Pertinent Issues In Public Health&nbspEssay

PARAGRAPH FROM Essay :

Running head: PUBLIC HEALTH

PUBLIC HEALTH 12

Week 5 Assignment:

Why were American Businesses Originally Motivated to offer healthcare to their employeeS? How does this choice influence healthcare in America today?

The system of employer-sponsored insurance is largely a result of one event World War II, and the tax policy and wage freezes that emerged out of it (Field & Shapiro, 1993). Before the 1930s, American employers had little motivation to provide health coverage, and citizens paid their own way where medical costs were concerned (Field & Shapiro. 1993). Employees who worked in dangerous professions such as railroads, steel, and mining had access to company doctors in union-operated infirmaries or industrial clinics, but no coverage was offered for healthcare services beyond these (Rook, 2020). Private insurance in the form of Blue Cross and Blue Shield began to emerge in the 1930s following the Great Depression, where many families, hard-pressed to provide the basic necessities, found themselves leaving healthcare unattended (Rook, 2020). Employers were generally not in the picture at this stage as health insurance offerings were purchased almost exclusively by individuals (Rook, 2020). Things, however, changed during World War II.

With so many eligible workers diverted to military service, there was a severe labor shortage and policymakers feared that businesses would keep raising salaries to compete for the few workers available (Rook, 2010). This would push inflation out of control as was the case in war-torn Germany (Rook, 2020). To minimize this risk and combat inflation, President Roosevelt signed Executive Order No 9250, which established the Office of Economic Stabilization (Rook, 2020). In a bid to combat inflation, the newly-established office froze wages such that businesses were not allowed to raise their pay in order to attract workers (Rook, 2020). In response, employers began to offer health benefits as incentives to employees instead. In 1943, the Internal Revenue Service instituted a policy exempting employer-based insurance from taxation. The tax exemptions increased the incentive for employer-sponsored health coverage, making it cheaper to obtain coverage through a job than by any other means (Rook, 2020). Thus, the original motivation for employer-sponsored coverage was the need to attract workers in a regime of capped wages.

Today, employer-sponsored coverage continues to influence the provision of healthcare. According to Americas Health Insurance Plans (AHIP), approximately 180 million Americans receive their health coverage through employer-sponsored plans (AHIP, 2021). One of the most prominent effects of the current system is job lock, which is a situation where people are dependent on their jobs for their health insurance and are less inclined to leave their jobs even when doing so may be profitable for them. In most cases, workers affected by job lock are often afraid to leave their job because they fear that Medicaid or other market exchange coverage may not be as good (Mann, 2021). The reliance on employer-sponsored insurance coverage induces people to spend more money on health insurance than other things, which consequently increases the level of overall healthcare spending (Mann, 2021). The high demand for employer-sponsored coverage increases health coverage premiums, while wages remain fairly stable.

Secondly, the connection between access to health insurance and employment status means that as people lose their jobs in…

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The next few years may bring about significant changes to health insurance. However, employers are expected to still play a large role in administering health insurance (Mann, 2021). The most plausible way to manage the gaps in coverage resulting from the overreliance on employer-sponsored coverage would be for employers and the government to work together to provide insurance coverage for all Americans regardless of their employment status (Mann, 2021).

References

Americas Health Insurance Plans (202). Employer-Provided Coverage. AHIP. Retrieved from https://www.ahip.org/issues/employer-sponsored-plans/

Field, M. J., & Shapiro, H. T. (Eds.). (1993). Employment and Health Benefits: A Connection at Risk. Washington, DC: National Academies Press.

Mann, R. (2021). The Employment-Health Nexus: Sufficiently Entrenched to Survive Healthcare-for-All. American Bar Association, (Summer 2020)

Rook, D. (2020). A Brief History of Employer-Sponsored Healthcare (From the 1930s to Now). JP Griffin Group. Retrieved from https://www.griffinbenefits.com/blog/history-of-employer-sponsored-healthcare#:~:text=To%20combat%20inflation%2C%20the%201942,health%20benefits%20as%20incentives%20instead.

Week 6 Assignment

Write an essay about a current event elated to health policy. It could be local, state, national, or international

On 11th March 2021, President Joe Biden signed into law the $1.9 trillion Covid19 Stimulus Bill that seeks to deliver direct and immediate relief to workers and families impacted by the Covid19 pandemic. Among the core provisions of the Bill, which was passed by Democrats in Congress without a Republican vote, is an incentive to entice the 12 states that are yet to expand Medicaid coverage under the Affordable Care Act of 2010 to do so. The provision is based on the Federal Medial Assistance Percentage (FMAP), which is the amount of federal money states receive to fund their Medicaid programs (Rudowitz, Corallo & Garfield, 2021). The FMAP is 90 percent for beneficiaries eligible through Medicaid expansion, which implies that the federal government already covers nearly the entire cost of expansion (Rudowitz et al., 2021). The Bill, however, incentivizes Medicaid expansion by the 12 states that are yet to do so by having the federal government pay for an additional 5 percentage points of Medicaid costs in the traditional Medicaid program for two years (Rudowitz et al., 2021). This increase of 5 percentage points represents a massive flow of federal funds to states as sources project that even in states that have expanded coverage, spending in the traditional Medicaid program accounts for almost 80 percent of total program spending (Gee & Waldrop, 2021).

Another provision in the Bill seeks to have the federal government temporarily pick up health insurance costs for those who have lost their employer-sponsored or private coverage due to the Covid19 pandemic. It is estimated that the generous subsidies to non-expanding states and the other changes related to private insurance would increase the number of Americans enrolled in health insurance by 5.3 million (Ollove, 2021). The targeted states also stand to reap huge benefits from the incentive for instance, Florida and Georgia, the two largest holdout states, could net $3.5 billion and $5.9 billion respectively if they took the deal (Rudowitz et al., 2021). This begs the question – to expand or not to expand Medicaid coverage?

The ACAs original design was such that all persons in households earning up to 138 percent of the federal poverty level were eligible for Medicaid (Sohn & Timmemans, 2017). A Supreme Court ruling in National Federation of Independent Business vs. Sebelius (2012), however, limited the ability of the federal government to enforce state compliance (Sohn & Timmemans, 2017). This opened up avenues for states to expand Medicaid eligibility within their jurisdictions in line with economic conditions, political factors, and the number of uninsured citizens (Sohn & Timmemans, 2017). Twenty-four states and the District of Columbia had expanded coverage by January 2014, and only 12 states are yet to expand coverage this far (Sohn & Timmemans, 2017).

However, the decision on whether or not to expand coverage ought to be based on the long-term benefits and costs of such expansion, and not the two-year subsidies proposed in the Covid19 Stimulus Bill. Medicaid expansion has been shown to reduce the number of uninsured persons in a state (Sohn & Timmemans, 2017). For instance, Medicaid expansions in…

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