History of health care reform in the United States

src: www.benefitfocus.com

The history of health care reform in the United States has spanned many years with health care reforms that have been the subject of political debate since the beginning of the 20th century. Recent reforms remain an active political issue. Alternative reform proposals are offered by both candidates in the 2008 and 2016 presidential elections.

Video History of health care reform in the United States

Federal health care proposal

19th century

One of the earliest health care proposals at the federal level is the 1854 Bill for the Benefits of the Unfamiliar, who will set up mental hospitals for crazy madmen, as well as the blind and deaf, through federal land grants to the state. The bill was proposed by activist Dorothea Dix and passed both houses of Congress, but was vetoed by President Franklin Pierce. Pierce argues that the federal government should not commit to social welfare, which it claims to be the responsibility of the states.

After the Civil War, the federal government established the first medical care system in the South, known as the Freedmen Bureau. The government built 40 hospitals, employed more than 120 doctors, and treated more than a million former sick and dying slaves. The hospital was short-lived, lasting from 1865 to 1870. The Freedmen Hospital in Washington, D.C. remained in operation until the late nineteenth century, when it became part of Howard University.

The next major initiative came in the 1930s New Deal law, in the context of the Great Depression.

1900s-1920s

In the first 10-15 years of 20th century Progressivism influenced Europe and the United States. Many European countries are passing the first social welfare measures and form the basis for government-run or voluntary subsidized health care programs. Great Britain passed the National Insurance Act of 1911 providing medical care and replacement of some lost wages if a worker fell ill. It does not, however, cover the spouse or dependents. The US effort to achieve universal coverage began with a progressive health care reformer who supported Theodore Roosevelt for the President in 1912, even though he was defeated. Progressive campaigning was unsuccessful for state-guaranteed disease insurance. Unique American history of decentralization in government, limited government, and the tradition of classical liberalism are all possible explanations for the suspicion surrounding the idea of ​​compulsory insurance run by the government. The American Medical Association (AMA) is also strongly opposed to the idea, labeled "socialized medicine". In addition, many US urban workers already have access to disease insurance through an employer-based illness fund.

Early industrial insurance insurance purchased through employers is one of the most influential economic origins of the American health care system today. The late 19th century and early 20th century disease insurance schemes were generally inexpensive for workers: small-scale and local administration remained low, and because people who bought insurance were all employees of the same company, people who are already ill because of buying. The presence of an employer-based disease fund may have contributed to why the idea of ​​a government-based insurance did not take over in the United States at the same time as Britain and all of Europe moved towards a socialized scheme such as the British National Insurance Act of 1911. Thus, 20, Americans are accustomed to associate insurance with employers, paving the way for the start of third-party health insurance in the 1930s.

1930-1950

With the Great Depression, more and more people are unable to pay for medical services. In 1933, Franklin D. Roosevelt called on Isidore Falk and Edgar Sydenstricter to help draw up pending Social Security legislation for Roosevelt funding including a publicly funded health care program. The reform was attacked by the American Medical Association as well as state and local AMA affiliates as "compulsory health insurance." Roosevelt finally abolished the health care provisions of the bill in 1935. The fear of organized drug opposition to universal health care became the standard for decades after the 1930s.

During this time, each hospital began offering their own insurance program, the first being the Blue Cross. Hospital groups as well as groups of doctors (ie Blue Shield) immediately begin selling group health insurance policies to employers, who then offer them to their employees and collect premiums. In 1940 Congress passed a law supporting a new third party insurance company. During World War II, Henry Kaiser used the arrangement in which doctors passed the cost of traditional and contracted care to meet all the medical needs for his employees on a construction project along the west coast. After the war ended, he opened the plan to the public as a non-profit organization under the name Kaiser Permanente.

During World War II, the federal government introduced wages and price controls. In an effort to continue to attract and retain employees without violating such controls, employers offer and sponsor health insurance to employees in lieu of dirty payments. This is the beginning of a third-party payment system that starts to replace direct payments outside the pocket.

After the war, President Harry Truman called for universal health care as part of the Fair Agreement in 1949 but a strong opposition halted part of the Fair Agreement. However, in 1946, the National Mental Health Act was passed, such as the Hospital and Construction Survey, or the Hill-Burton Act. In 1951 the IRS declared the group premiums paid by employers as tax-deductible business expenses, which solidify the premises of third-party insurers as the primary provider of access to health care in the United States.

1960s-1980s

1960s

In the era of Civil Rights of the 1960s and early 1970s, public opinion shifted toward uninsured issues, especially the elderly. Because care for parents will one day affect everyone, health care reform advocates are able to avoid the worst fear of "socialized medicine", which is considered a dirty word for its relationship to communism. After Lyndon B. Johnson was elected president in 1964, the stage was set for the endorsement of Medicare and Medicaid in 1965. However, Johnson's plan was not without resistance. "Opponents, especially AMA and insurance companies, oppose the Johnson administration's proposal on the grounds that it is mandatory, it represents a socialized drug, it will reduce the quality of care, and it's 'not American'." These views are no different, Medicare was established by law signed into law on July 30, 1965, by President Lyndon B. Johnson. Medicare is a social insurance program administered by the United States government, providing health insurance coverage to persons 65 years of age or above, or who meet other specific criteria.

1970s

In 1970, three proposals for a single national health insurance payer financed by payroll taxes and general federal income were introduced in the US Congress. In February 1970, Representative Martha Griffiths (D-MI) introduced a national health insurance bill - no cost sharing - developed with AFL-CIO. In April 1970, Senator Jacob Javits (R-NY) introduced a bill to extend Medicare for all - withholding Medicare share charges and coverage limits - developed after consultation with Governor Nelson Rockefeller (R-NY) and former Johnson HEW Secretary Wilbur Cohen. In August 1970, Senator Ted Kennedy (D-MA) introduced a bipartisan national health insurance bill - no cost sharing - was developed with the National Health Insurance Committee established by United Auto Workers (UAW) president Walter Reuther, with a bill introduced at the House of Representatives on month next by Representative James Corman (D-CA). In September 1970, the Senate Workers' and Community Welfare Committee held its first congressional hearing in twenty years about national health insurance.

In January 1971, Kennedy began a decade as chairman of the Health subcommittee of the Senate Labor and Welfare Committee, and introduced a reconciled bilartisan Kennedy-Griffiths proposal that proposed universal national health insurance. In February 1971, President Richard Nixon proposed a more limited health insurance reform - an employer's mandate to offer private health insurance if employees voluntarily paid 25 percent of the premium, federalization of Medicaid for the poor with dependent children, and support for health care organization (HMO). The national health insurance hearing was held by the House Ways and Means Committee and the Senate Finance Committee in 1971, but no bill was supported by the chairman of the Wilbur Mills Representative Committee (D-AR) or Senator Russell Long (D-LA).

In October 1972, Nixon signed the Social Security Amendment in 1972, extending Medicare to those under 65 who have been severely disabled for more than two years or had end-stage kidney disease (ESRD), and gradually increased Medicare Part A tax salary from 1.1% to 1.45% in 1986. In November 1972, Nixon won re-election in a landslide over the only Democratic presidential candidate not supported by the AFL-CIO, Sen. George McGovern (D -SD), which is a sponsor of the Kennedy-Griffiths bill, but does not make national health insurance a major issue in his campaign.

In October 1973, Long and Senator Abraham Ribicoff (D-CT) introduced a bipartisan bill for the protection of health insurance for workers financed by payroll taxes and for Medicare recipients, and federalization of Medicaid with extensions for poor people without dependent children. In February 1974, Nixon proposed a more comprehensive health insurance reform - an employer's mandate to offer private health insurance if employees voluntarily pay 25 percent of the premium, Medicaid replacement by state-run health insurance plans is available to all with income-based and cost-sharing premiums , and Medicare replacement with a new federal program that eliminates restrictions on hospital days, adds out-of-pocket expense limits, and adds outpatient prescription coverage. In April 1974, Kennedy and Mills introduced a nearly universal bill for universal national health insurance with benefits that were identical to Nixon's expanded plans - but with mandatory participation by employers and employees through payroll taxes and with a lower cost-sharing - both plans are criticized by workers' organizations, consumers, and senior citizens because of the huge cost sharing.

In August 1974, following the resignation of Nixon and President Gerald Ford's request for health insurance reform, Mills tried to advance the compromise under Nixon's plan - but with mandatory participation by employers and employees through premiums to private health insurance companies and health insurance coverage financed with payroll taxes - but gave up when it could not get more than 13-12 majority of the committee to support the compromise plan. In December 1974, Mills resigned as chair of the Means and Means Committee and was replaced by the Al-Ullman Representative (D-OR), who opposed payroll taxes and financing the federal general income of national health insurance.

In January 1975, in the midst of the worst recession in four decades since the Great Depression, Ford said it would veto health insurance reforms, and Kennedy again sponsored his national universal health insurance bill. In April 1975, with one-third of its sponsors leaving after the November 1974 election, the AMA replaced the "Medicredit" plan with a mandate proposal of an employer similar to Nixon's 1974 plan. In January 1976, Ford proposed the addition of disaster coverage to Medicare, offset by an increase in cost sharing. In April 1976, Democratic presidential candidate Jimmy Carter proposed a health care reform that included key features of Kennedy's national health insurance bill.

In December 1977, President Carter told Kennedy that his law should be changed to retain a major role for private insurance companies, minimizing federal expenses (excluding payroll tax financing), and gradually so as not to disrupt the federal budget balance. Kennedy and the organized worker compromised and made the requested changes, but broke with Carter in July 1978 when he would not commit to pursue one bill with a fixed schedule for comprehensive coverage gradually.

In May 1979, Kennedy proposed a new bipartisan national health insurance bill - the option to compete with a federally administered health insurance plan with the division of fees financed by income-based premiums through an employer's mandate and individual mandate, Medicaid's replacement by government payments from premiums for private insurance companies, and increased Medicare by adding prescription drug coverage and eliminating premiums and cost sharing. In June 1979, Carter proposed a more limited health insurance reform - an employer's mandate to provide private health insurance plus coverage without cost-sharing for pregnant women and infants, federalization of Medicaid with extension for very poor people without relying on small children , and improved Medicare by adding disaster coverage. In November 1979, Long led a conservative majority of the Senate Finance Committee to support the employer's mandate to provide only private disaster insurance and Medicare enhancement by adding disaster coverage, but the effort left in May 1980 due to budget constraints on the face. a deteriorating economy.

1980s

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the 1974 Employee Retirement Income Act (ERISA) to give some employees the ability to continue health insurance coverage after leaving work.

Clinton Initiative

Health care reform is a major concern of the Bill Clinton administration led by First Lady Hillary Clinton. Clinton's 1993 health care plan includes mandatory registration in health insurance plans, subsidies to ensure affordability across all income ranges, and establishment of health alliances in each state. Any citizen or permanent resident will be guaranteed medical treatment. The bill faced by Republican critics, led by William Kristol, who communicated his concern that the Democratic health-care bill would "revive the reputation... Democrats as a benevolent patron of the interests of the middle class." And that would be at the same time blowing punishes against the Republic's claim to defend the middle class by holding the government. "The bill was not passed into law.

The "Health Security Express," a cross-country tour by several buses carrying President Clinton's national health care reform supporters, began in late July 1994. During each stop, bus drivers will talk about their personal experiences, health care disasters and why they feel important for all Americans to have health insurance.

Bush-era debates

In 2000, the American Health Insurance Association (HIAA) partnered with the Family USA and the American Hospital Association (AHA) on the proposal of "strange sleeping friends" intended to seek common ground in expanding coverage for uninsured.

In 2001, the Patient Rights Act was debated in Congress, which would give patients a list of explicit rights regarding their health care. This initiative basically takes some of the ideas found in the Bill of Rights Consumers and applies them to the health care field. It is done in an effort to ensure the quality of care of all patients by maintaining the integrity of the processes occurring within the health care industry. Standardizing the nature of health care agencies in this way proves to be somewhat provocative. In fact, many interest groups, including the American Medical Association (AMA) and the pharmaceutical industry came out strongly against the congressional bill. Essentially, providing emergency medical care to anyone, regardless of health insurance status, as well as the patient's right to maintain their health plan is responsible for any and all of the harm done has proven to be the biggest stumbling block to the bill. As a result of this intense contradiction, the Bill of Rights initiative in Patients finally failed to pass Congress in 2002.

As president, Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act laws that include prescription drugs for parents and disabled Americans.

During the 2004 presidential election, the campaigns of George Bush and John Kerry offered health care proposals. Bush's proposal to expand the scope of health care is simpler than the proposals proposed by Senator Kerry. Some estimates were made comparing the costs and impacts of Bush and Kerry's proposals. While estimates vary, they all show that the increased coverage and funding requirements of Bush's plan will be both lower than Kerry's more comprehensive plan.

In 2006 the HIAA replacement organization, the American Health Insurance Plan (AHIP), issued another reform proposal.

In January 2007 Rep. John Conyers, Jr. (D-MI) has introduced the United States National Healthcare Act (HR 676) in the House of Representatives. As of October 2008, HR 676 has 93 joint sponsors. Also in January 2007, Senator Ron Wyden introduced the Healthy American Act (S. 334) in the Senate. In October 2008, S. 334 had 17 cosponsors.

Also in 2007, AHIP issued a proposal to ensure access to coverage in the individual health insurance market and proposals to improve the quality and safety of the US health care system.

"United States Economic Survey 2008: Health Care Reform" by the Organization for Economic Cooperation and Development, published in December 2008, said that:

• The tax benefits of an employer-based insurance should be written off.
• The resulting tax revenue should be used to subsidize the purchase of insurance by individuals.
• This subsidy, "which can take many forms, such as direct subsidies or refundable tax credits, will improve the current situation in at least two ways: they will reach those who now do not benefit from tax exemptions, and they will encourage purchasing health care and health care insurance plans that are more cost conscious because, in contrast to the exclusion of unrestricted taxes, such subsidies will reduce the incentives to purchase health plans with little share of costs. "

In December 2008, the Institute for the Future of America, along with the head of the Sarana and Sarana Health Subcommittee, Pete Stark, launched a proposal from Jacob Hacker, co-director of U.C. The Berkeley School of Health Law Center, which essentially says that the government should offer public health insurance plans to compete at the level of the playing field with private insurance plans. This is said to be the basis of the Obama/Biden plan. This argument is based on three basic points. First, the public plan is successful in managing cost control (Medicare medical expenditure is up 4.6% per year compared to 7.3% for private health insurance on a 10-year like-for-like basis from 1997 to 2006). Second, public insurance has better payouts and improved methods of quality because of its large databases, new payment approaches, and maintenance coordination strategies. Third, it can set standards against which private plans should compete, which will help bring communities together around widely shared risk principles while building greater confidence in government over the long term.

Also in December 2008, the American Health Insurance Plan (AHIP) announced a series of proposals that included setting a national goal to reduce projected growth in health care spending by 30%. AHIP says that if this goal is achieved, it will result in a five-year cumulative savings of $ 500 billion. Among the proposals is the establishment of an independent comparative effectiveness body that compares and evaluates the benefits, risks, and additional costs of new drugs, devices, and biology. The previous "Technical Memo" published by AHIP in June 2008 estimated that a reform package involving comparative effectiveness research, health information technology (HIT), medical responsibility reform, "payment for performance" and disease management and prevention could reduce the US. national health expenditures "by 9 percent by 2025, compared to current basic trends."

Debate in the 2008 presidential election

Although both candidates have a health care system that revolves around the private insurance market with the help of the public insurance program, both have different opinions on how this system should operate when enacted.

Senator John McCain proposed a plan that focused on making health care more affordable. The Senator proposes to replace specific tax breaks for people with employer-based healthcare coverage with a universal system of tax credits. This credit, $ 2,500 for individuals and $ 5,000 for families will be available to Americans regardless of income, employment or tax liability. In his plan, Senator McCain proposes a Guaranteed Access Plan that will provide federal assistance to the state to secure coverage of health insurance through high-risk areas.

Senator McCain also proposed the idea of ​​an open market competition system. This will give families the opportunity to cross national borders and purchase health plans, expand personal options for affordable coverage and force health insurance companies to compete for consumer money on an unprecedented scale.

Barack Obama called for universal health care. Her health care plan calls for the creation of a National Health Insurance Exchange that will include both private insurance plans and government-run options such as Medicare. The coverage will be guaranteed regardless of health status, and the premium will not vary based on health status as well. It will require parents to cover their children, but does not require adults to buy insurance.

The Philadelphia Inquirer reports that both plans have different philosophical focus. They illustrate the purpose of McCain's plan to "make insurance more affordable," while Obama's plan goal is to "more people have health insurance." The Des Moines Register also characterizes the plan.

A poll released in early November 2008, found that voters favored health care listed in Obama as their second priority; voters who backed McCain listed it as fourth, bound by the war in Iraq. Affordability is a major health care priority between the two groups of voters. Obama voters are more likely than McCain voters to believe that the government can do much about health care costs.

The 2009 reform debate

In March 2009 AHIP proposed a set of reforms aimed at addressing waste and unsustainable growth in the health care market today. These reforms include:

• Individual insurance mandates with financial punishment as quid pro quo for guaranteed issues
• Renewal of Medicare doctors' fees schedule;
• Set standards and expectations for diagnostic safety and quality;
• Promote patient-centered care coordination and care by appointing a "medical home" that will replace split care with a coordinated approach to care. Doctors will receive periodic payments for a set of prescribed services, such as care coordination that integrates all treatments received by patients across all illnesses or acute events. It will promote sustainable comprehensive maintenance management, optimize patient health status and assist patients in navigating health care systems
• Link quality payments, adherence to guidelines, achieve better clinical outcomes, provide better patient experience and lower total maintenance costs.
• bundled payments (not individual bills) for the management of chronic conditions in which the provider will share accountability and responsibility for the management of chronic conditions such as coronary artery disease, diabetes, chronic obstructive pulmonary disease and asthma, as well as
• Average fixed payments are all included on average for acute care episodes that tend to follow a pattern (although some episodes of acute care may be more expensive or less than this).

On May 5, 2009, the US Senate Finance Committee held a hearing on health care reform. In the panel of "invited stakeholders", no supporters of the Single Payer health care system are invited. The panel features Republican senators and industry panelists who oppose all forms of expanded health care coverage. Closing the single payer option of the discussion led to significant protests by the physician in the audience.

There is one bill now before Congress but others are expected to be presented soon. One single bill combined is a possible outcome. The Affordable Health Options law is currently in front of the House of Representatives and the key points embedded in the stage of inflation of the legislation already exist in two areas; suppose the government provides the option of a public insurance plan to compete directly with the private insurance sector, and secondly a comparative effectiveness study has to be done to control the costs that the public health service provider fulfills. Some Republicans have expressed opposition to a public insurance option that believes that the government will not compete fairly with private insurance companies. Republicans have also objected to the use of comparative effectiveness research to limit coverage in public sector plans (including public insurance schemes or existing government schemes such as Medicare), which they consider to be rationing by the back door. Democrats claim that the bill will not do this but are reluctant to introduce a clause that would prevent, arguing that it would limit the right of DHHS to prevent payments for services that are clearly not working. The American Health Insurance Plan, the umbrella organization of private health insurance providers in the United States recently urged the use of CERs to cut costs by limiting access to ineffective care and ineffective costs/benefits. The Republican Amendment to the bill would not prevent the private insurance sector from citing CERs to limit coverage and implement their rationing of funds, a situation that would create an imbalance of competition between public and private insurance companies. The proposed short bill but not yet enacted with the same effect is the 2009 Republican-sponsored Patient Law.

On June 15, 2009, the US Congressional Budget Office (CBO) issued an initial analysis of the key provisions of the Affordable Health Options Act. The CBO estimates a ten-year fee to the federal government from major insurance-related provisions of a bill of about $ 1.0 trillion. During the same ten-year period from 2010 to 2019, the CBO estimates that the bill would reduce the number of uninsured Americans by around 16 million. At about the same time, the Associated Press reported that the CBO had given Congressional officials an estimated $ 1.6 trillion for a companion cost measure developed by the Senate Finance Committee. In response to this estimate, the Senate Finance Committee postponed action on the bill and began work to reduce the cost of the proposal to $ 1.0 trillion, and the debate over the action of Affordable Health Options became even more fierce. The Democratic Congress was shocked by the magnitude of the forecast, and the uncertainty made by the forecasts has boosted Republican credentials critical of the Obama Administration's approach to health care.

However, in the June New York Times editorial, economist Paul Krugman argues that although this estimate of universal health coverage is still affordable. "The fundamental fact is that we can afford universal health insurance - even that high estimate is less than $ 1.8 trillion in Bush's tax-cut costs."

In contrast to previous advocacy of a publicly funded health care program, in August 2009 Obama administration officials announced they would support health insurance cooperatives in response to the deep political riots between the Republican Congress and among residents at city hall meetings held across America. However, in a June 2009 NBC News/Wall Street Journal survey, 76% said "very" or "enough" was important to "give people a choice of both public plans administered by the federal government and personal plans for their health insurance."

During the summer of 2009, members of "Tea Party" protested the proposed health care reform. Former Wendell Potter PR executive from the Center for Media and Democracy - whose funding comes from groups like the Tides Foundation - argues that the hyperbole produced by this phenomenon is a form of corporate astroturfing, which he says he uses to write for CIGNA. Opponents of government involvement, such as Phil Kerpen of America for Prosperity - whose funding mainly came from Koch Industries companies denied that the companies were opposed to public plans, but some tried to encourage unfair government actions to benefit them, as did the employer's mandate forcing private companies to buy health insurance. Journalist Ben Smith mentions in mid-2009 as "The Summer of Astroturf" considering the organizing and coordinating efforts undertaken by various groups on both sides of the pro and anti-reform.

Debate on healthcare, 2008-2010

Health reform is the main topic of discussion during the 2008 Democratic presidential primaries. As the race narrows, attention is focused on plans put forward by two major candidates, New York Sen. Hillary Clinton and the final nominee, Illinois Senator Barack Obama. Each candidate proposes a plan to cover about 45 million Americans who are not expected to have health insurance at some point every year. Clinton's plan would require all Americans to get protection (essentially, the mandate of individual health insurance), while Obama subsidizes but does not include a mandate. During the election, Obama said that improving health would be one of his top four priorities if he wins the presidency.

After his inauguration, Obama announced to a joint session of Congress in February 2009 of his intention to work with Congress to build a plan for health care reform. In July, a series of bills were approved by committees within the House of Representatives. On the Senate side, from June to September, the Senate Finance Committee held a series of 31 meetings to develop a health care reform bill. This group - in particular, Senator Max Baucus (D-MT), Chuck Grassley (R-IA), Kent Conrad (D-ND), Olympia Snowe (R-ME), Jeff Bingaman (D-NM), and Mike Enzi ( R-WY) - met for over 60 hours, and the principles they discussed, along with other Committees, became the basis of the Senate health reform bill.

With universal health as one of the stated goals of the Obama Administration, Congressional Democrats and health policy specialists such as Jonathan Gruber and David Cutler argue that guaranteed issues will require both a community assessment and an individual's mandate to prevent mis-selection and/or free rides from creating spiral of death insurance; they assured Obama that this was necessary, persuading him to accept Congress's proposal that included a mandate. This approach is preferred because the President and Congress leaders conclude that more liberal plans, such as Medicare-for-all, can not win the support of evidence in the Senate. By deliberately using bipartisan ideas - the same basic framework is supported by former Senate Majority Leaders Howard Baker (R-TN), Bob Dole (R-KS), Tom Daschle (D-SD) and George Mitchell (D-ME) - drafters of the bill hoping to increase the chances of getting the votes needed for travel.

However, after the adoption of the mandate of the individual as a major component of the reform proposed by the Democratic Party, Republicans began to oppose the mandate and threatened to file all the bills containing it. Senate Minority Leader Mitch McConnell (R-KY), who leads the Republican Congress strategy in response to the bill, calculates that Republicans should not support the bill, and work to maintain party discipline and prevent defections:

Republican senators, including those who supported the previous bill with similar mandates, began to describe the mandate as "unconstitutional". Writing in The New Yorker , Ezra Klein states that "the end result is... a policy that once enjoyed widespread support in Republicans suddenly facing a united opposition." The New York Times later noted: "It can be difficult to remember now, given the ferocity that many Republicans attacked as an attack on freedom, but the provision in President Obama's health law that requires all Americans to buy health insurance rooted in conservative thinking. "

Reform negotiations also attracted much attention from lobbyists, including agreements among certain lobbying and legislators to win support from groups opposed to reform efforts in the past, such as in 1993. The Sunlight Foundation documents the many reported links between "health care lobbyist complexes" and politicians in both major parties.

During the August 2009 summer congress recession, many members returned to their district and attended town hall meetings to collect public opinion about the proposal. During the recess, the Tea Party movement organized protests and many conservative groups and individuals targeting congress town hall meetings to voice their opposition to the proposed reform bill. There are also many threats made against members of Congress during the Congress debate, and many are given extra protection.

To maintain the progress of the legislative process, when Congress returned from the recess, in September 2009 President Obama delivered a speech to a joint session of Congress in support of the ongoing Congressional negotiations, to re-emphasize his commitment to reform and again outline his proposal. In it he acknowledged the polarization of the debate, and quoted a letter from the late Senator Ted Kennedy urging reform: "what we face above all moral issues: that the stakes are not just details of the policy, but the fundamental principles of social justice and the character of our country. "On November 7, the House of Representatives passed the Affordable Health Care Act for the United States in a 220-215 vote and forwarded it to the Senate for ratification.

Senate

The Senate began work on its own proposals while the House is still working on the Affordable Health Care Act for Americans. Instead, the Senate took H.R. 3590, a bill on the termination of housing taxes for service members. Since the United States Constitution requires all income-related charges to come from the House of Representatives, the Senate has received this bill since it was first ratified by the House of Representatives as a modification of revenue on the Internal Revenue Code. The bill was later used as a Senate vehicle for their healthcare reform proposal, which completely revised the contents of the bill. The bill as amended will eventually incorporate elements of a proposal reported both by the Senate Health and Finance committee.

With a Republican minority in the Senate swearing for filibuster every bill that they do not support, requiring a voting cloture to end the debate, 60 votes will be needed to get a share in the Senate. At the start of the 111th Congress, Democrats had only 58 votes; the Senate seat in Minnesota that will be won by Al Franken is still undergoing a recount, and Arlen Specter is still a Republican.

To reach 60 votes, negotiations are made to meet the demands of moderate Democrats, and to try to bring in some Republican Senators; special attention is given to Bob Bennett (R-UT), Chuck Grassley (R-IA), Mike Enzi (R-WY), and Olympia Snowe (R-ME). The negotiations continued even after July 7 - when Al Franken was sworn into office, and by that time Arlen Specter had switched sides - due to a dispute over the substance of the bill, which was still being drafted in committees, and because the moderate Democrats hoped to win bipartisan support. However, on August 25, before the bill could produce a vote, Ted Kennedy - an old advocate for health care reform - died, robbed Democrats of their 60th vote. Before the seat was filled, attention was drawn to Senator Snowe because of his vote in favor of the bill draft on the Financial Committee on October 15, but he explicitly stated that this does not mean he will support the final bill. Paul Kirk was appointed as temporary replacement for Senator Kennedy on September 24.

After the votes of the Finance Committee, negotiations turned to moderate Democratic demands to complete their support, whose voting will be needed to solve the Republican filibuster. Majority Leader Harry Reid focused on satisfying the centrist members of the Democratic caucus until his imprisonment narrowed to Connecticut Joe Lieberman, an independent who met Democrats, and Nebraska Ben Nelson. Lieberman, despite intense negotiations to seek compromise by Reid, refused to support public options; concessions are granted only after Lieberman agrees to commit to voting for the bill if such provisions are not included, despite having majority support in Congress. There is a debate among supporters of the bill on the importance of public options, although most supporters conclude that it is a small part of the overall reform, and that the Democratic Congress struggles for winning concessions; this includes a conditional abandonment that allows countries to set state-based public options, such as Green Mountain Treatment in Vermont.

With all Democrats now in favor and every other Republic is now blatantly opposed, the White House and Reid move to address Senator Nelson's concerns to win the filibuster-proof support for the bill; they at this point concluded that "it was a waste of time dealing with [Snowe]" because, after he chose the draft bill on the Financial Committee, Snowe had come under intense pressure from the Republican Senate Leaders who opposed reform. (Snowe retires at the end of his term, citing alignments and polarization). After the last 13 hours of negotiations, Nelson's support for the bill was won after two concessions: a compromise on abortion, modifying the language of the law "to grant the state the right to ban the scope of abortion in their own exchange of insurance," which would require consumers to pay for out- of-pocket if the state so decides; and amendments to offer higher Medicaid replacement rates for Nebraska. The final half of the compromise was mockingly referred to as the "Cornhusker Kickback" and subsequently revoked by the bill of subsequent reconciliation amendments.

On December 23, the Senate voted 60-39 to end the debate over the bill: a kloter vote to end the filibuster by opponents. The bill was then ratified by a 60-39 vote on 24 December 2009, with all Democrats and two independent votes, and all Republicans voted against one except (Jim Bunning (R-KY), did not vote). The bill is supported by AMA and AARP.

A few weeks after the vote, on January 19, 2010, Massachusetts Republican Scott Brown was elected to the Senate in a special election to replace the late Ted Kennedy after campaigning to give the Republican minority the 41st vote needed to defend the filibrator, even signing the signature as " Scott 41. " Special elections have become significant in the reform debates because of their influence on the legislative process. The first is psychological: the symbolic importance of losing the traditional Democratic ('blue') Massachusetts seat formerly held by Ted Kennedy, a staunch supporter of reforms, has led many Democratic Congress members to be concerned about the political costs of passing legislation. The second effect is more practical: the loss of Democratic supermajorism complicates the legislative strategy of reformers.

Home

Scott Brown's election meant Democrats could no longer break the filibuster in the Senate. In response, Chief of Staff of the White House, Rahm Emanuel, argued that the Democrats must step down to get a less ambitious bill; House Speaker Nancy Pelosi stepped down, dismissing Emanuel's reduced approach as "Kiddie Care." Obama also insisted on comprehensive reforms, and the news that Anthem Blue Cross in California intends to raise premium rates for its patients by as much as 39% gives it a new line of arguments to convince the nervous Democrats after Scott Brown's victory. On February 22, Obama put the "Senate-lean" proposal to consolidate the bill. He also held a meeting, on 25 February, with leaders of both sides urging the issuance of the Reform Bill. The summit proved successful in turning the political narrative away from Massachusetts's loss back to health policy.

With Democrats losing supermarkor evidence in the Senate, but after passing the Senate bill with 60 votes on Dec. 24, the most viable option for supporters of comprehensive reforms is for the House to abandon its own health reform bill, the Affordable Health Care Act for America, and passed the Senate bill, The Patient Protection and Affordable Care Act, instead. Various health policy experts pushed the House to pass the Senate version of the bill. However, the Democratic House is not happy with the contents of the Senate bill, and expects to be able to negotiate changes in the House Senate Conference before it passes the final bill. With that option out of the table, because any bill that emerges from different Conferences of the Senate bill should be ratified in the Senate over other Republican philosophers; most House Democrats agreed to pass the Senate bill on condition that it be changed by the next bill. They drafted the Health Care and Education Reconciliation Act, which can be endorsed through a reconciliation process. Unlike rules under regular orders, in accordance with the 1974 Reconciliation Congressional Budget Act can not be charged filibuster, which requires 60 votes to rest, but the process is limited to budget changes; This is why the procedure can never be used to pass a comprehensive reform bill in the first place, such as the ACA, due to inherent non-budgetary rules. While the approved Senate bill is unlikely to be resolved through reconciliation, most Democrats' demands are budget: "these changes - higher levels of subsidies, different types of taxes to pay them, nixing the Nebraska Medicaid deal - mainly involve taxes and in other words , they are the kind of policy suitable for reconciliation. "

The remaining obstacle is an important pro-life group of Democrats, initially reluctant to support the bill, led by Congressman Bart Stupak. The group found the possibility of federal funding for abortion would be substantive enough to warrant opposition. The Senate bill does not include language that satisfies their abortion concerns, but they can not include such additional language in the reconciliation bill, as it will be outside the scope of the process with its budget limit. Instead, President Obama issued Executive Order 13535, reaffirming the principles in the Hyde Amendment. This concession won the support of Stupak and his group members and guaranteed the ratification of the bill. The House of Representatives approved the Senate bill by voting 219 to 212 on 21 March 2010, with 34 Democrats and all 178 Republicans voted against it. The following day, Republicans introduced legislation to lift the bill. Obama signed the ACA into law on March 23, 2010. The amendment bill, the Health Care and Reconciliation Education Act, was also passed by the House of Representatives on March 21, later by the Senate through a reconciliation on March 25, and finally signed by President Obama. on March 30th.

Maps History of health care reform in the United States

Country and city reform efforts

Several states have taken steps toward universal health care coverage, particularly Minnesota, Massachusetts and Connecticut. Examples include the Massachusetts 2006 Health Reform Statute and SustiNet plan from Connecticut to provide health care to residents of the state. The influx of more than a quarter of a million newly insured residents has led to overcrowded waiting rooms and overworked primary care physicians in Massachusetts. Other countries, while not seeking to insure all inhabitants, include large numbers of people by replacing hospitals and other healthcare providers using what is generally characterized as a charitable care scheme; New Jersey is an example of a country that uses the last strategy.

Several single-pay referendums have been proposed at the state level, but so far all have failed to pass: California in 1994, Massachusetts in 2000, and Oregon in 2002. California state legislature twice passed SB 840, Health Care for All citizens of the California Act, a single-payer health care system. Both times, Governor Arnold Schwarzenegger (R) vetoed the bill, once in 2006 and again in 2008.

The percentage of the non-insured population varies from one state to another. In 2008 Texas had the highest percentage of population without health insurance, 24%. New Mexico had the second-highest percentage of uninsured in that year by 22%.

The state plays various roles in the health care system including health care buyers and regulators of health providers and plans, which gives them many opportunities to try to improve their function. While the state is actively working to improve the system in various ways, there is still room for them to do more.

A municipality, San Francisco, California, has established a program to provide health care for all uninsured residents (San Francisco Sehat).

In July 2009, Connecticut endorsed a plan called SustiNet, with the goal of reaching 98% health coverage by 2014. SustiNet legislation establishes a nine-member board to be recommended to the legislature on 1 January 2011. details and implementation process for a self-insured health care plan called SustiNet. The recommendations should address (1) a step-by-step offer from SustiNet plans to employees and state pensioners, HUSKY A and B beneficiaries, uninsured persons sponsored by employers (ESI) or with unreached ESI, small and large entrepreneurs, and other; (2) establishing contracting entities with insurance companies and healthcare providers, setting rates of reimbursement, developing patient care hospitals, and encouraging the use of health information technology; (3) model benefit package; and (4) public outreach and ways to identify uninsured citizens. The Council should establish a committee to make recommendations for it concerning health information technology, home medical, clinical care and safety guidelines, and better preventive care and health outcomes. It also establishes an independent information clearinghouse to inform employers, consumers and the public about SustiNet and its private health care plan and creates task forces to tackle obesity, tobacco use, and health care personnel issues. The effective date of SustiNet's law is July 1, 2009, for most provisions.

In May 2011, the state of Vermont became the first state to pass a law establishing a single payer health care system. The law, known as Law 48, establishes state health care as a "human right" and places the responsibility on the state to provide the health care system that best meets the needs of Vermont citizens. In December 2014, the governor of the state of Vermont postponed plans to implement this single payer system because of its cost.

src: www.commonwealthfund.org

See also

• Health care reform in the United States
• Health Economics
• Health insurance exchange
• Health insurance in the United States
• Health policy analysis
• Health care politics
• List of health care reform advocacy groups in the United States
• National health insurance
• United States National Healthcare Act

src: slideplayer.com

References

Source of the article : Wikipedia