Universal Health Care: Government’s Duty to Provide Quality and Affordable Health Care

One of the government’s obligation is to protect and advance the interest of its citizen. In legal

parlance it pertains to the “general welfare clause.” According to Article I Section 8 of the U.S. Constitution

the Congress is granted the power to “lay and collect Taxes, Duties, Imposts, and Excises, to pay the Debts

and provide for the common defense and general Welfare of the United States.” One of the aspects within

the ambit of this general welfare clause is to provide the society the delivery of high quality health care

(Tang, Eisenberg, & Meyers , 2004 Jan).

Tang et. al (2004) stated in their research, since the market cannot solely ensure all Americans

access to quality health care, the Government must preserve the interest of the citizens by supplementing

the market where there are gaps and regulating the market where there is inefficiency or unfairness. In

achieving the ultimate goal of high quality of care, this will require a strong partnership among federal,

state and local governments and the private sector.

The police power of the state provided in the Tenth amendment of the Constitution gives the

government the power to establish and enforce laws protecting the welfare, safety and health of the

public. The governments action to take aggressive role in reshaping the healthcare system is in

accordance to its mandate to protect and advance the interest of its citizens. This had been showed when

the constitutionality of the Patient Protection and Affordable Care Act (ACA or the Act) was upheld by the

Supreme Court of the United States.

In the study conducted by Jones 2013, while the act’s mandate is to address the population of

uninsured who could afford insurance but chose not to purchase it, clearly there are many uninsured who

cannot afford health insurance. To address this problem ACA provides for ways to help these groups

become insured. Included in this mechanism will be tax subsidies, tax breaks, and credits for individuals
or small groups to now purchase insurance. In 2014, individuals and small groups started to have access

to either state or federal insurance exchanges that will assist with obtaining health insurance. These

exchanges will provide summaries of new insurance products as well as summaries of what subsidies tax

break or credits may apply to assist with purchasing the insurance.

The main issues revolve on three main elements of the legislation, particularly cost, access and

quality.

To address the cost of obtaining an insurance, Section 1413 of the Act mandates the Secretary in

general to streamline procedures for enrollment through an exchange and state Medicaid, chip, and

health subsidy programs. Under the same provision of ACA, states are required to develop secure

interfaces to allow exchange of data electronically and to help match data among the citizens and the

applicable subsidy to the individuals.

For employers operating a small enterprise, Section 9022 of ACA provides for guidelines on how

to qualify in purchasing cheaper insurance for its employees and maintaining law mandated division of

contribution and at the same time a progressive scheme on the premium payment depending on the

status of the employee.

Next is the issue as to access to healthcare. With the passage of the Act, access to healthcare is

now more open to the citizen. This does not only pertain to lowering the cost of insurance premiums but

also to those who will be eligible to purchase insurance products.

Under the Act, particularly, Section 1101 Subtitle B and Section 2704 Subtitle B, the former

ensures the access to insurance for uninsured individuals with preexisting condition and the latter imposes

prohibition of preexisting condition exclusions or other discrimination based on health status. These

provisions of the law paves way to individuals who has preexisting diseases to purchase insurance and

gain access to healthcare without paying higher premiums or being denied in buying insurance.
 Children will also be covered longer. Section 2274 extends dependent coverage of children until

they turn 26. Also, under the same Act, Subtitle B, “Increasing Access to Clinical Preventive Services”, the

provisions recommend preventive care must be covered by insurance. Jones 2013 stated, in order to shift

cost from so called “rescue care,” which results from delayed access to care or treatment, insurance is

required to cover for preventive care. This scheme addresses the issue of higher cost when care is delayed

and patients are sicker.

One of the salient provisions of ACA is mandating insurers to use 85% percent of the insurance

premiums to medical care otherwise, patients gets rebate. Finally, insurance companies must keep

overhead expenses to a minimum and use bulk of the insured premium dollars for providing health care

or they must refund the premium dollars to the insured. By following this scheme, on the first year of this

requirement, this provision was estimated to have saved consumers approximately $1.5 billion. (Jones

E., 2013)

Finally, the issue of rendering quality health care the ACA created three particular programs; 1.)

The Hospital Acquired Condition Reduction Program (HACRP) 2.) Hospital Readmission Reduction Program

and (HRRP) 3.) Medicare Hospital Value Based Purchasing Program (HVBP).

According to Beezley-Smith (2017) in her study entitled Pay-for-Performance in Medicare, Section

3008 of the Act established HACRP where hospitals in this program are evaluated. The Secretary of the

Department of Health and Human Service must adjust payments to applicable hospitals that rank worst-

performing quartile of all subsection (d) hospitals with respect to risk-adjusted HAC quality measures.

In the same study, HRRP which was established under Section 3025 of ACA requires the Secretary

of the Department of Health and Human Services to establish a Hospital Readmissions Reduction Program

whereby the Secretary reduces Inpatient Prospective Payment System (IPPS) payments to hospitals for

excess readmissions beginning on or after October 1, 2012.

 Lastly, Hospital Value-Based Purchasing (VBP) Program, applied under Medicare’s inpatient

prospective payment system (IPPS), adjusts payments to hospitals based on CMS measures of quality of

care furnished to patients. Starting in October 2012, with payment adjustments beginning in fiscal year

2013, the program “affects payment for inpatient stays in more than 3,000 hospitals across the country.”

Medicare makes incentive payments to hospitals based on either how well they perform on each measure

or how much they improve their performance on each measure compared to their performance during a

baseline period.

All three programs aim to incentivize hospitals which performs better in providing care to its

patients.
References
Dana Beezley-Smith, P. (2018, 06 14). Pay-for-Performance in Medicare. Retrieved from U.S. Health
Policy Gateway: http://ushealthpolicygateway.com/payer-trade-
groups/qualitysatisfaction/quality-improvement/general-approaches/pay-for-performance/pay-
for-performance-in-medicare/#Hospital_Value-Based_Purchasing_Program_HVBP

Elaine C. Jones, M. F. (2013). Supreme Court decision on the Affordable Care Act. Neurol Clin Pract, 61-
66.

Tang, N., Eisenberg, J., & Meyers , G. (2004 Jan). The roles of government in improving health care
quality and safety. Jt Comm J Qual Saf, 30(1):47-55.

Dana Beezley-Smith, P. (2018, 06 14). Pay-for-Performance in Medicare. Retrieved from U.S. Health
Policy Gateway: http://ushealthpolicygateway.com/payer-trade-
groups/qualitysatisfaction/quality-improvement/general-approaches/pay-for-performance/pay-
for-performance-in-medicare/#Hospital_Value-Based_Purchasing_Program_HVBP

Elaine C. Jones, M. F. (2013). Supreme Court decision on the Affordable Care Act. Neurol Clin Pract, 61-
66.

Tang, N., Eisenberg, J., & Meyers , G. (2004 Jan). The roles of government in improving health care
quality and safety. Jt Comm J Qual Saf, 30(1):47-55.

U.S. Const. amend. X