Healthcare and Politics Sample Paper

Healthcare and Politics Sample Paper

Healthcare and politics are inseparable, considering that the health sector relies on government policies and guidelines to define services’ quality, cost, and plans. The political domain influences various disciplines, including public policies, organizational systems, and legislative provisions. Depending on the existing political regime, healthcare changes are inevitable.

In the US, state and national politics determine comprehensive healthcare plans that include Medicare and Medicaid. Other healthcare developments dependent on the administrative tenures are patient protection Acts, Affordable Care Act (ACA), alongside others that continue to shape healthcare institutional expectations, operations, affordability, and accessibility. Therefore, politics and health are intertwined concepts that share historical dynamics.

History of Private Health Insurance and Managed Care

Private Health insurance and managed healthcare are among the fundamental health developments that became operational in the 20th century. In the late 19th century, few state and private insurance companies provide policies to cover care costs for employees and people with disabilities. Coverage for health issues unrelated to workplace accidents did not exist until the late 20th century. Between the 1910s to the mid-1940s, few hospitals and healthcare groups like the Western Clinic in Tacoma provided prepaid services.

For instance, the American Association of Labor Legislation conceptualized a health insurance bill framework for industrial workers in 15 states by 1915 (Oberlander, 2019). The program targeted lumber mill owners and employees. Between the mid-1940s to mid-1960s, states and federal governments embraced policies to foster the expansion of health benefits. Although at a slow pace, the era ushered the emergence of health insurance groups such as the Health Insurance Plan (HIP) of Greater New York and the Seattle-based Group Health Cooperative of Puget Sound.

Health insurance reforms unfolded in the subsequent years of the 1960s to 1970s. President John F. Kennedy proposed a health plan that became the Part A of Medicare. Kennedy’s plan targeted to finance healthcare services through taxes on earned income. In 1965, Congress passed two landmark Acts for healthcare insurance: Medicare for the elderly and Medicaid for low-income families (Hines et al., 2017).

However, it was until a decade later when managed care became a reality. In 1973, the Health Maintenance organizations (HMO) Act authorized startup grants and loans, more essentially, promoted the emergence of a holistic employer-based insurance market. From the 1970s to the 1980s, health insurance developments set avenues for the current policies such as the 2010 Affordable Care Act and Patient Protection (Gruber, 2017).

Although these landmark developments are fundamental in influencing access to healthcare services, the primary concern is reducing salary deductions and providing incentives to private insurance providers to share the cost of delivering medical covers. Therefore, the national government engages with various healthcare stakeholders to increase financial allocations and other prerequisite resources to complement private insurers’ efforts and reduce tax burdens.

Federal Laws that Protect Individuals Enrolled in Private Insurance

Undoubtedly, private insurers are fundamental in bolstering healthcare services by providing flexible and comprehensive insurance covers to employees and other individuals enrolled in their contracts. Therefore, the federal government includes these private insurance companies as subjects to various legal provisions to help protect individuals from price, safety, and quality compromises. The most profound laws that protect individuals enrolled in private insurance providers include the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Patient Safety and Quality Improvement Act (PSQIA) of 2005. The HIPAA provisions protect American employees, regardless of their employers, from transferring (carry) health insurance policies from job to job.

The program allows employees to apply for health insurance plans to replace lost coverage and adjust changes such as marriages, adoptions, and births (Cohen & Mello, 2018). More importantly, HIPAA protects insured individuals against discrimination based on health problems. Private health insurance providers who discriminate against individuals based on individual characteristics such as disability are punishable by federal law.

Simultaneously, PSQIA protects healthcare employees who report unsafe working conditions (Boulanger et al., 2019). The federal government created this Act to encourage effective reporting of medical errors while maintaining patient’s confidentiality rights. Therefore, the law is strict on protecting individual data during the process of healthcare quality reporting.

Customer-Driven Healthcare and Consumer Empowerment

Customer-driven healthcare and consumer empowerment are fundamental concepts that influence how people access, pay, and understand healthcare services. Consumer-driven healthcare originated in the late 1990s to engage consumers in healthcare purchases (Ferguson et al., 2020). The idea was to allow health insurance members to use various ways to pay for routine healthcare expenses. Before the plan, patients and people on regular healthcare services faced economic problems because healthcare expenses inflicted financial pressure. Therefore, the consumer-driven healthcare plan availed various payment opportunities to individuals, including health saving accounts (HSAs), Health Reimbursement Accounts (HRAs), and other payment accounts for medical purposes to protect individuals from costly out-of-pocket expenses. This aspect gave patients control over the health budget because they enjoyed opportunities to pay for routine services via personal-controlled accounts and fixed health insurance benefits.

Although consumer-driven healthcare services were essential in fostering quality and affordability, organizations faced the urge to embrace consumer empowerment practices to ensure greater transparency. According to Bridge et al. (2017), patient empowerment entails efforts to ensure that consumers have adequate support, resources, and tools to access, afford, and appreciate healthcare services. Under the consumer empowerment objective, the functional areas include promoting information transparency, engaging patients as partners, promoting patients’ experiences, and price transparency. These elements are crucial in improving relationships between patients and healthcare institutions.

Roles of Nurses Within the Private Insurance Market

Notably, the private insurance market plays an essential role in promoting healthcare quality, accessibility, and affordability. Due to the existing federal government’s provisions under different health Acts, it is valid to argue that private insurers hold an ideal position in the overall health improvement objective. Regardless of the prevailing changes in the healthcare sector, nurses remain ethically bound to engage in different efforts of improving health and healthcare services (Salmond & Echevarria, 2017). The recent healthcare provisions such as the Affordable Care Act of 2010 require expanding institutional scopes and systems to accommodate many consumers enrolled in flexible medical covers.

Nurses are crucial stakeholders in facilitating such reforms by providing medical expertise, leadership skills, and innovative competencies that complement healthcare system expansion. More importantly, opportunities for integrating advanced healthcare systems and organizational infrastructures place nurses as ideal figures for healthcare promotion, alleviating disease morbidity and mortality rates, and utilizing evidence-based healthcare practices (Salmond & Echevarria, 2017, pp. 20). Therefore, it is valid to argue that nurses have opportunities for transforming healthcare practices by accommodating recent reforms and assimilating their subsequent provisions to enhance service quality.

Conclusion

Private insurance providers are crucial stakeholders in transforming the health care sector in the county. These insurers provide medical covers based on monthly premium payments and other terms agreed upon with customers. Due to their essentiality, the federal government values them and enacts provisions to protect individuals enrolled in such plans. The reason for integrating private insurers into the mainstream healthcare reforms is to promote consumer-driven practices and empower individuals to control their budgets.

Current reforms such as the Affordable Care Act (ACA) operates to consolidate all stakeholders to increase healthcare efficiency, affordability, quality, and accessibility. Regardless of the tremendous changes in the US healthcare sector, nurses are crucial stakeholders who provide the necessary expertise, models, and practices relevant to the changes. Therefore, their opportunities are increasing due to the expanding healthcare scopes.

References

• Boulanger, J., Keohane, C., & Yeats, A. (2019). Role of Patient Safety Organizations in Improving Patient Safety. Obstetrics and Gynecology Clinics of North America, 46(2), 257-267. https://doi.org/10.1016/j.ogc.2019.02.001
• Bridges, J., Loukanova, S., & Carrera, P. (2017). Patient Empowerment in Health Care. International Encyclopedia of Public Health, 416-425. https://doi.org/10.1016/b978-0-12-803678-5.00324-6
• Cohen, I., & Mello, M. (2018). HIPAA and Protecting Health Information in the 21st century. JAMA, 320(3), 231. https://doi.org/10.1001/jama.2018.5630
• Ferguson, W., White, B., McNair, J., Miller, C., Wang, B., & Coustasse, A. (2020). Potential savings from consumer-driven health plans. International Journal of Healthcare Management, 1-6. https://doi.org/10.1080/20479700.2020.1770425
• Gruber, J. (2017). Delivering Public Health Insurance Through Private Plan Choice in the United States. Journal of Economic Perspectives, 31(4), 3-22. https://doi.org/10.1257/jep.31.4.3
• Hines, A., Raetzman, S., Barrett, M., Moy, E., & Andrews, R. (2017). Managed care and inpatient mortality in adults: effect of the primary payer. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2062-1
• Oberlander, J. (2019). Lessons from the Long and Winding Road to Medicare for All. American Journal of Public Health, 109(11), 1497-1500. https://doi.org/10.2105/ajph.2019.305295
• Salmond, S. W., & Echevarria, M. (2017). Healthcare Transformation and Changing Roles for Nursing. Orthopedic Nursing, 36(1), 12–25. https://doi.org/10.1097/NOR.0000000000000308