Question

What obligation do you think the Executive Branch of the government has to support current health care law and policy?

The article notes that actions by the current administration that are not officially policymaking actions (like legislation or rulemaking) will affect the effectiveness of current law: the ACA.

• What do you think about this?

• Does an administration have a duty to support previously enacted laws that deal with health policy?

• Is an administration justified in "undermining" a current law/policy when it disagrees with that policy as long as it doesn't break the law in doing so?

Answer 1

The role of government in health care has expanded over the years and influenced political discourse and policy. Whether this is an appropriate role has been contested. Still, the government, with extensive programs and market influence, is likely to play a major role in achieving better quality and value in health care and in the success or failure of lasting healthcare reform. This paper attempts to describe current efforts of the government to improve quality and value in the healthcare system by discussing the Affordable Care Act (ACA) of 2010 and various “drivers” the government uses.

U.S. spends more per capita on health care than any other nation in the world.Yet the measured outcomes of the care provided are no better than, and are often inferior to, outcomes achieved by other developed nations that spend substantially less (Organization for Economic Co-operation and Development).

Healthcare costs have increased over the past 3 decades and consume an increasing share of the U.S. Gross Domestic Product (GDP), now accounting for a greater percentage of GDP than any other sector of the U.S. economy

Federal leadership has been stimulated anew under the ACA and numerous other pieces of recent healthcare legislation. As a result, the role of government in the U.S. healthcare system is being contested more than ever.

Federal Involvement in Healthcare Quality, Value, and Prevention

The federal government has played a major role in health care over the past half century from the establishment of Medicare and Medicaid in 1965—ensuring access to insurance coverage for a large portion of the U.S. population—to multiple pieces of legislation from the 1980s to early 2000s that protect individuals under employer-sponsored health insurance and expanded federal healthcare programs, in 2008, led to expenditures of $1.11 trillion.

Because of its influence, the government has played an important role in promoting the use of preventive services. It also has promoted increased recognition of how disease prevention contributes to healthcare efficiency and cost-savings. Originally, Medicare was not allowed to authorize primary preventive services. Specifically, “screening tests” were expressly excluded as a benefit under Medicare, and that general exclusion continues to the present day.

1980 that the U.S. Congress authorized the first specific prevention screening benefit for Medicare beneficiaries. Since that time, Congress has added separately benefit status to some preventive services as recommended by various bodies responsible for preventive services guidelines..

Section 101 of the Medicare & Medicaid Improvements for Patients and Providers Act (MIPPA) of 2008, Congress authorized the Secretary of DHHS to add additional preventive services to the Medicare benefit structure via the National Coverage Decision (NCD) process of the Centers for Medicare & Medicaid Services (CMS). This is a major advance in facilitating prevention benefits and coverage in the Medicare program, albeit with limitations.

Medicare decision making with respect to what services are/are not covered influences Medicaid, its Children's Health Insurance Program (CHIP), and private-sector payers, it presents an important opportunity for federal healthcare policy to promote preventive services as necessary for optimal individual healthcare delivery and address public health issues.

The Affordable Care Act and Preventive Health Care

The most recent, and potentially most influential, federal healthcare legislation is the ACA. It illustrates how federal legislation can address the inadequacies of current federal healthcare efforts by promoting greater emphasis on disease prevention and health promotion as essential building blocks of overall healthcare reform, improving health outcomes, and reducing healthcare costs.

The ACA is divided into 10 major titles. One of them, Title IV: Prevention of Chronic Disease and Improvement of Public Health, is devoted entirely to prevention issues and initiatives.

Title IV, Subtitle A, Section 4001, directed the President to establish, within DHHS, the National Prevention, Health Promotion and Public Health Council. In addition to having presidential oversight, the council includes members from a comprehensive list of government agencies. Chaired by the Surgeon General of the U.S., the council is perhaps the highest-level and broadest administrative group in the Executive Branch, save the Cabinet.

On June 16, 2011, the council issued a 125-page report titled “National Prevention Strategy.” Its vision was “working together to improve the health and quality of life for individuals, families, and communities by moving the nation from a focus on sickness and disease to one based on prevention and wellness.” Its overarching goal was to “increase the number of Americans who are healthy at every stage of life.”

Just a few months before the council's report was issued, DHHS submitted its own report, the “National Strategy for Quality Improvement in Health Care,” to Congress in March 2011.

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The six national priorities identified were making care safer by reducing harm caused in the delivery of care; ensuring that each person (and family) is engaged as a partner(s) in patient care; promoting effective communication and coordination of care; promoting the most effective prevention and treatment practices for the leading causes of mortality; working with communities to promote the use of best practices to enable healthy living; and making high-quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare-delivery models..

cost sharing.

The ACA included recognition that recommended preventive services are used at levels far below desired utilization. Cost-sharing for these services by patients, including copayments, co-insurance, and deductibles, was cited as a barrier to achieving desired rates. Subsequent to ACA requirements, a regulation was issued jointly by DHHS, the Department of Labor, and the Department of the Treasury requiring health plans to cover a prescribed list of recommended evidence-based preventive services and eliminate cost-sharing as of September 23, 2010

improving health care.

Beyond the ACA, federal healthcare agencies, particularly CMS, have long had statutory authority to effect change in the U.S. healthcare system. This authority, when used effectively, wields a great deal of power to address deficiencies in the quality and value of health care provided to the public. This authority extends beyond federal healthcare programs to affect the private sector, including providers, payers, and health plans; state and local government; pharmaceutical and device manufacturers; other suppliers; and myriad other categories of healthcare stakeholders.

prevention.

Increased Healthcare System Transparency

Payment System Incentives

Strategic Use of Regulation

Evidence-Based Decision Making