Analysis of Healthcare Reforms

The healthcare and insurance sector, as well as consumers, are encountering birth pangs as a result of the unfavorable implementation of the Patient Protection and Affordable Care Act (PPACA). The PPACA is naturally inclined in its scope, effect, as well as political consequences. Such a perspective is however myopic since the path that has led to reforms in the healthcare sector has been well traveled. In the wake of the Second World War, all the presidential candidates have introduced policy reforms that are dissonantly similar to the provisions made in the PPACA. This is not the first attempt by the country to discuss controversial proposals on healthcare reforms. This discussion shall explore healthcare reforms and how the health policy has evolved in the various administrations after World War II, barriers and successes to health reforms in the modern era.

The Truman Administration (1945-1953)

The first efforts to change the policies on the health sector was experienced in the period after the war during the tenure of President Harry S. Truman in the U.S Franklin D. Roosevelt who was his predecessor made minimal efforts to the healthcare cause and accessibility to healthcare was among the few social needs that were not addressed in the New Deal Programs. President Truman made a proposal to the Congress where he recommended a universal health insurance policy that was to be issued and compensated for by a National Insurance Board. The bill, however, was not supported in the Congress with those opposed to it, such as the American Medical Association describing it as socialized medicine. Truman attempted to re-introduce the debate following his re-election in 1948 but the proposal did not make it past the Korean War. The efforts by his administration, however, managed to modernize health facilities and increased the number of hospitals in America (Allen, 2013). The Hospital Survey and Construction Act was enacted by Congress in 1946 which created a provision of loans and federal grants with the aim of constructing, expanding, and modernizing hospitals. The Ford administration introduced legislations that would streamline rapid growth of healthcare facilities that remained unregulated since they were introduced.

The Eisenhower Administration (1953-1961)

This administration introduced minimal reforms to the health sector with its efforts being focused on the Cold War that emerged around that time. The Military Medicare health reform was introduced to cover healthcare expenses for military people. The administration also supported the Forand bill that was expected to provide a policy for health insurance for those who benefitted from Social Security (Allen, 2013).  

The Kennedy Administration (1961-1963)

This administration introduced the King-Anderson bill that advocated for health insurance policies to be restricted to citizens from 65 years and above, as well as is included in the Social Security benefits package. In this bill, Kennedy provided the foundation for what came to be known as Medicare. President Kennedy took to the streets to the public in over 33 political rallies in different parts of the country to drum up support against the special interests that attempted to water down the proposal (Taylor, 2014).

The Johnson Administration (1963-1969)

This administration enjoyed a super-majority in both houses which made it possible for the implementation of a wide range of social reforms that were titled the Great Society. Legislations on Medicare as well as Medicaid initiatives steam-rolled their way through Congress despite the vocal opposition from conservative Republicans and the AMA (Taylor, 2014). The law paved way for the provision of coverage of healthcare for people from and above 65 years of age, the disabled, blind, and the poor. The coverage accommodated health services offered by physicians, hospitals, home care providers and nursing facilities (Taylor, 2014).

The Nixon Administration (1969-1974)

Nixon’s government proposed in 1971 the National Health Insurance Standard Act. This reform suggested a minimum threshold for insurance coverage set by the government that would be facilitated by employers. Funding could be done through through payment of premiums by employees as well as employers. This reform would create an environment of competition between the providers of private insurers thus expand coverage (Taylor, 2014). 

The Ford Administration (1974-1977)

The National Health Planning and Resources Development Act was introduced in 1974 with the aim of regulating inflation in the healthcare sector that was driven by the huge federal funds that were being channeled in the healthcare system of payment. The HRPDA played a key role in avoiding duplication of health services and facilities by mandating a certificate of necessity in States (Schremmer, & Knapp, 2011). 

The Carter Administration (1977-1981)

Jimmy Carter campaigned for national healthcare insurance that enjoyed the universal coverage and went ahead to work towards preparation of a legislation on the same. The concept was embraced by the American Hospital Association in principle with reservations on any systems that took a universal approach of one size for all. The details of the plan by President Carter did not receive much support from the Congress or audience from the public because issues pertaining to a deep recession took center-stage (Schremmer, & Knapp, 2011). 

The Reagan Administration (1981-1989)

This administration did not introduce new programs on healthcare with the aim of streamlining government expenditure by reducing the deficit spending. This administration introduced a couple of new legislations with the objective of cutting the escalated levels of federal spending on healthcare and increasing efficiencies (Peterson, 2011). This was to be achieved through changing the approaches used in reimbursing methodologies in most cases cutting reimbursement to physicians and hospitals as well as by introducing tight measures to control fraud. The Reagan administration nonetheless sailed through Congress the initial major expansion of benefits arising from Medicare. This was introduced in the Medicare Catastrophic Coverage Act that was enacted in 1988. This policy broadened the Medicare coverage for outpatient drugs, covered the loopholes on co-pays from the pockets for physician and hospital services and increased payments for care in the long term. The program was to be funded entirely using beneficiaries of Medicare by increasing premiums as well as a surtax on wealthier beneficiaries on the basis of income. 

The George H.W. Bush Administration (1989-1993)

This administration took up a partisan mess in the Medicare Catastrophic Coverage Act that was enacted in 1988. There was widespread frustration among the elderly concerning the level of expanded benefits as well as strong resentment that emanated from escalated payments in premiums and taxes. These opinions contributed to a senior revolt that was against the policy 17 months after it had been implemented (Peterson, 2011). 

The agenda by President Bush on healthcare law entailed a couple of new strategies to reduce the level of federal expenditure on healthcare as well as eliminate cases of fraud and exploitation in Medicaid and Medicare programs. Among some of his landmark reforms on healthcare was the elimination of self-referrals from physicians for clinical laboratory services. 

The Clinton Administration (1993-2001)

Bill Clinton made history by being elected as the first Democrat after 12 years and his administration hit the ground running in terms of proposing reforms to healthcare. The American Health Security Act of 1993 was forwarded to the Congress following a report from a task force that was chaired by the first lady Hillary Clinton. It proposed provision of affordable health coverage for all citizens through managed competition (Peterson, 2011). The Clinton proposal suggested that coverage of health insurance through private insurers competing for consumers in a market that is regulated to a large extent, supervised, and directed by health alliances to be established in all the states. The health plans were required to provide a threshold for benefits. Employers would be needed to provide coverage of insurance for their employees as well as 80% of the premium. 

The George W. Bush Administration (2001-2009)

Reforms in healthcare were not ranked top of the agenda in President George W. Bush’s administration. This is considering he was elected president in the wake of the 9/11 attack with most of his term being consumed on that as well as the war on terror on American soil and abroad. As part of his legacy, however, Medicare experienced among the largest expansion of Medicare in the history of the program (Morone, 2010). The changes in the Medicare program were introduced in the Medicare Drug Improvement and Modernization Act that was implemented in 2003. The most notable one was the prescription drug coverage benefit that was introduced as part D of Medicare.

The Obama Administration (2009 – 2017)

It did not come as a surprise that President Obama ranked reform in healthcare as one of his major priorities. As part of his campaign promise, he promised to enact changes in the healthcare system in an attempt to minimize costs as well as make insurance coverage to be available to most Americans. Within six months of his inauguration, he had sent a bill on health reform to Congress. This was followed by a heated political process. There were divisions along party lines with debates over options on public health plans, misinformation of the public, as well as news being spread over the airwaves, print media, and the internet on charges for socialized medicine. Following much political maneuvering as well as intrigue that was not seen under normal circumstances in Washington, the policy managed to garner the necessary support of the House of Representatives and was approved in 2010 (Morone, 2010).

In summary, heated divisiveness among parties, political intrigues, as well as campaigns on the grassroots have proved to be an impediment to implementation of proper health reforms. Nonetheless, democratic processes have taken their due process and the process has worked. The present strategies on health reforms have enhanced access to healthcare and saved the lives of millions.

References

Allen, J. I. (2013). Health care reform 3.0: the road gets bumpy. Clinical Gastroenterology and Hepatology, 11(12), 1527-1528.

Jacobs, L., & Skocpol, T. (2015). Health care reform and American politics: What everyone needs to know. Oxford University Press.

Morone, J. A. (2010). Presidents and health reform: from Franklin D. Roosevelt to Barack Obama. Health Affairs, 29(6), 1096-1100.

Odom, L., Owen, R., Valley, A., & Burrell, P. (2011). Obamacare: an ethical analysis of his leadership and the health reform initiative. Leadership in Health services, 24(4), 325-336.

Peterson, M. A. (2011). It was a different time: Obama and the unique opportunity for health care reform. Journal of health politics, policy and law, 36(3), 429-436.

Schremmer, R. D., & Knapp, J. F. (2011). Harry Truman and health care reform: The debate started here. Pediatrics, 127(3), 399-401.

Taylor, J. W. (2014). A Brief History on the Road to Healthcare Reform: From Truman to Obama. Hospital Review.