| Healthcare in the United States |
|---|
Healthy San Francisco is a health access program launched in 2007 to subsidize medical care for uninsured residents of San Francisco, California operated by the San Francisco Department of Public Health. [1] The program's stated objective is to bring universal health care to the city. [2] [3]
Healthy San Francisco is not a true insurance program, as it does not cover services such as dental and vision care, and only covers services received in the city and county of San Francisco. [4] The program itself acknowledges its limitations, and has stated that "insurance is always a better choice." [4] [5] [ failed verification ] Healthy San Francisco represents the first time a local government has attempted to provide health insurance for all of its constituents. [6] The program is open to low-income city residents over the age of 18 who do not qualify for other public coverage, and who have had no insurance for at least 90 days. [7] Eligibility is not conditional on citizenship, immigration, employment or health status. [7] [8] The program covers a range of services, but only pays providers within San Francisco. [4] By July 2010, almost 90% of the uninsured adults in San Francisco — over 50,000 people — had enrolled in Healthy San Francisco. [9]
Prior to the implementation of Healthy San Francisco, the city's safety net health care system for the low-income and uninsured consisted of several community health clinics, a public hospital (San Francisco General Hospital), and a citywide managed care plan. [9] In Mayor Gavin Newsom's first term, he worked to extend the city-funded health insurance program, started under Mayor Brown, to young adults, a program that had been previously offered only to children. Newsom's more ambitious plan on healthcare began to take shape in 2007. In his budget proposal for fiscal year 2007–2008, Newsom announced his intention to provide universal health care for all city residents, based on long-time City Supervisor Tom Ammiano's plan. The care would be provided through the San Francisco Health Access Plan also known as Healthy San Francisco. [10] [11] The system planned to improve coordination between the current health care safety net, focus on preventive care, and implement information technology through the use of electronic enrollment and referrals. [9] [12] Newsom's proposal has prompted Oakland mayor Ron Dellums and San Mateo County's Board of Supervisors to look into possibilities for providing their own taxpayer-subsidized health care. [13] [14]
Healthy San Francisco mandated large businesses to provide health insurance for their employees, or instead either pay into a citywide healthcare fund or contribute to employees' health savings accounts. [4] The Golden Gate Restaurant Association filed a lawsuit seeking to overturn this policy, claiming the employer mandate conflicted with ERISA. [15] The Ninth Circuit Court of Appeals rejected their arguments in May 2009, and an appeal to the U.S. Supreme Court was declined on June 29, 2010, legally clearing the program for continued existence for the foreseeable future. [16] [17]
The Patient Protection and Affordable Care Act (ACA) was implemented in 2010 and health care exchanges were established in 2013. The 2010 Affordable Care Act also removed categorical eligibility for Medicaid, thus expanding the number of people who could enroll in the public insurance program. [18] As a result, many who previously did not qualify for Medicaid and instead relied on Healthy San Francisco could enroll in Medi-Cal. [18] Approximately half of Healthy San Francisco's 60,000 patients enrolled in 2013 became eligible for Medi-Cal due to this expansion. [19] Another 10,000 or so Healthy San Francisco enrollees were predicted to get health insurance through the Covered California health exchange that was created as part of the Affordable Care Act. [19] A 2011 report found that the passage of the ACA could reduce Healthy San Francisco enrollment by up to 60%. [1]
Although the ACA led to many people becoming insured, there were still millions who were left without health coverage. Today in San Francisco, these patients are still eligible for Healthy San Francisco. These remaining patients include undocumented immigrants, prisoners, people who have lived in the city for less than 5 years and are thus ineligible for Covered California, and people whose incomes are too high above the Federal Poverty Line to qualify for Medi-Cal but not enough to afford private health insurance. [19]
Healthy San Francisco is funded by the city, the federal government, patient co-payments, and fees imposed on San Francisco businesses whose owners do not follow the mandate to provide health coverage for their employees. [1] The Health Care Security Ordinance included a requirement that employers with more than 20 workers spend at least a minimum amount towards employee health coverage. The minimum payment for 2014 ranges from $1.63 to $2.44 per hour, depending on firm size; for-profit employers with fewer than 20 workers and non-profits with fewer than 50 workers are exempt. [20] Employers can elect to satisfy this requirement by paying into Healthy San Francisco, in which case their workers may apply for the program. [8] As of early May 2008, over 700 employers had decided to participate in the program. [21] [22] Early evidence suggest that employers are spending more on health benefits, but some are raising prices and cutting back on hiring. [22] [23]
Healthy San Francisco reportedly costs about $140 million per year, which is expected to go down as the 2013-2014 health exchanges start. [19]
94% of surveyed Healthy San Francisco enrollees reported that they were somewhat or mostly satisfied with the health access program. [24] More than 90% would recommend it to a friend, but only 40% of participants said their care was considerably better since joining the program. [25] Usage of primary and specialty care services among Healthy San Francisco enrollees was similar to that of the uninsured across the state of California. [9]
Much of Healthy San Francisco's positive reception stems from the city's uniquely structured health care safety-net network, consisting of a conglomerate of both public and private hospitals, clinics, and health centers. [9] This collaborative system allows for greater communication between providers and enables patients to access facilities that are equipped to offer the type of care they need, whether that be primary, specialty, or urgent care. [9] The creation of a more coordinated system also led to more efficiency and less redundancy. As more patients became established in primary care medical homes, duplicative services waned. [9]
San Francisco residents who have benefitted from Healthy San Francisco have noted how the program has made them less wary of accessing health care, as previously many of the beneficiaries of Healthy San Francisco did not see a provider regularly due to cost. [6] Healthy San Francisco significantly affected access to ongoing care and chronic disease management for the uninsured, particularly because the Emergency Medical Treatment and Active Labor Act (EMTALA) had previously made emergency care available. [9]
Although Healthy San Francisco does not directly impact those with private or public insurance, studies have found that increasing the proportion of people insured in a community can lead to higher quality of care even for those who are insured, particularly in terms of access to and availability of specialty care. [26]
In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding. States are not required to participate in the program, although all have since 1982.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
The prices of health care in the United States are higher than in other countries. Compared to other OECD countries, U.S. healthcare costs are one-third higher or more relative to the size of the economy (GDP). According to the CDC, during 2015, health expenditures per-person were nearly $10,000 on average, with total expenditures of $3.2 trillion or 17.8% of GDP. Proximate reasons for the differences with other countries include higher prices for the same services and greater use of healthcare. Higher administrative costs, higher per-capita income, and less government intervention to drive down prices are deeper causes. While the annual inflation rate in healthcare costs has declined in recent decades, it still remains above the rate of economic growth, resulting in a steady increase in healthcare expenditures relative to GDP from 6% in 1970 to nearly 18% in 2015.
The Massachusetts health care reform, commonly referred to as Romneycare, was a healthcare reform law passed in 2006 and signed into law by Governor Mitt Romney with the aim of providing health insurance to nearly all of the residents of the Commonwealth of Massachusetts.
The California Medical Assistance Program is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and support. Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020.
In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.
Healthcare reform in the United States has had a long history. Reforms have often been proposed but have rarely been accomplished. In 2010, landmark reform was passed through two federal statutes: the Patient Protection and Affordable Care Act (PPACA), signed March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, which amended the PPACA and became law on March 30, 2010.
In the United States, health insurance coverage is provided by several public and private sources. During 2019, the U.S. population was approximately 330 million, with 59 million people 65 years of age and over covered by the federal Medicare program. The 273 million non-institutionalized persons under age 65 either obtained their coverage from employer-based or non-employer based sources, or were uninsured. During the year 2019, 89% of the non-institutionalized population had health insurance coverage. Separately, approximately 12 million military personnel received coverage through the Veteran's Administration and Military Health System.
In the United States, health insurance marketplaces, also called health exchanges, are organizations in each state through which people can purchase health insurance. People can purchase health insurance that complies with the Patient Protection and Affordable Care Act at ACA health exchanges, where they can choose from a range of government-regulated and standardized health care plans offered by the insurers participating in the exchange.
Medicaid estate recovery is a required process under United States federal law in which state governments adjust (settle) or recover the cost of care and services from the estates of those who received Medicaid benefits after they die. By law, states may not settle any payments until after the beneficiary's death. States are required to adjust or recover all costs under certain circumstances, all involving long-term care arrangements. Federal law also gives states the option to adjust or recover the costs of all payments to health care providers except Medicare cost-sharing for anyone on Medicaid over the age of 55.
Members of the United States population between the ages of 18 and 29 who decide that it is in their financial best interest to forgo health insurance are sometimes referred to as young invincibles by the insurance industry, a term coined to express the idea that the young demographic perceives themselves as immune to sickness and injury. The argument is that these individuals are young and in good health, so they have a low risk of experiencing substantial health issues that would lead to large amounts of spending on health care. Further, this group tends to have a mentality of “it won’t happen to me” with regards to most causes of injury. Together, these beliefs lead to the young invincibles not purchasing insurance.
A health insurance mandate is either an employer or individual mandate to obtain private health insurance instead of a national health insurance plan.
The Affordable Care Act (ACA), formally known as the Patient Protection and Affordable Care Act (PPACA) and informally as Obamacare, is a landmark U.S. federal statute enacted by the 111th United States Congress and signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act of 2010 amendment, it represents the U.S. healthcare system's most significant regulatory overhaul and expansion of coverage since the enactment of Medicare and Medicaid in 1965. Most of the act's provisions are still in effect.
The community health center (CHC) in the United States is the dominant model for providing integrated primary care and public health services for the low-income and uninsured, and represents one use of federal grant funding as part of the country's health care safety net. The health care safety net can be defined as a group of health centers, hospitals, and providers willing to provide services to the nation's uninsured and underserved population, thus ensuring that comprehensive care is available to all, regardless of income or insurance status. According to the U.S. Census Bureau, 29 million people in the country were uninsured in 2015. Many more Americans lack adequate coverage or access to health care. These groups are sometimes called "underinsured". CHCs represent one method of accessing or receiving health and medical care for both underinsured and uninsured communities.
Welfare in California consists of federal welfare programs—which are often at least partially administered by state and county agencies—and several independent programs, which are usually administered by counties.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates. It is administered by an independent agency of the government of California.
Healthy Way LA (HWLA) was a free public health care program available to underinsured or uninsured, low-income residents of Los Angeles County from 2007 until 2014. The program, administered by the Los Angeles County Department of Health Services (LADHS), was a Low Income Health Program (LIHP) approved under the Section 1115 Medicaid Waiver. HWLA was succeeded by My Health LA, a no-cost health care program which ran from 2014 until 2024, when access to Medi-Cal was expanded.
Health care finance in the United States discusses how Americans obtain and pay for their healthcare, and why U.S. healthcare costs are the highest in the world based on various measures.
This article summarizes healthcare in California.
Under the public healthcare policy of the United States, some people have incomes too high to qualify in their state of residence for Medicaid, the public health insurance plan for those with limited resources, but too low to qualify for the premium tax credits that would subsidize the purchase of private health insurance. These people are described as falling into the Medicaid coverage gap.
