Healthcare in the United States: Timeline and Reforms

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Topic: Health & Medicine
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Health Care Timeline

An analysis of important events, major figures and their contribution, the formation of health related organizations gives an insight into the history of U.S. health care ensuring better understanding of current health care system reforms.

  • 1847 Foundation of American Medical Association (AMA) by Nathan S. Davis put a start for organized medicine in the United States. AMA united physicians and medicine students to promote public health.
  • 1912 President Roosevelt and Progressive party announced social insurance program including health insurance in their campaign.
  • 1929 The first prepaid insurance program was introduced by Baylor Hospital in Texas and a union of local teachers.
  • 1934-1935 President Roosevelt appointed Committee on Economic Security focused on social and medical insurance problems. However, Social Security Act passed without national health insurance.
  • 1945-1949 President Truman proposed mandatory national health care insurance and reforms in medical sphere. However, AMA and other opposing powers blocked the president’s proposals calling it “social”.
  • 1946 The Hill-Burton Act (Hospital Survey and Construction Act) passed. It called for financing the construction of hospitals, prohibition of discrimination in health care services, and still “separate but equal” facilities. (History of health reform efforts in the United States, 2011, para. 31).
  • 1965 The Medicare (medical insurance for seniors (65 and older) and disabled citizens) and Medicaid (medical insurance for citizens with a low income) programs were signed by President Johnson.
  • 1970s Economic hardships resulted in crises in health care.
  • 1980s Reforms and amendments were introduced to Medicare and Medicaid programs to overcome the crises.
  • 1990–1994 President Clinton proposed a “managed competition” approach in the Health Security Act but it was blocked by his opposition (History of health reform efforts in the United States, 2011, para. 45).
  • 2006 Massachusetts, Vermont, and San Francisco passed laws providing almost universal health care coverage to all state and city residents.
  • 2010 Obama’s Patient Protection and Affordable Care Act requires insurance for all the United States citizens starting 2014.

The timeline of health care evolution in the United States testifies of difficulties the Presidents faced trying to pass “social” care reforms since 1912. Therefore, Obama’s Patient Protection and Affordable Care Act marked the new era in health care legislation.

Health Care Reform Outcomes

After introduction of Patient Protection and Affordable Care Act, health care in the United States should be focused on improving healthcare quality and lowering health care costs. However, the task is challenging, and some reform outcomes should be measured to understand future perspectives.

According to Ahuja (2013), one of the core issues of the Obama’s health care reform stated in 2009, 2010, and 2012 was the ability to keep doctors or insurance plans that individuals chose. However, in March 2013 Obama (as cited in Ahuja, 2013) claimed that “if insurers decided to downgrade or cancel these substandard plans, what we said under the law is, you’ve got to replace them with quality, comprehensive coverage” (para. 12).

Moreover, an individual “can be eligible for cost sharing or premium subsidies” with the subsidy determined on “a sliding scale based on income… limiting out-of-pocket expenses” (Panning, 2014, p. 108). However, the web “rollout of the federal and many of the state exchanges did not go well” in 2014 (Panning, 2014, p. 108).

Therefore, it is necessary to provide additional up-to-date information for individuals, communities, small enterprises and create easy-to-manage websites for them “to shop for and purchase insurance” (Panning, 2014, p. 108). Hence, introduction and implementation of the reform in such a complex area as public health will demand future changes to the plans and close cooperation between all health care givers in the United States.

For example, the Institute for Healthcare Improvement (IHI) developed “the Triple Aim initiative as a rubric for health care transformation: improving the experience of care, improving the health of populations, and reducing per capita costs of health care” (Hacker & Walker, 2013, p. 1163).

However, accountable care organizations (ACO) and the patient-centered medical home (PCMH) should evolve to achieve the goals of the current reform. Since health care payment models will “shift from fee-for service to global payment,” ACOs will have to shift from “a disease focus to a wellness focus” (Hacker & Walker, 2013, p. 1164).

For instance, now ACO in rural areas cannot provide “enough access for immunizations to elders”, so collaboration with “the public health authority and local pharmacies” should be developed to solve the problem (Hacker & Walker, 2013, p. 1166). Hence, wellness issues and close collaboration of healthcare givers and community in educating individuals about healthy lifestyles should improve to accumulate additional funds and develop new incentives to provide preventive medicine.

Furthermore, employer requirements will change and develop. After introduction of ACA, “the business community had lobbied hard against a “mandate” and won (Panning, 2014, p. 109). However, companies that have more than 50 employees “will be assessed a fee per full-time employee in excess of 30 if they do not provide coverage” (Panning, 2014, p. 109). Hence, due to the fact that large corporations must provide healthcare to their workforce and ACA calls for universal health insurance, other members of business community will have to come to terms with the reform and follow the plan of ACA.

Although Obama’s Patient Protection and Affordable Care Act is a great value for improvement of health care system in the United States, implementation of the reform will take much time and efforts.

References

Ahuja, M. (2013, October 31). Timeline: Obama’s promise that people can keep their insurance. The Washington Post.

Hacker, K., & Walker, D. K. (2013). Achieving population health in accountable care organizations. American Journal of Public Health, 103(7), 1163-1167.

History of health reform efforts in the United States. (2011)

Panning, R. (2014). Healthcare reform 101. Clinical Laboratory Science, 27(2), 107-11.