Health Policy in the USA Overview


For many years, the United States has been having the poorest medical policy among the developed nations across the world. This led to private health insurance companies exploiting their clients because the government did not have any better plan to offer. The poor on the other hand had no insurance policy at all. For this cause, Obama used this as a campaign tool, he promised to bring about health reforms. The beginning of the year 2010 saw two very important steps towards achieving a better health policy. The National Health Reform Law was passed setting the US on the path to start revising and improving their health care policy. The Patient Protection and Affordable Care Act (PPACA) were also passed and the president signed it into law in March 2010.

Major Provisions of the Law

The health reform law contains some crucial provisions that will fundamentally transform the US medical system. These requirements include;

  • To have the majority of the US citizens and legal immigrants medically covered by the year 2014 (Kaiser Family Foundation 2010, para. 3).
  • To have each state have its own exchanges through residents can purchase an insurance policy with a subsidized offer for the low-income families or individuals
  • To expand the Medicaid program so that many poor individuals can access care
  • Employers are required to ensure their workers or face the consequences except when the employees are too few (Kaiser Family Foundation 2010, para. 3)
  • The primary care will have increased payment (Sultz & Kristina, 2010, p. 61).
  • The private insurance sector is required to ensure individual despite their health statuses (Kaiser Family Foundation 2010, para. 3)

The law is expansive and therefore its implementation is spread over several years but all the major provisions mentioned above are set to take effect by the beginning of the year 2014.

Goals of the Reforms

The health reforms are expected to accomplish several objectives in the United States so that every individual can access better quality health care (Sultz & Kristina, 2010, p. 61). The main goals include;

  1. to expand the health insurance cover to the majority of the US residents
  2. to ensure better insurance cover for those who have already purchased insurance cover from private policy providers (Sultz & Kristina, 2010, p. 61)
  3. to make sure that access to health care is improved and that the caregivers offer quality services to the people (Kaiser Family Foundation 2010, para. 3)
  4. to manage the ever increased cost of accessing health care services

The Implications of the Reforms

This is a major reform task and over 31 million uninsured Americans will access healthcare through this plan (Gruber, 2010, p. 2052). With such an expanded healthcare system, there is likely to be some crucial implication of the reform.

Complying with the law will be a major task because Americans have a mixed history of observing state mandates. Basically, how will the Americans deal with the federal directive that they have to buy insurance that meets the revised standards? Or will subsidies and penalties affect better compliance? This is very tricky but only time will tell. However, the government is optimistic that Americans will comply with the new law for better healthcare (Scott, 2010, para. 3).

Changing Concept to Reality

The new law requires that states must have insurance exchanges by the beginning of 2014, that is, in January. This is one of the major goals of the reform but most challenging as well. Many states will be looking at the standards and conditions that the federal government will set for the exchanges and conversely the discretion that each state will maintain (Scott, 2010, para. 4). Many people hope that these will be similar to Expedia and Orbitz.

Possible Co-op Plans

The government anticipates that if it funds healthcare, better services and cooperation will come up. Congress is offering 6 billion dollars to introduce a new trend in the insurance sector (Gruber, 2010, p. 2052). The PPACA envisioned that co-ops will come up and they will be new, non-profitable firms and run by members across all the states. Though such plans exist already, the government anticipates that with increased federal funding and HHS involvement, these co-ops will be unique. The major concern is whether the funding by the government could propel new imperative health plan competition (Scott, 2010, para. 4). The co-ops are not likely to be fearsome and consequential on the US insurance market.


It’s likely that the reform will spur more consolidation among the providers and available plans. Mergers and acquisitions are likely because of the market conditions through barriers to this may come up like government regulations.

High Risk

The government hopes that the state’s high risk will improve their services and that’s why the people who were not able to purchase their own insurance are insured under the existing conditions. The reforms provide for the creation of temporary programs to bridge the gap between new reforms’ effective date and enactment (Scott, 2010, para. 5).

Medicare Advantage

Medicare Advantage cuts will be modified through a unique formula. This formula is the state approach which could become law very soon. The approach is founded on a competitive bidding model and it’s very difficult for health planners to implement (Sultz & Kristina, 2010, p. 64). House reconciliation has a different style that is divided into four sections. First, the Medicare advantage payments would be connected to the free-for-service standards with discrepancies for low and high cots services. Second, the CMS five-star system will be expensive as per the higher quality ratings. Third, the CMS will control the favorable cost impact of risk-adjusted payments through a coding system (Scott, 2010, para. 6). Finally, Medicare will set a minimal health loss ratio at 85% and a number of penalties for plans which fail to meet this. If the reconciliation is passed, the Medicare advantage will have great chances to new payment models.


It’s expected that states will accept managed care contracts to provide services to the increased customer number. The federal matching payments, shortened, consistent eligibility requirements across the country will mean a more stable and predictable program that was initially lacking. The main concern is now how will Medicaid interact with the new state-based cover exchange requirements and the increased linkage between Medicare and Medicaid programs for dual eligibility (Scott, 2010, para. 7).

Reference List

Gruber, J. (2010). “The Cost Implications of Health Care Reform,” N Engl J Med; 362:2050-205

Kaiser Family Foundation, (2010). Focus on Health: Summary of New Health Reform Law. No. 8061, Menlo Park, CA. Web.

Scott, G. (2010). Health Care Reform: Patient Protection, Affordable Care Act and Implications for Health Plans. Web.

Sultz, H.A & Kristina, M.Y. (2010). Health Care USA: Understanding Its Organization and Delivery, Jones & Bartlett, Sudbury, MA

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