Healthcare Financing in U.S

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Healthcare Financing in U.S

Health care financing in the United States has taken huge strides over the past two decades. In 2000, the Long-Term Care Security Act was passed by congress. This provided a program to provide long-term care insurance for federal employees, civilians, uniformed armed services and military retirees. The Clinton administration had been unable to redesign the health care delivery system and opted for smaller steps to expand and offer new choices for health insurance. Dealing with health care cost had already become an issue and the government needed to take efforts to control health care costs and ensure quality care for the elderly, children and the employed population(Sommers et al., 2015).

When the republican took power in 2002, enacting a national health insurance plan was not among the agenda. The government emphasized on controlling the rising costs of health care through consumer driven plans. The consumers became responsible for their own health expenses.

The private sector also saw an emergence of new programs. Value-based reimbursement started to take shape. Physicians were being reimbursed on the basis of their performance to attain quality of care. This was in stark contrast to the previous systems where doctors, hospitals and other health providers were reimbursed regardless of the outcome. The earlier systems were not concerned with whether patients were satisfied with their care. The value-based reimbursement models were trying to eliminate expensive mistakes in health care delivery by requiring high quality services(Sommers et al., 2015). They were also targeting to do away with inefficiencies in treatment and management of patient care. Providers with highest quality are reimbursed high fees with the worst providers receiving a reduction in fees. This will eventually allow consumers access to information about their providers cost and quality of care.

In 2003, congress enacted Medicare Prescription Drug, Improvement and Modernization Act. This mechanism created a way for patients to pay for their health care costs. In addition, it covered the elderly people from the costs of prescription drugs. It created a health savings account. This is a combination of retirement account in combination with insurance policy to cover medical costs. It can be used to pay for routine medical bills. Consumers or their employers fund this account yearly. The payments are pretax but withdrawals form medical expenses would be tax-free. Using the funds for nonmedical expenses before age of 65 would attract a penalty. After this age, consumers can use the funds for nonmedical expenses without attracting a penalty. This program was intended to encourage consumers to seek inexpensive treatment to reduce unnecessary spending(Sommers et al., 2015).

In 2010, the Affordable Care Act (ACA) or Obamacare was enacted by congress. The program aimed at making health insurance available to more people. The act also expanded Medicareeligibility and mandated Americans to obtain health insurance(Cutler, 2015). Insurance companies werealso prohibited from denying coverage or even charge more as a result of any pre-existing condition. Children were also allowed to remain on their parent’s insurance plans until they attain the age of 26.

ACA was designed to reduce health care insurance costs for people who could not qualify. Individuals and families with low incomes were provided with premium tax credits and cost-sharing reductions to lower their expenses. Premium tax credits lowered the monthly health insurance bill while reductions reduced the out-of-pocket costs. Health insurance plans are also required to cover at no cost a list of preventive services. ACA requires that checkups, counselling, immunizations and screening be covered in insurance plans(Cutler, 2015). Under this act, states were allowed to extend Medicaid coverage to a wide range of its population. In 2017, the penalties for not having a health insurance was scrapped. In the same year, Trump’s government attempted to repeal this law but was unsuccessful. This year, there are 11.3 million people covered by ACA plans. The expansion of ACA has seen 14.8 million people enrolled in Medicaid.

ACA rules have set the maximum out-of-pocket limit to essential health benefits. This limit has been set at $8,550 per individual, as long as the person receives health care from an in-network medical provider. However, health plans are allowed to have smaller caps but cannot exceed the set limit.

The debate to enact a national health insurance is not over. President Teddy Roosevelt campaigned on a promise of national health insurance in 1912. Many years later, almost every admiration has proposed the enactment of the same with no success. Faced with many challenges, the health insurance field must demonstrate innovation and flexibility to ensure affordable and quality health care for Americans. The private sector is also determined to develop programs to curb the rising health care costs. There is no single program that enjoys permanent success for the whole nation. However, the federal government expenditure on health care have continued to rise. Whether public or private, an answer needs to be found to address the health care crisis that faces the American people(Shrank et al., 2021). No program has been able to stem the tide of increased health care nor the quality of care.






Cutler, D. (2015). From the Affordable Care Act to Affordable Care. JAMA314(4), 337.

Shrank, W., DeParle, N., Gottlieb, S., Jain, S., Orszag, P., Powers, B., &Wilensky, G. (2021). Health Costs And Financing: Challenges And Strategies For A New Administration. Health Affairs40(2), 235-242.

Sommers, B., Gunja, M., Finegold, K., &Musco, T. (2015). Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act. JAMA314(4), 366.