1. Democrats-Support government intervention to balance the market inequalities to provide access to healthcare for all at a reasonable cost.
1.1. Healthcare Policies
1.1.1. Medicaid
1.1.1.1. Historical Development
1.1.1.1.1. The Great Depression economics spurred political action. In 1934, the Federal Emergency Relief Administration dispersed grants to local governments to assist that included medical care for the poor (Patel & Rushesky, 2014).
1.1.1.1.2. The 111th Congress passed Medicaid in 1965. Medicaid is not the national healthcare plan the democratic party had proposed historically but is a compromise that fulfills the commitment to the poor show by Presidents Hoover, Truman, and Kennedy (PBS News Hour, 2014).
1.1.1.1.3. In 2010, President Obama and the Democrat majority pass the Affordable Care Act (ACA). In 2014 the legislation allowed states to expand Medicaid programs to include citizens under 65 whose families fall below 138 percent of the FPL (Longest, 2016).
1.1.1.2. Implementation
1.1.1.2.1. The 1965 Democratic legislation covered the gap low income citizens that Medicare left behind. States were mandated to create a delivery of care.
1.1.1.2.2. In 2014, more citizens were eligible and covered those under 65 whose families fall below 138 percent of the FPL (Longest, 2016)
1.1.1.3. Impacted Populations
1.1.1.3.1. Children of lower income families
1.1.1.3.2. Low income Individuals
1.1.1.3.3. Pregnant Women
1.1.1.3.4. Women with newborns (1 year)
1.1.1.4. Stakeholders
1.1.1.4.1. Proponents
1.1.1.4.2. Opponents
1.1.1.5. Financing
1.1.1.5.1. Current
1.1.1.5.2. Future
1.1.2. Medicare
1.1.2.1. Historical Development
1.1.2.1.1. Kerr-Mills (Patel& Rushefsky, 2014)
1.1.2.1.2. Democrats sweep elections in 1964, with Lyndon Johnson as President, Medicare is passed under the "Great Society" (Patel& Rushefsky, 2014)
1.1.2.1.3. Democrats sponsored hospital coverage through part A. Their philosophy of mandatory contribution for the greater good is achieved by utilizing payroll taxes to fund the program (Patel & Rushefsky, 2014)
1.1.2.1.4. President Clinton proposes drug coverage in 2000. It was defeated through strong opposition including that of PhRMA who was concerned there would be price controls on drugs (Lee, et al., 2004).
1.1.2.1.5. In 2004, Democrats decide some coverage for drugs is better than no coverage. Their spend estimates are nearly double what the Republicans project. After much compromise, the party passes the (MMCA).
1.1.2.2. Implementation
1.1.2.2.1. Medicare A is available in 1966, covering most of the elderly population.
1.1.2.3. Impacted Populations
1.1.2.3.1. Elderly Citizens
1.1.2.3.2. Disabled Citizens
1.1.2.3.3. Physicians and Providers
1.1.2.4. Stakeholders
1.1.2.4.1. Proponents
1.1.2.4.2. Opponents
1.1.2.5. Financing
1.1.2.5.1. Current
1.1.2.5.2. Future
1.1.3. Affordable Care Act
1.1.3.1. Historical Development
1.1.3.1.1. President Clinton proposes reform legislation that would build on prior reform initiatives but he fails to pass major reform. Costs continue to climb for insurance premiums, prescription, provider fees and hospital stays.
1.1.3.1.2. Several factors such as costs, access to care, and market recession create pressures on patients and employers to pay for care.
1.1.3.1.3. President Obama proposes legislation based on campaign promises to reform healthcare. He learns from the Clinton era and capitalizes on a democratic majority to pass the initiative. On March 23, 2010 President Obama signs the Affordable Care Act (ACA), (Patel & Rushefsky, 2014).
1.1.3.1.4. In 2012, the supreme court upholds most of the components of legislation in ACA.
1.1.3.2. Implementation
1.1.3.2.1. Medicare part C & D are reformed and provides alternatives delivery models
1.1.3.2.2. 2013 the health exchange opens allowing citizens to purchase insurance in four tiers. Subsidies are available to help cover the premium costs for many people.
1.1.3.3. Impacted Populations
1.1.3.3.1. Students
1.1.3.3.2. Patients with pre-existing conditions
1.1.3.3.3. Chronically ill patients
1.1.3.3.4. Employers with 50+ employees
1.1.3.4. Stakeholders
1.1.3.4.1. Proponents
1.1.3.5. Financing
1.1.3.5.1. Current
1.1.3.5.2. Future
1.2. Healthcare Programs
1.2.1. Health Information Technology for Economic and Clinical Health (HITECH) Act 2009
1.2.1.1. Historical Development
1.2.1.1.1. HIPAA Privacy Rule was signed in 1996 and the HIPAA Security Rule was signed in February of 2003.
1.2.1.1.2. HITECH legislation was written under the Bush Administration but was not signed until February 17th, 2009 by President Obama (Hales, 2020).
1.2.1.2. Implementation
1.2.1.2.1. This Act strengthened privacy rules and provided incentives for providers and hospitals to convert to electronic medical records (Hales, 2020).
1.2.1.2.2. In 2018, (HITECH) infrastructure supported the conversion of meaningful to Promoting Interoperability Program. The goal is to improve metric collection.
1.2.1.2.3. Health IT EchoSystem is a 10-year vision sponsored by (HHS) that works off of the IT infrastructure built through (HITECH), (CDC.com, n.d.).
1.2.1.3. Impacted Populations
1.2.1.3.1. Patients
1.2.1.3.2. Healthcare Providers
1.2.1.4. Stakeholders
1.2.1.4.1. Proponents
1.2.1.4.2. Opponents
1.2.1.5. Financing
1.2.1.5.1. Current
1.2.1.5.2. Future
1.2.2. The Indian Health Service
1.2.2.1. Historical Development
1.2.2.1.1. In the 1800's, The War Department assigned the task of Indian medicine. The care was based on the prevention of diseases such as smallpox.
1.2.2.1.2. In 1912, President Taft sent a message to congress about a survey of the conditions on Indian reservations. He described them as "deplorable". Congress allocates increases to the Bureau of Indian Affairs (BIA). Over the course of three years the support increases from $200,000 to $350,000 (Patel & Rushefsky).
1.2.2.1.3. President Jackson viewed the native Indian groups as impeding expansion of America. The reservation system was the strategy of removal and migration west.
1.2.2.2. Implementation
1.2.2.2.1. Indian Health Service provided comprehensive health services, coordination of health services between government entities, and training (Patel & Rushefsky,2014).
1.2.2.2.2. 1976 legislation allowed IHS to bill Medicaid for services.
1.2.2.2.3. In 1994, President Clinton approved "compacting" which allows tribes discretion on how they use government funding. Tribes vary in how they contract or compact with IHS, but many do over the fear of losing funds (Patel & Rushefsky, 2014).
1.2.2.3. Impacted Populations
1.2.2.3.1. 565 federally recognized American Indian and Alaskan Native tribes and more than 100 state-recognized tribes.
1.2.2.4. Stakeholders
1.2.2.4.1. Proponents
1.2.2.4.2. Opponents
1.2.2.5. Financing
1.2.2.5.1. Current
1.2.2.5.2. Future
2. Republicans-Support increased reliance on market competition to ensure market allocation; favor state run initiatives
2.1. Healthcare Policies
2.1.1. Medicaid-1965
2.1.1.1. Historical Development
2.1.1.1.1. Kerr-Mills Act passed by Congress in 1960. The act federally matched states for elderly, disabled, and low-income individuals. The state-run program adheres to Republican philosophy, but unfortunately, only 30 states adopt the reform, and only two do it well, leaving many uncovered citizens (Berkowitz, 2005)
2.1.1.1.2. Medicaid and CHIP (Children's Health Insurance Program) created in 1965 along with Medicare. The portion of the legislation is a compromise for the AMA who supported state-administered means-testing (Patel & Rushesky, 2014).
2.1.1.1.3. In 2009, State Children's Health Insurance Program (SCHIP) is initiated as a revision of CHIP. The legislation includes the Children's Health Insurance Program Reauthorization Act (CHIPRA) and Patient Protection and Affordable Care Act (HCER) as part of the Republican-sponsored Balanced Budget Act of 1997 (Longest, 2016).
2.1.1.2. Implementation
2.1.1.2.1. Designed to be run by state governments. States have control over the structure of the program.
2.1.1.2.2. 2009 initiation of (SCHIP) provides coverage for low-income children whose family income is below 200 percent of the (FPL) .
2.1.1.2.3. 2009 expanded Medicaid to allow all children under 19 in families with incomes at or below the FPL, pregnant woment whose family income is at or below 133 percent of (FPL) and infants born to eligible women for the first year of life (Longest, 2016).
2.1.1.3. Impacted Populations
2.1.1.3.1. Children of lower-income families.
2.1.1.3.2. Low income individuals
2.1.1.3.3. Pregnant women
2.1.1.3.4. Women with newborns (1 year)
2.1.1.3.5. Eligible seniors with disabilities
2.1.1.3.6. Citizens with disabilities and certain medical conditions
2.1.1.4. Stakeholders
2.1.1.4.1. Proponents
2.1.1.4.2. Opponents
2.1.1.5. Financing
2.1.1.5.1. Current
2.1.1.5.2. Future
2.1.2. Medicare-1965
2.1.2.1. Historical Development
2.1.2.1.1. The party opposes national healthcare of NHI proposed by President Roosevelt in 1935
2.1.2.1.2. In 1965, offer a proposal for a voluntary insurance program that is subsidized through general revenues (Longest, 2016)
2.1.2.1.3. Medicare passes in 1965 but there is a compromise to accommodate the Republican proposal of a voluntary plan; Medicare part B is that compromise.
2.1.2.1.4. Republicans control congress after the 1994 elections. Under the Contract with America, they plan to reduce waste and healthcare spending as part of the Tax Equity and Fiscal Responsibility Act (TERFA). Intentions to modernize Medicare through competitive plans produce Medicare Part C or Medicare Advantage Plan (Mcguire, et. al, 2011).
2.1.2.1.5. In the 2000 Presidential race, the Republican platform began offering a subsidy plan. The 2001 attacks halted discussions. In 2004, President G.W Bush's proposals were passed (MMCA) but with criticism of both parties and with substantial compromises (Longest, 2016).
2.1.2.2. Implementation
2.1.2.2.1. Republican concept of Medicare Part B is implemented in 1966 and covered nineteen million people.
2.1.2.2.2. In 1997, Medicare Part C provided patients with an option to self-select a plan that offers part A's benefits.
2.1.2.2.3. In 2004, Medicare part D offers a discount card and a subsidy for the enrollment fee of the card (Longest, 2016)
2.1.2.2.4. In 2006,part D was modified and the discount cards phased out. Part D now offerers voluntary insurance coverage with premium payments and subsidies for low income enrollees.
2.1.2.3. Impacted Populations
2.1.2.3.1. Elderly Population
2.1.2.3.2. Disabled Population
2.1.2.4. Stakeholders
2.1.2.4.1. Proponents
2.1.2.4.2. Opponents
2.1.2.5. Financing
2.1.2.5.1. Current
2.1.2.5.2. Future
2.1.3. Affordable Care Act-2010
2.1.3.1. Historical Development
2.1.3.1.1. Much of the legislation is based on prior Republican initiatives.
2.1.3.1.2. Despite HMO and republican budget cutting initiatives to reduce spending on healthcare, healthcare costs rise. (Cutler, 2014) states costs are one to 2 percent above the rate of the economy.
2.1.3.1.3. Republicans do not support the initiative but presidential candidate John McCain did support the conversion to medical records that included stipends for help shoulder the cost. He also agreed there needed to be more transparency of consumer information (Patel & Rushefsky, 2014).
2.1.3.2. Implementation
2.1.3.2.1. Many conservatives seek to revise the legislation and promote state marketplaces as the long-term reform solution.
2.1.3.3. Impacted Populations
2.1.3.3.1. Students
2.1.3.3.2. Patients with pre-existing conditions
2.1.3.3.3. Medicaid recipients
2.1.3.3.4. Medicare recipients
2.1.3.4. Stakeholders
2.1.3.4.1. Opponents
2.1.3.5. Financing
2.1.3.5.1. Current
2.1.3.5.2. Future