Passage Of Medicare Research Articles

The Stage Was Set for Disaster: For-Profit Nursing Homes, Federal Law, and COVID-19

For-profit nursing homes came to dominate nursing-home care in the United States in the second half of the twentieth century, especially after the passage of Medicare and Medicaid legislation in the 1960s. However, for-profit nursing homes on average provided inferior care when compared to state-run and nonprofit nursing homes. Congress attempted to address the problems in nursing homes in the final decades of the twentieth century, but massive statutes and abundant regulations served mostly to legitimize the problematic for-profit nursing home. COVID-19 then tragically underscored the flaws in the legally sanctioned for-profit nursing home as a major socio-legal institution in American life.

The future of health professions education: Emerging trends in the United States.

The future of health professions education: Emerging trends in the United States.

How Radiologists Are Paid: An Economic History, Part I: The Fight forIndependent Billing.

In the first article in a four-part work, the authors review the economic history of how radiologists are paid, from the fight for independent billing in the 1960s to the impact of advanced imaging technologies on radiologists' incomes in the 1980s to the "bubble years" of the 1990s and to the end of the bubble in the first decade of the 21 century. The authors begin in this first part with the connections among a radiologist from Arkansas, a congressman, and the passage of Medicare, the program that gave radiologists the right to bill independently and gave the federal government a big role in health care spending.

The Social, Political, and Economic Effects of the Affordable Care Act: Introduction to the Issue

The Patient Protection and Affordable Care Act, commonly referred to as the ACA and signed into law on March 23, 2010, was the most significant reform of the American health-care system since the passage of Medicare and Medicaid a half century earlier. As former President Barack Obama noted in his

Ascertaining Business's Interests and Political Preferences

Medicare is one of the largest social programs in the world. Did organized industry favor Medicare's passage in 1965? If it did, this would represent powerful evidence in favor of the theory that social programs typically require cross-class alliances to pass, such as alliances between business and labor. However, in a previous article in this journal, I argued that answering questions about political actors’ preferences—such as whether organized industry favored Medicare's passage—can be surprisingly difficult due to the “problem of preferences”; that is, political actors might misrepresent their true policy preferences for many reasons. For example, when their ideal proposals are not politically feasible, political actors may wish to bolster support for a more politically viable alternative to a disliked proposal—even if they do not truly support this alternative to the status quo. To better understand political actors’ true policy preferences, I argued, scholars should trace how those actors’ expressed preferences change as a function of their strategic context—just as scholars seeking to understand the impact of any other variable trace the effects of changes in it.

Heading Into the Home Stretch

Back to table of contents Previous article Next article From The PresidentFull AccessHeading Into the Home StretchAltha StewartM.D.Altha StewartSearch for more papers by this authorM.D.Published Online:25 Jan 2019https://doi.org/10.1176/appi.pn.2019.2a22Over the years, I’ve watched more than a few presidents as they set priorities; represented the organization at the local, national, and global levels; and worked through the challenges they faced during their terms. One of the things I noticed is the balance they struck between the priorities on which they campaigned and the challenges they faced in getting them done. I’m about two-thirds through my term, and I am pretty sure that I’m not the first president who has said around this time, “It’s an interesting and challenging time to be president of APA!” So, as I am reaching this important milestone at the start of a new year, I thought I would share some of the reasons why I’m glad to be a psychiatrist and APA president right now.I am extremely proud that we have continued to advocate on behalf of members on one of the most important issues faced by our members—maintenance of certification (MOC). As we enter the new year, we are focused on working to make sure that MOC requirements are not a barrier to medical licensure, hospital credentialing, or joining insurance panels. And although we remain committed to lifelong learning and professionalism, we will continue to work on solutions that offer options for our members to demonstrate continued learning and competence in their specific area of work.I will always be proud that APA was the first professional medical organization to speak out against the harm done to children and their families separated at the border based on national policies. We were soon joined by other associations, and ultimately the policy was reversed. However, the repercussions from that and related policies have created emotional harm about which we are still concerned. One of our own, Dr. Pamela McPherson of the Department of Homeland Security’s Office of Civil Rights and Civil Liberties, brought the government’s child detention practices to our attention and represented the profession well in her appearance before a Senate committee and later on “60 Minutes.” The story touched most Americans and, as I told her in a personal communication, made me proud to be president of an APA with members like her.It was a year of ups and downs as APA continued to focus its advocacy efforts on the lack of full implementation of mental health parity and the ongoing challenges to the Patient Protection and Affordable Care Act (ACA). From the landmark case in Texas in which the judge ruled that the ACA is unconstitutional to the current efforts in the House to create legislation to save what is considered the most important overhaul to the U.S. health care system since the passage of Medicare and Medicaid in 1965, APA has consistently spoken in favor of what is in the best interest of our patients and our members. And while engaged in these advocacy efforts, we have continued to provide high-quality services, including in response to a variety of natural disasters, violent incidents in the community resulting in mass deaths, and attacks on the profession.Finally, the ongoing initiative involving physician burnout, wellness, and resiliency continues to be an important member benefit. We understand from members that excessive productivity quotas and documentation requirements and limits on the time we spend with patients are significant factors contributing to dissatisfaction for psychiatrists and other physicians, and we will continue to explore ways to promote the system changes needed to adequately address this problem.These are some of the reasons that I believe that APA is a value-based, professional entity that asserts this identity every day as we advocate, champion, practice, research, and teach. I am looking forward to the final third of my term and pledge to continue to focus on maintaining that identity. May the new year allow each of us to do the same on an individual level in our roles as advocates, champions, practitioners, researchers, and teachers. ■ ISSUES NewArchived

Implementation of Medicaid‐Funded Long‐Term Care: The Impact of Prior History on the Development of the Nursing Home Industry

Growth of the “nursing home” industry was enhanced considerably by passage of Medicare and Medicaid in 1965 (Public Law 89–97, Titles XVIII and XIX of amendment to the Social Security Act). Injection of federal funds into Medicare for extended‐care nursing (ETC) and into Medicaid for means‐tested, long‐term care (LTC) spurred the growth of for‐profit and nonprofit enterprises. Prior to 1965, the effects of vendor payments for Medicare and Medicaid and federal low‐interest real estate loans for facility construction resulted in the initial development of a specialty real estate industry that was to become an important substrate in extended‐ and long‐term medical care. Although the LTC industry has evolved over the decades, the basic structure and function of the industry had been established prior to passage of the 1965 Social Security Amendments. The power and influence of Southern Democrats, the American Medical Association, and ultraconservative Republicans were major factors in development of a nursing home system designed for welfare medicine, state control, and industrialization. No vision of care for a looming precipitous growth in an elderly population needing long‐term care in skilled‐nursing facilities guided congressional debate during the enactment of Medicaid. The Medical Assistance for the Aged Act (MAA or “Kerr‐Mills“) and other legislation preceding the passage of Medicaid established precedent for vendor payments, spend downs, and, consequently, means‐testing. Kerr‐Mills codified elderly individuals too poor to pay for medical care but not poor enough to qualify for Old Age Assistance into a new category of U.S. resident: “the medically indigent.” This categorization through legislation of poor Americans needing care would have far‐reaching consequences in the U.S. medical care system. By legislating a categorical, means‐tested, industrialized, long‐term care system into existence, Congress ensured that the nursing home system would be characterized by the “total institution” as opposed to maximum support for community and home‐based systems. Excessive institutionalization of the frail elderly and disabled in institutions based on profitability and, hence, economy and efficiency, has been responsible for an industry with revenues approaching a half trillion dollars. From the view of Southern Democrats and their allies, Medicaid‐funded, long‐term care has been well implemented. Advocates for patients and most scholars believe that it has failed the patients whom it was intended to serve.

Misrepresented Interests: Business, Medicare, and the Making of the American Health Care State

A belief that there is a pervasive and enduring adversarial relationship between business and the welfare state is shared widely across scholarly disciplines engaged in historical and comparative analysis of social politics. According to that view, each stage in the expansion of the American welfare state was a defeat for capitalists. Detailed evidence on the politics of health care, with special focus on the passage of Medicare in 1965, casts serious doubt on this dominant view about class politics, the welfare state, and the power of business. It shows that much of the literature takes a hazardous inferential leap from national business organizations’ official positions against reform to overconfident conclusions about actual business opinions. The literature also mistakenly discounts evidence of business support for moderate reforms as strategic camouflage of actual opposition designed to head off more radical ones. Extensive evidence reveals enormous division within business rather than unity about the health care state, and a great deal of support from large and powerful corporations for its creation and expansion. Evidence about the economic implications of health insurance for businesses, including before and after Medicare, and all the way to the Affordable Care Act of 2010, indicates that the support was genuine, not strategic, and that sometimes it was critical for passage. That support calls for new thinking about how to answer the perennial question about class power in America: “Who actually governs?”

How Much Do We Know About the Affordable Care Act (ACA) and Its Impact on Fertility Services in the United States?

The ACA, signed into law in March 2010, together with the Health Care and Education Reconciliation Act, represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Since its inception, public awareness regarding infertility coverage has been heightened but there is still confusion and angst expressed regarding the implementation of the Act.

The Affordable Care Act: a primer for plastic surgeons.

The Patient Protection and Affordable Care Act, sometimes referred to as Obamacare, was signed into law on March 23, 2010. It represents the most extensive overhaul of the country's health care system since the passage of Medicare and Medicaid in 1965. The Affordable Care Act has two goals. The first goal is to reduce the uninsured population in the United States. Key elements to covering the uninsured include the following: (1) expanding Medicaid coverage for low-income individuals and (2) establishing health insurance marketplaces for moderate-income individuals with subsidies and tax cuts in an effort to make health insurance more affordable. The second goal of the Affordable Care Act is to address concerns about quality and the overall cost of U.S. health care. It is imperative that plastic surgeons thoroughly understand the impact that the Affordable Care Act will undoubtedly have on the country, on our patients, and on our clinical practices. Plastic surgery will see many changes in the future. This will include an overall increase in the number of insured patients, a push toward joining accountable care organizations, and a shift in payment systems to bundled reimbursement for episodes of care. In this article, the authors describe how these changes are likely to occur and what plastic surgeons must do to be part of the change.

Orthopaedic trauma and the evolution of healthcare policy in America.

Healthcare policy has changed drastically, and with the 50-year anniversary of the passage of Medicare approaching in 2015, the authors evaluate the development of the current healthcare system and its relationship to the development of modern orthopaedic trauma. With more changes in healthcare policy forthcoming, it is increasingly important for the orthopaedic traumatologist to understand how changes in policy will affect practice. Historically, the motivators for change have remained largely the same over the past 50 years. The development of diagnosis-related groups, the resource-based relative value scale, and the sustainable growth rate are 3 defining policies that were designed to control costs, but which had an unexpected effect on those caring for the trauma population. Healthcare reform has a unique effect on those systems where care is dictated by a defining event or injury. Evaluating the development of trauma systems, the authors find that legislation directed toward the trauma population has been driven by the study of patient outcomes, providing an opportunity for orthopaedic traumatologists to contribute to future changes in policy. As healthcare policy changes begin to take effect, having a thorough understanding of reform and its drivers will be increasingly important in taking an active role in advocating for the field of orthopaedic trauma and its patients.

It's a matter of trust: Nurses supporting family caregivers

With enactment of the Affordable Care Act (ACA), the U.S. health care system is undergoing its most dramatic overhaul since passage of Medicare in 1965. Written in the ACA are explicit guidelines for health insurance coverage, guaranteed health care choices, and enhanced health care quality for all Americans. These important systemic changes are at the tail of the Institute of Medicine’s (IOM) The Future of Nursing report and its bold endorsement of expanded nurse education and practice capacity. 1 Taken together, it seems safe to say that nurses can and must play a vital role in shaping the future health of the American public. This is no more important than when considering the health needs of older adults, whose proportion of the U.S. population and use of more complex and intensive health care services has increased significantly since the implementation of Medicare. Nurses, no longer viewed as “physician’s hands” completing doctor’s orders, 2 have evolved into

Commercial pressures on professionalism in american medical care: from Medicare to the Affordable Care Act.

Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S. counterparts who increasingly have their practices micromanaged. The Affordable Care Act illustrates the ways that managerial strategies and a market model of health care have shaped the financing and delivery of health care in the U.S., often with little or no evidence of their effectiveness.

The “Problem of Preferences”: Medicare and Business Support for the Welfare State

Few political observers would readily assume that a present-day politician's or interest group's claims about their preferences accurately reflect their genuine views. However, scholars often unwittingly make this very assumption when inferring the preferences of historical political actors. In this article I explore the influence of business groups on Medicare's passage to illustrate how inattention to political actors’ strategic misrepresentations can bias qualitative and quantitative research. An ongoing debate wrestles with the pattern that businesses often grant support to welfare-state expansions just before they occur, a regularity some take as evidence that business interests dictate these expansions. I use Medicare as a case study and document that key business groups and their allies did not truly favor the program. However, I also show that these actors strategically misrepresented their preferences as Medicare's passage became likely in order to advance more limited alternatives. The strategic nature of this position is exceptionally easy to miss; yet inattention to it produces the opposite, erroneous conclusion about these actors’ historical role. Medicare's legislative history thus illustrates the methodological necessity of documenting whether political actors are misrepresenting their preferences. I discuss how scholars can do so by tracing actors’ stated preferences across strategic circumstances, including audiences and time.

History for the Future (of Nursing)

On October 5, 2010, the Institute of Medicine (IOM)1 released the report The Future of Nursing: Leading Change, Advancing Health.2 Based on the two yearlong deliberations of a stellar committee chaired by former Health and Human Services Secretary Donna Shalala and vice chair Linda Burnes Bolton, CNO of Cedars Sinai Medical Center in Los Angeles, the report is positioned to serve as a blueprint for transforming the nursing profession. The report's main message directly addressed nursing and patient care: Health care reform could not be accomplished without better educated nurses who had the skills and knowledge to lead improvements in the quality of care and patient access. As the Nurse Scholar in Residence at the IOM3 in 2010, I proposed to work with the Future of Nursing committee as part of my residence commitment. When I first interviewed with a committee senior staff member, she was hesitant and questioned what I could contribute as a historian. My response was and context. Because all deliberations are confidential, I cannot relate specific contributions, but as you read the report, the historical perspective and the use of context as an explanatory framework is clear. As an historian I knew that numerous studies about the nursing profession had been conducted by many different groups, and that the reasons for and findings of each study reflected the politics (both local and national) of the time period and the participants. The Future of Nursing study followed this tradition. This does not mean that the members sought individual political gain, but that each had their own sense (and perhaps that of the groups they represented) of the nursing profession and its place in the health care system. Economists, political scientists, insurance executives, physicians and nurses themselves each came from their particular standpoint and place in terms of how they valued nurses' work and what they thought could and should be accomplished by the report. Each understood nursing's history from their own political, personal, and historical vantage point. The IOM conducted its last major study on nursing in 1983, which was situated in a different political and social context.4 Yet, some of the recommendations from the 1983 report seemed familiar-the need for better educated nurses, better workforce data, a more diverse workforce, and the need to remove practice barriers. But, context and contingency are time and place dependent and shape the work we do and the meaning that work holds for patients. We also know there is, indeed, historical continuity that gives shape to our values and our responsibilities as the largest group of caregivers in the health care arena. These perspectives implicitly shaped how the report and the recommendations were developed as historical evidence grounded modern data. But history also provides examples of opportunities and possibilities. We know that nurse leaders such as Dorothy Smith (University of Florida Gainesville) and Mary Elizabeth Carnegie (Florida A&M) changed how and where nurses were educated and how African American nurses negotiated their space in the professional association structures in the post War decades. And we know that nurses have been innovators in public and community health- types of care that will be the backbone of new delivery systems such as medical homes and accountable care organizations. We also see the worth and work of pioneer advanced practice nurses as they practiced in medically underserved areas or in collaboration with physician colleagues. As historians we can learn from these historical examples and use them to explain and to critique larger policy issues. For example, better quality, value, and access to health care services can be achieved only with the participation of nurses as leaders and as valued clinicians. This is as true today as it was with the passage of Medicare and Medicaid in 1965, but unlike previous health reform initiatives we now have the opportunity provided by explicit recognition of this relationship in the text of the legislation. …

Can Health Insurance Reduce School Absenteeism?

Enacted in 1997, the State Children’s Health Insurance Program (SCHIP) represented the largest expansion of U.S. public health care coverage since the passage of Medicare and Medicaid 32 years earlier. Although the program has recently been reauthorized, there remains a considerable lack of thorough and well-designed evaluations of the program. In this study, we use school attendance as a measure of the program’s impact. Utilizing state-level data and the use of fixed-effects regression techniques, we conclude that SCHIP has had a positive and significant effect on state average daily attendance rates, as measured by both SCHIP participation and eligibility rates. The results support the renewal and expansion of the program.

The Lessons of Success — Revisiting the Medicare Story

After reviewing recently released Oval Office tapes, Blumenthal and Morone conclude that President Lyndon Johnson played a larger role in the passage of Medicare and Medicaid in 1965 than historians have reported. They believe the revised version of events suggests that successful enactment of major health care reform would require strong commitment and speedy action on the part of our next president.

The Medicare Approach: Political Choice and American Institutions

The most significant health reform in American history was the passage of Medicare in 1965, but this was an accomplishment born of defeat. Medicare was designed and understood by its early promoters as an approach to health reform, not simply as a discrete program for a distinct target population. Although Medicare incrementalism has tended to be shunted aside when the opportunities for health reform are most promising, the final years of the Johnson administration reveal previously underappreciated efforts to expand Medicare eligibility to large new population groups and offer insights into the continuing potential of Medicare incrementalism in our own time.

Health Care and Public Opinion

Health Care and Public Opinion

Health Security for All: Dreams of Universal Health Care in America

Back to table of contents Previous article Next article Book ReviewsFull AccessHealth Security for All: Dreams of Universal Health Care in AmericaGerald N. Grob Ph.D.Gerald N. Grob Ph.D.Search for more papers by this authorPublished Online:1 Jun 2006https://doi.org/10.1176/ps.2006.57.6.887aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Among the industrialized nations, the United States is the only one that does not guarantee all its citizens access to basic health care even though it leads the world in total health care expenditures. Nor does the nation rank especially well in such indicators as mortality or longevity. More than 40 million Americans lack health insurance, and millions more are underinsured. Individuals without adequate insurance have higher disability and mortality rates and often face bankruptcy because of medical bills. Paradoxically—according to Alan Derickson, a professor of history at Pennsylvania State University and author of two books dealing with workers' health—Americans of all political persuasions have long been committed to the ideal of universal access. In Health Security for All he traces the many ways this ideal has been articulated and describes plans of action offered during the past century. Equally important, he provides an explanation for the failure to translate this ideal into reality as well as the roles of race and class. Three themes have shaped the argument on behalf of universal health care in 20th-century America. The first emphasizes the moral obligation to help other suffering persons. The second reflects the concept of efficiency; access to health care would create a more productive workforce. The third is based on rights; full citizenship includes access to essential medical services. The significance of each has shifted as societal values changed over time.The history of the debate over universal health care is hardly an inspiring one. In the early 20th-century concern with the problems of poverty and sickness led some to advocate social insurance to protect lower-paid workers. This approach omitted a majority of Americans and hence drew little support. During the 1920s the growing faith in scientific medicine led to an emphasis on universal health care for all. Members of the biomedical community, including the American Medical Association, were supportive. By the 1930s the notion of a social right to health care became more pronounced. But the advent of the Cold War resulted in the identification of national health insurance with subversion.The growth of employment-based insurance benefits also tended to weaken efforts to adopt universal access and strengthen those who favored a voluntary system. The ideal of universality was further undermined by the passage of Medicare and Medicaid in 1965. And during the past three decades of the 20th century, rising costs began to undermine private insurance. Moreover, a wide chasm remained between those demanding a revolutionary transformation that included universal access and a comprehensive package of benefits and those in favor of an incrementalist approach.At the close of the book, Derickson argues that the failure of several reform campaigns that relied on elite expertise illustrates "the imperative need to build a mass movement among the uninsured to reframe the policy debate and the political contest." Given the current political environment and the proliferation of interest groups each with quite different agendas, it is doubtful that this is a viable possibility. Moreover, the commitment to universal access has often been superficial. The fact that all plans to implement this ideal have failed suggests as much, verbal statements notwithstanding.Derickson's book is undoubtedly important contribution that deserves a wide readership. Even if the study of the past offers no concrete lessons, it nevertheless suggests some broad themes and provides an understanding of the importance of context that is useful in evaluating policy alternatives and strategies.Dr. Grob is Henry E. Sigerist professor of the history of medicine emeritus at the Institute for Health, Health Care Policy, and Aging Research at Rutgers University, New Brunswick, New Jersey. FiguresReferencesCited byDetailsCited ByNone Volume 57Issue 6 June, 2006Pages 887-888PSYCHIATRIC SERVICES June 2006 Volume 57 Number 6 Metrics PDF download History Published online 1 June 2006 Published in print 1 June 2006