CELF 2012-2013 Research Project: Public Financed Health Care Programs

8/14/2019 CELF 2012-2013 Research Project: Public Financed Health Care Programs

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Civic Engagement Leadership Fellowship Program

Hailing Wang

Lan Chen

Wenyi Zhang

Xiuzhi Wang


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Public Financed

Health Care Programs

Hailing WangLan ChenWenyi ZhangXiuzhi Wang

Civic Engagement Leadership Fellowship Program 2013:


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ContentsForewordAbstract

1 Healthcare Reform History in the United

2.1 NHI and the New Deal 2.2 NHI and the Fair Deal 2.3 The Great Society: Medicare and Medicaid 2.4 The Health Security Act 2.5 The Affordable Care Act

2 Foreign Health Care System Compariso

1.1 United States 1.2 Switzerland 1.3 Norway 1.4 Comparisons with USA Health Care Systems

3 Publicly Financed Health Care Program Medicaid and Medicare

3.1 Medicaid:Safety-net Health Care Program forPeople with Low Income and Resources

3.2 Medi-Cal: The Medicaid Program in the State of Californ 3.3 Medicare: Public Health Care Program for

Senior or Disabled Citizens

4 Resources for the Community

5 Conclusion

6 Works Cited

7 About the Interns

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4

10

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ForewordThe CAUSE Executive interns are pleased to present the 2013 Healthcare Research

Project. This project comprises of extensive research on the healthcare reform efforts,healthcare programs and resources in the United States. We have conducted variousinterviews with researchers, physicians and community leaders in the Greater Los Angeleswho helped us to have better understanding of how healthcare system in the United Stateschanges over time and how it operates in California.

Health security relates to every individual in the United States. It is widely believed thatquality and affordable health care should be a right for each individual, not for a privilegefor the few. However, compared to many developed countries, the United States medicalservices are not only very expensive, but of low quality as well. In addition, millions of

Americans are uninsured and more are under-insured. This has become a growingconcern for the Americans who feel the pressure to afford the medical services once theyor their family members are sick. The Medicare and the Medicaid programs as well as thenewly pass of the Affordable Care Act by President Obama are the publicly funded healthprograms to help the unemployed, poor, aged and disabled to get access to better healthservices. The programs and the act are too complicated for the ordinary people with littleknowledge of the healthcare. Therefore, we would like to present a readable and simpleguide for the API community members to know more about the health policies. It is ourhope to let the API community members to get more information from reading this brochureand know how to protect their health right.

This project would not be as what it is without the contributions of other supporters.The CAUSE executive class of 2013 would like to extend its great gratitude to a fewspecial people that has did a huge favor to this research project. Without the existenceof CAUSE and its Executive Internship Program for the first year, we would not have had

the opportunity to complete the research project. We would like to give special thanks tothe CAUSE Executive Director Carrie Gan, the CAUSE Program Director Grace Hsieh, theCAUSE Communication Director Sophia Islas, and Charlie Woo, Chairman of the Board ofCAUSE, who spent many hours and made great efforts to provide us with various resourcesthat are of great importance to move our project ahead. We would also like to thank themany interviewees: Mark Masaoka, the policy coordinator of A3PCON and John Romely,professor at University of Southern California. They have engaged in the research andpractical work in the healthcare field for a very long time. We would like to thank for theirvaluable time that they spent with us. Because of their insightful talk, we are able to bringthis project to a higher level of professionalism and sophistication. Thanks to all the helpthat mentioned above. Without them, we could not complete this project.

Sincerely,The 2013 CAUSE Executive Interns


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AbstractAs a guideline of current United States health care systems, this project mainly intends

to present some basic ideas of the history of United States medical systems, comparisonsbetween America and some countries that have well organized and healthy medicalsystems and the underway United States Health care reform in order to provide a better,more comprehensive understanding of the health care reform for voters.

First of all, the project maps out the history journey of the health care reform in theUnited States. Dating back to the beginning of 20th century, many presidents in their termsmade great efforts to pave ways for the universal health care coverage. However, becauseof the great oppositions from the health industry, as well as physicians, conservatives whoregard universal health insurance coverage as communist and unnecessary. The plan wasnot signed into law until 2010 when the Obama Administration finally put it into action.

Whats more, by going through countries that have successful health care systems andcompare them with Americas health care system, this project tries to find cohesions inforeign systems that Americans can learn from or adapt into its current reform, which aretwo publicly financed health care programs in the US--Medicaid and Medicare, the specificMedicaid program in California is Medi-Cal. Medicaid is jointly funded by federal and state,so each state has its own Medicaid program, which is Medi-Cal in California state. In thispart, information includes eligibility, cost and services covered in each program, as a result,it provide a comprehensive perspective for voters to acknowledge the current situation inthe United States especially in California.

Last but not least, this project also layouts online resources for the communitymembers in order to assist them with doubts and questions, those online resources includegovernment and nonprofit websites mostly, on behalf of the communities, they help them

know more.


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Many of us believe that we need health care reform.

That being said - Americans felt like they werent being lis-

tened to. There were a lot of people across the political spec-

trum who said we dont want a one-size-fits all healthcare

plan.

- Timothy Griffin,U.S. Representative for Arkansas 2nd Congressional District


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Health care has undergone dramatic transformation since its emergence in the earlytwentieth century. In the first half of the 20th century, medical care in the United States wasfar more structurally primitive compared to its present-day form. Following the World War I,medical technological advances started to rapidly change, resulting in a dramatic increasein medical costs. Medical care expense, once a concern of the unemployed and the poor,imposed a greater financial burden on the middle class, health care expenses seemed

unpredictable and uncontrollable (Shi & Singh, 2009). About 46 million Americans are notinsured, and even millions are underinsured, more still worrying about being under-insuredor uninsured in the future (Kaiser Family Foundation, 2009).

The quality of health care in the U.S. falls far behind other countries, such as Canadaand England. The problematic health care system undermines the U.S. image as aleading nation in the world. The U.S. government has made continuous efforts to reformthe problems that the healthcare system faces. However, many of the plans and proposalsfailed to come into effect because of a plethora of reasons including the complexity ofthe issues, ideological differences, the lobbying strength of special interest groups, aweakened presidency and the decentralization of Congressional power (Kaiser FamilyFoundation, 2009). The reforms are presented chronologically:

1Health Care Reform History in the United States

Cost-Containment Trumps NHI

The Health Security Act

NHI and the New Deal

Medicare Perscription Drug, Improvement,and Modernization Act

Affordable Health Care Act

NHI and the Fair Deal

The Great Society: Medicare and Medicaid

Competing NHI Proposals

1934-1939

1945-1950

1976-1979

1992-1994

2003

2008-2010

1960-1965

1970-1974


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2.1 NHI and the New Deal

After the Great Depression, many working groups, veterans, and senior citizens felt theneed for a national health insurance policy. They advocated for NHI and garnered publicsupport that allowed it to move into the legislative consideration. Because of the push forsocial programs and the creation of the New Deal, NHI made itself into the preliminaryreports of the Social Security Act, but, unfortunately, not the final report (Willison, 2013).

A strong force of opposition against NHI came from the emerging power of the American

Medical Association (AMA). Physicians feared that the significant structural changes thatNHI brought would lead to a loss of overall professional physician autonomy, and wouldresult in lower wages for physicians (David, 1985). Furthermore, the growing marketof private insurance companies also took offense to the threat of a restructured healthcare system. Due to these strong oppositions, the issues of unemployment and workerprotections appeared as priority in the final bill, covering the importance of NHI (Willson,2013). President Roosevelt hoped that a national health policy could pass just after thepassage of the Social Security Act, but its advocates lost momentum.

2.2 NHI and the Fair Deal

President Harry S. Truman is regarded as the first president to champion nationalobligatory health insurance coverage. Trumans efforts to achieve national obligatory

insurance coverage defined a pathway to current healthcare reform in President BarackObamas term. One year after Truman took office, he called for compulsory healthinsurance for all Americans that would be funded by payroll deductions. All citizens wouldreceive medical and hospital services regardless of their ability to pay (Leibowitz, 2010).Unfortunately, these reform efforts failed in both of his terms.

I have had some bitter disappointments as president, but the one that has troubledme most, in a personal way, has been the failure to defeat organized opposition to anational compulsory health insurance program President Harry Truman

In November of 1945, President Truman called for the creation of a national healthinsurance fund to be run by the federal government.Participants would pay monthly fees for the plan that would cover the cost of any and allmedical expenses. The government would also pay for the cost of services accrued bydoctors who chose to be a part of the program. President Truman publicly argued, Thehealth of American children, like their education, should be recognized as a definite publicresponsibility (Truman, 1945). He then pushed for national health insurance as a partof his Fair Deal after World War II. Despite the plan has a large popularity, it did not geta hearing before the House Ways and Means Committee (Schremmer & Knapp, 2011).The voice of strong opposition argued that the government control of health care wouldundermine the existing system and that national healthcare insurance could be expensivefor the nation to afford, and also unnecessary since private insurance had already done agood job (Kaiser Family Foundation, 2009).


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2.3 The Great Society: Medicare and Medicaid

While the elderly yield the highest medical costs of any group in the nation, many ofthem are unable to afford private health insurance. This results to medical bills being themajor cause of poverty among the elderly. In 1960, President Eisenhower signed into law,which is considered to be Medicare, which gave grants to states for health care for theaged poor. But, by 1963, only 28 states were participating (Noonan, 2009).

Even though the situation of a Democratic majority and a Republican minority seemedto provide a great opportunity for President Lyndon Johnson to pass the Medicare andMedicaid, a huge size of democrats obscured the importance of President Johnsonsleadership in this cause. Many democrats in both houses were conservative southernerswho were hostile to expand social programs. President Johnson did not give up but takeevery means to move the programs through (Nonan, 2009).

President Johnsons efforts were not in vain. Medicare and Medicaid are considered astwo of the great legacies that the Great Society era of the mid-1960s has left to the U.S..Medicare covers senior citizens and many of the disabled. Medicaid is a federal-statepartnership providing insurance to the poor. Both these programs cover tens of millions ofpeople and remain giants of the current American social contract (Centers for Medicare andMedicaid, 2012).

2.4 The Health Security Act

The Health Security Act, also known as the Clinton health care plan, named afterPresident Bill Clinton, who first proposed by the President Bill Clinton Administration toreform the health care system in the United States. In the 1992 presidential election, BillClintons campaign focused heavily on health care. The task force began in 1993 withthe goal of formulating a comprehensive plan to provide universal health coverage forall Americans (Robin & Steinburg, 2003). The proposed plan was to enforce a mandatefor employers to provide health insurance coverage to all of their employees throughcompetitive but closely regulated maintenance organizations.

However, conservatives, liberals, and the health insurance industry were stronglyagainst the plan, seeing it as overly bureaucratic and restrictive of patients choices (Moffit,1993). The industry even produced a television show Harry and Louise as advertising togain public support against the plan. Also, other democrats offered a number of competingplans of their owns to oppose to the Presidents original proposal (Kramer, 1994). BySeptember 1994, the final compromise was declared dead marking the Health Security

Acts failure.

Clinton Tried to enact health care reform in the United States

but failed.

Source: Bill Clinton Photo Gallery at history.com/p[hoto/bill-

clinton/photo14


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The Affordable Health Care Act extends the healthcareinsurance to many people who dont have Medicaid, and all

residents and citizens are qualified for it. The way of delivery

will be more efficient.

- John Romely,Research Assistant Professor,

Leonard D. Schaeffer Center for Health Policy and Economics of USC


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2.5 The Affordable Care Act

As we have seen, U.S. has been on the verge of national implementary healthcaresince the early 20th century. Presidents Roosevelt, Truman and Clinton mentioned above,made great endeavors to push the universal healthcare insurance forward in history. Theblueprint for universal health care, however, remains to be of a slightest hope until PresidentObama took persistent actions to provide all the Americans with better health security.

Rather than start at the outset talking about legislative process and whats going tohappen in the Senate and the House and this and that lets talk about the substance:How we might help the American people deal with costs, coverage, insurance, these otherissues. And we might surprise ourselves and find out that we agree more than disagree.

And that would then help to dictate how we move forward. It may turn out on the other handtheres just too big of a gulf. President Obama

On March 23 2010, President Obama signed a major health care legislation, thePatient Protection and Affordable Care Act (also known as ACA), into law. The ACA makespreventive care more accessible and affordable for the Americans. Some of the provisionshave been taken into effect, while others are still in process and will be implemented in thecoming years. With the Health Care and Education Reconciliation Act, it represents themost significant government expansion and regulatory overhaul of the health care system sincethe creation of Medicare and Medicaid in 1965 (Vincini & Stempel, 2012).

President Obama signed majro health care legislation into law on March 23, 2010

Source: New York Times at nytimes.com/2010/03/24/health/policy/24health.html?_r=0


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I think we should pay for quality healthcare rather than

just quantity. Besides, coordinated healthcare system should

be improved.

- John Romely,Research Assistant Professor,

Leonard D. Schaeffer Center for Health Policy and Economics of USC


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1.1 United States Since health care is one of the biggest issue across the world and each country hasits own unique systems. As a beginning to describe healthcare systems in the UnitedStates, we need to look at some successful countries and compare them with Americanconstructions in order to have a better understanding of the whole idea of the reform andcome up with more solutions to improve the mechanism.

Since 2002, employer-sponsored health coverage for family premiums has increased by97%. In the U.S. an increase that has burdened both employers and their workers. [KaiserFamily Foundation, 2012] In the public sector, Medicare covers the elderly and the disabled.Medicaid provides coverage to low-income families. Due to the aging of the baby boomerpopulation, Medicaid enrollment grew. [Centers for Medicare and Medicaid Services, 2012]This means that the total government spending has increased largely, straining federaland state budgets. As a result, health spending accounted for 17.9% of the nations GrossDomestic Product (GDP) in 2010. [Martin, 2012]

Health care spending in the United States per person is characterized as being themost costly, despite its high cost; overall the quality of health care is low due to someinefficient coordination. According to the World Health Organization (WHO), total healthcare spending in the U.S. amounted to 17.9% of its GDP in 2011, the highest in the world.[ National Health Expenditure Data, 2008] Per each dollar spent on health care in theUnited States, 31% goes to hospital care, 21% goes to physician/clinical services, 10% topharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home health care, 3% forother retail products, 3% for government public health activities, 7% to administrative costs,7% to investment, and 6% to other professional services (physical therapists, optometrists,etc.). [KaiserEDU.org, 2009] Around 84.7% of Americans have some form of healthinsurance; either through their employer or the employer of their spouse or parent (59.3%),purchased individually (8.9%), or provided by government programs (27.8%; there is some

overlap in these figures). [The Commonwealth Fund, 2010]

While the U.S. currently deals with Obamacare as the state of California deals with itsown health care system reforms. It would be wise to looking at different and successfulhealth care plans. Different countries have come up with various ways to build systemsthroughout history. Here are some of examples from the globe in comparison with U.S.health care systems.

2Foreign Health Care Systems and Comparisons


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1.2 Switzerland

Switzerlands healthcare system is neither based on tax nor partly financed by employercontributions. The responsibility to acquire health insurance coverage pay the requiredpremium lies solely on the individual rather than the employer. There are numerous tariffsand rates to meet individual needs, but every public health insurance provider must offera basic package that complies with national standards. Except for compulsory medicalinsurance, there is an optional daily benefits insurance, which ensures continuous pay in

case of prolonged periods of absence from work due to illness. [InterNations] Patients canchoose their doctors freely. They have direct access to specialists without prior consultationfrom a family doctor or a general practitioner. Switzerland has a relatively high nationalstandard. Both public and private hospitals exceed international healthcare standards. Dueto the international nature of private health care sector, most of the staff is English-speaking.Pharmacies in Switzerland are clearly marked with a green cross. Many medicinesfrequently found in supermarkets or considered over the counter elsewhere are generallyonly available at the pharmacy. They can be purchased without prescription but must berequested. [Rovner, 2008] Pharmacies are listed in the telephone directory. As a result,even the smallest mountain states usually have at least one pharmacy. All-night pharmaciesoperate in most large towns and cities. [Jones, 2013]

1.3 Norway

Norway has an excellent standard of compulsory state funded healthcare. Healthcare isavailable to all citizens and registered long-term residents, the Ministry of Health in Norwaydesigns healthcare policy and oversees the state system.

As necessary well trained, doctors are the first to contact with the Norwegian healthsystem. Private healthcare is also available. The health service is funded predominantlythrough taxes taken directly from worker salaries and there is no specific health contributionfund. The National Insurance Administration, known as the Trygdeetaten, is accountablefor the National Insurance Scheme (NIS), a state insurance program that guaranteeseverybody a basic level of health care. The NIS provides benefits for illness, accidents,bodily defects, pregnancy, birth, disability, death, and loss of the breadwinner as well asfor unemployment and old age. All citizens who live or work in Norway or are on workpermanent within the Norwegian Continental Shelf must contribute to the NIS. [Europe-cities] There are significantly high charges for dental treatment for adults. Private healthcaredoes not play a large role in Norway since they have excellent standard of state healthcare.Emergency treatment is provided at the emergency room of all hospitals which are openyear-round.


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1.4 Japan

Japans social security system is approximately divided into four pillars: socialinsurance, social welfare, public assistance, public health. The core social insurance is acompulsory system that ensures the livelihood of citizens by providing a given amount ofcash or in-kind benefits in case of life events insured against unexpected diseases. Withinthis framework, a universal healthcare insurance system extended to all citizens has beenset up in accordance with the National Health Insurance Act. Japanese citizens have to be

covered by one of the following medical insurances: 1) employees health insurance foremployed individual, 2) national health insurance for self-employed individuals and thoseout of employment, and 3) the healthcare system for the late-stage, elderly aged 75 yearsor older.

In the medical insurance system, the insured pays an individual fixed amount of moneyeach month to the insurers. In 2008, the national health expenditure reached 34, 808.4billion yen, with more than half of total contribution to healthcare costs for the elderly aged65 or older. The ratio of national health expenditure to national income was 9.9% and that toGDP was 8.1%, and ranked 22nd in the ranking of major OECD countries. [The Economist,2011] At present, it is under consideration to abolish this system and to establish a newsustainable system that applies to all citizens.

Source: nurse.or.jp/jna/english/nursing/medical.html


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1.5 Comparing to the United States

Although the Japanese spend half that what Americans spend on health care, they livelonger. Thanks to their cheap and universal health insurance system kaihoken, Japanesesee doctors twice as often as Europeans and take more life-prolonging and life-enhancingmedicines. They stay three times as long as the rich-world average and life expectancyhas risen from 52 in 1945 to 83 today. The country boasts one of the lowest infant-mortalityrates in the world. In addition, Japanese health-care costs are a mere 8.5% of GDP. [The

Economist, 2011]

Norwegian systems are in high quality, whether it is public or private. The taxes aredirectly taken from salaries at no extra cost. They have reached to a level where everyonecan have access to high quality health care and they receive highly standard care and eachone can have his special treatment from his own doctor.

The Swiss government entities spend approximately 3.5% of its GDP on healthcare in2010, compared to 8.5% in the United States. Thats a difference of more than $5 trillionover 10 years, especially relative to the $16 trillion debt in the United States. There is nopublic option in Switzerland. Instead, citizens are eligible for means-tested, sliding-scalesubsidies and are able to choose from a variety of regulated, private-sector insuranceproducts. The Swiss have the freedom to choose their own doctors, as Americans do,and access to the latest medical technologies. They also have short waiting time for

appointments. In Switzerland everyone is required to pay for the insurance. On one hand,individuals not employers or the government choose from a broad array of healthplans, sold by private insurance companies. On the other hand, everyone in Switzerlandhas health coverage but health insurance premiums are not linked to income. Thuseveryone pays the same rate. In the United States care was of high quality, but expensive.


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The health care reform bars insurers from placing

lifetime limits on what they will pay for a workers medical

care, plus there are new restrictions on annual benefit

limits. Insurers are no longer able to arbitrarily cancel your

insurance policy when you get sick, except in cases of fraud.

- Brian Chiglinsky, Spokesman for the Centers for Medicare & Medicaid Services


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In the United States, there are two major publicly financed health programs knownas the Medicaid and Medicare program. The Medicaid program serves financially and/ormedically vulnerable populations, while the Medicare program targets the senior populationwho are in need of medical services. Medicaid is jointly funded by the Federal and Stategovernment. Therefore, states could have greater autonomy in tailoring their specificMedicaid program to their perspective states needs. In the state of California, the Medicaid

program is called Medi-Cal.The following parts provide basic introductions on the Medicaid, Medi-Cal, and Medicare

programs; each includes an overview, the eligibility description, cost allocation, servicecoverage, and any additional information the public might need.

3Publicly Financed

Health Care Programs


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3.1 Medicaid: Saftety-Net Health Care Program for People withLow Income and Resources

Overview

Medicaid is the United States health program for families and individuals with lowincome and resources. It is a means-tested program that is jointly funded by the stateand federal government, and is managed by each state. Individuals who are eligibly for

Medicaid are U.S. citizens or legal permanent residents, including low-income adults, theirchildren, and people with certain disabilities. Although poverty alone does not necessarilyqualify someone for Medicaid, it is the largest source of funding for medical and health-related services for people with low income in the United States. According to the HealthInsurance Association of America, Medicaid is defined as a government insuranceprogram for persons of all ages whose income and resources are insufficient to pay forhealth care. Medicaid is state-administered and financed by both the states and the federalgovernment (HIAA, pg. 232).

Eligibility

Medicaid and CHIP (Childrens Health Insurance Program) provide health coverageto nearly 60 million Americans, including children, pregnant women, parents, seniors,and individuals with disabilities. In order for states to participate in the Medicaid program,federal law requires states to cover certain population groups (mandatory eligibility groups).However, states have the flexibility to cover other population groups (optional eligibilitygroups). States set individual eligibility criteria within federal minimum standards. Statescan apply to Center for Medicare & Medicaid Services (CMS) for a waiver of federal law toexpand health coverage beyond these groups. (www.medicaid.gov)

Many states have expanded coverage, particularly for children, above the federalminimums. For many eligibility groups, income is calculated in relation to a percentageof the Federal Poverty Level (FPL). For example, 100% of the FPL for a family of four is$23,550 in 2013. The Federal Poverty Level is updated annually. For other groups, incomestandards are based on income or other non-financial criteria standards for other programs,such as the Supplemental Security Income (SSI) program.

(Figure retrieved from Kaiser Family Foundation, A primer of Medicaid 2013)


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The Affordable Care Act of 2010Expanding Medicaid Eligibility in 2014

The Affordable Care Act of 2010, signed by President Obama on March 23, 2010,created a national Medicaid minimum eligibility level of 133% of the federal poverty level($29,700 for a family of four in 2011) for nearly all Americans under the age of 65. ThisMedicaid eligibility expansion goes into effect on January 1, 2014, but states can chooseto expand coverage with Federal support any time before this date. For the first time, low-

income adults without children will be guaranteed coverage through Medicaid in every statewithout need for a waiver, and parents of children will be eligible at a uniform income levelacross all states (www.Medicaid.gov).

As mentioned previously, the Medicaid program is jointly funded by the federalgovernment and states. The following data shows the number of enrollees in the CaliforniaMedicaid program, as well as the total program cost by federal and state shares.

Number of Enrollees in the California Medicaid Program

Total Program Cost by Federal and State Shares


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Overview

The California Medical AssistanceProgram, or Medi-Cal, is the name ofthe California Medicaid welfare program.

Medi-Cal targets low-income families,seniors, persons with disabilities, childrenin foster care, pregnant women, andcertain low-income adults. Medi-Cal is

jointly administered by the CaliforniaDepartment of Health Care Services(DHCS), and the Centers for Medicare andMedicaid Services (CMS), which providesmany services implemented at the locallevel mainly by the counties of California.

Approximately 8.8 million citizens wereenrolled in Medi-Cal for at least 1 monthin 2009-10, or about 23% of Californiaspopulation (Medi-Cal Program Enrollment

Totals for Fiscal Year 2009-10).

3.2 Medi-Cal: The Medicaid Program in the State of California

Eligibility

Medi-Cal (MC) provides health coveragefor people with low income and limitedability to pay for health coverage. Beginningin 2014, under the Patient Protection and

Affordable Care Act (PPACA), which isinformally referred to as Obama Care, thosewith family incomes up to 133% of thefederal poverty level will become eligiblefor Medi-Cal (Center for Medicare andMedicaid) Individuals with higher incomesand some small businesses may choosea plan in the new California Health BenefitExchange with potential federal subsidies(Medi-Cal Program Fact Sheet, 2011).

To be eligible for Medi-Cal, theperson must be a California resident.However, there is no durational residencyrequirement. To receive full-scope

coverage, an individual must be a UScitizen or a noncitizen with satisfactoryimmigration status. Noncitizens withoutsatisfactory immigration status and citizenswith no proof of citizenship and identity mayreceive coverage limited to emergency,skilled nursing, and pregnancy related care(Medi-Cal Program Fact Sheet, 2011).

Services Provision

Applicants who are eligible to receivefull-scope MC benefits are covered witha comprehensive range of health care

services such as dental care (for pregnantwomen and children ages 0 up to 21years), and prescription drugs (both inand out of a hospital or nursing home),from health care providers who participatein the program. Pregnant women may beentitled to benefits that include pregnancy-related services and 60 days of postpartumservices at zero share of cost (Medi-CalProgram Fact Sheet, 2011).

For noncitizens who do not havesatisfactory immigration status and citizenswith unverified proof of citizenship, Medi-

Cal would cover pregnancy-related serviceswhich include labor and delivery of aninfant, and emergency medical servicesonly (Medi-Cal Program Fact Sheet, 2011).

Income Requirement for Eligibility

An applicants non-excluded resourcesmust not exceed the limits, based on familysize, as shown below:

Data taken from Medi-Cal Program Fact Sheet, retrieved from http://dpss.lacounty

gov/dpss/WAC/pdf/factsheets/Medi-Cal%20Fact%20Sheet%20July-Sept%202011

pdf Medicaid Program

$3,450

$3,600

$2,000

$3,750

$4,050

$3,900

$4,200

$3,000

$3,150

$3,300

1 Person

2 Persons

5 Persons

6 Persons

7 Persons

9 Persons

8 Persons

10 or More Persons

3 Persons

4 Persons


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3.3 Medicare: Public Health Care Program for Senior or Disabled Citizens

Overview

In the United States, Medicare is a national social insurance program administered bythe federal government. Medicare mainly provides health insurance for Americans age 65and older and people age under 65 with disabilities (Medicare.gov, 2012).

Medicare serves a large population of old and disabled individuals. In 2010, 47 millionAmericans benefited from the Medicare Insurance program39 million people age 65 andolder and 8 million younger people age under 65 with disabilities. On average, Medicarecovers about half (48 percent) of health care costs for enrollees, while the rest of the costmust be covered by Medicare enrollees themselves. (Kaiser Foundation, 2010)

There are four types of Medicare services, which are referred to as Medicare Part Athrough Part D. In general, Medicare Part A provides hospital insurance; Part B providesMedical Insurance; Part C, known as Medicare Advantage, allows participants to receivehealth care services through a provider organization; while Part D provides prescriptiondrug coverage. (Difference between Medicare Parts A, B, C and D, 2013)

Eligibility

Generally, people who are over age 65 and getting Social Security automatically qualifyfor Medicare Parts A and B. If applicants arent yet 65, they might also qualify for coverageif they have a disability or are diagnosed with End-Stage Renal disease (permanent kidneyfailure requiring dialysis or transplant). (www.medicare.gov) Applicants must have both Part

A and Part B in order to get enrolled in Part C. As for Part D, it is voluntary and the costs arepaid for by the monthly premiums of enrollees and Medicare. Participants have to opt in byfilling out a form and enrolling in an approved plan. (Differences between Medicare Parts A,B, C and D, 2013)


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Coverage

Medicare offers all enrollees certain benefits. As mentioned previously, hospital careis covered under Part A and outpatient medical services are covered under Part B. UnderPart A and Part B, Medicare offers a choice between an open-network single payer healthcare plan (traditional Medicare) and a network plan (Medicare Part C), where the federalgovernment pays for private health coverage. A majority of Medicare enrollees havetraditional Medicare (76 percent) over a Medicare Advantage plan (24 percent) (Medicare.

gov, 2012). Medicare Part D covers outpatient prescription drugs exclusively through privateplans or through Medicare Advantage plans that offer prescription drugs. Since the majorityof Medicare participants are enrolled in Part A and Part B, the following parts would use Part

A and Part B to illustrate service coverage and costs of Medicare program.

Hospital care Skilled nursing facility care Nursing home care (as long as custodial care

isnt the only care you need) Hospice Home health services

In General, Part A Covers: Part B Covers Two Types of Services

Medically necessary services:Services or supplies that are neededto diagnose or treat your medicalcondition and that meet acceptedstandards of medical practice.

Preventive services: Health care toprevent illness (like the flu) or detect

it at an early stage, when treatmentis most likely to work best.


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Cost

According to a report from official website of Medicare Program, Medicare Part Aparticipants could pay up to $441 each month in 2013. But, most people get premium-freePart A. In most cases, people enrolled in Part A must also have Medicare Part B and paymonthly premiums for both. The following table demonstrates Part B premiums by income in 2011:

3.4 Hot Topic: Raising the Age of Medicare Eligibility from 65-67

As the federal debt continues to increase, some experts are proposing to raise theage of Medicare eligibility beyond age 65 as one of the many options to reduce financialpressure of the federal government.

A study done by the Kaiser Family Foundation examines the expected key effectsof raising the age of Medicare eligibility to age 67. Specifically, the study assumes fullimplementation of the plan in 2014 to illustrate the likely effects once fully implemented.

The study found that federal spending would be reduced, on net, by $5.7 billion in 2014if the Medicare eligibility age was expanded from 65 to 67. Seven million people age 65 or66 at some point in 2014 would be affected by the policy change for one or more months.This number is equivalent to five million people affected for 12 months. Of that five million,it is estimated 42 percent would turn to employer-sponsored plans for health insurance,38 percent would enroll in the Health Insurance Exchange (referred to as Exchange forshort), and 20 percent would become covered under Medicaid. Two-thirds of adults ages65 and 66 affected by the proposal are projected to pay more out-of-pocket expenses, onaverage, in premiums and cost sharing under their new source of coverage than they wouldhave paid under Medicare. However, nearly one in three individuals are projected to havelower out-of-pocket costs than they would have had if covered by Medicare, on average,mainly due to provisions in the health reform law that provide subsidies to the low-incomepopulation through Medicaid and the Exchange. (Kaiser Foundation, 2013)

Premiums in the Exchange would rise for adults under age 65 by 3% on average. Inaddition, costs to employers are projected to increase by $4.5 billion in 2014 and coststo states are expected to increase by $0.7 billion. In the aggregate, raising the age ofeligibility to 67 in 2014 is projected to result in an estimated net increase of $3.7 billion inout-of-pocket costs for those ages 65 and 66 who would otherwise have been covered byMedicare. This analysis underscores the importance of carefully assessing the distributionaleffects of various Medicare savings proposals to understand the likely impact onbeneficiaries and other stakeholders. (Kaiser Foundation, 2013)

Source: medicare.gov

Part B Premiums by Income

$272.70

$109.90

$146.90

$209.80

$272.70

You Pay (in 2013)

Above $428,000

$170,000 or Less

Above $170,000 up to $214,000

Above $214,000 up to $320,000

Above $320,000 up to $428,000

Joint Tax Return Amount

Above $214,000

$85,000 up to $107,000

Above $85,000 to $107,000

Above $107,000 to $160,000

Above $160,000 to $214,000

Individual Tax Amount


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23

Health is a human necessity; health is a human right.

- James Lenhart, Family Physician,

Author of Conversations for Paco


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Organization

25

Healthcare. Gov is a federalgovernment website managedby the U.S. Department of

Health & Human Services.

Centers for Medicare andMedicaid Services (CMS)provides health coverage for100 Million people through

Medicare, Medicaid, and theChildrens Health InsuranceProgram.

The Commonwealth Fundis a private foundation thataims to promote a highperforming health care systemthat achieves better access,improved quality, and greaterefficiency, particularly forsocietys most vulnerable,including low-income people,the uninsured, minority

Americans, young children,and elderly adults.

The U.S. Chamber ofCommerce is the worldslargest business organizationrepresenting the interests ofmore than 3 million businesses

of all sizes, sectors, andregions.

Health insurance basics

Health insurance options tailored by

criterias such as states,

age, finance situation andcurrent insurance status Healthcare law

Things to know about Affordable

Care Act, possible healthinsurance plans.

Current news, educational materials,

and reports on healthcare Database of healthcare terms

General medicare, health plan,

advantages, contracting and

payment information Medicaid federal policy and

information Medicare and Medicaid coordination

and provider information Health insurance options

Healthcare related legislations,

regulations and policies Current research, statistics and data

Outreach and education

opportunities

Practical tools, case studies, and

innovative state strategies to helpput policy into practice

Latest news in healthcare

Current surveys and data ondifferent health-related topics

Grants opportunities for independent

research on health and social

issues and programs improvinghealth care practice and policy

Health reform law

Employer mandate

Health reform coverage,

penalty, and timeline Healthcare events

On the National Scope

Description Services


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26

Healthcare.Gov

Commonwealth Fund

Chinese Translation

Commonwealth Fund

U.S. Chamber of Commerce3

www.healthcare.gov

www.cms.gov

www.commonwealthfund.org

www.uschamber.com/health-reform

U.S. Department of Health &Human Services

200 Independence Avenue,

S.W. Washington, D.C. 20201

Centers for Medicare &Medicaid Services

7500 Security Boulevard,Baltimore, MD 21244

New York City Headquarters: 1East 75th Street, New York, NY10021 | Phone: 212.606.3800 |

Fax: 212.606.3500 |Washington, D.C., Office:

1150 17th Street, NW,Suite 600, Washington, D.C.,

20036

HeadquartersU.S. Chamber of Commerce

1615 H Street, NWWashington, DC 20062-2000Main Number: 202-659-6000

Customer Service: 1-800-638-6582

Website

Address


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27

Organization

Kaiser is a non-profit, privateoperating foundation focusingon the major health care issues

facing the U.S., as well as theU.S. role in global health policy.

SBA is an independent agencyof the federal government toaid, counsel, assist and protectthe interests of small business

concerns.

The website offers the latestfrom the White House,including breaking news, policyexplainers, behind-the-scenesexclusives and more.

The Obama Care Facts websiteoffers the latest ObamaCarenews and facts.

Non-partisan source of facts,

information, and analysis forpolicymakers, the media, the

healthcare community, and thepublic Policy research

Information about healthcare reform

Public opinion

Healthcare glossary

Related provisions of law and

regulations Guidance, and proposed employee

health insurance plans for small

businesses State specific information

Healthcare glossary

The myths and facts of the Affordable

Care Act The relief that reforms provide

Latest heathcare news

The new reforms

Healthcare case studies

Introduction about ObamaCare,

Health Care Reform and The

Affordable Care Act Healthcare reform timeline

ObamaCare Health insurance

exchanges The population coverage of the

ObamaCare Healthcare reform Links to Obamacare topics such as

RomneyCare, Healthcare Reform& HIV/AIDS, and lobby

On the National Scope



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28

Kaiser

SBA

Chinese Translation

Website

Affordable Care Act

( ObamaCare) (Health Care Reform)Affordable Care Act

Address

healthreform.kff.org/

www.sba.gov/healthcare

www.whitehouse.gov/healthreform

www.obamacarefacts.com/

Website Only

Website Only

Website Only

Website Only


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29

Organization


On the Statewide Scope of California

The California HealthcareFoundation (CHCF) seeks toreduce barriers to efficient,

affordable health care forthe underserved; promotegreater transparency andaccountability in Californiashealth care system; andsupport the implementation ofhealth reform and advancingthe effectiveness of Californiaspublic coverage programs.

The CA. gov Department ofHealth Care Services (DHCS)works to deliver health careservices to low-income persons

and families who meet definedeligibility requirement.

Healthy Families is low costinsurance for children andteens. It provides health, dentaland vision coverage to childrenwho do not have insurance anddo not qualify for free Medi-Cal.

The CA. gov Department ofManaged healthcare (DMHC)helps California consumersresolve problems with theirhealth plan and works to

provide a more stable andfinancially solvent managedcare system.

Information about implementing

Affordable Care Act in California inaspects of payment and delivery

system, improved access,insurance changes andimplementation timeline

Publications/ News articals on

healthcare Links of other healthcare

organizations and research

institutions Other civic engagement events

information

Healthcare programs and services,

their introduction, qualifications,

application guidance Laws and regulations

Medi-Cal business partner andprovider information

Published reports and documents

Latest news

Program overview, eligibility,

application, coverage, cost and

benefit analysis Possible health, dental and vision

plans

Providers information

Choices of health plans, their

comparisons in terms of benefits,

costs and quality Informations of healthcare common

problems, protections,

opportunities to families, seniors,individuals with pre-existingconditions and small businesses


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30

CHCF

(Californias publiccoverage programs)

DHCSMedi-Cal

Chinese Translation

Website

Healthy FamiliesMedi-Cal

DMHC

Address

www.chcf.org/publications/2010/05/the-

affordable-care-act-in-california

www.dhcs.ca.gov/Pages/default.aspx

www.healthyfamilies.ca.gov

www.dmhc.ca.gov/aboutthedmhc/gen/ann/gen_

ann_hcr.aspx

Oakland1438 Webster Street #400

Oakland, CA 94612

Tel: 510.238.1040 Fax:510.238.1388

Sacramento1415 L Street #820

Sacramento, CA 95814Tel: 916.329.4540 Fax:

916.329.4545

General InformationContact: 916-445-4171

Website Only

For General InformationVoice: 1-888-466-2219

FAX: 916-255-5241

Visiting and Mailing Address:

California Department ofManaged Health Care9809th Street, Suite 500

Sacramento, CA 95814-2725


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31

It is hard to talk about middle ground for something that

is a fundamental right.

- Teri Reynolds, UCSF Medical Center,

Author of The Obama Syndrome: Surrender at Home


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5Conclusion

Like many other countries, the United States have been looking for appropriate publichealth care programs since early 1990s. As the only OECD country that doesnt haveuniversal health insurance coverage, the United States are believed to have most cutting-

edge health technologies but very high costs of health care services. In the past few decades, several Presidents have launched reforms to improve thepublicly financed health care programs in the U.S., especially the currently on-going twoprograms Medicare and Medicaid. Most recently, the newly signed Patient Protectionand Affordable Care Act (PPACA) in 2010 is expected to start a new round of health carereform, with lots of modification on Medicare and Medicaid implementation. The constantly-modified Medicare and Medicaid programs are designed to provide more health insurancecoverage to U.S. residents especially the low-income population.

With full implementation starting in January 2014, the PPACA is expected to bring anew look to Americas health care system. As publicly financed programs, Medicare andMedicaid should continue to get more healthcare-vulnerable population enrolled in orderto reduce the un-insured population in the US. As more reforms are going on, publicly

financed health care programs should avoid making rules complicated and confusingbenefit recipients. Also, to save budget, different programs should probably collaborate interms of reducing overlap in service population. In one word, the publicly financed healthcare programs are believed to play a more important role in American healthcare system infuture.


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6Works Cited

Centers for Medicare and Medicaid Services, Office of the Actuary, National Health StatisticsGroup, National Health Care Expenditures Data. (Jan. 2012).

Centers for Medicare and Medicaid Services. (Jan. 2013). National Health Expenditure Data:NHE Fact Sheet. Retrieved from http://www.cms.gov/Research-Statistics-Data-and-

Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html

Centers for Medicare & Medicaid Services. (2012). Tracing the history of CMS programs: FromPresident Theodore Roosevelt to President George W. Bush. Retrieved from http://www.

cms.gov/About-CMS/Agency-Information/History/downloads/presidentcmsmilestones.pdf

David, S. I. (1985). With Dignity: The Search For Medicare and Medicaid. Westport, CT:Greenwood Press.

Davis, Karen, Schoen, Cathy, and Stremikis, Kristof (June 2010). Mirror, Mirror on the Wall: Howthe Performance of the U.S. Health Care System Compares Internationally, 2010 Update. TheCommonwealth Fund.

Difference between Medicare Parts A, B, C and D (2013). Official Social Security Website. Retrieved from http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/167/~/differences- between-medicare-parts-a,-b,-c-and-d on May 30th, 2013.

Fahs, M. C. (1993). Japans Universal and Affordable Health care. New York University.Retrieved from http://www.nyu.edu/projects/rodwin/lessons.html

Frithjot-Norheim, O. (May. 28, 2013). Healthcare in Norway. Norway by europe-cities. Retrieved

from http://www.europe-cities.com/en/633/norway/health/Japanese Nursing Association. (2006). Japanese healthcare system. Retrieved from http:// www.nurse.or.jp/jna/english/nursing/medical.html

Kaiser Family Foundation. A primer of Medicaid. (2013).

Kaiser Family Foundation. (2013). Kaiser Commission on Medicaid and the Uninsured.

Kaiser Family Foundation. (2009). National health insurance a brief history of reform efforts inthe U.S. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7871.

pdf

Kramer, M. (Jan. 31, 1994) The political interest: Pat Moynihans healthy gripe. Time Magazine.Retrieved from http://www.time.com/time/magazine/article/0,9171,980052,00.html

Kaiser Family Foundation and Health Research and Educational Trust. (Sep. 2012). EmployerHealth Benefits 2012 Annual Survey.

KaiserEDU.org. (July 2011). U.S. Healthcare Costs: Background Brief. See also Trends inHealth Care Costs and Spending- Fact Sheet. Kaiser Permanente. Retrieved from http://

www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Policy-Research.aspx


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Legislative Analysts Office, California. (July 2005). Major Features of the 2005 CaliforniaBudget.

Legislative Analysts Office, California. (July 2005). Major Features of the 2005 CaliforniaBudget.

Leibowitz, W. R. (Apr. 13, 2010). Harry and health care. Truman Scholars Association. Retrievedfrom trumanscholars.org/for-scholars/harry-and-health-care/

Moffin, R. E. (Nov. 19, 1993) A guide to the Clinton health plan. The Heritage Foundation.Retrieved from http://www.heritage.org/research/reports/1993/11/a-guide-to-the-clinton-

health-plan

Martin, A.B. et al. (Jan. 2012). Growth in US health spending remained slow in 2010; Healthshare of gross domestic product was unchanged from 2009. Health Affairs 31(1): 208-219.

Medi-Cal Program Enrollment Totals for Fiscal Year 2009-10. The Research and Analytic StudiesSection, California Department of Health Care Services. Retrieved from http://www.dhcs.

ca.gov/dataandstats/statistics/Documents/2_1_Reporting_Year_FY2009-10.pdf

Medi-Cal program Fact Sheet July 2011 September 2011. County of Los Angeles Departmentof Public Social Services. Retrieved from http://dpss.lacounty.gov/dpss/WAC/pdf/

factsheets/Medi-Cal%20Fact%20Sheet%20July-Sept%202011.pdf

Orion, Jones. (Feb. 25, 2013). Switzerlands Innovative, Conservative Healthcare Program.Bigthink.com. Retrieved from http://bigthink.com/ideafeed/switzerlands-innovative-

conservative-healthcare-program

Rodin, J., & Steinberg, S. P. (Eds.). (2003). Public discourse in America: Conversation andcommunity in the twenty-first century. University of Pennsylvania Press, 96-122.

Rovner, J. (2008). In switzerland, a health care model for america?, National public radio.Retrieved from http://www.npr.org/templates/story/story.php?storyId=92106731

Shibuya, K. (2011). Healthcare in Japan: Not All Smiles. The Economist. Retrieved from http:// www.economist.com/node/21528660

Schremmer, R. D., & Knapp, J. F. (2011). Harry Truman and health care reform: The debate

started here. Pediatrics, 127(3), 399-401.Shi, L., & Singh, D. A. (2009). Delivering health care in America. Jones & Bartlett Publishers,

81-112.

Truman, H. S. (Nov. 19, 1945). Special message to the Congress recommending comprehensivehealth program, November 19, 1945. Public Papers of the Presidents of the United States,Harry S. Truman, 1953. Retrieved from http://www.trumanlibrary.org/publicpapers/index.

php?pid=483&st=&st1=

Vicini, J. & Stempel, J. (June 28, 2012). Up top court upholds healthcare law in Obama triumph.Reuters. Retrieved from http://www.reuters.com/article/2012/06/28/usa-healthcare-

court-idUSL2E8HS4WG20120628

Willison, C. (Apr. 10, 2013) Reflections: A brief history of healthcare reform in America. BioethicsInternational. Retrieved from http://www.bioethics.net/2013/04/reflections-a-brief-history-

of-healthcare-reform-in-america/

Zeeck, M. (2012). Healthcare in switzerland. Retrieved from http://www.internations.org/ switzerland-expats/guide/living-in-switzerland-15504/healthcare-in-switzerland-2


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7Meet the Interns

Hailing Wang

Major:Master of Public Administration

School:University of Sourthern California,2014 Candidate

Role in Project:Project Lead. Staff Writer forPublicly Financed Health Care ProgramsandConclusion

Lan Chen



Role in Project:Staff Writer for AbstractandForeign Health Care Systems and Comparisons

Wenyi Zhang



Role in Project:Editor for Interviewmaterials, Table of Contentand Work Cited.Staff Writer for Resources for the Community

Xiuzhi Wang

Major:Master of Public Policy


Role in Project:Copy Editor. Staff Writer forForwardandHealthcare Reform History in theUnited States


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About the Civic Engagement Leadership Fellowship Program 2013

Recently launched, the Civic Engagement Leadership Fellows (CELF) program worksto empower and develop the next generation of leaders to pursue careers that will createimpactful policies. CAUSE looks to develop exceptional international students studying inthe graduate fields of political science, public policy, and public administration by offeringthe opportunity to acquire skills and build vital social networks that will enhance their careerand their effectiveness as leaders. The program allows top students studying in the USto have first-hand experience with the democratic process and community outreach. Weprovide them with the opportunity to study the American political process and how publicpolicies impact the immigrant community; these fellows, in turn, reach out and educate newimmigrants in their native languages on the importance of public policy discussion and civicparticipation.


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Center for Asian Americans United for Self Empowerment (CAUSE) is a 501(c)(3)nonprofit, nonpartisan, community-based organization with a mission to advance thepolitical empowerment of the Asian Pacific American (APA) community through nonpartisanvoter registration and education, community outreach, and leadership development.

Founded in 1993, CAUSE is comprised of committed professional, business,community and political leaders, and has established itself as a unique nonpartisan APAorganization dedicated solely to APA civic and political participation. Based in the GreaterLos Angeles area, CAUSEs influence reaches throughout California.

CAUSE BOARD

OFFICERS & DIRECTORSChairCharlie WooMegatoys

Vice ChairMarcella LowThe Gas Company

Vice ChairKenny YeeImuarock Partners

Legal CounselKenneth K. LeeJenner & Block LLPSecretaryBen WongSouthern California EdisonTreasurerJames HsuSquire Sanders (US) LLPBoard of DirectorsGary H. ArakawaCovington Capital ManagementLing-Ling ChangCity of Diamond BarSandra Chen LauUniversity of Southern California

Alan K. Kims, M.D.

Ardmore Medical Group Inc. &Advantage Health NetworkFred RowleyMunger, Tolles & Olson LLPNita SongIW Group, Inc.K. Luan TranLee Tran & Liang, APLC

Emily WangEast West BankRon WongImprenta Communications GroupRobert YapTotal Call International

Albert Young, M.D., M.P.H.Network Medical ManagementExecutive DirectorCarrie GanDirector of ProgramsGrace D. HsiehDirector of CommunicationsSophia Islas


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