Health Care Law and Policy Outline

Outline
Professor Rich – University of Illinois
Health Law and Policy – Fall 2010
 
Highlights of the American HC System
–          Three central actors in American HC System
o   Consumer/Patient
o   Provider
o   3rd Party Payer
 
–          in the realm of social policy, what rights are guaranteed?
o   Education,
Economy Attributes
–          supply/demand
–          free choice/voluntary transactions
–          rational actors in the system
o   symmetry of information – equal access to information
–          In HC
o   Provider doesn’t give symmetry of information
o   HC is not voluntary
Major issues facing American HC System
–          Spending/Cost/Yield
o   Over 16% of GDP is on HC, projected to go to 20%
o   Twice as much on HC as any other country (Canada/GER are next at 10%)
o   Outcome: we are not better off than other countries, often worse
–          End of life/long-term care
o   US spends more by far than any other country
–          Uninsured/Underinsured
o   24% of population is un/underinsured
–          Gov’t role in HC
o   We have multiple HC systems (ages 18-65, medicare for over 65, veterans care, Medicaid for poor/dx, native American HC)
–          # of providers (especially primary care and nurses)
–          preexisting conditions – right now insurance can deny coverage for these and for those who contract a disease like cancer (can cancel your ins)
–          status of illness
Obamacare
–          mandates as of 2014 everyone must have insurance, employers >50 employees must make insurance available
–          financing
–          role of Gov’t
–          how many uninsured are really covered
–          implementation schedule
o   little is being implemented before 2014
–          medicare/Medicaid reform
–          illegal immigrants
o   doesn’t deal with this issue/mention
Social k in the American Health Care System
–          began as nothing in the beginning
–          in general, no obligations, but there are exceptions
–          Health Care is a private manner
–          moved to add Medicaid/Medicare
–          children, veterans, native americans
–          private system is financed by employers/employees, individuals, and Gov’t has no role except for regulation
–          Health Care is not a legal right
–          Law represents the codification of main stream values
–          As main stream values change, the law changes over time or interpretation of law changes over time
Seven Significant Moments in Health Care History (insurance)
1. Pre-New Deal
– medical profession was not high status profession
– hospitals then become more prominent, much more concern for public health issues such as disease
            2. New Deal/Fair Deal Eras (Roosevelt/Truman)
                        – Passage of Social Security
                        – Payroll taxes, mandatory retirement at 65
                        – legislature made Roosevelt drop health care part of Social Security
– Truman tried as part of fair deal to pass Health Care, but this was defeated
            3. Medicare/Medicaid – Kennedy/Johnson Administration
– Medicare – over 65 (financed through payroll tax – up to 95k of income taxed, employees and employers pay) – health insurance, Medicare has revolutionized Gov’t regulation in Health Care
– Medicaid – dx and low income (intergovernmental system, run by fed and states, financed through income taxes, not payroll) – part of welfare system
            4. Era of Managed Care
                        – replaced fee-for-service system
– incentives for physician, consumer in fee-for-service system is to get every possible test done
– managed care began in 1972 and its height was 1995
– capitation in managed care – employer will pay HMO/PPO set amount of money per year, physicians provide fewer services, copayments are paid by patient
            5. Era of Consumer Choice
                        – individual chooses whether or not the have Health Care
– may pay a low premium and with incentives based on how many services you get
– good for everyone healthy because most don’t have to use many services in a year
            6. Era of Bioethics
                        – pay attention to questions of physican-assisted suicide
                        – non-traditional methods of birth, organ transplants, etc.
                        – cloning, stem cell research
            7. Health Care Reform
                        – Current Era
Advancement in Health Care has became largely dependent on development of the medicine
More attention has been paid to provider and regulating provider
Overview of Major Legal Foundation of American Health Care System
–          McCarran – Ferguson Act
o   State decides which companies can do business in state and is in charge of regulation of those companies
o   Does not allow citizens to purchase insurance out of state
–          Hill – Burton Act 1946
o   Responsible for construction of community hospitals
§ Fed Gov’t provided money to construct
o   Hospital must provide a certain percentage of uncompensated care to qualify for Hill-Burton money
–          Medicare/Medicaid Act 1965
o   Part of Social Security legislation
o   Revolutionized Health Care System
–          HMO Act 1973
o   Afraid of national health insurance, HMO Act was offered instead
o   Forerunner in manage care era
–          ERISA 1974
o   Primarily legislation dealing with regulating retirement income/benefits
o   Single largest barrier to Health Care Reform
–          Emergency Medical Treatment and Active Labor Act (EMTALA) 1986
o   Entitled to appropriate screening and you may not be transferred until you’ve been stabilized
o   Responsible for closing of many emergency rooms because it is unfunded
–          HIPPA – Health Insurance Purchasing and Portability Act of 1996
o   Health insurance companies can only deny insurance to people with preexisting conditions in limited circumstances
o   Portability portion – if changing jobs and one likes old employers policy better,