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Social Welfare and Health Policy

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

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  1. Social Welfare and Health Policy Chapter 16 Pearson Education, Inc. © 2008

  2. 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

  3. Social Welfare Policy • Social insurance programs • Social Security (including Medicare) • Unemployment Compensation • Workers’ Compensation

  4. 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

  5. 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)

  6. Number of Persons in Poverty and Poverty Rate 1959-2004

  7. Changing Welfare CaseloadsSelected Years 1961-2005

  8. Drop in Welfare Rolls by State1993-2000

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

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