Health care policy

Health care policy:
Considerations

• What role should the government play in healthcare?
• Is healthcare a right? Or a consumer good/commodity?
• What role should the market play?
• Should we pay for other people’s access to healthcare?
• Access versus care, coverage versus care
• In a perfect society, what would the health care system look like? Who would pay? Should your income be a factor in what you pay?
• Why does this matter to social work?

The paradox of health care in the United States

• Advanced medical care but lack of access for many Americans
• Health care generally not perceived as a basic right, but rather a commodity
• Health insurance coverage is an important determinant of one’s ability to access adequate health care, and a lack of health insurance has been linked to negative health outcomes
• Uninsured are less likely than those with insurance to receive preventive care and services for major health conditions and chronic diseases
• Heavy emphasis on the workplace—over half of all coverage is obtained through employment

Employer-sponsored insurance

• Prior to the 1930s, health care was available to those who could pay
  • Costs were relatively low
  • Medicine was in the process of professionalization and accreditation
• During the Great Depression, hospitals and physicians struggled
  • In response, hospitals began to create “prepayment plans,” which became Blue Cross plans
• During World War II, there was a freeze on wages, but the government ruled that “fringe benefits” were exempt from the cap
  • Employers offered health care benefits as a way to compete for labor (could not offer to pay more)

Employer-sponsored insurance:
Managed care

• Managed care had a limited impact on health care costs
• Health plans and employers began to other means to attempt to reduce costs
  • Charging employees a larger portion of the premium
  • Increasing copays and coinsurance
  • Using health savings accounts

Part 2

Government health coverage

• Medicaid
• CHIP
• Medicare
  • Medigap plans
  • Medicare managed care
• Veterans Affairs
• Indian Health Service
• Workers compensation

2018 Federal poverty line

Medicaid

• Established in 1965
• State administered; federally funded with a state match that varies state by state
• 60 million recipients in US, largest insurer in Ohio
• Eligibility and coverage vary from state to state
• Most states rely on Managed Care Organizations
• In Ohio, Medicaid covers:
  • Children up to age 19 (up to 206% FPL)
  • Pregnant women (up to 200 % FPL)
  • Adults up to age 64 (up to 138 % FPL) (through expansion)

Medicaid waivers

• Waivers are exceptions granted to federal rules governing how states can implement jointly-administered programs like Medicaid
  • The idea is to allow states the flexibility to meet their own unique situations, and to try innovations that may be successful
• Many waivers are uncontroversial, provide flexible implementation that benefits recipients, and save money
  • Ohio has a Medicaid waiver program (PASSPORT) that pays for in-home care and services for elderly and disabled persons who are eligible for nursing home placement
    • These services allow some individuals to stay in their homes and save the state money overall

Children’s Health Insurance Program (CHIP)

• Created in 1997
• Designed to provide increased access to health coverage for children in families with income too high to qualify for Medicaid but too low to afford private coverage
• Federal funding with state match
• Depending on state, coverage ranges from 200-300 FPL
  • 46 States and the District of Columbia cover children up to or above 200% of the FPL and 24 of these states offer coverage to children in families with income at 250% of the FPL or higher
  • In Ohio, Healthy Start, 206% FPL
  • Covers 9 million US children (2017), over 300,000 Ohio children

• On January 22, 2018, Congress passed a six-year extension of CHIP funding
• Federal funding for CHIP had expired on September 30, 2017
• States operated their CHIP programs using remaining funds from previous years
  • some states came close to exhausting funding, leading them to make contingency plans to reduce coverage and notify families of potential coverage reductions
  • In late December 2017, Congress provided some short-term funding for early 2018, but some states still expected to exhaust funds by March 2018