HEALTH POLICY 8
Healthpolicies shape and reflect contemporary and historical politicalphilosophies and priorities and drive government actions. The paperwill discuss five emerging issues in health care policy. These issuesinclude affordable care act, drug price, reproductive health, healthcare entitlement and opioids and heroin.
AffordableCare Act (ACA)
ACAintroduced a comprehensive health insurance reforms to provide allAmericans with health security. These improvements include holdinginsurers accountable, increasing care affordability and expandinghealth care coverage. The law expands Medicaid coverage particularlyto Americans from low socio-economic background. ACA bandiscrimination based on pre-existing conditions by compellinginsurers to provide health coverage to any persons regardless oftheir current medical conditions. It also prohibits insurancecompanies from charging patients different coverage premiums forsimilar conditions. ACA also contains other provisions aimed atimproving access to care for an underserved population such asschool-based health centers, community health workers, and supportfor nurse-managed health centers.
ACAis increasing access to quality health care. According to Reisman(2015), more than 17 million Americans have gained health coveragethrough ACA. Although ACA has significantly reduced the number ofuninsured people, it has increased the cost of health care. Furthermore, ACA affects medical reimbursement policy for health careproviders. Due to the expansion of the covered services, providersexpect a rise in reimbursement due to a greater influx of patients.The high number of insured people may provide a boost in revenue.However, physicians are likely to be overloaded due to the currentshortage of health care providers. The Center for Medicare andMedicaid Services (CMS) is reducing payments to services that fail tocomply with their initiatives. It imposes a penalty on physicians whodo not meet their standards. The rising penalties will reduceproviders’ reimbursement.
Inmy opinion, ACA is a highly complex legislation featuring manyregulatory provision meant to address the lack of health insurancecoverage affecting different groups. Although it is changinghealthcare immensely, it has failed to meet its purpose (reducing thehealth care cost). ACA must deliver what it promised Americans togain public support. ACA remain highly politicized, but politiciansremain deeply divided in their opinion about ACA. Some of thepoliticians want the Congress to repeal the law and replace it with anew plan that increases access to quality care for more Americans ata lesser cost while others want the law expanded.
Drugpricing in the US has become a major issue for policy makers, payers,and patients. It is a nearly impossible task to design efficient andreasonable drug pricing that take into consideration patients’situation. Individual spending on the drug in the US is higher thanin any other country. The brand name of drugs continues to increaseat rates that are beyond consumer price index. Monopoly rights givento the drug manufacturers through patents and approval by Food andDrug Administration has led to market exclusivity protected that inturn allows drug manufacturers to set high prices (Kesselheim, Avorn& Sarpatwari, 2016). Drug manufacturers in the US remain solemanufacturers due to the patent system that is currently in place.Moreover, FDA gives manufacturers exclusivity for certain products.
Theincreasing cost of prescription drugs affects Medicare part D. Thehigh prices of certain drugs contribute to rising federal paymentsfor the catastrophic coverage in the Medicare part D. In catastrophiccoverage, the federal government pays the vast majority of the costfor drugs. In 2015, federal payments for catastrophic coverage wasover $33 billion, triple the amount paid in 2010 (Kesselheim, Avorn &Sarpatwari, 2016). The high price drugs were responsible for abouttwo-thirds of the federal payments for catastrophic coverage. Theeffect of high drug price is not exclusive to catastrophic coverage.It affects the entire part D program and can lead to higher costs forall beneficiaries.
Inmy opinion, fixing the US drug pricing issue is not an easy task, butthe action is necessary to address the issue to allow both innovationand affordability. However, the government should feel the need tocontrol drug pricing. It should extend exclusivity right and createan opportunity negotiation of drug prices. Furthermore, CMS shouldcreate more transparency for drug pricing and restructure the part Dbenefit to create opportunities and incentives to lower cost.
Drugpricing is subject to a lot of political debate. Politicians blamesome drug makers for raising prices and lack of competition. Somepoliticians feel that the pharma executives have done little to lowerthe cost of prescription drugs. The congressional Republicans havesuggested two policies that can reduce drug cost: changing thestructure of FDA in a way that can allow new drugs to be approvedmore quickly to foster competition and invest more funds in research(US Department of Health and Human Services, 2017).
Reproductivehealth emphasizes on people and their rights to reproduction, familyplanning, sexuality and information to actualize these rights. Poorreproductive health can have devastating consequences on families andindividuals along with adverse effect on the health care system.Currently, there are many reproductive health issues in womenincluding infertility, sexually transmitted diseases, endometriosis,fibroids, postnatal depression and polycystic ovary syndrome. Menreproductive health issues include sexually transmitted diseases,infertility, erectile dysfunction and prostate cancer. Thereproductive health burden falls heavily on women due to biologicalreasons (Nash, 2016). The more severe reproductive health risk forwomen is family planning and maternity. Restriction of familyplanning services and inadequate health services continues to affectthe reproductive health of many people. Furthermore, there isinequality in reproductive health which is reflected by the highmortality rate among low-income and underrepresented population.
Disparitiesin reproductive health affect the ACA that has provisions related tothe reduction of disparities in health care. ACA resolves gaps inhealth care by requiring preventive services including those relatedto reproductive health are covered. It has also affected Medicaid bylimiting family planning providers’ eligibility (Nash, 2016). Somestates have excluded family planning entirely from Medicaid program.
Inmy opinion, limiting family planning services affects womendisproportionally due to biological characteristics. Restrictingaccess to family planning services will continue to increase healthcare burden and affects women`s quality of life and health caresystem. The government should strive to make accessible reproductivehealth through primary health care system. Reproductive healthpolitics continue to endanger women`s health. Since 2011, statelegislatures have passed over 250 laws that put women`s reproductivehealth at risk (Nash, 2016). Politicians have reduced access tofamily planning services leading to unwanted pregnancies.
Thespending on three main government entitlement programs (Medicare,Medicaid, and social security) is projected to rise significantly.Entitlement programs take up a large share of the federal budget, andthey are becoming more expensive over time (US Department of Healthand Human Services, 2017). The rising spending comes from sources:increases in the average spending per person and increases the numberof beneficiaries. The growing expenditures on health entitlementsnecessitate an assessment of public spending.
Inmy opinion, health entitlements are enormous and primary drivers ofthe deficits. They are also unsustainable because many Americans livein retirement driving up the cost of the programs. If the risingspending on health entitlement is left unaddressed, the increase inhealth entitlement spending put the government`s budget at risk.Politicians are insisting significant cuts to Medicare and Medicaidas a way to reduce the budget deficit. However, cutting Medicare andMedicaid benefits will hurt most of the vulnerable Americans. Otherpoliticians have suggested raising the Medicare eligibility age, butthis change will increase total health care costs and shift theburden to individuals and employer without achieving a significantsaving of government money. The best strategy for reducing Medicareand Medicaid spending is extending provisions in the ACA to encourageefficient ways to deliver health care (US Department of Health andHuman Services, 2017). Such an approach will reduce federal deficits.
Theabuse of opioids such as heroin is a serious issue that affectseconomic, social and health welfare of the society. Approximately 2.1million Americans suffer from complications related to opioids abuse.In a study conducted by Barry et al. (2016) 69.5% of Americansreported having used opioid in their lifetime. Americans view theabuse of opioid pain relievers as an issue that warrants attentionand supports all the policy recommendations by public health, lawenforcement, and a medical expert to curb the epidemic. The problemof prescription painkiller abuse continues to affect many Americanseither directly or indirectly. Deaths related to opioidsprescriptions continue to increase at an alarming rate. Severalfactors contribute to the severity of the opioid problem. Theyinclude greater social responsibility for using opioids for differentpurposes, increases in the number of prescription and aggressivemarketing by the pharmaceutical companies (Volkow, 2016).
Theabuse of opioid affects health policies related to insurance. Thestate government requires the private insurance companies to covertreatment services for opioids. However, many health insurance plansprovide limited coverage for treatment programs for people addictedto heroin. Requiring private insurers to expand coverage for opioidtreatment program may increase the cost of health insurance premiumsfor insured people.
Inmy opinion, users of opioid, pharmaceutical industry that sell opioidand doctors who prescribe them inappropriately are the three groupsmainly responsible for the abuse. Politicians from both democrat andrepublican view abuse of opioid as a serious problem that affects thequality of life. They also think that treatment programs areessential for people caught possessing opioids without prescription.
Thepaper has discussed five current issues facing the health caresystem. It is clear that all the issues discussed affect healthpolicies related to health insurance. They also influence theaffordability of health care services and the quality of health.
Barry,C. L., Kennedy‐Hendricks,A., Gollust, S. E., Niederdeppe, J., Bachhuber, M. A., Webster, D.W., & McGinty, E. E. (2016). Understanding Americans’ views onopioid pain reliever abuse. Addiction,111(1),85-93.
Kesselheim,A. S., Avorn, J., & Sarpatwari, A. (2016). The high cost ofprescription drugs in the United States: Origins and prospects forreform. Jama,316(8),858-871.
Nash,E. (2016). Laws affecting reproductive health and rights. State trendat mid-year, 2016. Retrieved 23 March 2017 fromhttps://www.guttmacher.org/article/2016/07/laws-affecting-reproductive-health-and-rights-state-trends-midyear-2016
Reisman,M. (2015). The Affordable Care Act, Five Years Later: Policies,Progress, and Politics. Pharmacyand Therapeutics,40(9),575–600.
USDepartment of Health and Human Services. (2017). High-Price Drugs AreIncreasing Federal Payments for Medicare Part D Catastrophic Coverage. Retrieved23 March 2017 fromhttps://oig.hhs.gov/oei/reports/oei-02-16-00270.asp
Volkow,N. (2016). America’s Addiction to Opioids: Heroin and PrescriptionDrug Abuse. National Institute of Drug Abuse. Retrieved 23 March2017 fromhttps://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2016/americas-addiction-to-opioids-heroin-prescription-drug-abuse