Health Care Delivery System

Expansion of the MCO model occurred with the enactment of the Health Maintenance Organization Act of 1973. This Act provided the foundation for managed health care and required employers with greater than 25 employees to provide and HMO offering. The Act served to counter Democratic efforts to nationalize U.S. health care and to stimulate competition within the health care market. HMO’s also began the concept of for profit health care operations. While most health care providers are not for profit (Phelps, 2011) and number operate under a for profit model. Non-profit dominates the healthcare sector based on their tax exempt status.

rehend the PPACA, one must understand the history of the United States’ health care system. The most successful and known reform would be the passage of Medicare and Medicaid. President Johnson’s main objective with his program was to provide health insurance to those over 65 years old, who otherwise wouldn’t be able to receive coverage due to retirement or being financially unfit to purchase health insurance. It has since been expanded to cover those with disabilities, and lower income families (“Overview,” 2015). Brady (2015) examines President Clinton’s attempt to massively overhaul health care in the United States. His plan, the Health Security Act (HSA), required employers to offer health insurance to their employees, and mandated that every US citizen purchase health insurance. This plan would have most likely expand health insurance to many more Americans; however, many feared the large tax increases, restricted options for patients, and with the lack of general support for the bill, it failed in Congress and was never implemented (p. 628). President Clinton’s failed attempt at health care reform opened up the door to future reforms, and it even shared multiple similarities to the PPACA. Smith (2015) updates the history of the health care system in America stating that “In the mid-2000s, America’s uninsured population swelled to nearly 47 million, representing about 16 percent of the population” and how “16 million Americans […] were underinsured” (p. 2). People

citizen and permanent resident alien to become registered in a competent health plan that covered them and their families if necessary. The requirements also indicated that the person enrolled is not to be unenrolled unless they were protected by another plan. Minimum coverages were listed with yearly out-of-pocket costs for each plan (Clinton, 1992). There was also the proposal of the establishment of corporate health provider alliances that were to be a part of the fee for service schedule which allowed them to get paid if the service was not covered by the chosen plan. Those citizens who were below or at the poverty thresholds were to pay nothing and still be covered. This was a plan that was great in theory because it was helping many that needed this type of assistance at that time. Medical insurance is and continues to be something that is expensive being a single person or with a family. The legislation stated that funds were to be sent to the various states in order to implement this plan into action beginning in

The New York Times printed an article by Robert Pear, which reported that on December 24, 2009, the US senate passed the first bill, which would call for major reform regarding health care in the United States (Pear). The article titled “Senate Passes Health Care Overhaul on Party-Line Vote,” discusses the fact that while this step was a major milestone in the process of providing Americans with affordable heath care, it was not the end of the road. Over the coming months and years there would be a lot of give and take between democrats and republicans to revise the bill to the point where both sides could support it. One of the major points in this reform is that the US government was now going to offer affordable plans including subsidy options which would allow more Americans affordable options which were

While managed care saves money, not all states were quick to adopt it, and the extent to which they did varied widely across states. Why states chose to adopt the programs they do has been the topic of much research, the most groundbreaking being by Walker (1969) and Gray (1973). They claim that each region of the United States has within it one or two states that are more likely to adopt new programs before others. Managed care adoption began in earnest in 1993. To use 1993 as a starting point for examining managed care adoption would confuse innovativeness with those factors which genuinely may make managed care a more appropriate policy choice. Hence, this paper focuses on the year 1996.

In this paper I will provide my understanding on why I feel Clinton’s Health Plan was unsuccessful. I will discuss the features of Clinton’s health care reform plan and provide my reasons I feel it failed. I will also discuss the influences of the various interests groups and governmental entities that were present during this process. Lastly I will discuss the policy process and policy environment key players that were involved and the other circumstances that shaped this policy-making effort.

Other developed countries, such as Germany, Austria, Hungary, Norway, Britain, Russia, The Netherlands, Sweden, France, and Switzerland, all had socialized or nationalized healthcare as late as 1912. The primary reason for the emergence of these programs in Europe was income stabilization and protection against the wage loss of sickness rather than payment for medical expenses, which came later (pnhp.org). In the United States during this time, federal regulation of health care programs was nonexistent; states were given the responsibility and right to regulate within themselves and to determine what- if any- programs were available to their

Prior to understanding the PPACA and determining its effects on health care quality, it is important to comprehend its origins and the causes of this vast change in policy. The idea of a national healthcare system, according to the Kaiser Family Foundation, was proposed as early as 1912, but lawmakers were unsuccessful until the 1960’s when Lyndon Johnson amended the Social Security Act to encompass both Medicare and Medicaid. This was the first health care reform allocating federal funding and establishing federal control over health care for primarily senior citizens and low-income families. George W. Bush made the next reform that expanded the scope of Medicare coverage in 2003 when he passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). In the years following the MMA’s passage, private health insurance companies began to take advantage over clients,

Less than a hundred years ago, in the late 1920’s and 30’s, almost 90% of Americans did not have health insurance (Fall of HMO’s 4). They used a variety of home remedies and when medical assistance was truly needed, they paid for it out of pocket, even incurring vast amounts of debt. This had been the case throughout history, and it changed due to an important factor, medical equipment. The industrial revolution finally caught up with the medical industry and the country saw a vast change in the scientific instruments used by physicians. These instruments required a lot of money to make and care for which caused prices to rise. Due to this massive problem, a committee was formed of health care professionals and after a 5 year study, the Committee on the Cost of Medical Care suggested that health insurance co-operatives start. These corporate medical practices became known as Health Maintenance Organizations (HMO’s) and preferred provider organizations (PPO’s), and up until the 1970’s, were an experiment to regions across the U.S. Factors that hindered health care included bullying of “money politics” from both sides of the isle as well as Presidential views and tactics as well. President Nixon first

In 1993 First lady Hillary Clinton was assigned to a proposal to reform healthcare with the goal to become universal by US president Bill Clinton, this reform was titled Task Force on National Health Care Reform (Boundless, n.d.). At that time, 37 million Americans did not have health insurance and the cost to obtain health insurance was very unaffordable to the middle class (Boundless, n.d.). The main purpose of this reform was to mandate employers to provide health coverage to all employees HMOs’. However, this reform was aggressively opposed by the health insurance industry, libertarians, and conservative republicans stating that it was restrictive to the employees choice (Boundless, n.d.). Additionally, they argued that the proposal a

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

The health care reform debate between 2008 and 2010 led to the passage of Patient Protection and Affordable Act. It was reminiscent of opportunities for reform that have occurred on a cyclical basis throughout American history. These opportunities occurred most notably in the presidential administrations of Franklin Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, and William J. Clinton. (Rich, Cheung, Lurvey, 79). We have to look at recent opportunities that have expanded today.

U.S. health care reform is currently one of the most heavily discussed topics in health discourse and politics. After former President Clinton’s failed attempt at health care reform in the mid-1990s, the Bush administration showed no serious efforts at achieving universal health coverage for the millions of uninsured Americans. With Barack Obama as the current U.S. President, health care reform is once again a top priority. President Obama has made a promise to “provide affordable, comprehensive, and portable health coverage for all Americans…” by the end of his first term (Barackobama.com). The heated debate between the two major political parties over health care reform revolves around how to pay for it and more importantly, whether it

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

The United States has no special type of nationwide system of the health care delivery. In order to obtain health care insurance, the individuals must buy it in the private marketplace, or it is given to them by the government . Part of the traditional health insurance plans, permits the unrestricted selection of the health care provider and compensates on the fee for the service basis, recently, it covers less than 30% of all the employees. There are basically two kinds of MCOs: Health Maintenance organizations and Preferred Provider Organizations. About 70% of the employees registered in MCOs. HMO is the health care delivery system that associates