Health care reform in the United States

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Health care reform in the United States
General
Healthcare Reform in USA Patient Protection and Affordable Care Act Healthcare Bill (PPACA): Provisions Debate over reform History Public opinion Rationing Uninsured United States National Health Care Act (H.R. 676: the lead legislative proposal; formerly the "Expanded and Improved Medicare for All Act") More Information Legislation Superseded and enacted proposals Proposed system changes Health Care and Education Reconciliation Act of 2010 (H.R. 4872) Patient Protection and Affordable Care Act (Senate bill - H.R. 3590) America's Healthy Future Act (Baucus bill - S. 1796) Healthy Americans Act (Wyden-Bennett Bill - S. 391) America's Affordable Health Choices Act of 2009 (Tri-Comm. Bill - H.R. 3200) Affordable Health Care for America Act (House bill - H.R. 3962) Systems Comparison of Canadian and American health care systems Free-market health care Health insurance exchange National health insurance Publicly-funded health care Single-payer health care Two-tier health care Universal health care Reform advocacy groups American Medical Student Association California Nurses Association/National Nurses Organizing Committee Democracy for America Health Care for America NOW! Healthcare-NOW! National Physicians Alliance Physicians for a National Health Program Health care in the United States This box: view • talk • edit

Health care reform in the United States in 2010 was enacted nationally and most recently in two bills: the Patient Protection and Affordable Care Act which became law on March 23, 2010^[1][2] and was shortly thereafter amended by the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) (which became law on March 30). No Republicans voted in favor of either bill.^[3]

Reuters and CNN summarized the March 2010 reforms and the year in which they take effect.^[4][5]

Contents 1 History of national reform efforts 2 Key reform drivers for the 2010 reforms 2.1 Extend coverage through insurance mandate 2.2 Guaranteed issue, community rating, individual mandate 2.3 Make health insurance more effective 2.4 Reduce the deficit 2.5 Eliminate overpayment in Medicare Advantage 3 Political positions of the main parties 4 Public policy debate 4.1 Abortion 4.2 Lobbying 5 Possible future reforms 5.1 Universal health care 5.2 Balancing doctor supply and demand 5.3 Bundled payments 6 2010 Patient Protection and Affordable Care Act details 6.1 Within one year of enactment (2010–2011) 6.2 Effective during 2011 6.3 Effective as of 2012 6.4 Effective as of 2013 6.5 Effective as of 2014 6.6 Effective 2015 6.7 Effective 2018 7 Legal challenges 7.1 Health reform and the 2008 presidential election 8 See also 9 Further reading 9.1 Books 9.2 Articles and links 10 References 11 External links

[edit] History of national reform efforts

Here is a summary of reform achievements at the national level. For failed efforts, State based efforts, native tribes services and more details generally, see the main article History of health care reform in the United States.

• 1965 President Lyndon Johnson enacted legislation which introduced Medicare, covering both hospital and general medical insurance for senior citizens paid for by a Federal employment tax over the working life of the retiree, and Medicaid permitted the Federal government to partially fund a program for the poor, with the program managed and co-financed by the individual states.^[6][7]

• 1985 The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) amended the Employee Retirement Income Security Act of 1974 (ERISA) to give some employees the ability to continue health insurance coverage after leaving employment.^[8]

• 1997 The State Children's Health Insurance Program, or SCHIP, was established by the federal government in 1997 to provide health insurance to children in families at or below 200 percent of the federal poverty line.^[9]

• 2010 The Patient Protection and Affordable Care Act is enacted by President Barack Obama, providing for the phased introduction over four years of a comprehensive system of mandated health insurance with reforms designed to eliminate "some of the worst practices of the insurance companies" — pre-condition screening and premium loadings, policy rescinds on technicalities when illness seems imminent, lifetime and annual coverage caps. It also sets a minimum ratio of direct health care spending to premium income, and creates price competition bolstered by the creation of three standard insurance coverage levels to enable like-for-like comparisons by consumers, and a web based health insurance exchange where consumers can compare prices and purchase plans. The system preserves private insurance and private health care providers and provides more subsidies to enable the poor to buy insurance.

[edit] Key reform drivers for the 2010 reforms

Just before the passage of the bill, President Obama gave a speech at a rally in Pennsylvania in which he outlined the key elements of his reforms and why he felt it was imperative for Congress to vote for the legislation.^[10]

[edit] Extend coverage through insurance mandate

The law includes health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of the federal poverty level (FPL),^[11] subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be on sliding scale from 2% to 9.8% of income,^[12][13] providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research. The new law mandates that by 2014, people must have adequate insurance coverage or else pay a fine. It is estimated will reduce the number of the uninsured from 19% of all residents in 2010 to 8% by 2016.^[14] To achieve this the new law provides subsidies to encourage smaller employers to buy coverage for their workers and makes it easier to qualify for Medicaid. For those not on a government program such as Medicare or who do not get employer sponsored insurance, direct subsidies will help those on lower incomes to purchase insurance through a new on-line exchange, an internet State run market place, where there will be like-for-like price transparency of insurance company offerings. This is expected to improve price competition between insurers. The 8% figure of uninsured are expected to be mostly illegal immigrants (5%), who are not eligible for subsidies, and the remaining 3% will be those who exercise their freedom not to be insured and who opt instead to pay the fine.^[14][15]

The new law aims to offset the cost of the insurance subsidies from savings to be made by reducing the problem of the medically uninsured. Approximately $43 billion was spent annually (in 2008) supporting a minimal level of health care services for the uninsured^[16] and the average family was reckoned to be paying an additional $1,000 per year in insurance premiums to cover the uninsured.^[17] The subsidies will most likely go to benefit the poorest and sickest (i.e. those who have the most difficulty in getting insurance currently) and who are most likely already in receipt of subsidies of one form or another (through uncompensated care schemes or by the higher costs levied on those with insurance). Making insurance mandatory rather than voluntary will tend to bring younger, healthier people into the insurance pool at a relatively low incremental cost which should reduce costs for everybody else in the pool.^[18]

The new law should also improve the health of the nation by increasing insurance coverage. A 2009 Harvard study published in the American Journal of Public Health found more than 44,800 excess deaths annually in the United States associated with lack of insurance.^[19][20] More broadly, a 1997 analysis estimated the number of people in the United States—insured and uninsured—who die per year because of lack of medical care was nearly 100,000.^[21]

[edit] Guaranteed issue, community rating, individual mandate

Starting in 2014, the law will prohibit insurers denying coverage to sicker applicants, or imposing special conditions such as higher cost sharing, higher premiums, setting black-out periods, and rescinding policies for minor errors in the insurance application. This requirement is called guaranteed issue with community rating. Health care expenditures are highly concentrated with the most expensive 5% of the population accounting for half of aggregate health care spending, whereas the bottom 50% of spenders account for only 3%, which means that insurers' gains to be had from avoiding the sick greatly outweigh any possible gains from managing their care. As a consequence, insurers resources have been devoted to such avoidance at a direct cost to effective care management which is against the interests of the insured.^[16] Instead of providing health security, the health insurance industry had, since the 1970s began to compete not on service and price but by becoming good risk differentiators, seeking to insure only those with good or normal health profiles and excluding those considered to be or to become unhealthy and therefore less profitable. According to a study from Cambridge Hospital, Harvard Law School and Ohio University, 62% of all 2007 personal bankruptcies in the United States were due to an inability to pay medical costs.^[22] Many of these people forced into bankruptcy had medical insurance but the effect of caps, exclusions, and inability to fund or continue COBRA coverage was behind many of these bankruptcies. Medical impoverishment is almost unheard of in wealthy countries other than the US either because the state covers everyone or everyone is obliged by law to have insurance.^[23]

Also starting in 2014, the law will require most people to have health insurance which meets a nationally approved minimum standard. This type of Health insurance mandate as a means of gaining near universal coverage and achieving community rating is used in Massachusetts law and is a feature of health care law in many other countries. The law requires all insurers to accept all applicants without personal medical underwriting and all applicants must be accepted for coverage without the imposition of special coverage rules for cost sharing and without the loading of premiums for pre-existing conditions. State-run internet based exchanges begin operations, providing a market place for small businesses and private individuals without health insurance to buy coverage on a group basis. These exchanges will be similar to others already in existence such as the Massachusetts Connector and that operating for Federal employees. Premiums in the exchange can only vary according to age, geographic region, coverage type (individual or family), or tobacco use.^[24] The exchanges are expected to sharpen price competition by showing prices from each competing insurer in the exchange for like-for-like policies.

[edit] Make health insurance more effective

By forcing insurers to cover more of a person's health care costs by excluding lifetime and annual caps, cover first dollar costs for screenings and immunizations and preventing exclusions for necessary care. Ensure that no more than 15% of insurance premiums were swallowed up in insurance company overheads. Some insurance or health benefit schemes were considered wholly inadequate.^[25]

[edit] Reduce the deficit

Reducing the deficit was another driver in health care reform. The reform legislation that passed was estimated by the Congressional Budget Office to reduce the deficit by $138 billion over 10 years.^[26]

[edit] Eliminate overpayment in Medicare Advantage

Medicare Advantage plans are offered by private insurers and provide benefits over and above coverage in Medicare Parts A and B and receive funding from the Medicare fund for taking on Part A and B coverage. However, under a revised contract made during the previous Bush presidency, Medicare was overpaying the private insurers. MedPAC estimated the overpayment as being approximately $12 billion a year.^[27] This meant that the average person in traditional Medicare was paying $90 a year as a subsidy to private insurers for which they received zero benefit and eliminating this overpayment would save $177 billion over ten years.^[28]

[edit] Political positions of the main parties

The main political opposition to the passing of health care reform legislation in 2010 came from the Republican party and similar groupings on the right of American politics, such as the Tea party movement. In the most tightly contested vote for the final passage of the bill prior to reconciliation, not a single Republican in the House or Senate voted in favor of the bill.^[29] This opposition was broadly based on objections to rises in taxation, especially of the so-called "Cadillac insurance plans" and the corollary increase in government spending on affordability subsidies. The GOP also objected to a new Health Insurance Rate Authority that would determine whether rate increases were "unreasonable" and to enforced rebates or premium reductions, and to any proposal that might have allowed government funds to subsidize abortion.^[30] The opposition declared the law to be a "government takeover of health care", although the government did not propose taking over either the management of the health care system, which largely remains in private hands, nor was there ultimately legislation for a public insurer competitor. One version of an original draft prepared in the House of Representatives did call for a "public option" (a public insurer as one extra choice for consumers, competing against private insurers). Some Republicans have contested the constitutionality of the clause in the final legislation requiring people to purchase insurance. Both the government and the insurance industry have argued that this is a necessary prerequisite to achieve universality and equity for other insurance payers and to prevent people buying insurance only in time of need. The government argues that this is covered under the Commerce Clause, whereas detractors argue that this is wrong. As of 2010, this matter is still before the courts. The Associated Press has pointed out that some Republicans have flip-flopped on the issue such as Mitt Romney and Scott Brown. It also pointed out that past Republican figures such as Richard Nixon as well as some writers for the conservative think tank Heritage Foundation have supported a mandate.^[31] The same is true of the concept of the insurance exchanges which the bill sets up, with some Republicans and the Heritage Foundation once supported.^[32]

On the other side, Obama gave, in his State of the Union Address held just before the final passage of the bill, his reasons for taking on the issue of health care. He said it was because of the stories that he had heard from Americans with pre-existing conditions whose lives depend on getting insurance coverage; stories of patients being denied coverage, and of families with insurance who are just one illness away from financial ruin. He said that the approach being taken would protect every American from the worst practices of the insurance industry. He said it would give small businesses and uninsured Americans a chance to choose an affordable health care plan in a competitive market. He claimed that if they did nothing, millions of Americans would lose their health care this year and the deficit would grow. He said that premiums would increase and patients would be denied the care they need, and that small business owners would continue to drop coverage altogether. He said he would not walk away from those Americans, and he urged others in Congress not to do so either. He claimed that doctors and nurses in the health care system, who know the system best, consider this (legislation) a vast improvement over the status quo. He challenged anyone, from either party, with a better plan that would bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, to let him know, because he was eager to see it.^[33]

[edit] Public policy debate

[edit] Abortion

A lot of the political debate centered on the prevention of the Federal funding of abortion. In the legislation that was finally passed the existing law on the preservation of the principle of no Federal funding for abortion (except in cases of rape, incest, or to preserve the life of the mother) was preserved.^[34] The law requires people to pay for that element of coverage with a separate check to create a specific fund which is not subsidized and which is used to fund these services. State insurance commissioners are charged with policing this “segregation of funds”. Whether insurers in the exchanges can offer abortion coverage at all was left as a matter for individual States to decide. The default is that insurers will be allowed to offer abortion coverage as they do now unless a State passes legislation to the contrary.

[edit] Lobbying

According to Obama, America's health insurance industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other proposed legislation.^[35] There are six registered health care lobbyists for every member of Congress.^[36] The campaign against health care reform has been waged in part through substantial donations to key politicians. The single largest recipient of health industry political donations and chairman of the Senate Committee on Finance that drafted Senate health care legislation is Senator Max Baucus (D-MT).^[37] A single health insurance company, Aetna, has contributed more than $110,000 to one legislator, Senator Joe Lieberman (ID-CT), in 2009.^[38]

America's Health Insurance Plans, a lobby group funded by American private health insurance companies published its plans for health care reform in December 2008.^[39] The key elements called for co-ordinated national strategy for health care with insurance regulation set in a national framework but enforced by the states.^[39] It also called for a personal health care mandate requiring every American to have health insurance or face penalties. This, it said, was a necessary pre-requisite for guaranteed issue policies to prevent insurers from having to pre-screen applicants and set limits on coverage for pre-existing conditions, otherwise healthy people would put off buying insurance until they get sick.^[39] It also called for the establishment of body to reform the payment system (including a shift from fee-for-service to fee-for-quality-outcomes), and a body to undertake Comparative effectiveness research because it admitted that the current system was not effective at providing value for money or even best practice and computerization and standardization of health care records and claims processing.^[39] Most of the issues which AHIP called for in its plans have been implemented by the Obama administration and Congress in the reform process with the exception of a completely national framework for health care insurance regulation. Though the bill does place certain national rules for insurance to qualify as being "coverage" acceptable within the meaning of the individual mandate, states have retained the power under the reforms to regulate the industry and this was not put in a national framework.

[edit] Possible future reforms

The Patient Protection and Affordable Health Care Act 2010 contained provisions which allows the Centers for Medicare and Medicaid Services (CMS) to undertake pilot projects which, if they are successful could be implemented in future.

[edit] Universal health care

The universal health care proposal pending in Congress is called the United States National Health Care Act (H.R. 676, formerly the "Medicare for All Act.") The Congressional Budget Office and related government agencies scored the cost of a universal health care system several times since 1991, and have uniformly predicted cost savings,^[40] probably because of the 40% cost savings associated with universal preventative care^[41] and elimination of insurance company overhead costs.

[edit] Balancing doctor supply and demand

The Medicare Graduate Medical Education program regulates the supply of medical doctors in the U.S. By adjusting the reimbursement rates to establish more income equality among the medical professions, the effective cost of medical care can be lowered.

[edit] Bundled payments

A key project is one that could radically change the way the medical profession is paid for services under Medicare and Medicaid. The current system, which is also the prime system used by medical insurers is known as "fee for service" because the medical practitioner is paid only for the performance of medical procedures which, it is argued means that doctors have a perverse incentive to do more tests (which generates more income) which may not be in the patients' best long term interest. The current system encourages medical interventions such as surgeries and prescribed medicines (all of which carry some risk for the patient but increase revenues for the medical care industry) and does not reward other activities such as encouraging behavioral changes such as modifying dietary habits and quitting smoking, or follow-ups regarding prescribed regimes which could have better outcomes for the patient at a lower cost. The current fee-for-service system also rewards bad hospitals for bad service. Some^[who?] have noted that the best hospitals have fewer re-admission rates than others, which benefits patients, but some of the worst hospitals have high re-admission rates which is bad for patients but is perversely rewarded under the fee-for-service system.

Projects at CMS are examining the possibility of rewarding health care providers through a process known as "bundled payments"^[42] by which local doctors and hospitals in an area would be paid not on a fee for service basis but on a capitation system linked to outcomes. The areas with the best outcomes would get more. This system, it is argued, makes medical practitioners much more concerned to focus on activities that deliver real health benefits at a lower cost to the system by removing the perversities inherent in the fee-for-service system.

Though aimed as a model for health care funded by CMS, if the project is successful it is thought that the model could be followed by the commercial health insurance industry also.

[edit] 2010 Patient Protection and Affordable Care Act details

Key provisions of the health-care legislation passed in March 2010 are:^[4]

[edit] Within one year of enactment (2010–2011)

• Insurance companies barred from dropping people from coverage when they get sick, ending the practice of rescission. Lifetime coverage limits eliminated and annual limits restricted.
• Young adults able to stay on their parents' health plans until age 26. Many health plans previously dropped dependents from coverage when they turned 19 or finished college.
• Uninsured adults with pre-existing conditions will be able to obtain health coverage through a new program that will expire once new insurance exchanges begin operating in 2014.
• Insurance companies cannot deny group or new (non-grandfathered) individual coverage to children under age 19 due to a pre-existing condition.^[43]
• A temporary reinsurance program is created to help companies maintain health coverage for early retirees between the ages of 55 and 64. This also expires in 2014.
• Medicare drug plan beneficiaries who fall into the Medicare Part D coverage gap (the so-called "doughnut hole") will get a $250 rebate. The new law eventually closes that gap completely. (The old law required the sick person to pay 100% of their own annual medicine costs after $2,700 was spent in the coverage year and did not start again until after $6,154 was spent).
• A tax credit becomes available for some small businesses to help provide coverage for workers.
• A 10% tax on indoor tanning services that use ultraviolet lamps goes into effect on July 1.

[edit] Effective during 2011

• Medicare provides 10% bonus payments to primary care physicians and general surgeons.
• Medicare will cover the full cost of annual wellness visits and personalized prevention plan services for beneficiaries. New health plans will be required to cover preventive services with little or no direct cost to patients.
• A new program under the Medicaid plan for the poor goes into effect in October that allows states to offer home and community based care for the disabled that might otherwise require institutional care.
• Payments to insurers offering Medicare Advantage services are frozen at 2010 levels. These payments are to be gradually reduced to bring them more in line with traditional Medicare.
• Employers are required to disclose the value of health benefits on employees' W-2 tax forms.
• An annual fee is imposed on pharmaceutical companies according to market share. The fee does not apply to companies with sales of $5 million or less.

[edit] Effective as of 2012

• Physician payment reforms are implemented in Medicare to enhance primary care services and encourage doctors to form "accountable care organizations" to improve quality and efficiency of care.
• An incentive program is established in Medicare for acute care hospitals to improve quality outcomes.
• The Centers for Medicare and Medicaid Services, which oversees the government programs, begins tracking hospital readmission rates and puts in place financial incentives to reduce preventable readmissions.
• Companies will be required to issue 1099 forms to any vendor of services or rental property to which the business has paid more than $600. Form 1099 is also sent to the IRS. Under the existing law, businesses issued the Form 1099 only to individuals who provided services or property to a business. The health care law included the same form be issued to corporations as well, and that the form be issued to individuals and corporations that provide property to the business.^[44][45] Only business related payments are reportable, personal payments not.^[46] There are a number of exceptions. For example: payments for merchandise, telephone, freight, storage, payments of rent to real estate agents are excepted.^[46] The health care bill mandate aims to collect lost revenue from companies that under-report on their tax returns. The provision is expected to raise $17 billion over 10 years.^[47]

[edit] Effective as of 2013

• A national pilot program is established for Medicare on payment bundling to encourage doctors, hospitals and other care providers to better coordinate patient care.
• The threshold for claiming medical expenses on itemized tax returns is raised to 10% from 7.5% of income. The threshold remains at 7.5% for the elderly through 2016.
• The Federal Insurance Contributions Act tax (FICA) is raised to 2.35% from 1.45% for individuals earning more than $200,000 and married couples with incomes over $250,000. The tax is imposed on some investment income for that income group.
• A 2.9% excise tax is imposed on the sale of medical devices. Anything generally purchased at the retail level by the public is excluded from the tax.

[edit] Effective as of 2014

• State health insurance exchanges for small businesses and individuals open.
• Individuals with income up to 133% of the federal poverty level qualify for Medicaid coverage.
• Healthcare tax credits become available to help people with incomes up to 400 percent of poverty purchase coverage on the exchange.
• Premium cap for maximum "out-of-pocket" pay will be established for people with incomes up to 400 percent of FPL.^[48][11] Section 1401 of PPACA explains that the subsidy will be provided as an advancable, refundable tax credit^[49] and gives a formula for its calculation.^[50] Refundable tax credit is a way to provide government benefit to people even with no tax liability^[51] (example: Child Tax Credit). According to White House and Congressional Budget Office figures, the maximum share of income that enrollees would have to pay for the "silver" healthcare plan would vary depending on their income relative to the federal poverty level, as follows:^[52][12] for families with income 133–150% of FPL will be 4-4.7% of income, for families with income of 150–200% of FPL will be 4.7-6.5% of income, for families with income 200–250% of FPL will be 6.5-8.4% of income, for families with income 250-300% of FPL will be 8.4-10.2% of income, for families with income from 300 to 400% of FPL will be 10.2% of income. In 2016,the FPL is projected to equal about $11,800 for a single person and about $24,000 for family of four.^[52] See Subsidy Calculator for specific dollar amount.^[53]
• Most people required to obtain health insurance coverage or pay a tax if they don't.
• Health plans no longer can exclude people from coverage due to pre-existing conditions.
• Employers with 50 or more workers who do not offer coverage face a fine of $2,000 for each employee if any worker receives subsidized insurance on the exchange. The first 30 employees aren't counted for the fine.
• Health insurance companies begin paying a fee based on their market share.

[edit] Effective 2015

• Medicare creates a physician payment program aimed at rewarding quality of care rather than volume of services.

[edit] Effective 2018

• An excise tax on high cost employer-provided plans is imposed. The first $27,500 of a family plan and $10,200 for individual coverage is exempt from the tax. Higher levels are set for plans covering retirees and people in high risk professions.

[edit] Legal challenges

As Congressional approval neared, opponents of health care reform shifted from parliamentary and procedural opposition to challenge the constitutionality of the legislation. The Virginia General Assembly passed the Virginia Health Care Freedom Act before Congress completed action on its bill. Governor Robert F. McDonnell signed that law on March 24, prior to House approval of the reconciliation bill.^[54] The Virginia law prohibits any individual from being required to purchase health insurance. On March 17, 2010, Virginia Attorney General Ken Cuccinelli sent House Speaker Nancy Pelosi a letter threatening constitutional challenge to the enactment of the bill if the House used a self-implementing rule and deemed the bill, which had begun in the Senate, to pass.^[55] On March 23, 2010, Cuccinelli filed Commonwealth v. Sebelius in the Federal District Court for the Eastern District of Virginia challenging the Constitutionality of the insurance requirement.^[56] Also on March 23, 2010, the Attorney General of Florida, together with the States of South Carolina, Nebraska, Texas, Utah, Louisiana, Alabama, Michigan, Colorado, Pennsylvania, Washington, Idaho and South Dakota filed a joint law suit in a Florida district court also challenging the new law.^[57]

Some Constitutional law professors and commentators in the press have opined that the lawsuits and state laws are unlikely to succeed.^{[58][59][60][61]} However, other Constitutional law professors and other legal experts maintain that the health insurance mandate (the requirement that individuals purchase insurance, or face a penalty) is, in fact, unconstitutional.^[62][63]

On August 2, 2010, District Court Judge Henry Hudson, presiding over Virginia's lawsuit challenging the Obama administration's health care reform package, denied the Justice Department's attempt to have that lawsuit dismissed, stating that Virginia's case raises Constitutional issues - mainly whether Congress has the right under the Commerce Clause to regulate and tax a person's decision not to participate in interstate commerce.^[64]

[edit] Health reform and the 2008 presidential election

[edit] See also

• McCarran–Ferguson Act, United States federal law that exempts health insurance companies from the federal anti-trust legislation that applies to most businesses.
• United States National Health Care Act
• Health care in the United States
• Health care reform
• Health care reform debate in the United States
• Health care system
• Health care system: Cross-country comparisons — tabular comparisons of the U.S., Canada, and other countries not shown above.
• Health economics
• Health insurance exchange
• Health policy
• History of health care reform in the United States
• List of healthcare reform advocacy groups in the United States
• Medicare Sustainable Growth Rate
• National health insurance
• Uninsured in the United States

[edit] Further reading

[edit] Books

• Christensen, Clayton Hwang MD, Jason, Grossman MD, Jerome, The Innovator's Prescription, McGraw Hill, 2009. ISBN 978-0-07-159208-6
• Mahar, Maggie, Money-Driven Medicine: The Real Reason Health Care Costs So Much, Harper/Collins, 2006. ISBN 978-0-06-076533-0
• Starr, Paul, The Social Transformation of American Medicine, Basic Books, 1982. ISBN 0-465-07934-2
• Malhotra, Umang, Solving the American Healthcare Crisis, iUniverse, 2010. ISBN 978-1-4401-8018-7
• Reid, T.R. (2009). The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care. Penquin Books. ISBN 978-1594202346. 

[edit] Articles and links

• Comparing Health Care Plans: A Guide to Reform Proposals, Committee for a Responsible Federal Budget
• Doctors support universal health care: survey, Reuters, March 31, 2008 (first reported in Annals of Internal Medicine).
• Health Care Reform Chronology 2010–2018, from Aon Corporation
• Health Care Cost Survey Reveals High-Performing Companies Gain Health Dividend (2009) from Towers Perrin
• Hidden costs, value lost: uninsurance in America. Institute of Medicine Committee on the Consequences of Uninsurance. Washington, DC: National Academies Press, 2003.
• Paying More, Getting Less from Dollars & Sense
• Reducing Costs While Improving the U.S. Health Care System: The Health Care Reform Pyramid by Deloitte, January 2009 (Broken link)
• Sick Around the World: Can the U.S. learn anything from the rest of the world about how to run a health care system? from Frontline, PBS.
• Barack Obama - Town Hall Transcript - August 11, 2009
• Charlie Rose Show - Interview with Mayo Clinic President & CEO Denis Cortese
• The New Yorker-Atul Gawande-The Cost Conundrum-June 2009
• GAO-U.S. Financial Condition and Fiscal Future Briefing-2008
• President Obama Remarks by the President to a Joint Session of Congress on Health Care September 9, 2009

[edit] References

[edit] External links

• HealthReform.gov official government site
• Health Insurance Reform Reality Check official White House rumor control site
• Health Care from WhiteHouse.gov

Directory

• Health care reform in the United States at the Open Directory Project

News media

• Health Care in America from CNN
• Health Care Hub from C-Span
• Health Care Reform & YouTube from Governing Dynamo, includes nearly all White House videos on health care reform
• Health Care Reform collected news coverage from The New York Times
• Prescriptions for Change collected news coverage from NPR
• Healthcare Reform collected news coverage from Reuters
• Health-Care Reform 2009 collected news coverage from The Washington Post
• In Search of Health Care Reform interactive overview
• Health Care Policymakers at WhoRunsGov at The Washington Post
• In Historic Vote, House Approves Landmark Healthcare Reform Bill - video report by Democracy Now!
• Health Systems and reform, a special program of the World Association for Medical Law

Financial information

• Congressional Budget Office official government site
• Estimated Impact of Health Care Reform Proposals from the Centers for Medicare and Medicaid Services
• Office of Management and Budget official government site
• Comparison of House and Senate Health Care bills from Committee for a Responsible Federal Budget group
• Interactive and Sharable Graphs Comparing the Health Care Bills
• Kaiser Family Foundation: Health Reform Subsidy Calculator—Premium Assistance for Coverage in Exchanges/Gateways

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