as loyal readers will already know, laura and i recently finished a health policy elective. this course allowed us to exploit and experience some of dc’s more unique medical dimensions, and it immersed us in the details of america’s bewildering political landscape. i wrote an essay for competition sponsored by kaiser. therein, i addressed president obama’s health care plan and the impact of recent stimulus legislation on his proposals. as the topic seems fairly salient, i’m posting some of my work. enjoy! (this is most definitely copyrighted…no stealing)
Work in Progress: American Recovery and Reinvestment Act as a Model for Obama’s Health Care Reform
President Barack Obama’s health care plan includes a broad array of proposals for the revision of America’s health care system. Released in the context of the 2008 Presidential campaign, his plan is rich in conceptual ideas but relatively poor with respect to details. Since he took office, America’s financial landscape has changed dramatically. The nation is currently faced with the daunting dichotomy of waning resources and growing health problems. Rates of uninsurance and chronic disease are rapidly rising; per capita medical spending is increasing; and American public health is failing to keep pace with other industrialized nations. These factors have conspired to thrust health care reform into the spotlight with a new sense of urgency.
At this time, it’s unclear how President Obama’s ideas will be practically implemented. His first budget outline, released on February 26, is in its infancy, and his health care plan has not been formally revisited1. One interesting and informative development, however, is the the February American Recovery and Reinvestment Act (HR 1)2. The so-called “stimulus package” represents an existing source of resources that have already been approved, many for health care and related initiatives. President Obama and his democratic allies fought hard to pass HR 1 and win the support of a crucial few republican legislators. As such, the contents of this bill offer an important case study regarding the kinds of health care reform that stand the greatest chance of garnering practical political acceptance. The following will explore how provisions from the HR 1 legislation satisfy elements of President Obama’s health care plan and reflect his larger ideological priorities.
The first portion of President Obama’s health care plan pertains to cost-saving strategies. He proposes several major initiatives including expansion of medical technology, disease management programs, pharmaceutical cost containment, and catastrophic illness coverage. The plan endorses electronic health information technology systems (HIT) and their ability to prevent medical errors, organize care between multiple providers, and avoid redundant diagnostics. This aspect of the President’s plan is already being realized; HR 1 offers $19 billion for HIT, which is to be distributed longitudinally throughout the health care system. Funds will be offered to public institutions and private medical practices with the intention of facilitating a national medical information exchange. The legislation also provides $1.5 billion for community health centers, which provide care essential to medically underserved populations.
In its second section, President Obama’s plan addresses issues related to insurance coverage. Therein, the President makes his most significant proposal – a new federal insurance program that will offer affordable coverage and guaranteed eligibility for all Americans. This measure, arguably the centerpiece of the President’s health care strategy, has not yet materialized. But the plan also calls for expanded funding of other federal programs, namely Medicaid, Medicare, and SCHIP. HR 1 gives appreciable money to many of these initiatives. It provides $30 billion to COBRA, extending insurance coverage to unemployed Americans; it ensures 100% funding to State Medicaid programs for coverage of unemployed individuals and their dependents; and it offers $87 billion of additional Medicaid aid to states (FMAP). A separate piece of legislation, also passed in February, granted an additional $35 billion for the expansion of SCHIP3.
Altogether, these allocations represent a substantive endorsement of existing federal insurance programs. In his provisional budget, President Obama proposes setting aside roughly $634 billion for a health care “reserve fund”. This money, presumably, is intended to finance the new federal insurance coverage option. As drafted, the resources are derived from three principal sources: tax increases on the wealthy, emission tariffs on industry, and cost-savings in Medicare. These changes are likely to meet considerable Republican resistance, and their actualization probably represents the President’s greatest health care challenge. The underlying message, however, seems clear. President Obama is serious about expanding and equalizing American medical insurance.
The final third of Obama’s plan deals with public health. He explicitly addresses every social level – from individuals to the federal government – implicating each as a necessary component in the promotion of a healthier public. Again, HR 1 legislation bears out important goals. The stimulus includes nearly $20 billion for food and nutrition programs. Most target children – the Special Supplemental Nutrition Program (SNAP) for Women, Infants, and Children (WIC), but an additional $200 million is given for elderly nutrition. There are clear correlations between disease and diet, and this money has compelling potentials. HR 1 also includes significant funds for American drinking water, including $1 billion for the Bureau of Reclamation and more than $6 billion for individual state projects. More directly, the legislation also provides $1 billion to establish a Prevention and Wellness Fund. Many disparities in health status between populations are directly attributable to inequality in education status. HR 1 provides more than $41 billion for a variety of educational programs, including Title I, IDEA, and Pell grants. Most of these resources preferentially benefit children living in disadvantaged communities.
President Obama’s health care plan proposes a wide range of changes, and the current socioeconomic atmosphere has shifted national priorities. Important progress has already been made toward the realization of many goals. The “stimulus” package, the new President’s first major legislative accomplishment, contains funding for many health care objectives spanning everything from disease prevention to reinforcement of the safety net. In his first budget, the President communicates a persisting desire to dramatically reform health care insurance coverage, and this goal will be a formidable political challenge. It will be difficult to gather funds from a reeling economy, particularly because the readiest source seems to necessitate changes in federal tax code – a move that will be unpopular with many conservatives. Ultimately, the fate of President Obama’s health care plan is uncertain. He has made important strides in a short time, and he has demonstrated considerable resolve in the pursuit of reform.
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