PLS 347-01

Govt in healthcare

  • 1906: FDA (jungle – Sinclair – progressive)
  • 1914: Harrison Act (narc regs)
  • post-WWII: Hill-Burton Act (hospital construction)
  • 1960s: Great Society (LBJ)

Medicare

  • 1.45 ee
  • 1.45 er
  • Medicare Pt.A: mandatory – payments for hospitalization (stay only, not treatment)
    • 1 day: $1050-1150
    • 2-60 days free
    • 60-90 days $256/day
    • 90+ days $512/day
  • Medicare Pt.B: voluntary – medical expenses
    • $96.50-100/mo.
    • $250 deductible
      • 80/20  fed/individual cost split
    • 2/3 cost coverage (diagnostic related groups)
  • Medicaid
    • voluntary by state (all states participate)
    • discretionary
    • 50/50 fed/state cost split
      • up to 80% fed, depending on state pov rate

Nixon 1970s

  • Kaiser plans (model for HMO)
    • Dr = fee per service
    • HMO = fee per membership
  • certificate of need (not implemented)

Reagan 1980s

  • COBRA (individual picks up entire cost)
  • catastrophic care coverage
    • individual cost caps
    • AARP opposition to sliding scales defeated program

Clinton 1990s

  • employer mandate (pay or play)
  • regional exchanges
  • “Hillarycare”

Ted Kennedy 1996

  • Healthcare Portability Act
    • lose job, can keep ins for limited time
    • pre-exist has 1-year cutoff
    • med expense > 7.5% of income = med costs tax-deductible
    • HC sav accts
      • pre-tax $$$ for HC costs

SCHIP 1997

  • state block grant for low-income child coverage

Patient Bill of Rights 1998

  • HMO no longer exempt from suit via ERISA
  • treatment-type gag order eliminated
  • fem can choose own gynecologist
  • emergency = nearest facility, not just HMO-preferred

Bush 2000

  • Medicare pt.D (voluntary buy-in)
    • drug coverage
    • $35-40/mo
    • $250 deductible
    • from $250-2250 gov pays 75%
    • from $2250-3600 (donut hole, no gov contrib)
    • from $3600+, gov/ind 90/10
    • $750 mln. unfunded mandate
  • proposed shift away from employer-based coverage
    • coverage no longer deductible by employer (bus. expensing)
    • shift cost to employee
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