Unit 5 Health Care Reform: History 2
Unit 5 Health Care Reform: History 2 POL 536
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This 12 page Class Notes was uploaded by Hannah McGoldrick on Tuesday March 3, 2015. The Class Notes belongs to POL 536 at a university taught by Donna Shalala in Spring2015. Since its upload, it has received 37 views.
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Date Created: 03/03/15
Health Care Reform History 03022015 History And Political Strategy The Progressive Era How we make sure everybody in this country gets health care 0 The American medical association has been very nervous about government getting into the health care eld 0 Role of government in health care weary Private insurers have been opposed in large part because they make money off of how the current system are organized 0 Have a lot of power in this system 0 Even if its an inefficient system they are still making money FDR s New Deal o 55 l took half the loaf Major step in social policy social security 0 Initially wanted coverage for seniors and the poor Truman s Fair Deal Socialized medicine came up the idea 0 VA place where you go and there s no bills 0 Heavily under funded Truman s deep desire to get a national insurance program a fair deal Socialized medicine concerns stopped his efforts in health reform The debate is always about should the government do this Or not ldeology between 2 political parties arguing about the role of the government particularly about the domestic side l address the role of the federal government 0 We don t want government federal government digging into health care Johnsons Great Society Pushed through Medicare and Medicaid The Nixon Years 0 Brought the concept back of national health insurance The Clinton Campaign 0 He argued that we needed some sort of universal system 0 Clinton heard individual stories about death and bankruptcy 0 He sits and listens to people 0 For him the portal of anecdote was data 0 Feels the populations issues 0 Natural politician The economy was changing l sending jobs over seas auto jobs 0 You send health insurance with them o More and more people in the US now didn t have insurance because the jobs they were searching for were not covering insurance working families l couldn t afford health insurance The Presidents Task Force on National Health Reform 0 Donna Shalala talked about her career in the Clinton administration Falling Behind schedule The Clinton health plan o It was going to be administered by the states 0 Did have an employer mandate Government would provide subsidies and contributions would be capped at a certain percentage of payroll The response of the Insurers It wasn t targeted just to those who didn t have insurance o It effected everyone who had insurance 0 Hit too many parts of the health care industry wasn t straight foreword Difficult to get a consensus from the stake holders 0 Harry and Louise l Adds 0 Pretty simple and straight forward that people would under stand HIAA 2minute advertisement If they choose we lose Series of adds and those adds had a tremendous impacts and they shaped peoples ideas The congressional process 5 committees claimed jurisdiction no one in the white house wasn t going to testify l relied on the department to testify Democrats nervous because of the HIAA and how it was affecting Americans Business communities started to come out against the Clinton bill Clinton sent a very detailed bill to the hill l congress didn t have the opportunity to look at the bill 0 Obama care was basically drafted by the congress The bills stalled in congress and the president lost control of both houses and part of the election was about the health care bill Clicker Questions 1 B l AMA 2 NFIB 3 All of the Above Lessons from history Must know political landscape you are walking into o Is the economy going up or down Nurses doctors providers people who make their money out of the current system are stake holders People who get services are stake holders Why has national reform failed in the past 0 There was a private sector dimension 0 There was no competition before 0 There is a private sector that believe they can do it better than the government competition between market and the government Summary of Health Reform Lessons 0 Every 20 years we get into this debate 0 Changes in the health care system effects the type of reform Medicare didn t have a pharmaceutical bene t l added during the bush administration l by the time we got to the bush administration we were using drugs instead of operations l substituting for medical procedures gt so reform was needed Passage of the Affordable Care Act Passing the bill through congress Each house have different committees that will claim jurisdiction in the bi Some sense and it takes a longtime before oor action occurs 0 After a bill changes whatever chamber it starts in can be politically dicey l if there are difference of opinions in the two houses 0 Then sent to the president Political Obstacles to Reform ACA Obama care was very tough to draft and pass Democrat had super majority but had to hold onto every 60 votes and 1 independent vote and conservative democrats Gave conservative democrats a lot of power 0 Moderates in the house had a lot of leverage Economic Obstacles to Reform Restoring federal de cit It had to be revenue neutral in order for it to be pass through congress l conservative democrats forced Unexpected Hurdles Edward Kennedy major proponent in this movement He spent his last few months in Miami to end his life Umami hosptal Senator Kennedy was the rst hurdle l we needed him for a bipartisan leadership 2nCI hurdle Tom Daschle l withdrew from Sec of HHS 0 Because he failed to disclose the use of his limonene in one of his consultancies Nominated the governor of Kansas not great for Washington it was her unfamiliarity with the senate and the house Town meetings to talk about plans 2009 0 Public latched onto to death panels AMA doctors be reimbursed for consultations about end of life care for that discussion Constant beating of the drum government take over of health care Republican Scott brown nominated Learning from history Clinton had other things on his agenda at the beginning Obama moved quickly l he did not release a full elaborative plan left the details for congress Massachusetts under governor Romney coverage for the working poor Obama administration cut deals with major stakeholders l learn from the Clinton administration 0 Some terrible deals some good deals 0 To build a positive stake holder coalition Neutralization of Stake holders The hospital association and pharm association cut pretty good deals Timeline of Health Care Reform Public plan option or not How they were going to nance reform Abortion Cut deals on each one of them Obama didn t draft bill himself he left it up to congress unlike Clinton who did the opposite 0 Every organization that didn t like some aspect of the plan teamed up with other organization l native coalitions Time line of Health Reform 2010 o Moved relatively quickly Clicker Questions 1 C l conference committee Summary of Health Reform Politics 0 Because the health care system is fragmented its very hard to make change in the existing system 0 Obama care narrowly identi es a group that doesn t have coverage 0 Dealt with that group l working group and for a variety of reasons do not have health insurance Reduced Payments to Medicare and Medicaid Providers 0 Medicare 0 Advantage program in which the government were overpaying for the services they provided 0 Medicaid 0 Cut off some expenses 0 Increased primary care services for everyone Cost Containment Measures for Private Insurers 0 Simpli ed l by exchanges and picking certain plans Provider incentives for lowering costs and improving quality care in Medicare FOCUS on PREVENTION Free quality wellness checkups visits Government also tried to do something s to bundle the payments and let them decide how to manage the money Some reforms in the way we pay did things like if someone leaves hospital with infection it is the hospital responsibility to treat that not the insurance 0 CAUGHT hospitals attention hand washing Administration never really go it put in place people were scared to death and never Medicaid Expansion Critical part of Obama Care 133 Current Status of the States with ACA Open debate still considering it Ones that aren t moving forward l southern states Key to Medicaid expansion l government will pay for expansion and then after that will pay 90 Florida is in the change to adopt this policy Financing of Medicaid Expansion under the ACA Expanding Health Insurance Coverage Other component l everyone must have coverage or pay a penalty Markets set up if a state doesn t want to then the federal government would run an exchange 0 Florida has the highest enrollees per capita in the US You sign up for a plan and then calculate the subside The lower your income the higher you re subside Individual Mandate Financial penalties are starting Some religious objections and those who are covered already are exempt Health Insurance Exchanges No million dollar cap If you have an expensive disease you will be covered If you have 120 and your state does not expand Medicaid you re out of it Essentially who haven t expanded Medicaid the wealthier of the poor get subsides and the poorest of the poor do not get subsides Changes to Private Insurance College kids can stay on their parents insurance Kids up until they are 26 Added 500 young people on the universities plan did not take a nancial hit at all reassured parents that their kids had health insurance Not allowed to charge higher premiums to people with preexisting conditions Timeline of Implementation The real tough part of government is implementation Legislation very difficult to understand l 1000 pages and all it does and takes existing laws and making changes to it Challenges to Implementation States voluntary act not required to expand State based exchanges 14 set up their own 0 Real problem with expanding state Medicaid A challenge on the increase l we will not have enough primary care Nurses can do 70 of primary care Role of nurses l changing dramatically l less people attracted to primary care nurses are advanced practice nurses and are lling the gap more patient centered care if you use nurses Setting Up health insurance Exchanges in the States Department of HHS would set it up for them if they didn t Millions have signed up for it Florida Implementation at the state level War state by state Increasingly the republican states not wanting to leave the money on the table The states have be encourage to take Medicaid money for exchanges in order to simplify and create expansion Waivers l welfare reform in the 1990 s l congress was debating l 44 states with waivers l transfer their welfare systems I we allowed them to take the same amount of money different approaches l welfare reform 0 Unfortunately l barely starting in health care 0 Never had the opportunity to test out Massachusetts approach that might have rooted where the states took ownership Increasing Primary Care Capacity Professions are going to change dramatically Role of nurses PTs and Pa s all part of a health care team We can only produce a limited number of doctors Use people up to their training scope of practice 0 Determine not by the federal government but by the states 0 Licensure what each occupation can do Restrictions on what a nurse can do 0 Prescription writing state law and state regulation New Hampshire allows nurses more freedom More conservative states allow a greater role for health care providers and their responsibility Debate in this country if the state trains state money going into training state controls curriculum l also determine whether they can practice up to their training pure politics determined by a political system depending on the power of the medical associations will depend on the scope of practice Summary ACS Totally dependent on the states Trying to expand coverage and reduce costs We don t know how it play out Success of the ACA depend on the courts congress and on the presidency Future of it will depend on it next election Are
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