Explain the laws in our healthcare system
“Everyone should have health insurance? I say everyone should have health care. Not selling insurance.”; This is a famous quote by Dennis Kucinich. The American healthcare system is a complex and often confusing network of medical providers, insurers, and government agencies. According to Shrank is a market-based system that relies heavily on private insurance companies and for-profit hospitals, which sets it apart from many other developed countries that have universal healthcare systems (4). While the American healthcare system has some of the best medical technology and highly skilled medical professionals globally, it is also one of the most expensive and inefficient systems, leaving millions of Americans without access to affordable healthcare. One of the biggest problems with the American healthcare system is its lack of universal coverage. The system is built around the idea that people must purchase insurance or receive it through their employers, leaving those who cannot afford it without access to healthcare; This has resulted in millions of Americans being uninsured or underinsured and unable to receive the care they need (Shrank 7). As a result, many Americans struggle with medical debt or forgo necessary medical care due to the cost. Despite these challenges, there are some positives to the American healthcare system (Shrank 9). The United States has some of the world’s most advanced medical technology and highly skilled healthcare professionals. Patients have access to cutting-edge treatments and therapies, and the system has made significant progress in areas such as cancer treatment and heart disease (Shrank 13). The Affordable Care Act (ACA) established several provisions that have expanded health care coverage to millions of Americans, the Health Insurance Portability and Accountability Act (HIPAA) protects the privacy and security of individuals’ health information, and Medicare and Medicaid provide coverage to vulnerable populations, such as elderly individuals and low-income families.
The Affordable Care Act (ACA), also known as Obamacare, is a healthcare law signed into law in 2010 by former President Barack Obama. According to Chait, the goal of the law was to increase access to affordable healthcare for all Americans, regardless of their income or health status (8). While the law has faced significant political opposition and controversy, it has significantly impacted the American healthcare system. One of the key provisions of the ACA was the requirement that individuals have health insurance or pay the penalty; This individual mandate was intended to spread the cost of healthcare across the population and encourage more healthy individuals to purchase insurance, which would help to offset the cost of covering individuals with pre-existing conditions (Chait 9). While the individual mandate was controversial, it helped to reduce the number of uninsured Americans and expand access to healthcare. The ACA also introduced new regulations for insurance companies, such as the requirement to cover pre-existing conditions. Before the ACA, insurance companies could deny coverage or charge higher premiums to individuals with pre-existing conditions, making it difficult for many to access healthcare (Chait 12). The ACA prohibited this practice, ensuring that individuals with pre-existing conditions could access the necessary care. The ACA also introduced new regulations for healthcare providers, such as the requirement to implement electronic health records and participate in value-based payment programs. Thus, The Affordable Care Act was signed into law and intended to improve the quality of care and reduce costs by incentivizing providers to focus on outcomes rather than the volume of services provided.
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that was enacted in 1996. According to Edemekong, the primary goal of HIPAA is to protect the privacy and security of individuals’ health information, also known as protected health information (PHI) (6). The law established national standards for the handling of PHI by healthcare providers, health plans, and other entities that handle health information. HIPAA has several key provisions that healthcare providers and other covered entities must adhere to. Edemekong also stated that one of the most important provisions is obtaining patient consent before disclosing their PHI (8). Covered entities must obtain written consent from patients before sharing their PHI with other entities, except in certain circumstances, such as for treatment or an emergency. HIPAA also requires covered entities to implement appropriate safeguards to protect the confidentiality and integrity of PHI; This includes measures such as implementing secure electronic systems for storing and transmitting PHI, training employees on how to handle PHI and conducting regular audits to ensure compliance with HIPAA regulations (Edemekong 14). Another key provision of HIPAA is providing individuals with access to their PHI. Covered entities must provide individuals with copies of their medical records upon request and an accounting of any disclosures of their PHI made by the covered entity. HIPAA also includes penalties for non-compliance with its regulations (Edemekong 16). Covered entities that violate HIPAA regulations can face significant fines and penalties, damage to their reputation and loss of business. Thus, the law established national standards for the handling of PHI by healthcare providers, health plans, and other entities that handle health information.
Medicare and Medicaid are two of the most essential healthcare programs in the United States. According to Badger, the federal government established both Medicare and Medicaid programs to provide healthcare coverage to vulnerable populations, including elderly individuals and low-income families (2). While the two programs share some similarities, they also have important differences. Badger also stated that Medicare is a federal healthcare program that provides coverage to individuals 65 years of age or older and some individuals with disabilities (4). Medicare is funded through payroll taxes, premiums paid by beneficiaries, and general revenue. The program has several different components, including Medicare Part A (hospital insurance), Medicare Part B (medical insurance), Medicare Part C (Medicare Advantage plans), and Medicare Part D (prescription drug coverage). Conversely, Medicaid is a joint federal-state program that provides healthcare coverage to low-income individuals and families (Badger 8). Medicaid is jointly funded by the federal government and individual states, with the federal government providing a certain percentage of funding based on each state’s per capita income. Medicaid covers many healthcare services, including doctor visits, hospital stays, and prescription drugs. One of the key differences between Medicare and Medicaid is eligibility (Badger 8). While Medicare is available to all individuals 65 or older, Medicaid is only available to low-income individuals and families. Medicaid eligibility varies by state but typically includes individuals with incomes at or below 138% of federal poverty (Badger 8). Thus, the federal government established both Medicare and Medicaid programs to provide healthcare coverage to vulnerable populations, including elderly individuals and low-income families.
In conclusion, the laws in the American healthcare system play a crucial role in ensuring that individuals have access to quality healthcare services while protecting their privacy and rights. The Affordable Care Act (ACA) established several provisions that have expanded health care coverage to millions of Americans, while the Health Insurance Portability and Accountability Act (HIPAA) protects the privacy and security of individuals’ health information. Medicare and Medicaid are essential healthcare programs covering vulnerable populations, such as elderly individuals and low-income families. However, despite the many laws and regulations, the American healthcare system continues to face challenges, including rising healthcare costs, disparities in access to care, and gaps in coverage for certain services. Addressing these challenges will require ongoing efforts from policymakers, healthcare providers, and patients to ensure everyone has access to the care they need to lead healthy and productive lives.
Badger, Doug. “The center for Medicare and Medicaid innovation: the case for reform.” Inquiry: The Journal of Health Care Organization, Provision, and Financing 59 (2022): 00469580221118036.
Chait, Nadia, and Sherry Glied. “Promoting prevention under the affordable care act.” Annual Review of Public Health 39 (2018): 507-524.
Edemekong, Peter F., Pavan Annamaraju, and Micelle J. Haydel. “Health insurance portability and accountability act.” (2018).
Michener, Jamila. “Race, politics, and the affordable care act.” Journal of Health Politics, Policy and Law 45.4 (2020): 547-566.
Shrank, William H., Teresa L. Rogstad, and Natasha Parekh. “Waste in the US health care system: estimated costs and potential for savings.” Jama 322.15 (2019): 1501-1509.
Silber, Jeffrey H., et al. “Disparities in breast cancer survival by socioeconomic status despite Medicare and Medicaid insurance.” The Milbank Quarterly 96.4 (2018): 706-754.