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Healthcare System and the delivery of healthcare to citizens

"Eliza Amato" (2019-07-21)

Chronology of legislation intended to improve the quality of the U.S. healthcare system

Health care legislation reform in the United States traces itself to a lengthy history (Altman & Shactman, 2011). Many reforms have gotten proposed over years. Some, however, have been implemented while have rarely been accomplished leave alone implemented.

Here is a chronological summary of such reforms on the health legislation in the United States of America.

In 1965, President Lyndon Johnson endorsed a legislation that introduced Medicare insurance. This legislation was purported to cover both hospital and general medical insurance for senior citizens in the states. This program was to be funded through a Federal employment tax over the working life of any retiree covered. Nevertheless, Medicaid sanctioned the government to fund a program for the poor partially, with the program managed and co-financed by the individual state. Twenty years later, the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) was put in place. That revised the Employee Retirement Income Security Act of 1974 (ERISA). Thus, it accommodated the giving of some employees the opportunity to continue being members of the health insurance even after leaving their places of employment (Turner & Hurley, 2002).

In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was put in place. This act got accredited with two major objectives: simplify peoples maintenance of health insurance despite fall-outs and provide protection and privacy of healthcare information. A year later (1997), the State Children's Health Insurance Program, abbreviated SCHIP, was instituted by the central government. This program got enacted with an aim of providing health insurance to children from families at or below 200 percent poverty line (Murray, 2007). SCHIP got followed by the enactment of the Patient Protection and Affordable Care Act, also known as Obama care Act. That got enacted in 2010 with the aim of providing quality and affordable health insurance through lowering the uninsured rate. To arrive at that, the act provided for the expansion of private and public insurance coverage (Altman & Shactman, 2011). That simplified the comprehensive system of mandated health insurance with reforms designed to eliminate "some of the worst practices of the insurance companies". That addressed premium loadings, pre-existing condition screening and policy cancelations on technicalities when illness becomes imminent. It also included annual and lifetime coverage caps. That marks a short history of heath legislation.

This paper dedicates its focus on one law. That is, the health Insurance and Accountability Act of 1996.

The Health Insurance Portability and Accountability Act of 1996

Enacted in August 21st, 1996, HIPAA got founded by the United States Congress and signed by President Bill Clinton in 1996. It gets also known as the Kennedy-Kassebaum Act or Kassebaum-Kennedy Act after two of its primary, leading sponsors. The act got enacted with the objects of providing protection to patients from medical personnel decisions and disclosure of medical and financial information to third parties and extending coverage before and after quitting jobs. In general, HIPAA was designed to regulate patient identity theft and insurance fraud which was rampant before.

Factors that contributed to the need of HIPAA

In the past and before the enactment of this law, many employers' group health plans limited, and at times totally denied coverage. That occurred if a new employee required protection before enrolling in the insurance plan (Murray, 2007). Further, many self-employed persons could not afford to pay the high insurance premiums for health insurance without an income tax exclusion as compared to what other employees enjoyed. Individuals and employees who wanted to purchase insurance for long term care also lacked decent direction as to whether the there was a provision to exclude premiums from taxation. Thus, persons with terminal illnesses faced burdensome taxes on the accelerated death benefits or life insurance settlements with which they could pay for their medical and living costs. Further, the coverage was limited to that period before quitting the current jobs or retiring. In addition, the privacy of health and patient information was detrimental. Consequently, many people resolved to avoid seeking care because they could not pay for the services. Secondly, many were concerned about their records. The fear that their medical records would not remain confidential drove a remarkable number away. Another problem was in the complexity of obtaining individual cover rather than group cover (Biegelman, 2009).

In light of that, the Office for Civil Rights enforced the HIPAA got erected.

HIPAA addressed the above concerns as a six-fold. It assigns responsibility for regulating and enforcing these standards to both the federal government and the states (RIA, 1997).

Availability and portability

HIPAA sets new standards for health insurance coverage in five areas. It assigns responsibility

for regulating and enforcing these standards to both the federal government and the states (RIA, 1997).

Preexisting conditions

Going by the Act, group health insurers, health maintenance organizations and self-insured employers were not to limit or deny coverage for any preexisting conditions for more than twelve months, called the waiting period. The right to full coverage after this period was made "portable" in case the employee changes jobs or the employer changes health plans. No new preexisting condition restrictions are to get imposed if coverage is maintained with no gap longer than sixty-three days. Furthermore, a preexisting condition restriction is only imposed for a medical condition that was diagnosed or treated at some time during the six months. That is the period immediately preceding the twelve-month waiting period and cannot get imposed at all on pregnant women or newborns or newly adopted children (Zineddine, 2008).

Availability of coverage for small employers

The act also provided for small employees inclusion for protection. From the enactment point of HIPAA, insurance carriers and health plans do not refuse to offer any small group products to employers that have between two and fifty employees (Biegelman, 2009).

Availability of Coverage for Individuals

The act provided for the quest of people to obtain individual covers though under some conditions. Thus, the Act requires Insurers and health planners should offer coverage to persons who initially had group health insurance for a period of at least eighteen months. Those include the ones who have exhausted coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). That is those who are ineligible for coverage under any other employment-based health plan. States may ratify their individual market reforms to conform to the criteria for individual coverage. If a state fails to opt to the enactment of reforms, insurers are required to offer eligible persons access to coverage. It is thus possible to enjoy individual health insurance coverage In addition HIPAA Provides additional opportunities for enrollment in a collective health plan if one loses other coverage or experiences certain life events (Zineddine, 2008).

Discrimination Based on health status

That is another area critical under the statute of HIPAA. The Act provides that employers who offer health services may not bar an employee or a dependent from coverage or drop an employee or a dependent from coverage. Further, they may not charge an employee higher than established premiums because of that persons or their dependents health status or medical history. That includes patients disability, his/her genetic information, history of episodes of domestic violence, and previous health care (Zineddine, 2008).


Finally on renewability, the Act provide that Insurers are required to renew coverage to all employers as long as premiums are paid, with the exception of when there is evidence of fraud or misrepresentation by an employer.

Privacy Rule

Privacy Rule got aimed to protect the privacy of individually identifiable health information via some rules, three of which get discussed here. The HIPAA Security Rule instills national standards for the security of electronic protected health information. Second is the HIPAA Breach Notification Rule. This rule requires covered parties and business associates to provide notification following a breach of unsecured protected health information. Thirdly, is the confidentiality provision of the Patient Safety Rule, which protect identifiable information being used to evaluate the patient safety events and advance safety of the patient (Sullivan, 2004).

In summary, HIPAA came into existence with two main goals, as its name suggests. These are: making health insurance more portable when persons change employers, and making the health care system more accountable for costs through trying especially to eliminate waste and fraud.

Political Circumstances that got involved with proposition of HIPAA

During the one year of 1993 to1994 over the Clinton administrations health care reform proposals, affiliates of Congress from both parties and envoys of diverse interest groups conceded to the need for modification of the insurance markets. Members had been receiving complaints about problems of availability and portability from the citizens, state legislators, and insurance commissioners. In hearings concerning health care reforms, officials of the National Association of Insurance Commissioners (NAIC) produced considerable evidence of the problem encountered in health insurance markets to the attention of Congress and congressional staff.

In the summer and fall of1994, associates of more than thirty of the largest self-insured employers called members of Congress and officials of nine states loosely organized as the Reforming States Group. They said that they might be willing, someday, to eliminate employees anxieties about portability and renewability in exchange for maintaining employers freedom under ERISA from state regulation and premium taxes. Other employers, relieved by avoiding a federal insurance mandate, signaled their willingness to support reforms that would improve standards of coverage. The insurance industry was eager to keep off additional regulation and mandates, but it stood in support of bringing self-insured employers under the same rules that applied to commercial insurance. Moreover, the industry could easily oppose protecting the market against rapacious conduct by a handful of carriers (Turner & Hurley, 2002).

Politics in passing of the law

When Senators Kassebaum and Kennedy introduced their bill in the dawn of 1995, they attracted enviable support and encountered little public antagonism. Supporters of the bill comprised of the American Association of Retired Persons, the AFLCIO, the Blue Cross and Blue Shield Association and the NAIC. Neither the Group Health Association of America (nowadays the American Association of Health Plans) nor the Health Insurance Association of America got opposed to the bill. However, they were concerned that portability reform would make rates premiums to increase, particularly in the individual market. The American Academy of Actuaries, however, disagreed with that claim. At a critical point, AAA said that rate increases as a result of portability were likely to become minimal (Murray, 2007).

After that, the Independent Insurance Agents of America (IIAA) expressed its strong support for the bill during a White House meeting and press conference. That shed a glimmer of light at the tunnel end; enactment seemed possible. By the late fall of 1995, a team of Senator Kassebaum predicted more than eighty votes in support of the legislation if they could get it to the Senate floor. Several senators joined in the hold of the bill and action delayed. Some of these holds seemed to be as a result of backing by proponents of MSAs while others of efforts by small business to get ERISA preemption for purchasing pools (Murray, 2007).

Sen. Robert Dole (R-KS) for instance, some observers say, held to the belief that killing the bill would help his clear the path in his approaching Republican presidential primaries. Similar conflicts in the House accounted for some of the earlier delays of the bill passage. Advocates for small business, for instance, requested for preemption under ERISA in accordance with multiple-employer welfare arrangements (MEWAs).

In the early 1996 Senator Kassebaum publicly requested Senator Dole to permit a vote on the bill. Immediately, she began an intensive campaign for support in the Senate. With alliance from members of both houses and both parties who were in a quest for insurance reform, they began the journey of seeking votes. A tough debate in committees and on the floor of both houses followed, and the bill eventually passed (Murray, 2007).

Some of the circumstances that impacted to the enactment of the legislation: the House got concerned about the aggravating cost of medical services had made consumers unable to seek medical treatment. There were also many regulations and established standards that impeded the protection of individually identifiable health. Also, information pertaining health of patients and the entirety of health stake required to get guaranteed. HIPAA privacy regulations got implemented on April 14, 2003 (Biegelman, 2009).


HIPAA has gotten tagged with a lot of impacts, since its implementation to date. One of the consequences brought by the enactment of HIPAA is that today healthcare organizations, providers, health planners are be required to comply with the rules of HIPAA. The Department of Health is also required to comply, in all its levels within the organization. Metro clinics are also required to adapt to the requirements. That means compliance is totally mandatory and never an option (Zineddine, 2008). The implications of all these are that, the number of insured persons continues to grow. Health insurance portability has increased an American ability to retain health insurance cover even in the event of changing or losing their jobs. Not only does HIPAA protects health insurance to workers and their families when they change or lose their jobs, but it also insured the health insurance companies against pre-existing conditions (Biegelman, 2009).

The uniform code set and electronic requirements of HIPAA simplify the procedures for making claims thereby decreasing the cost of health insurance and enhancing the quality of care availed to everyone. Moreover, with the growing use of electronic media, the privacy rules of HIPAA have successfully ensured that patients identifiable medical information gets amply guarded. Thereby it decreases the likelihood that this information can get into `wrong hands and get used against the patient's detriment. In fact, wrongful disclosures of health data are liable to civil penalties (Mamorsky, 2001).


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Research Institute of America.(1997). Special study of regulations issued under Health Insurance Portability and Accountability Act of 1996, with a full text of regulations. New York: RIA Group.

Sullivan, J. (2004). HIPAA: A practical guide to the privacy and security of health data. Chicago, Ill: American Bar Association, Health Law Section.

Turner, H., & Hurley, J. (2002). The history and practice of health Insurance. Lexington, Ky: University Press of Kentucky.

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