The United States is believed to be on the edge of the national health reform. Nevertheless, healthcare quality is questionable because the country is considered to have the leading healthcare system globally (Shi & Singh, 2017). Approximately forty-six million Americans are not insured with more being underinsured (Shi & Singh, 2017). During the 2008 presidential campaign, the health reform was the leading concern to be solved under the new government, and it seemed that even the economic crisis would not hinder that. However, in the USA, attempts to transform the healthcare system have occurred several times until the present day. Although healthcare reforms in the country are on the right path towards universal healthcare, the political opposition has created a significant hindrance.
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History of the National Healthcare Reform
Healthcare reforms can be traced back to the early 1900s. During 1934-1939, President Roosevelt proposed the National Health Insurance (NHI) and the New Deal, which comprised social policies aimed at securing employment, medical care, and retirement due to hard economic times (Shi & Singh, 2017). President Truman proceeded with the national health program shortly after World War II between 1945 and 1950. During 1960-1965, the Great Society policies that focused on social welfare marked the early beginning of Medicaid and Medicare (Olson, 2012). In 1970 and 1974, President Richard Nixon wanted employees to be covered by their employers, as well as created federal support to enable everyone to purchase private insurance until he was interfered by the Watergate scandal (Shi & Singh, 2017). From 1976 to 1979, President Jimmy Carter prioritized a compulsory national health plan, however, due to costly uncontrollable health care and the economic recession the initiative stalled (Kirsch, 2013). In 1992 to 1994, President Bill Clinton mandated his wife, Hillary Rodham Clinton, to develop a plan demanding employees to acquire health insurance covered by their employers (Kirsch, 2013). During 1997-2003, he signed a bipartisan legislation insuring millions of children in families with incomes that were too high to qualify for Medicaid (Olson, 2012). With the aim of the major expansion of the elderly program, President George W. Bush convinced the Congress to include the coverage of prescription drugs in Medicare. On March 13, 2010, President Obama signed Obamacare into law despite the lack of support from Republicans (Kirsch, 2013). However, President Donald Trump, a Republican, has promised to repeal the law. It can be seen that healthcare reforms occurred with successive administrations in the USA.
Political Struggle to Pass PPACA
In 2010, when President Obama signed the federal healthcare reform, it received numerous objections. Various laws were recommended to aid in reforming the existing system, and it led to the adoption of the Patient Protection and Affordable Care Act (PPACA) into law by President Obama on March 23, 2010 (Kirsch, 2013). It received opposition with a number of state attorney generals filing a lawsuit jointly in the U.S. District Court of Pensacola, FL, claiming that the Act violated Articles 1 and 4 and the Tenth Amendment to the Constitution (Kirsch, 2013). Later, other states and the National Federation of Independent Business joined them as co-plaintiffs, causing a political struggle.
Political Impact of Medicare and Medicaid on the Push for Universal Coverage
The political impact of Medicare and Medicaid on the push for universal coverage is that these programs take a huge chunk of the federal budget; as a result, they have been subject to opposition because of the view that achieving universal coverage is a costly undertaking. Moreover, because of Medicare and Medicaid, the federal government exercises significant control over the healthcare industry. However, these programs have been instrumental in creating the view that universal coverage in the USA is possible. Medicare has provided numerous elderly Americans with access to prescription drugs, hospitals, and doctors (Olson, 2012). However, it is surprising that the program still faces opposition from a few critics, saying that costs are unmanageable and that the role played by the federal government is too great. Medicare faces negative attitudes that instead of serving the whole population of Americans it is limited to a section of society (Olson, 2012). Nevertheless, a three-quarter of people consider this program very essential, with 70% wanting it to remain as it is and ignoring suggested changes by politicians (Olson, 2012).
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Major Issues from the Legislative and Executive Perspectives
The legislature raised a number of concerns. Opposing the Act, the Republicans termed the law as a job killer claiming that it was costly for businesses. However, following the achievement of Obamacare, there was a 9% increase in employment in the healthcare sector (Kirsch, 2013). The Republicans also decried the law as unnecessary interference into the dealings of private businesses and individuals (Kirsch, 2013). Moreover, the House of Representatives controlled by the Republicans has taken numerous votes in a bid to revoke the law, causing a partial administration shutdown concerning the issue. In state capitals, the Republicans have also promised to weaken the law in any possible manner. Supporting the national reform, the executive branch and the President considered that the PPACA was to enhance health insurance affordability and quality, reducing costs of healthcare and expanding insurance coverage through decreasing the uninsured rate (Kirsch, 2013). As a result, the Affordable Care Act (ACA) initiated such mechanisms as insurance exchanges, subsidies, and mandates.
The Politics Surrounding the National Health Insurance Agenda and Its Impacts on the PPACA
The agenda of healthcare insurance is a politically contentious issue in the USA (Kirsch, 2013). The PPACA has political undertones based on the manner in which it was initiated. In 2008, President Obama campaigned on the healthcare reform platform (Kirsch, 2013). Being true to his word, he ensured that the adoption of the PPACA on March 23, 2010. Nonetheless, Republicans continued to criticize every aspect of the law, wanting every U.S. citizen to acquire health insurance or to pay fine to the treasury from 2014, whereas the Medicaid program aimed to insure adults with low-income, with which the opposition did not agree (Olson, 2012). As a result, twenty-six states filed lawsuits in federal courts. In 2012, the fate of the PPACA depended on the ruling of the Supreme Court in July, as well as congressional and presidential elections in November, which were a success. Thus, families from poor backgrounds qualify for Medicaid and do not have to pay for private insurance (Shi & Singh, 2017).
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The healthcare reform has been discussed in the USA with successive governments since the early 1900s as part of a broader policy to enhance the social welfare of the citizenry. Medicare and Medicaid have marked a significant step in the path towards the achievement of universal healthcare in the country. The PPACA is the most recent reform on healthcare that has been enacted facing considerable opposition at the legislative level. Therefore, while the USA is coming closer to universal coverage, its hopes are dwindled by such political pressure.
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