Question

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What are the three roles of the U.S. government in the health care system and in health insurance?

Without the government Healthcare in the United States and basically anywhere in the world would not exist. In the U.S the government has three important roles, the United States government acts as a provider, payor and lawmaker.

The government provides health care directly through for example; The Veterans Administration, TRICARE and the India Health Service. There are clinics, hospital and other health organizations that are supported by the government. As a payor to third party organizations or services. These services could be for example, to handle the claims for Medicare among other things. The third role of the United States government in the Health Care system is to act as a lawmaker, regular, to promote fair competition and avoid monopolies, moreover, the government enact laws to protect and service the public.

Provide some examples of the influence the Federal government has on private health insurance.

In terms of the influence the government has had on private health insurance. The state provides regulations and mandates to providers of health insurances, they must comply with certain regulations and requirement. The state also controls and monitors their legal functions and structure to ensure the company can meet its obligations.

Answer 1

The role of the Federal Government in healthcare has expanded over the years and has fueled political discourse and policy. The United States spends more per capita on healthcare as compared to any other country in the world, however, the measured outcomes of the care provided are not of the same standards​, and often inferior, to other developed nations who spend substantially less on their healthcare programs. In addition, the best-practices guidelines are seldom followed and there exists a wide geographic variation in healthcare costs and quality. The overall increase in the healthcare costs over the past 3 decades has consumed an increasing share in the US Gross Domestic Product (GDP) which now accounts for a greater percentage than any other sector of the country's economy. This research below aims at providing a fair outlook towards the existing measures and the role of the Federal Government in providing better healthcare for the citizens of the country.

​Federal involvement​ in Healthcare Quality and Value

Over the past half-century, the Federal Government has played a major role in healthcare services by:

• establishing Medicare and Medicaid in 1965 - ensuring access for a large number of US citizens to proper insurance coverage,
• ​multiple legislatures fr0m the 1980s to the early 2000s aimed at protecting individuals under employer-sponsored health insurance,
• in 2008, Federal Government influence resulted in public programs that led to expenditures of over $1.1 trillion.

The laws, regulations, policies, payment systems and oversight of all of these exorbitant federal programs have major influences on private-sector payers and healthcare that isn't covered under federal programs. More recently, there has been legislation passed to add additional preventive services to the Medicare benefit structure which is being considered as a major advancement in facilitating preventive benefits and coverage in the Medicare program. Since the decision making of services covered influences Medicaid, its ​Children’s Health Insurance​ Program (CHIP) and private-sector payers, it prevents a massive opportunity for the federal policies to promote preventive measures as necessary for optimal individual healthcare delivery helping to address public health issues.

​The Affordable Care Act​ (ACA)

Arguably, one of the most recent and most influential federal healthcare legislation ​is the ACA. It demonstrates the way federal legislation is able to address the inadequacies of the present federal healthcare efforts by laying more importance on disease prevention and health promotion as the base of overall healthcare reform. This will potentially lead to improving health outcomes and reducing healthcare costs.

​The ACA also highlighted that the recommended preventive services are much lower than the desired utilization due to cost-sharing for these services by patients (including, but not limited, to co-payments, co-insurance, and deductibles)​. Following the measures outlined in the ACA, a regulation was issued requiring health plans to cover a set of prescribed evidence-based preventive services and eliminate the concept of cost-sharing for these. Spanning from routine adult services to a comprehensive list of children's and women's services and a number of disease-specific services for cardiac disease, obesity, cancer, diabetes, and other chronic illnesses was covered in the said regulation.

Role of the ​Centers for Medicare & Medicaid Services (CMS)

​Apart from the ACA, ​federal healthcare agencies - CMS, in particular, have had statutory authority to inflict change in the U.S. healthcare system for long. This authority, when wielded, is beyond capable to address the deficiencies in the quality and value of healthcare provided to the citizens as CMS' reach extends much further than just the federal programs. It has the power and resources to affect even the private sector, including providers, payers, and health plans; state and local government; pharmaceutical and device manufacturers; other suppliers; and countless other categories of stakeholders. ​

​Thus, it is safe to say that the Federal Government's role in health care has expanded significantly over the years. Examples of strong federal leadership have been demonstrated under legislation like the ACA and numerous others that provides powerful drivers of healthcare quality and value improvement. The question still remains as to the success of the federal efforts but it is likely that the Federal Government will play a major role in achieving better quality and value in healthcare in the years to come!