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    A) Since the Bureau of Freedmen, the United States government has implemented more sustainable policies that plan to assist the population with public welfare across race and class. Established in 1865 the Freedmen’s Bureau was the United States’ first federal healthcare program, its benefits that aimed to help the entire population were denied in attempts to target the wellbeing of black people. One century later Medicare and Medicaid were signed into law, after this legislation was passed and it allowed for more policies to be built on improving the United States healthcare system for the elderly and the disadvantaged. The Affordable Care Act of 2010 even builds on the expansion of Medicaid so that it is more inclusive to low-income citizens. I am choosing to focus on policies that are built on well-known 20th-century legislation and how effective their contributions have been to Medicaid, Medicare, and, or, the Affordable Care Act. These policies include the Health Insurance Portability and Accountability Act of 1996, Children’s Health Insurance Program, and the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

    The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996 and has three main goals. It aims to protect health insurance coverage for workers when they are transitioning or have lost their jobs, protect health data, and allows for national regulation of the healthcare system (Greevy). The impacts of HIPAA are recognized through all branches of the healthcare system and play a crucial role in establishing trust between patients and practitioners. From the perspective of healthcare institutions, HIPAA has also allowed for a standardization of data which has been beneficial for coordination of insurance benefits and payments (Bowers). These steps are valued in the modernization of the healthcare system in order to make progress within it more efficient and minimize human errors. However, there has been concern about the interpretation on how to release patient information. It has also accelerated health information management professionals to become more skilled in technology and computer skills (Bowers). Arguments also recognize that HIPAA does not effectively secure employees’ health care when coverage is lost through unemployment due to failure to acknowledge the economic power of private interests (Stephen). Overall misunderstandings between patients and providers demonstrate a need to add amendments to HIPAA in order to make it more effective, but the basic guidelines that were put in place where necessary issues to be addressed.

    In addition to Medicaid’s mission to provide health care coverage to eligible low-income populations the Children’s Health Insurance Program (CHIP) was established in 1997 in order to cover low-income children who were ineligible for Medicaid. As of 2018 9.6 million children are enrolled in CHIP nationwide (“Children’s Health Insurance Program”). Extensive research has shown that Medicaid and CHIP have not only increased coverage among low-income children but that the care that is received is valued and utilized. The median percentage of visits to a primary care provider was 97%. These two programs combined have also provided a safety net during economic recessions and downturns along with reducing racial disparities in children’s coverage due to a significant minority percentage of enrollees (Paradise). Adding CHIP to federal legislation has been beneficial in supporting children during these critical times of critical psychological and physical growth. Other CHIP influenced programs such as Medi-Cal, which plans to be expanded to serve all undocumented children, will become more important in addressing public health issues for some states more than others (McConville et al.). The key issue that CHIP faces is federal funding for Medicaid and CHIP if funding decreases then this could lead to lower benefits or higher out-of-pocket costs (Ubri). This program demonstrates a need as it would leave many children and families vulnerable if there were any abrupt changes.

    The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) addresses an issue that impacted Medicare services. On average by 2004 Medicare beneficiaries were on average spending about $1,000 each year on prescription drugs. In order to adjust to current times, this act opened the option of coverage by price tiers for out-of-pocket expenses (“History of Healthcare Policy in the United States”). Based on the tier level of protection Medicare beneficiaries could then save from $1,700 to $5,900 on drug costs each year (“Fact Sheet”). The act allowed for reductions in premiums of 56%-84% as found by WellChoice, Inc., one of the largest health insurers in the State of New York, at the start of 2004 (Bohren). As the issue of out-of-pocket must have been addressed this act did not address the overall issue of continuously rising drug prices. As it is projected that the cost for prescription drugs will continue to rise and reach a value of about $1,600 in expenditures per capita it will become increasingly more important to open up this problem and address the issue at the source (“Why Are Prescription Drug Prices Rising”).

    In conclusion, federal health policies are bound to have different impacts from a state perspective however there are some consistent patterns that determine the impact federal policies have nationwide. CHIP is the most successful federal policy implemented that adds value to the existing federal program Medicaid. Both the HIPAA and MMA address key issues however in their implementation there are some key issues as they relate to their goals. Due to lack of clarity HIPAA’s main fault is in its impact on employer-based health insurance. Different interpretations of HIPAA’s guidelines can have varying impacts on employees with pre-existing conditions and an impact on job mobility. The MMA as it proves to be effective is only a temporary solution to the overall problem of rising prescription drug costs. Even though it benefits a population that is heavily impacted by the issue it is an approach that will continue to be strained in terms of funding. Therefore, CHIP is seen as the most successful due to its widespread demonstrated need in communities and its long-term impacts. By investing in children’s health care, it helps aid better growth and development while also possibly providing more stability within low-income households. CHIP is successful because it aims to help improve society by investing in it at a young age. More federal policies in healthcare should aim to address problems at the source of the issue similarly to CHIP in order to obtain the most benefit.

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