HP 353 - Chapter 16 Textbook

What were the major attempts to legislate NHI in the U.S.?

• American association for labor legislation plan

• wagner-murray-dignell bill

• medicaid and medicare

• Kennedy-Griffiths Health Security act vs nixon's employer mandate

• clinton employer mandate plan

• Affordable Care act

Why were all of the major attempts to legislate NHI unsuccessful?

• strong opposition from the AMA, private insurers, and political partnership

• public mistrust of government

• resistance to new taxes

What was Nixon's employment mandate model of NHI?

• Employers were required to purchase private health insurance for employees, paying ~75% of premiums while employees paid ~25%.

• Government subsidized unemployed workers.

Why was Nixon's plan significant?

It shifted NHI proposals toward the private sector, preserving the role of private insurers instead of replacing them with government financing.

What was the Heritage Foundation's individual mandate model of 1989?

• Required all U.S. residents to purchase individual health insurance polices.

• Provided tax credits or vouchers to help lower-income families afford premiums.

How did the individual mandate model (Heritage Foundation 1989) differ from employer-based insurance?

It served as the link between employment and insurance, allowing portability and continuity of coverage regardless of job status.

What did the Massachusetts' 2006 health reform law do?

• Required all residents to have health insurance or pay a penalty.

• Provided subsidies for individuals below 300% of the FPL.

What was the impact of the Massachusetts individual mandate plan?

• Reduced the uninsurance rate from 14% to 3.7%.

• Served as a model for the ACA.

What financing models did the ACA combine?

• Government financing (Medicaid expansion)

• employer mandates

• individual mandate with subsidies

What was the impact of the ACA?

Reduced the number of uninsured Americans from 50 million to 27 million.

Why is the ACA considered pluralistic?

It blended government programs, employer-based insurance, and individual private insurance rather than relying on a single financing model.

What do supporters of a single-payer plan argue?

• universal coverage

• reduced administrative costs

• employers relieved of insurance burden

• more provider choice

• portability across jobs

What do opponents of the single-payer plan argue?

• too bureaucratic

• excessive government control

• reliance on taxes is unacceptable

• loss of private payment options

What do supporters of government financed plans argue?

• lower administrative costs

• employers freed from insurance responsibility

• greater physician choice for consumers

What do opponents of government financed plans argue?

• the public is unwilling to accept higher taxes

• mistrust of government

What do supporters of the employer mandate plan argue?

• needed to raise enough funds to insure the uninsured without a large tax increase

• less disruptive to extend this process

What do opponents of the employer mandate plan argue?

Unfair burden on small businesses.

What do supporters of the individual mandate plan argue?

• employers are freed from providing insurance.

• stable coverage regardless of employment, disability or job changes.

What do opponents of the Individual mandate argue?

• inefficient for individuals to buy their own insurance.

• affordability issues even with tax credits.

• higher-out-of-pocket costs for vulnerable groups compared to staying uninsured (esp for seniors and sick ppl).