Health Policy History in the U.S.

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Questions and Answers

What significant initiative began in 1912 regarding health policy in the United States?

The passage of the Social Security Act

The establishment of the Children’s Bureau

Social insurance endorsed by the Progressive Party (correct)

The introduction of Blue Shield plans

Which act provided matching funds to states for prenatal and child health services?

National Health Survey Act

Sheppard-Towner Act (correct)

Baylor Hospital Act

Social Security Act

What was the primary focus of the Committee on the Costs of Medical Care formed in 1927?

Studying the economics of medical care (correct)

Creating new types of health insurance

Assessing the impact of World War I on health care

Implementing the Sheppard-Towner Act

During what historical period did the United States experience the Great Depression?

1929-1939 Signup and view all the answers

What was a major outcome of the National Health Conference convened in 1938?

The creation of a national health bill that failed in committee Signup and view all the answers

Who was appointed to address social policies during the Great Depression?

Franklin D. Roosevelt Signup and view all the answers

What was the significance of the Baylor Hospital pre-paid plan introduced by 1929?

It was the forerunner of future Blue Cross Plans Signup and view all the answers

What did the 1935 Social Security Act primarily restore?

Programs established under the Sheppard-Towner Act Signup and view all the answers

What significant action did President Bill Clinton take regarding health reform upon assuming office in 1993?

He appointed Hillary Clinton as chair of a task force. Signup and view all the answers

Which legislation was enacted to provide Medicaid coverage for uninsured women diagnosed with breast or cervical cancer?

Breast and Cervical Cancer Treatment and Prevention Act Signup and view all the answers

What was a main feature of the Health Insurance Portability and Accountability Act (HIPAA) passed in 1996?

It improved the privacy of medical records. Signup and view all the answers

What program was established in 1997 to provide health insurance coverage for low-income children?

State Children’s Health Insurance Program (S-CHIP) Signup and view all the answers

Which act allowed for the establishment of Health Savings Accounts (HSAs)?

Medicare Drug, Improvement, and Modernization Act (MMA) Signup and view all the answers

What key change did the Mental Health Parity Act of 1996 introduce for group health plans?

It prohibited lower limits on mental health benefits compared to medical or surgical benefits. Signup and view all the answers

Which initiative was aimed at extending coverage for working disabled individuals above 250% of the poverty line?

Ticket to Work Incentives Improvement Act Signup and view all the answers

What percentage of the population was uninsured in 1997 according to the data provided?

15.7% Signup and view all the answers

What did the Medicare Part D program introduced in 2006 provide?

Voluntary subsidized prescription drug benefits. Signup and view all the answers

Which act aimed to eliminate employer-sponsored insurance programs?

Healthy Americans Act Signup and view all the answers

What was the primary focus during the presidential campaign of 2008 regarding health care?

National health reform Signup and view all the answers

Which program was introduced by President Obama to provide additional support for uninsured children?

Children’s Health Insurance Program (CHIP) Signup and view all the answers

Which action was taken regarding Medicaid in the Personal Responsibility and Work Opportunity Act of 1996?

It allowed states to cover parents and children at higher rates. Signup and view all the answers

What did the Balanced Budget Act include concerning the Medicare + Choice program?

It established provider payment changes to slow Medicare spending. Signup and view all the answers

What was a requirement of the Patient Protection and Affordable Care Act that was implemented by 2014?

All individuals must have health insurance. Signup and view all the answers

Which legislation included reforms to the national student loan system?

The Health Care and Education Reconciliation Act of 2010 Signup and view all the answers

What action did President Trump take regarding the individual mandate section of the Affordable Care Act?

He eliminated the individual mandate entirely. Signup and view all the answers

What was one significant outcome from Operation Warp Speed during the COVID-19 pandemic?

Accelerated development of COVID-19 vaccines. Signup and view all the answers

How did the American Rescue Plan Act (ARPA) enhance the Affordable Care Act?

By enhancing subsidies for health insurance coverage. Signup and view all the answers

What common barrier contributed to lower enrollment rates in health insurance coverage, even among those eligible?

Shorter enrollment periods. Signup and view all the answers

What was one of the reasons individuals were left uninsured despite being eligible for subsidized coverage?

Confusion over the affordability of insurance options. Signup and view all the answers

What factor has contributed to the existence of the 'Medicaid Gap'?

States opting out of expanded Medicaid eligibility. Signup and view all the answers

What demographic saw a decline in uninsured rates from late 2020 to early 2023?

Children aged 0-17. Signup and view all the answers

What has been a challenge for individuals paying full price for Marketplace health plans?

Perceived high premiums and premium increases. Signup and view all the answers

What has been attributed to the low enrollment and high dropout rates in Medicaid?

High cost sharing and confusion. Signup and view all the answers

Which of the following was not a change made by the Biden Administration regarding healthcare?

Implementing new penalties for the uninsured. Signup and view all the answers

What has been a barrier to care for individuals with insurance?

High deductibles and cost-sharing plans. Signup and view all the answers

What was one of the main provisions of the Wagner-Murray-Dingell bill?

Universal comprehensive health insurance Signup and view all the answers

What significant health legislation did President Truman revive post-World War II?

The Wagner-Murray-Dingell bill Signup and view all the answers

Which act prohibited discrimination in medical services based on race, religion, or national origin?

The Hill-Burton Act Signup and view all the answers

What was a primary objective of the Federal Employees Health Benefit Plan initiated in 1960?

To ensure health insurance for federal workers Signup and view all the answers

Which program was incorporated into the Social Security Act in 1965?

Medicaid Signup and view all the answers

What was the primary purpose of the Health Planning Resources Development Act passed in 1974?

To prevent duplication of medical services Signup and view all the answers

What did the Emergency Medical Treatment and Active Labor Act (EMTALA) require hospitals to do?

Screen and stabilize all individuals in emergency departments Signup and view all the answers

What did the Hawaii Prepaid Health Care Act mandate for employers in 1974?

Provide insurance for employees working more than 20 hours weekly Signup and view all the answers

What was a key outcome of the National Medical Care Expenditure Survey (NMCES) conducted in 1977?

Detailed data on individual health care spending Signup and view all the answers

Which act allowed for an expansion of Medicaid coverage to children in 1990?

OBRA 90 Signup and view all the answers

Which President advocated for the Medicare program after President Kennedy?

President Johnson Signup and view all the answers

What significant change occurred with the introduction of Diagnostic Related Groups by Medicare in 1983?

Payment system for hospital procedures Signup and view all the answers

What was the effect of the 1981 federal budget reconciliation on Medicaid?

Required states to increase payments to hospitals Signup and view all the answers

What was a consequence of employer-based health coverage growth in the 1960s?

Difficulty in obtaining coverage for those with disabilities Signup and view all the answers

Study Notes

US Health Policy Reform (1900-Present)

Early 20th Century: Progressive Party advocated for social insurance, including health insurance (1912). Insurance Commissioners developed a model state law for health insurance regulation. Bills to require health insurance were drafted but not enacted due to WWI (1915). The Sheppard-Towner Act (1921) provided funding for prenatal and child health, expiring in 1929. The Committee on the Costs of Medical Care (1927) studied the economics of medical care, recommending group practice and voluntary insurance (1932). Baylor Hospital's pre-paid plan predated Blue Cross (1929).

Great Depression Era (1930-1939)

Social Security Act (1935): Included grants for Maternal and Child Health, restoring Sheppard-Towner programs. Expanded Children's Bureau's role to include child welfare. National Health Survey (1935-1936) assessed the nation's health. National Health Conference (1938) recommendations were incorporated into a national health bill, but failed to pass (1939). First Blue Shield plans were formed to cover physician costs (1938).

Post-War Era (1940-1949)

Wagner-Murray-Dingell Bill (1943): Proposed universal health insurance as part of social security, but failed. President Roosevelt advocated for medical care in 1944. Social Security Board supported national health insurance (1944). President Truman reintroduced the Wagner-Murray-Dingell Bill and similar legislation (1946-1947) but failed to pass. Hill-Burton Act (1946) funded hospital construction and prohibited discrimination. National Health Assembly recommended voluntary, universal coverage but faced resistance from the AMA (1948).

Mid-20th Century (1960-1969)

Employer-based health insurance growth but affordability challenges for retirees and disabled emerged. Federal Employees Health Benefits Plan created (1960). Kerr-Mills Act provided federal funds for state programs aiding the poor and elderly (precursor to Medicaid) (1960). White House Conference on Aging (1961) recommended elderly health insurance under Social Security. King-Anderson Bill (1961) aimed for government health insurance for elderly, facing AMA and insurance company opposition. President Kennedy and Johnson supported Medicare. Medicare and Medicaid (1965) signed into law, including significant public approval. Neighborhood health centers are established (1965).

Inflationary Era (1970-1979)

Health care costs and inflation increased. Nixon proposed the Comprehensive Health Insurance Plan and other reforms. SSI (Supplemental Security Income) program began (1972). Social Security amendments expanded Medicare coverage for disabled. Hawaii Prepaid Health Care Act required employer-coverage for employees with > 20 hours per week (1974). ERISA exempted self-insured employers from state health insurance regulations (1974). Health Planning Resources Development Act required healthcare planning (1974). Health Care Financing Administration formed (1977). National Medical Care Expenditure Survey (NMCES) measures healthcare spending (1977).

1980s: Shifting Medicaid and Medicare

Medicaid payments to hospitals were reformed in ways that reduced Medicare and Medicaid costs (1981). Medicaid waivers allowed state-managed care (1981). Medicaid expansions for institutional care to home care were also allowed (1982). Medicare instituted Diagnosis-Related Groups system (1983). EMTALA (Emergency Medical Treatment and Active Labor Act) mandated emergency department stabilization (1986). Medicaid expanded coverage for low-income groups (1986). 1987: 31 million uninsured.

1990s ACA Precursors:

OBRA 90 (1990) required Medicaid coverage for children (6-18) living below the poverty line. White House task force on health reform (1993) considered proposals like the Health Security Act (unsuccessful) and other proposals. Medicaid waivers expanded. Vaccines for Children program created (1990s). HIPAA (1996) addressed pre-existing conditions, medical records privacy and long-term care insurance. Personal Responsibility and Work Opportunity Act changed Medicaid eligibility linked to cash assistance and excluded some immigrants (1996). Mental Health Parity Act (1996) prevented mental health coverage from lower than medical coverage. Balanced Budget Act included Medicare + Choice program, S-CHIP, expanded disability coverage, and allowed for mandatory Medicaid managed care. 1997: Approximately 42.4 million uninsured. 1999: Ticket to Work Improvement Act expanded Medicaid coverage to disabled workers above 25% of poverty and allowed states to impose income-related premiums.

2000s: Prescription Drugs, Reform Attempts

Breast and Cervical Cancer Treatment Act (2000) covered uninsured women. Health center expansion (2002). Medicare prescription drug benefit (Medicare Part D)(2006). Massachusetts implemented near-universal health care legislation (2006). Vermont followed (2006). San Francisco implemented health services coverage (2006). "Healthy Americans Act" (2007) proposed government insurance but failed to pass. S-CHIP reauthorization failed. 2007: Approximately 45.6 million uninsured. Mental health parity expanded to substance use (2008).

2010s: Affordable Care Act

Affordable Care Act (ACA) passed and signed into law (March 23, 2010) aiming for near-universal coverage (2010). Required nearly all individuals to have health insurance by 2014, with subsidies for low to middle-income individuals, and penalties for large businesses without coverage. 2016: Individual mandate section of ACA was eliminated by President Trump.

2020s: Pandemic and ACA Evolution

COVID-19 pandemic impact on healthcare access and telemedicine, including expansion. Operation Warp Speed developed COVID-19 vaccines. Biden Administration sought to lower healthcare costs and increase enrollment using the healthcare marketplace. Uninsured rates declined (2023). Increased ACA subsidies and enrollment due to the American Rescue Plan and Inflation Reduction Act (2023).
Uninsured and under-insured: Challenges persist including affordability, low enrollment in Medicaid (in states that didn't expand it), perceived lack of affordable options through the market places, the "family glitch," the lack of eligibility for subsidies for some income groups, and other populations being excluded (immigrants). Low-income adults with chronic conditions face high deductibles and cost-sharing, cutting back on necessary care.

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Description

This quiz explores pivotal milestones in U.S. health policy, starting from initiatives in 1912 to significant acts like the Social Security Act of 1935. Test your knowledge on historical events during the Great Depression and the formation of key committees aimed at improving medical care. Understand the implications of early health plans and policies on contemporary health services.