The Health Care System In The US

Health Care Reform

The nation's health care system was a major part of President Obama's policy agenda and was a priority issue during the 2008 campaign.

Growing numbers of Americans were uninsured, and costs continued rising at an annual growth rate of 6.7%. The United States spends more money on health care than any other nation.

After much wrangling, Democrats eventually passed the Patient Protection and Affordable Care Act (ACA),known popularly as Obamacare, in 2010 with no Republican support.

Americans were deeply divided over the plan, based on party affiliation, race, and age. Republicans largely opposed the plan. Almost one-third of whites opposed it, while two-thirds of Hispanics and 91% of blacks favored it. Most senior citizens opposed the law, while younger Americans favored it.

States with Republican leadership balked at mandates they expand Medicaid and set up state marketplaces. They eventually won in the courts.

Who Has Health Insurance?

In 2019 the number of people in America not covered by health insurance saw a decline for the first time in a decade after the implementation of the ACA.

According to the U.S. Census Bureau, the drop was attributed to a 0.7% decline in Medicaid participants. Those with private insurance held at the same level, while Medicare participation rose 0.4%.

Kaiser Health News noted that 574,000 (2.3%) of those who lost coverage were non-citizens, speculating that President Donald Trump's anti-immigration policies and rhetoric may be behind the decline.

These are the statistics of where nonelderly Americans got their health coverage in 2016, according to the Tax Policy Center:

  • 56% through employer
  • 8% through the private market
  • 22% covered by Medicaid
  • 4% covered by other public sources
  • 10% percent uninsured

Almost all senior citizens receive health care through Medicare, and people with low incomes receive help through Medicaid.

How Much Does Health Care Cost?

Spending on health care in the United States grew 3.9% as a percentage of gross domestic product (GDP) in 2017, according to the Centers for Medicare and Medicaid Services. That was a total of $3.5 trillion, or $10,739 per person.

What Is Public Opinion?

Despite early worries about the ACA, once implemented, most Americans warmed up to most provisions of the law and did not want it repealed. Even though Republicans eventually took control of both houses of Congress and the presidency they failed to overturn the law as they had vowed—largely because it had become popular with much of the public.

Still, portions of the law, such as the individual mandate, which required all Americans to buy health insurance or pay a penalty were not popular. Though the mandate is still part of the law, Congress essentially nullified it by reducing the penalty to zero as part of the federal tax bill passed in 2017.

What Does Health Care Reform Mean?

The U.S. health care system is a complex mix of public and private programs. Most Americans who have health care insurance have an employer-sponsored plan. But the federal government insures the poor (Medicaid) and elderly (Medicare) as well as veterans and federal employees and Congressmen. State-run programs insure other public employees.

The 2020 Democratic presidential campaign has brought health care reform back to the spotlight with Massachusetts Sen. Elizabeth Warren and Vermont Sen. Bernie Sanders propose a Medicare-for-all plan.

Other candidates prefer a public option while still allowing people to buy private insurance. They include former Vice President Joe Biden, South Bend, Indiana Mayor Pete Buttigieg, Minnesota Sen. Amy Klobuchar, and businessman Tom Steyer.

Other candidates prefer something in between that offers some kind of path to universal coverage.

What Is Medicare?

Congress established both Medicare and Medicaid in 1965 as part of President Lyndon Johnson's social services programs. Medicare is a federal program specifically designed for Americans over age 65 and for some people under 65 who have disabilities.

Original Medicare has two parts: Part A (hospital insurance) and Part B (coverage for doctor services, outpatient hospital care, and some medical services not covered by Part A). Controversial and costly prescription drug coverage, HR 1, Medicare Prescription Drug, Improvement, and Modernization Act, was added in 2003; it took effect in 2006.

What Is Medicaid?

Medicaid is a jointly funded, Federal-State health insurance program for low-income and needy people. It covers children, the aged, blind, and/or disabled and other people who are eligible to receive federally assisted income maintenance payments.

What Is Plan B?

Although most discussion of health care issues in the U.S. revolves around health insurance and the cost of health care, those are not the only issues. Another high profile issue is emergency contraception, also known as "Plan B Contraception."

In 2006, women in Washington state filed a complaint because of the difficulty they had in obtaining emergency contraception. Although the FDA approved Plan B emergency contraception without a prescription for any woman who is at least 18 years of age, the issue remains at the center battle over "conscience rights" of pharmacists.

In 2007, the Washington State Pharmacy Quality Assurance Commission ruled that pharmacies must stock and dispense all FDA-approved drugs. A 2012 district court ruling found that the commission violated the religious and moral rights of pharmacists. But at 2012 federal appeals court ruling overturned the district judge's ruling.

The U.S. Supreme Court in 2016 refused to hear the case, leaving in place regulations from 2007 that Plan B, with all other drugs, must be dispensed.