental interference.
The 1970s and 1980s may be characterized as the years when the managed care and increasing health costs appeared. A system of health institutions started to control the price and use of services, which lead to a number of problems. For instance, “Medicare costs, physicians’ costs, and hospital expenses were increasing at alarming rates, and access was becoming even more limited” (Theodoulou & Kofinis, 2012, p. 363).
Another significant problem was the rapidly growing number of uninsured people. In response to these issues, the government argued for greater use of market forces and adopted some pieces of legislation. However, the policy did not result in a positive outcome, and the situation remained unsolved.
In the early 1990s, the need for reforms became apparent due to the high costs of health care. The George H. W. Bush administration suggested some directions to improve the state of national health insurance. Each one pursued the same goal of increasing access to healthcare regardless of the level of income. Bill Clinton and George W. Bush made a significant contribution to the development of the medical care system. Although the radical healthcare reform of George W. Bush was not successful, the fact of making such a decision emphasized the necessity of concrete steps and changes.
However, by 2009, the costs for a quality treatment remained relatively high. Hence, Barack Obama “made health-care reform a central aspect of his presidential campaign platform” (Theodoulou & Kofinis, 2012, p. 367). It resulted in the adoption of the ACA, which changed the health care policy substantially. LaFontaine, Vogenberg, and Pizzi (2019) say, “in the public insurance sector,” more Americans afforded the insurance than before the Act; “for private insurance providers,” the ACA created more “coverage opportunities for their beneficiaries” (p. 470). The Act is one of the most significant and sound reforms in the history of US medical care.
The number of insured Americans has been steadily declining since at least the mid-1990s. It means that a lot of Americans, for some time, had no insurance and confidence about their future. However, many residents of the country still have no health insurance. It resulted from a lack of funds for insurance registration or the presence of severe diseases that existed even before applying for it (the case of pre-existing conditions).
Today, for people with chronic illnesses, there is a federal Pre-Existing Condition Insurance Plan, or PCIP, a high-risk insurance plan. To be insured under this system, one does not need to have any insurance for six months, have a disease, and get a waiver from a private insurance company. The Patient Protection and Affordable Care Act provided people with the opportunity to get health insurance easier than before its adoption.
It gave all citizens of the US access to health insurance, regardless of their health status. Due to the crisis and the increasing unemployment, plenty of Americans required state insurance for low-income people. Nowadays, such insurance programs provide a third of Americans with accessible healthcare and cover nearly half of the country’s expenses for medical care. Public insurance covers predominantly vulnerable categories of people who are not able to get private insurance.
Nowadays, Americans are involved in the health insurance process via their state’s Health Insurance Marketplace. It is a new way to help citizens find an insurance company and an insurance plan that meets specific needs and budgets. Each citizen can register online, by mail, or by phone or come in-person to a consultant who will provide qualified assistance. The federal government or the state manages Health Insurance Marketplace.
The primary goal of this mechanism is to make a free choice of insurance possible for all citizens. Health Insurance Marketplace presents the offers of all private companies and indicates the size of contributions and all other critical features of each product of each company. Moreover, according to the ACA, no company is eligible to reject a client’s candidacy or force him to pay in excess of the plan if he or she already has an illness. Thus, the US medical care policy has walked a long and complicated path to its current structure.
The Intergovernmental Structure and the Actors Involved
The United States has a decentralized health care network (likewise plenty of other policy fields). Hence, the medical care reform initiatives may come from various levels. Theodoulou and Kofinis (2012) describe the governmental system of health care policy exhaustively:
Any state government has the ability to formulate and enact healthcare policy. At the federal level, a number of executive agencies are engaged in healthcare policy formulation, including the Centers for Medicare and Medicaid Services, the Department of Health and Human Services, and the Surgeon General’s Office. Additionally, presidents can assemble groups of interested actors to formulate policy recommendations. (p. 376)
Thus, the medical care policy of the United States is being monitored, reformed, and evaluated at both the state and federal levels, involving many officials. However, the healthcare system might still be too fragmented and seek a unified national approach to its organization. Policy-makers may need to build a constructive and reasonable dialogue to deeply realize the scope and nature of the current healthcare limitations and find solutions.
Conflicting Public Opinion and Impact on Policy Solutions
The current US policy has its specific advantages and disadvantages, which leads to the split in public opinion on the issue. People may face some difficulties with choosing their medical insurance and with access to other health care data (Doshi, Hendrick, Graff, & Stuart, 2016). It leads to support of Trump’s initiative on repealing the Act and changing the medical care policy. However, hospitals are against such an action and even appealed to the President with an official letter. It should be mentioned that the ones against the repeal are insurers, providers, and businesses. It might be suggested that public opinion has a substantial impact on policy solutions in the sphere as the ACA is still valid and remains the main source of health care principles.
The Approaches to Policy Formulation and Suggested Direction
The relevant point is that many officials propose to dismantle the Act as they do not see any good perspectives. Democrats and Republicans debate about an appropriate healthcare system: the former claim that the ACA should exist and only to be improved, while the latter vote for the repeal. Scholar dimension also expresses some doubts; for instance, Gaffney, McCormick, Bor, Woolhandler, and Himmelstein (2019) notice that before the ACA, patients received less unnecessary care. Despite this, a plethora of officials and scholars argue against the Act.
Policy-makers even tend to evaluate the US health care system through the prism of the other countries policies. Brown (2019) suggests four possible reform options, “incremental improvements to the ACA, expansion of eligibility for Medicare and Medicaid, a social insurance route to universal coverage, and the adoption of a single-payer system” (p. 1506). The latter is considered as the most reasonable option among the ones against the Act. A single-payer system is an approach to providing healthcare when there is only one source that pays providers of medical care. Its main advantages might be universal coverage and lowering costs for treatment.
However, it may lead to a considerable increase in taxes as “shifting nearly all private spending for health care onto the public ledger would necessitate very large increases in government spending” (Blumberg & Holahan, 2019, p. 5). Then, Brown (2019) notices that the single-payer system “would almost surely pay less for the services of physicians, hospitals, and drug producers” (p. 1507). Thus, the lower costs might result in higher taxes and lower salaries, which leveling this advantage.
It should also be mentioned that despite universal coverage is a vital aspect of providing healthcare, it cannot guarantee access to medical care in the US. Jodi and Brook (2017) state, “there have been concerns about narrow provider networks restricting access and lowering the perceived quality of plans” (p. 830). With present Medicare and Medicaid as well as free preventive care provided by the ACA, two main pros of the single-payer system become less convincible.
Thus, the option of making improvements to the Act might be the most appropriate as its provisions remain valid. It might be considered as a foundation of the whole US medical care system, and its repeal might result in inevitable disastrous consequences. In the future, the ACA might expand its insurance coverage and provide all citizens with high-quality health care.
All things considered, it seems reasonable to assume that the US medical care system has its strengths and weaknesses. The main legal source that dictates the policy in the field discovered is the Affordable Care Act. It has several gaps and limitations, such as considerable burdening on the national budget. Trump and his administration try to repeal the ACA, promising a better health care system. Four possible reform directions were identified; however, it was suggested that the Act is still an effective mechanism to provide medical care. Thus, the option of improving the ACA might be the most convincing one.
Blumberg, L. J., & Holahan, J. (2019). The pros and cons of single-payer health plans. Web.
Brown, L. D. (2019). Single-payer health care in the United States: Feasible solution or grand illusion? American Journal of Public Health, 109(11), 1506-1510.
Doshi, J. A., Hendrick, F. B., Graff, J. S., & Stuart, B. C. (2016). Data, data everywhere, but access remains a big issue for researchers: A review of access policies for publicly-funded patient-level health care data in the United States. eGEMs, 4(2), 1–20.
Gaffney, A., McCormick, D., Bor, D.; Woolhandler, S., & Himmelstein, D. (2019). Coverage expansions and utilization of physician care: Evidence from the 2014 Affordable Care Act and 1966 Medicare/Medicaid expansions. American Journal of Public Health, 109(12), 1694-1701.
Jodi, L. L., & Brook, R. H. (2017). What is single-payer health care? A review of definitions and proposals in the U.S. Journal of General Internal Medicine, 32(7), 822–831.
LaFontaine, P. R., Vogenberg, F. R., & Pizzi, L. T. (2019). From then until now: A top-down view of the Affordable Care Act. P&T: A Peer-Reviewed Journal for Managed Care & Formulary Management, 44(8), 467-493.
Theodoulou, S. Z., & Kofinis, C. (2012). The policy game: Understanding U.S. public policy making. Web.
Valdovinos, E., Le, S., & Hsia, R. Y. (2015). In California, not-for-profit hospitals spent more operating expenses on charity care than for-profit hospitals spent. Health Affairs, 34(8), 1296–1303.