Federal Health Care Reform Laws

The healthcare system of the United States of America is globally known for its capitalist nature, unlike other established healthcare systems, such as the ones in Japan and the United Kingdom. Although the system may differ from the rest of the world, the distinguishing factor is how effective the system is for its citizens rather than which concept, socialism or capitalism, it is based on. When forming healthcare laws, the United States has always used ordinary citizens as the criterion to determine rates and the provision of services. Although the federal and state governments seem to be the key players when forming healthcare laws, other stakeholders, such as religious groups, have influenced the process of developing and implementing the rules. The Christians strongly rejected Obamacare in 2010, while the American Medical Association opposed early efforts to form a healthcare plan in the 1940s. Similarly, the current regime is opposing Obamacare yet seems unable to draft a better alternative. Therefore, in order to successfully pass and implement a healthcare bill, any government has to understand and learn the history of healthcare reforms.

History of Healthcare System

The history of the healthcare system dates back to the initial formation of health insurance coverage for still mill workers in the 1800s. During that time, the workers’ union formed a pull where each employee would save an agreed amount of money, which would be used in case one fell sick. However, the union crumbled due to a lack of accountability and an ill-structured decision-making process. As manufacturing jobs increased in the late 1800s, the need for health insurance increased as workers were exposed to financial losses due to fatal injuries and illness (Frenk et al., 2010). At the same time, some members of the federal government started to see the essence of compulsory health insurance. In 1854, Dorothea Dix presented the first recorded healthcare bill known as the Bill for the Benefit of the Indigent Insane (Nesnera & Baldwin, 2013). According to her, the blind, the deaf, and the insane deserved to be protected from illnesses as they were the more vulnerable members of society. However, upon being successfully passed in both Houses, the Bill was vetoed by President Franklin Pierce on the ground that the federal government was not in a position whatsoever to protect the personal needs of the citizens (Nesnera, & Baldwin, 2013). To him, that was the responsibility of the state governments.

The first government health system was established in 1865 and operated until 1870. Freedmen’s Bureau, as it was called, saw the establishment of 40 hospitals where more than one million slaves were treated. Although the system collapsed after just 5 years of operation, one of its hospitals in Washington D.C. continued its services to the late 19th century. It was then handed over to Howard University where it would operate until 1975 (Frenk et al., 2010). Nowadays, the Howard University College of Nursing and College of Allied Health Sciences are located in the building.

The Progressive Era

The period between 1901 and 1920 is referred to as the progressive era in the history of the healthcare system in the United States. During this period, President Theodore Roosevelt was at the forefront of ensuring that workers had government insurance coverage. According to him, a nation was not productive if its workers were sick and weak. Although he was in support of the system, many healthcare initiatives happened at the state level (Dobrowolski, 2018). The most significant bill during the Progressive era was the 1906 Association of Labor Legislation (AALL) bill. The Bill was drafted in order to provide coverage to both the working class and those with low income. The coverage included children and would provide compensation to sick workers, maternity benefits, and a $50.00 funeral expense as a death benefit. However, the bill faced opposition from the American Federation of Labor and the private insurance industry. The opponents were majorly worried that government-offered insurance would weaken their activities. In 1914, the American Medical Association (AMA) was supportive of the Bill but later withdrew its support due to disagreements with several medical associations.

From 1930 to 1990, important bills were proposed but failed to work effectively. Henry Sigerist, who would play an influential role in healthcare reforms after World War II, stated in his diary that past mistakes should be used to change and advance modern medicine (Marks, 2014). The statement would later be used by Hillary Clinton in the 1990s to justify remarkable adjustments in the healthcare sector.

On July 30, 1965, President Lyndon B. Johnson signed the Social Security Amendments, where the first Medicare program was presented. According to that Bill, older adults were to be provided with improved medical attention just like anyone else. In his statement on that day, President Johnson said that the time had come for people aged above 65 to access the “healing miracle” of modern medicine. The Bill was widely accepted by the middle class mainly because young families would no longer have to spend much of their income on medication for their parents. Almost half a decade later, Johnson’s Bill would undergo several amendments during President Bush’s era and finally be shaped further to become Obamacare during Barrack Obama’s presidency. All this time, no cohesive bill would be fully categorized as a national health insurance program.

Clinton and Bush Era

The government of Bill Clinton spearheaded health reforms in the country. In 1993, a healthcare plan was proposed by first lady Hillary Clinton. According to the new Bill, it was compulsory for every citizen to have health insurance coverage. It, therefore, meant that all citizens would have coverage whenever they fell sick. The Bill faced criticism from the Republicans and never came into law. Nevertheless, essential Acts were adopted at that time, such as the 1996 Health Insurance Portability and Accountability Act (HIPAA) as well as the 1997 Children’s Health Insurance Program (CHIP). HIPAA majorly focused on the welfare of patients. It stated that the privacy of patients would be guaranteed and that all patient records would be made available upon request. On the other hand, CHIP provided medication to children under the age of 19 years. The latter Act is still functioning to date.

President George W. Bush’s era saw the passing of a bill that would cover the cost of prescribed drugs. Signed in 2003, the Medicare Part D Act gained the favor of many Americans and it is still in use today. The voluntary program ensured that all members can access drugs at the cost of the insurance program.

In the period between 2004 and 2006, little debate took place on healthcare systems as the country’s attention was diverted to the second war in Iraq. It was not until the campaign period between 2006 and 2007 that the national healthcare system became the leading subject of national discussions (Marmor, 2017). It was among the main agendas of the democrats led by their presidential candidate Barrack Obama.

Patient Protection and Affordable Care Act (PPACA)

Obamacare, also known as the Affordable Care Act or PPACA, is the most recent healthcare bill. It is regarded as the most complex bill in American history. The formation of the PPACA dates back to the 2006/2007 campaign period when candidates John McCain and Barack Obama promised to improve the healthcare system (Béland & Waddan, 2016). Therefore, when President Barack Obama came to power, he was determined to fulfill what he had promised.

On 23rd March 2010, President Barack Obama signed the PPACA into law after a series of debates in both Houses. The new healthcare law is comprehensive and may take years to be implemented and fully understood. One of the PPACA’s significant benefits is that healthcare coverage is now available to a broader scoop of people. Previously, insurers regarded some people as uninsurable according to certain criteria. However, the PPACA requires insurers to accept and cover anyone irrespective of their past medical history. Medicaid has also been expanded, whereby children and older adults in families above 138% of the federal poverty level (FPL) will be eligible for coverage from the federal government up to 2019 (Béland & Waddan, 2016). It is projected that the law will reduce the number of uninsured people in the country to 25 million by 2019, which is a 53% decrease compared to the number of uninsured in 2010.

Obamacare, as it is popularly known, has created the American Healthcare Benefits, which enables individuals and people in small-scale businesses to acquire health coverage. It is regarded as a way to reach many people who were previously unable to afford insurance. Also, employers are required to ensure all their employees, and likewise, all Americans are supposed to have health coverage or attract legal charges. From the beginning of 2014, the Bill has allowed states to issue basic healthcare plans to their citizens. The healthcare plans are to cover people between 134% to 200% of the federal poverty level and who are unlikely to qualify for Medicaid coverage (Béland & Waddan, 2016). Generally, all insurers are required by the law to cover costs for outpatient, laboratory tests, emergency room services, maternity services, mental treatment, pediatric care, and the cost of prescribed drugs.

Upon coming to power, President Trump vowed to change Obamacare. In 2016, a corresponding initiative was proposed in the Congress. However, it fell short of two votes in the legislative chambers. The rush for changes was propelled by the strong opposition to the Obamacare bill from the Republicans. It was argued that well-minded members could not embrace the risk of abolishing the PPACA with a single bill. There is a likelihood that Trump’s presidency will experience its share of healthcare reforms. However, as of now, no significant changes have been made.

Role of Religious Groups

Religious groups across the United States have been keen to study and understand the policy. Faith-based organizations were quick to criticize Obamacare, particularly regarding the coverage of contraceptives (Hedgecoe, 2009). Christian-based faith groups were at the forefront in opposing that section on the basis that God does not require people to have controlled procreation. Following the resistance, the White House together with the federal government drafted plans to persuade the religious leaders to support the Bill. During Ramadhan Iftar’s dinner with Muslim leaders at the White House, President Obama asked them to encourage their followers to embrace the policy because it would ensure everyone in the communities, especially children, was medically covered (Marmor, 2017). Thereafter, sermons were heard in mosques across the country encouraging to accept the Bill.

Following efforts to educate faith-based organizations, many accepted the policy. The Director of the African Methodist Episcopal Church’s Social Action Commission, Madam Jacquelyn DuPont-Walker was specific when she addressed the public through media, “at what other time will the nation as a whole focus on the wellness and health and wellbeing of every citizen?” (Marshall, 2016). The first quarter of 2014 saw religious group leaders (Jews, Hindus, Christians, and Muslims) conducting seminars and sermons about Obamacare. Faith-based religious groups have therefore played a vital role in increasing the acceptance of Obamacare among the citizens.

Personal Model of the Healthcare Law

Healthcare laws are there to promote the general health status of the people in the country. When vulnerable individuals, such as the elderly, children, the poor, the unemployed, and the homeless, lack proper means of accessing medication, the whole country becomes at risk as some of the diseases they may suffer from may be infectious or communicable (McKenzie, 2011). They may easily pass from one individual to another. It is therefore essential for the government to keep amending the law to suit the needs of the people on the ground.

ACA has made healthcare more accessible. However, it has not taken healthcare providers into consideration. A healthcare law should balance the two aspects. With many people having coverage, the number of people seeking medical attention is likely to double, while the number of those providing the service will remain constant. The law should therefore develop incentives aimed at training more medical practitioners and motivating the current ones. That way, there will be a sufficient workforce.

Additionally, the privacy and rights of the patient should be clarified before one signs up for the policy. In many situations, people have acquired insurance without understanding its terms and conditions. The policy should therefore make it mandatory for all the insurers to publicize their terms and conditions to avoid public confusion.

Cost should also be considered in any health care plan. The cost will determine whether all groups in the society will be able to afford the policy or not. Therefore, the plan should not be too costly so that people can afford it. At the same time, it should not be too cheap so as not to burden the government with expenditures. A moderately-priced insurance puts the government at ease in ensuring good health for the citizens, while at the same time working on other developments in the country. Also, the average person will be able to afford coverage.

Conclusion

The United States has had several healthcare reforms throughout history, and one key lesson that can be derived from it is that flexibility and change depending on the current time and circumstances are essential. Another lesson the country can pick from history is that acceptance takes time. Since President Truman proposed a Medicare bill, it took over 20 years for the bill to be finally passed and signed by President Johnson (Hinton, 2015). When it eventually became law, it received a lot of resistance from religious groups, medical practitioners, and activists. Nevertheless, people have eventually accepted and fully embraced healthcare laws, and most consider them an essential part of their lives.

References

Alegria, M., Lin, J., Chen, C. N., Duan, N., Cook, B., & Meng, X. L. (2012). The impact of insurance coverage in diminishing racial and ethnic disparities in behavioral health services. Health Services Research, 47(3pt2), 1322-1344.

Hedgecoe, A. M. (2009). Geneticization: Debates and controversies. eLS.

Marmor, T. R. (2017). The politics of Medicare (2nd ed.). Routledge.

Béland, D., Rocco, P., & Waddan, A. (2016). Obamacare Wars: Federalism, state politics, and the Affordable Care Act. University Press of Kansas.

Christiansen, J. M. (2013). The word[] ‘person’ includes corporations: Why the Religious Freedom Restoration Act protects both for- and non-profit corporations. Utah Law Review, 2, 623-659.

de Nesnera, A., & Baldwin, H. (2013). Commitment to treatment and care: The history of New Hampshire’s mental health commitment law. New Hampshire Bar Journal, 54, 24.

Marks, S. (2014). Reflections on the 1944 National Health Services Commission: A response to Bill Freund and Anne Digby on the Gluckman Commission. South African Historical Journal, 66(1), 169-187.

Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Kistnasamy, B. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923-1958.

McKenzie, J., Pinger, R., & Kotecki, J. (2011). An introduction to community health (7th ed.). Jones & Bartlett Publishers.

Dobrowolski, A. (2018). The progressive era, the depression, and the American mental institution system. Student Theses, Papers and Projects (History), 262.

Marshall, J. A. (2016). Burwell v. Hobby Lobby: Protecting religious freedom in a diverse society. New York University Journal of Law & Liberty, 10, 327-345.

Hinton, E. (2015). “A war within our own boundaries”: Lyndon Johnson’s Great Society and the rise of the Carceral State. The Journal of American History, 102(1), 100-112.