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.
The Balanced Budget Act of 1997 was an omnibus legislative package enacted by the United States Congress, using the budget reconciliation process, and designed to balance the federal budget by 2002. This act was enacted during Bill Clinton's second term as president.
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.
The Dartmouth Institute for Health Policy and Clinical Practice (TDI) is an organization within Dartmouth College "dedicated to improving healthcare through education, research, policy reform, leadership improvement, and communication with patients and the public." It was founded in 1988 by John Wennberg as the Center for the Evaluative Clinical Sciences (CECS); a reorganization in 2007 led to TDI's current structure.
There were a number of different health care reforms proposed during the Obama administration. Key reforms address cost and coverage and include obesity, prevention and treatment of chronic conditions, defensive medicine or tort reform, incentives that reward more care instead of better care, redundant payment systems, tax policy, rationing, a shortage of doctors and nurses, intervention vs. hospice, fraud, and use of imaging technology, among others.
In the United States, healthcare is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance. The United States spends more on healthcare than any other country, both in absolute terms and as a percentage of GDP; however, this expenditure does not necessarily translate into better overall health outcomes compared to other developed nations. Coverage varies widely across the population, with certain groups, such as the elderly and low-income individuals, receiving more comprehensive care through government programs such as Medicaid and Medicare.
The Center for Medicare and Medicaid Innovation is an organization of the United States government under the Centers for Medicare and Medicaid Services (CMS). It was created by the Patient Protection and Affordable Care Act, the 2010 U.S. health care reform legislation. CMS provides healthcare coverage to more than 100 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the Health Insurance Marketplace.
James Claude Robinson is a professor of health economics at the University of California, Berkeley School of Public Health, where he has the title of the Leonard D. Schaeffer Endowed Chair in Health Economics and Policy. Robinson is also the Chair of the Berkeley Center for Health Technology, which supports research and professional education projects related to coverage, management, and payment methods for innovative technologies including biopharmaceuticals, medical devices, and diagnostics.
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.
Rashi Fein was an American health economist termed "a father of Medicare" in the United States and "an architect of Medicare", was Professor of Economics of Medicine, Emeritus, in the Department of Global Health and Social Medicine at Harvard Medical School, and the author of the book Medical Care, Medical Costs: The Search for a Health Insurance Policy.
A safety net hospital is a type of medical center in the United States that by legal obligation or mission provides healthcare for individuals regardless of their insurance status or ability to pay. This legal mandate forces safety net hospitals (SNHs) to serve all populations. Such hospitals typically serve a proportionately higher number of uninsured, Medicaid, Medicare, Children's Health Insurance Program (CHiP), low-income, and other vulnerable individuals than their "non-safety net hospital" counterpart. Safety net hospitals are not defined by their ownership terms; they can be either publicly or privately owned. The mission of safety net hospitals is rather to provide the best possible care for those who are barred from health care due to the various possible adverse circumstances. These circumstances mostly revolve around problems with financial payments, insurance plans, or health conditions. Safety net hospitals are known for maintaining an open-door policy for their services.
Yuting Zhang is a professor of health economics at the University of Melbourne, and an expert on economic evaluations of health policy and healthcare reforms. She is a journal editor, award recipient, and has written numerous articles in influential journals in her field.
Howard P. Forman is a professor of radiology, economics, public health, and management at Yale University. Forman is known for his commentary on the U.S. government's response to the COVID-19 pandemic, his political and healthcare writing on Twitter, and his role in developing national leaders in healthcare.
Patrick H. Conway is an American physician and an advocate of health system transformation and innovation in the public and private sector. He is a practicing pediatrician formerly serving at the Cincinnati Children's Hospital and Children's National Medical Center. He was the chief medical officer and acting administrator at the Centers for Medicare and Medicaid Services (CMS) leading quality-of-care efforts for the nation. Conway also served as the Director of the Center for Medicare and Medicaid Innovation, and was responsible for new national payment models for Medicare and Medicaid focused on better quality and lower costs.
Lauren Hersch Nicholas is an American health economist. She is a professor at the University of Colorado Anschutz Medical Campus and an adjunct associate professor in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health.
Lee Alan Fleisher is an American anesthesiologist and health policy expert. In 2020, Fleisher was named Chief Medical Officer and Director of the Centers for Medicare & Medicaid Services Center for Clinical Standards and Quality. He previously served as Chair of Anesthesiology and Critical Care at the Perelman School of Medicine at the University of Pennsylvania and continues to practice clinically. He is also the Founding Principal and CEO at Rubrum Advising.
Cathy Schoen is an American economist at the New York Academy of Medicine. She previously served as the executive director of Commonwealth Fund Council of Economic Advisors and as the senior vice president for Policy, Research, and Evaluation at the Commonwealth Fund. Her research is concentrated on health economics and health care policy.
Elizabeth Fowler is an American lawyer who is Director of the Center for Medicare and Medicaid Innovation. She previously served under President Barack Obama at the National Economic Council. In 2022, she was included by Stat News on their list of leaders in the life sciences and she was elected a Member of the National Academy of Medicine.
