Government’s Participation in Health Care

The U.S. government plays an important role in healthcare delivery. The United States has three governmental levels participating in the healthcare system: federal, state, and local. The federal government provides a range of regulatory and funding mechanisms including Medicare and Medicaid, established in 1965 as federally funded programs to provide health access to the elderly (65 years or older) and the poor, respectively. Over the years, these programs have expanded to include the disabled. They also have developed programs for military personnel, veterans, and their dependents.

Federal law does ensure access to emergency services regardless of ability to pay as a result of EMTALA (Regenstein, Mead, & Lara, 2007). The federal government determines a national healthcare budget, sets reimbursement rates, and also formulates standards for providers for eligible Medicare and Medicaid patients (Barton, 2003). The state level is responsible for regulatory and funding mechanisms but also provides healthcare programs as dictated by the federal government. The local or county level of government is responsible for implementing programs dictated by both the federal and state level.

The U.S. healthcare system is not a true system because of its fragmentation and lack of centralized decision making (Shi & Singh, 2008). The United States has several federal health regulatory agencies including the CDC for public health, the Food and Drug Administration (FDA) for pharmaceutical controls, and Centers for Medicare & Medicaid Services (CMS) for the indigent, disabled, and the elderly. There is also The Joint Commission, a private organization that focuses on healthcare organizations’ oversight and the Agency for Healthcare Research and Quality (AHRQ) is the primary federal source for quality delivery of health services. The Center for Mental Health Services (CMHS), in partnership with state health departments, leads national efforts to assess mental health delivery services. Although the federal government is to be commended because of the many agencies that focus on major healthcare issues, with multiple organizations there is often duplication of effort and miscommunication that results in inefficiencies (KFF, 2013). However, there are several regulations in place that protect patient rights. One of the first pieces of legislation is the Sherman Antitrust Act of 1890 and ensuing legislation, which ensures fair competition in the marketplace for patients by prohibiting monopolies (Niles, 2013). Regulations such as HIPAA protects patient information; COBRA gives workers and families the right to continue healthcare coverage if they lose their job; the Newborns’ and Mothers’ Health Protection Act (NMHPA) of 1996 prevents health insurance companies from discharging a mother and child too early from the hospital; the Women’s Health and Cancer Rights Act (WHCRA) of 1998 prevents discrimination of women who have cancer; the Mental Health Parity Act (MHPA) of 1996 and its 2008 amendment requires health insurance companies to provide fair coverage for mental health conditions; the Genetic Information Nondiscrimination Act of 2008 prohibits U.S. insurance companies and employers from discriminating based on genetic test results; the Lilly Ledbetter Fair Pay Act of 2009 provides protection for unlawful employment practices related to compensation discrimination; and finally, the ACA of 2010 focuses on increasing access to healthcare, improving the quality of healthcare delivery, and increasing the number of those individuals who have health insurance. All of these regulations are considered social regulations because they were enacted to protect the healthcare consumer.