Health Care Reform Wayback – A Brief History of Health Care Reform in the USA
Is Health Care Reform New?
As somebody who is very interested in the progress of health care reform as a taxpayer, private consumer of health insurance and services, and as a professional, I have been trying to follow the current health reform debates. I am getting a little frustrated with the lack of progress on either side of the aisle, and also by some of the knee jerk reactions by politicians and their groupies.. You would think that the current administration, and its political adversaries, had just invented health reform or the cries of outrage that sound against it.
I decided to do my best to outline some of the highlights of the health reform attempts, failures, and progress in the past 100 years or so. I am not a professional historian, by any means, so some may feel as if I left out important things or took them out of context. I am trying to be balanced, but take all the blame if I neglected something you feel is important.
Teddy Roosevelt In the 1910′s
Teddy Roosevelt ran on a very progressive platform in the early part of the last century. His campaign promises for 1912 included protection for workers safety on the job women’s right to vote, and a national health care program. He was president of the United States, by the way, from 1901 – 1909. But he lost the election of 1912 to Woodrow Wilson. It is interesting to note that this Roosevelt was a Republic. Wilson was the Democrat. Never assume that American party politics are set in stone.
Early Models of Current Health Insurance and Cries of Socialism
In 1929, Baylor Hospital in Dallas, Texas came up with a pre-paid program for a large areal teacher’s union. This is considered one of the earliest models of health insurance. Now here’s the irony. A few years later, an Oklahoma doctor formed a farmer’s association with a pre-paid plan. Members of the association would pay into the plan, and then get services covered. The American Medical Association called this doctor’s plan socialism!
Despite this, pre-paid hospital and doctor plans continued to grow in popularity around the US. However, they usually left out the unemployed and elderly.
The New Deal in the 1930′s
Another Roosevelt, FDR, also wanted to implement national health reform. He wanted to include it as part of social security legislation. That did not work out, but even Truman wanted to set up a national fund. for health care. He figured everybody could pay in, like we do for social security, and then it could make sure that people’s most severe health needs were met. All of this was left out of the New Deal, and the AMA continued to criticize it as socialism.
Post World War II
By the end of the second world war, it became a lot more obvious that there was a big gap between health care costs and what mos people could afford. Congress did pass a bill to build a lot more hospitals. They also required hospitals to provide charity care. They had a clause to forbid discrimination on race, religion, etc. But they did allow separate but equal care, which did not always turn out to provide equal care to everybody.
In the 1950′s, labor unions began adding health benefits to their collective bargaining agreements. This really formed the basis for the group health insurance many people enjoy at work today. So group health plans became more popular, and in 1954, Congress voted to make this benefits tax-exempt.
The 1960′s
JFK fought hard for national health care, but again he was met with cries of socialism. But Medicare and Medicaid, regarded as American institutions now, did emerge despite this. Medicare is the US national health plan for seniors and disabled people. Medicaid is the national health plan for very poor people.
Despite the fact that millions of Americans had heath insurance coverage for the first time, in the 1960′s, health care spending and costs were beginning to rise.
The 1970′s – Nixon and Carter
President Nixon, a Republican, worked for health reform. He proposed a bill that would require employers to provide minimum health insurance coverage. Under his administration, money was allocated for the development of HMOs and managed care to contain costs.
Carter ran for president, and national health care was a large part of his campaign platform. Even though he won, the severe recession put these plans on hold.
The 1980′s and COBRA
COBRA is the national law that requires some employers to extend group health benefits to terminated employees for several months.
The 1990′s and The Clintons
Probably the most famous previous attempt to dramatically reform health care was under President Clinton. Hillary Clinton, then first lady, spear headed this work. You will probably not be surprised to learn that political critics of the pan delighted in calling it socialism. Experts contend that the plan failed because of partisan politics on both sides. The drug and insurance companies, and the American Medical Association (AMA) also spent a lot of time and money getting the Health Security Act defeated.
CHIPS - I cannot leave the 1990′s without mentioning CHIPS. This is the state and federal children’s health insurance program which covers millions of children from lower and moderate income families.
21st Century Health Reform
I have to credit George Bush, a Republican, with passing the Medicare Prescription plan in 2003. This is also known as Medicare Part D, and it helps fund prescription insurance for Medicare beneficiaries.
Obama ran on a platform that included health reform. It seems like it is as tough to pass now as it was during the time of Teddy Roosevelt, FDR, Truman, and Bill Clinton. Politicians are still making deals behind closed doors, and of course, people are still shouting socialism.
But some things have changed. The AMA now supports health reform. Many businesses are concerned about spiking costs of covering employees, and representatives have admitted they would like to see some reform that would help them. Even insurance companies have said they will cooperate.
Hopefully, we can see some progress. I have no idea what will (or should) happen next.
Health Care Reform – 5 Reasons to Begin Working With a PEO Today
Even with the vote in Massachusetts in January 2010, there is a thought throughout the country that health care reform is inevitable. In fact, there are many states looking at doing something themselves as a cost-cutting measure – providing greater access to medical insurance reduces their costs on programs for the uninsured. Ironically, we believe that the PEO is the original health care access reformer, by providing small business employers with access to affordable benefits, not to mention help with compliance on many government regulations. Still, with reform comes greater employer burden. Today we will review 5 items that were recently in the Senate version in December 2009 and how a PEO will help you to comply.
Reason #1 – Companies with 50 or more employees will be assessed a fee for having an employee on the payroll that is using a tax credit for the health insurance exchange (we will review exchanges in a future article). The PEO is ideally made for the tracking, reporting and remittance of this type of fee. Look for PEOs to provide this as part of their service offering for their larger clients.
Reason #2 – The language states that providing employers with 25 employees or less, and an average salary of $40,000 or less that provide health insurance for employees will get a tax credit. This is perfect for your PEO. By providing access to insurance, the PEO ensures you can receive the credit, but better yet, the PEO will also be helping you to get the correct paperwork together for this credit – in effect paying for the PEO’s services (depending on credit size).
Reason #3 – Wellness program equals win-win. The government will provide credits and/or subsidies to employers that provide access to a wellness program. The goal is that this will reduce health care costs overall. So, in addition to medical benefits, the PEO will provide access to these types of programs, allowing you to take advantage as soon as the law takes affect. In fact, the PEO will help assist you on reporting requirements to take advantage of the savings.
Reason #4 – Tax changes, HSA changes and tax reporting of employers providing benefits. Need we say more? A PEO helps you with payroll and tax reporting, they will do this for all of their clients once it’s enacted, so why worry about it – it will be automatic.
Reason #5 – You will be more competitive then ever before. Quite honestly, there will be a number of employers that will throw their hands up and take the hit on penalties and other ramifications. However, overall this increases the costs for many of your employees and as we know, the #2 reason employees stay with an employer is medical benefits. So, while your competitors are losing employees, your PEO will be helping you keep the good ones, now more then ever.
No matter what happens with Health Care Reform in 2010 and in the future, a PEO can help you today. Not only will they provide access to benefits that may be more affordable, but they will help you with understanding how the changes affect your business.
What Does the New Health Care Bill Mean For Medicare?
President Obama got his wish last night as the House of Representatives passed his new health care bill with a vote of 219-212. The bill is being sent to the White House to be signed into law by Obama on Tuesday.
Here is a summary of the 10 major points of the health care bill and how Medicare recipients will be affected by it. These major points are covering the immediate effects the health care bill will have on Americans. Many other points of the bill will not surface until 2014.
10 key points Obama’s health care bill covers:
* Children may remain as dependents on their parents’ policy until their 27th birthday
* Children under age 19 may not be excluded for pre-existing conditions
* No more lifetime or annual caps on coverage
* Free preventative care for all
* Adults with pre-existing conditions may buy into a national high-risk pool until the exchanges come online.
* Small businesses will be entitled to a tax credit for 2009 and 2010, which could be as much as 50% of what they pay for employees’ health insurance.
* The “donut hole” closes for Medicare patients, making prescription medications more affordable for seniors.
* All insurers must post their balance sheets on the Internet and fully disclose administrative costs, executive compensation packages, and benefit payments.
* Authorizes early funding of community health centers in all 50 states. Community health centers provide primary, dental and vision services to people in the community, based on a sliding scale for payment according to ability to pay.
* Effective immediately, you can’t lose your insurance because you get sick.
The nonpartisan Congressional Budget Office gave figures for the bill, saying $138 billion will be cut from the national deficit over the next decade with this bill, even though the bill itself is estimated to cost $938 billion.
The bill is hoping to raise the amount of insured Americans by 11% (to 94%) by 2014. The huge cost of the bill will be made up by added taxes, including an increased Medicare payroll tax. This brings us to the affect the health care bill will have on Medicare beneficiaries.
* As of now, in the Medicare D plan there is a coverage gap. If a Medicare beneficiary goes over the prescription drug coverage limit they have to pay for the entire prescription until it meets the catastrophic coverage threshold. The health care plan will help close this gap by giving all Medicare D beneficiaries $250 to help pay for prescriptions.
* The gap will continue to close in 2011 when brand-name prescription drugs will be discounted 50%, and is expected to completely close by 2020 (Medicare beneficiaries will still have to pay for 25% of the prescription cost, but the cost itself will be substantially decreased).
* Medicare hospital insurance tax rate will increase in 2012 by.9% for beneficiaries earning over $200,000 or a married couple making $250,000
* Sets a new standard for Medicare payment to hospitals and doctors