Evolution and Impact of U.S Health Care Policies

Health care policy changes have played a massive role in the United States for nearly a decade, from the 1930s New Deal programs to the creation of Medicare and Medicaid in 1965. The most recent legislation called for a national reform to health insurance; however, where Medicare was included in the initial reform, Medicaid relies on individual states to expand their programs. With the enactment of the Affordable Care Act, no discrimination against individuals with preexisting conditions has allowed many uninsured to become eligible for subsidized insurance or Medicaid; especially people living with HIV and AIDS.

According to Rushefsky, “There are four generic goals that are the focus of health care policy: security, equity, efficiency,

and welfare (179).” Security deals with the assurance of basic health needs and the ability to be taken care of when issues arise. Equity relates to access, which means the ability to have health and financial assistance when necessary to pay for services. Financial access issues have been addressed through time with the assistance of Blue Cross and Blue Shield and other public and private insurance companies. The third goal that Rushefsky discusses is the goal for efficiency. This goal “refers to getting the most out of something (Rushefsky 180),” but the conflict between the first two goals and efficiency has been great with rising health care costs and growing government expenditures. The last goal discussed by Rushefsky is welfare. Welfare “refers to needs and how those needs are met (Rushefsky 180),” which has proved difficult as questions are raised about the affordability and access to health services. Thus, the government has been conflicted on to what extent they should intervene in the health care system and what is defined as basic care needs for the American population.
Following the goals of health policy, policy tools help to reach those goals.

Rushefsky describes five policy tools: direct provision of services, rules, inducements and incentives, facts and persuasion, and the use of powers. Direct provision of services includes those services that are directly run by the government, like the VA hospitals and clinics. The second tool, rules, relates to the payment system of services “as to who may provide such services, how they may be provided, what services will be provided, how they shall be financed, and who is eligible (Rushefsky 180).” The next tool used in health policy is the use of inducements and incentives. Rushefsky describes that an example of an incentive is student loan forgiveness for new doctors who work over a period of time in an area with limited services, requiring medical assistance. He also describes an inducement for Medicare where hospitals are given a set amount of money for a specific diagnosis, thus the goal of this inducement to reduce a patient’s stay and cut off spending to a degree where the patient pays after a certain point. The fourth tool is the uses of facts or persuasion in order to promote smart use or changes of the use of different substances like cigarettes, alcohol, and drug use. The final tool used in health care is the use of powers, where there are two ideals whether states or the federal government should decide on reform and to what extent health services be provided by the

government.
Differing political viewpoints on government involvement in health care have been argued and are still relevant today. Conservatives believe the government should have little to very limited involvement in health care and the system should continue to be market-based. Liberals, on the hand, believe that all individuals are entitled to healthcare and are against the business-like system.
In relation to health care policy, I found an article that discusses the relevance of the Ryan White HIV/AIDS Program to the Affordable Care Act.

The Ryan White Comprehensive AIDS Resources Emergency Act was founded in 1990 and aims to assist people living with HIV/AIDS, particularly those who are low-income, uninsured, and underinsured individuals. With the Affordable Care Act extending coverage, “thousands of people living with HIV who have received Ryan White HIV/AIDS Program-funded care are now eligible for Medicaid or subsidized insurance (Cahill et al. 1).” However, the authors argue that the program is still essential as many services are not covered by any other sources. The services not covered by other sources include: “case management, treatment adherence counseling, housing support and advocacy, some kinds of HIV prevention and testing outreach in nontraditional settings, legal services and advocacy to help people newly diagnosed with HIV and AIDS access benefits, food and nutrition services, dental services, transportation, peer support, risk reduction counselling, and some mental health services (Cahill et al. 1 &

2).”
The authors continue and discuss the original intent of the program in relation to today’s implication. They brought up that the Ryan White Program addressed an issue with insurance coverage in relation to “its refusal to cover critically necessary enabling and support services that allow people to stay in care (Cahill 2),” which is vital to their successful treatment. Now, most people living with HIV/AIDS receive outpatient care with the aid of the Ryan White Foundation as they are a key funder of many HIV/AIDS related services. Since the advancement of antiretroviral therapy, HIV infected individuals are living longer; however, they experience increased morbidity.
According to Cahill, Mayer, and Boswell, the Ryan White care system has been a success and a model for HIV medical care. “Whereas 49% of all American HIV-infected patients aware of their status are not in ongoing care, 73% of patients in RWP clinical programs are in continuous care. Patients involved in stable care have had significant treatment success: 77% are virally suppressed compared with only 28% of all HIV-infected adults in the United States (Cahill et al. 2 & 3).” The Part C-funded clinics have greatly assisted with the treatment and counselling process as they help HIV-infected individuals who also had hepatitis B or C, substance use disorder, a serious mental illness, or received an AIDS diagnosis.
With the Affordable Care Act in place, the number of people living with HIV/AIDS who are uninsured has decreased by 5% since 2013. According to Cahill et al, “Only 41% of PLWHA in the United States receive regular medical care, and only 28% are virally suppressed (Cahill et al. 3).” Research has shown that earlier treatment of HIV decreases transmission and HIV incidence.