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Social Welfare and Health Policy Chapter 16 Pearson Education, Inc. © 2008 Social Welfare Policy Five general categories of government social welfare programs Income maintenance: TANF, General Assistance, Social Security, SSI, Unemployment Compensation

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social welfare and health policy

Social Welfare and Health Policy

Chapter 16

Pearson Education, Inc. © 2008

social welfare policy
Social Welfare Policy
  • Five general categories of government social welfare programs
    • Income maintenance: TANF, General Assistance, Social Security, SSI, Unemployment Compensation
    • Nutrition: food stamps, school breakfasts/lunch
    • Social Services: mental health, legalserlvices, support services such as child day care, etc.
    • Housing assistance
    • Health: Medicare, Medicaid other public health services
  • These programs are organized as either 1) insurance programs or 2) public assistance programs
social welfare policy3
Social Welfare Policy
  • Social insurance programs
    • Social Security (including Medicare)
    • Unemployment Compensation
    • Workers’ Compensation
social welfare policy continued
Social Welfare Policy(continued)
  • PublicAssistance Programs (means tested) are of two kinds
    • Cash payments
      • Supplemental Security Income
      • Temporary Assistance for Needy Families
      • General assistance
    • In-kind assistance
      • Medicaid
      • Food Stamps
      • Public housing assistance
who are the poor
Who Are the Poor?
  • Since 1965, between 12 percent and 15 percent of Americans have lived in poverty
  • African Americans and Hispanics are three times as likely to be poor
  • Female-headed households with children are over five times more likely to be poor than married couples
  • In 2004, approximately 37 million Americans are poor (app. the population of California)
health policy
Health Policy
  • In 2003, Americans spent $1.7 trillion on health care—average of $5,771 per person
  • Health care expenditures from all sources rose from 9 percent of GNP in 1980 to 16 percent of GNP in 2004, the highest in the world
  • Most Americans rely on health insurance provided by their employers
    • About 2/3 of Americans under 65 get health insurance from their employer
    • Retirees on Social Security are covered by Medicare
    • Veterans with disabilities have access to VA hospitals
    • Needy individuals are covered by Medicaid
    • Still about 45 million Americans have no health insurance
health policy continued
Health Policy (continued)
  • Public health care in America
    • Still largely in the private domain
    • In most other modern countries, government involvement in health care is standard and comes in two forms
      • Government operates a national health care service
      • Government mandates universal insurance coverage by employers and then covers the unemployed and retired
public health care in america
Public Health Care in America
  • Medicare
    • A federally administered health care program financed by contributions: 1) from employers and employees; and 2) federal revenues
  • Medicaid
    • A federal-state administered and financed health care program for the poor and needy
    • The federal government pays about 57 percent, the state 43 percent—averaging about 20 percent of state budgets
medicare
Medicare
  • Medicare—a federally administered social insurance program, financed by contributions from employer and employee
    • Provides benefits only to those who have qualified for Social Security or railroad retirement benefits by working for a certain period and making contributions into the fund
    • Part A is a basic compulsory program of hospital insurance
    • Part B is a voluntary program of supplemental medical insurance
  • In 2003, 41 million persons received Medicare
  • Total disbursements in 2002—$256.8 billion
medicaid
Medicaid
  • Medicaid is a health insurance program for the poor and needy
  • Jointly administered by the federal government and the states (all states participate)
  • In 22 states only TANF and SSI recipients are eligible
  • In the remainder of states Medicaid is open to other medically needy persons
medicaid continued
Medicaid (continued)
  • Over 51 million people received Medicaid benefits in 2003
  • Total disbursements in 2000, $168.3 billion
  • Federal government covers about 57 percent and the states 43 percent
  • Medicaid amounts to about 20 percent of state budgets
measures to contain health care costs
Measures to Contain Health Care Costs
  • U.S. reliance on third-party payers takes most incentives away from users to conserve on health care services
  • Health care providers have little incentive to reduce services because they get paid for providing services
  • Measures adopted to date
    • Prospective hospital reimbursement
      • DRGs
measures to contain health care costs continued
Measures to Contain Health Care Costs (continued)
  • Managed care: Health Maintenance Organizations (HMOs)
    • Department of Health approved to contract with HMOs
    • States followed suit
  • Rationing health care: the Oregon case
    • In1993, Oregon began a new program of broadening the base of Medicaid patients but reducing what services they can receive
the wal mart legislation
The Wal-Mart Legislation
  • In January 2006, Maryland became the first state to require large employers to expand and improve health insurance for their employees
  • On July 19, U.S. District Court ruled the Maryland law violated the federal Employment Retirement Income Security Law (ERISA) which bars state preemption of federal employer-benefits provisions