Employer Health Insurance Mandates - Research Paper Example

Employer Health Insurance Mandates A. Introduction Almost every American is aware of the ongoing debate on health care reform. We are aware of the simple fact that we all need the protection offered by health insurance. However, the debate lies on the extent of the coverage of the insurance and as to who shall be entitled to such. Many people coming from the poorer families do not have health insurance. The number of these uninsured people can be roughly estimated at 40 million. Then, even among those who do have health insurance, more or less twenty-five percent do not have adequate coverage. Thus, in case of eventuality, medical bills expose them to bankruptcy and helplessness in the current restrictive health system. Furthermore, these data do not yet factor in the quality of health care extended to the people. Given these propositions, it is not surprising that there are many unhappy citizens. This is because the United States may lead the rest of the world in the fight against terrorism. However, it falls behind in providing adequate and quality health care to its very own people. The question of health care reform has long been part of the programs of past administrations. The debate over health care reform has been part already of the consciousness of almost every Americans now. Ruling parties have claimed it to be part of their priority and many more Americans have relied heavily on these yet nothing happened. In as early as the time of Theodore Roosevelt’s Bull Moose party, there were already campaign platforms that mention health insurance. This was around 1912. Then we also have the progressive reformers who asserted for compulsory health insurance. Years passed and debates went on. Every American seems to agree that there is a need for a national health insurance system. However, there is no consensus as to how the health reform shall be executed. Many have promised to improve the system by removing the bureaucratic red tape in the picture. However, due to the other priorities that took most of the attention of the former presidents, health care has never progressed fast. The event of September 11, 2001 attacks pushed health reforms in the background and the issue on terrorism in the foreground. As the administration changed last 2009, health care reform once again became an important consideration. President Obama had been very vocal about the American health care system as one of the top priorities of his administration. He even said in his address to the Congress that “[h]ealth care reform cannot wait, it must not wait, and it will not wait another year” (2009). There are many ways to justify this position of President Obama. For one, in 1999 alone, the costs for health administration in the United States reached $294.3 billion and this is three times bigger than the costs in Canada but it is the latter that is now reputed to be one of the countries that provide more than ample provisions in health insurance (Woolhandler, 2003). Actually, among the members of the Organization for Economic Cooperation and Development or OECD, United States is the only high-income generating country left that does not provide universal health care coverage (Holstein & Litzinger, 2008). It is about time that there should be a consensus that health care reform is imperative. Numerous cases may be cited just to point out how important health reform is. We do commend the government’s efforts to improve the effectiveness and responsiveness of the United States health system. However, not everyone seems to embrace wholeheartedly the burden entailed by the current reforms in the health care system. There are still some who are skeptics. There are still those who want the benefits but none of the duties or consequences. This may be the case for some people. However, America needs to be reminded that it does not need another issue that shall divide the nation. The health care reform law should be properly understood and evaluated by the people who shall benefit from it. B. The Current American Health Care System The current system being implemented in the United States is relatively deplorable compared to other countries. The American healthcare system relied heavily in the free market. Thus private entities are relied upon to provide the solution to health care insurance. Reliance is placed on the probability that competition among health insurance providers will generate better alternatives for the people. However, in reality, not everyone gets covered and even those who are covered not everyone are assured to get the proper quality of care they deserved. Americans do have the Medicaid, but it only applies to those who are living below poverty line threshold. Americans do have Medicare, but it is targeted for the elderly of the society. Americans do have the State Children’s Health Insurance Program or SCHIP, but it is only extended to the young in the populace. Basing from these statements, it can be said that most of the uninsured people in the United States are comprised of those who are not poor enough to be qualified under Medicaid, too young to be entitled to Medicare and too old already to be included in SCHIP (Holstein & Litzinger, 2008, 17). This insufficient health insurance coverage only proves the inability of the government to provide high quality yet affordable health care system to the people. Such misgivings can result to financial and health losses to those who are inadequately covered by insurance. For in reality, not being able to get the right treatment may worsen the condition of the individual. There are even studies that would attribute the deaths of thousands of Americans every year to the lack of proper health insurance coverage. This is because they are not able to get the proper treatment or refused to get treatment because of the financial burdens they may face when they get better. On the other hand, even if the right treatment is sought, if the insurance coverage is inadequate, then the patient may eventually face financial burdens that can leave him or her bankrupt. We are aware of the maxim that says health is wealth. This is an old saying that runs true no matter where one goes. Any person who had been hospitalized for a prolonged time or someone who is taking costly medications will definitely agree to this maxim. The English philosopher John Locke even stated that, “a sound mind in a sound body is a short but full description of a happy man.” However, if we are to evaluate the current health system without the present reforms, it seems people need to get wealthy first before they can ensure their health and protection. This should not be the case. What would an ideal health care system entail? In an ideal world, a holistic health care system should be of exceptional quality and accessible to all. However, if a compromise must be made, the decision must be tilted to where more people can benefit to a greater extent. There are ways to ensure that many people benefit in the health care system adopted by the state. One way that this can be assured is to highlight primary care services. There are advantages in restructuring the health system to give emphasis on primary care. In a study conducted by the World Health Organization (2004), countries that improve their primary care system have shown to improve also their response to the health needs of the population. There is also a significant increase in the satisfaction of the patients and a decrease in piece-by-piece health spending by the citizens. Then, a focus on further improving the quality and efficiency of the primary care services should be able to give the necessary boost on the health outcomes. Possibly, extending primary care services to the people may be effective in reducing the inequities in the community. A healthy outlook and perspective shared by everyone in the community will undeniably help the attitude of the people towards health care systems. The health care reform system must also go beyond just giving primary services. It must take into account the need to include everyone in the benefits. The system must be sensitive to the conditions of those living below poverty thresholds. It should also put responsibility to those who are in the position to make decisions. Insurance plan providers must also be reminded that their industry should not solely look into profits. The health insurance industry must also be compassionate to the people who pay their premiums. These are just some of the aspects that can be considered in assessing health care reforms and their responsiveness to the needs of the people. C. The Health Reform Law As President Barack Obama promised, the administration was able to come up with a health reform law within the first quarter of 2010. The Patient Protection and Affordable Care Act became a law on March 23, 2010. This is also known as the Affordable Care Act. The Affordable Care Act is a very lengthy law comprised of more than two thousand pages in its final form. These pages break down the details of health care reform system that will make access to health care coverage affordable to all. This law provides for the many aspects of implementing the policy of the state on health care. The law follows a timeline before its full implementation. There are also various government agencies and organizations that need to be involved for the effective execution of the provisions of Affordable Care Act. A few changes were later introduced through the Health Care and Education Reconciliation Act of 2010, also known as the Reconciliation Act of 2010. President Barack Obama signed this into law on March 30, 2010, within a week of enactment of the Affordable Care Act. These laws on health care reforms all call for expanding the access of the people to insurance coverage and ensuring that quality health care is provided in the process. It aims look into the long term benefits of having all United States citizens and legal residents to be adequately covered by health insurance. 1. The Employer Mandate The traditional way to impose insurance coverage upon the people is to seek group insurance. This is most often seen in the office setting where the employer obtains insurance coverage for its employees. More or less 70 percent of the American population obtains their health insurance through their employment. This group insurance setup offers convenience to individuals. Joining group purchases can also help the individual member save more because bulk purchases may be granted discounts. This group purchases is supported by the “employer mandate” in health reform laws. Some think that the employer mandate is not good for the society in the long term. This is primarily because the employer mandate system only works for the benefit of those employed. It ignores the plight of people who are not enjoying the employer-employee relationship in the office setting. Aside from that, even among those who are employed, this mandate may still discriminate to those who do not have preferential status in their employment. There is also the possibility that the premiums to be paid by the employers may increase in time. A scenario we need to avoid in these situations is the possibility that employers may seek to recover the losses paid in premiums through other means, like lowering the wage of the employee or letting go of some of the employees. These consequences are especially crucial in the case of the low-income workers. These workers are only earning the minimum wage. If all employers are mandated to shoulder the costs of insurance for these workers, then the workers’ compensation will significantly decrease. Some of the workers who barely meet the minimum qualifications may be sacrificed in the process. There are studies that already stated this dilemma. Some even suggested that thousands of low-skill and low-income jobs would be lost if employers are forced to comply with such mandate on health insurance (Baicker & Levy, 2005). The Affordable Care Act calls for the employer mandate. However, the law does not stop there. This paper will further discuss other details illustrating that the law does not rely on the employer mandate alone. Under the Employer Mandate of the Affordable Care Act, effective on 2014, employers with more than 50 employees working full-time should offer insurance with “minimum essential coverage.” Failure to comply with this shall make the employer liable to pay a penalty of $750 for every qualified employee who has not been given coverage. The Reconciliation Act of 2010 that took effect a few days after the Affordable Care Act considers even the part-time employees as full-time for the purpose of determining the 50 employees in the company. There is also a provision that requires employers who extend health benefits to their employees to automatically enroll the latter. A notice regarding the automatic enrollment shall be given to the employees. They shall also be given the opportunity to decline it. Tax credits shall also be extended to small businesses. This is in recognition of the fact that being adequately covered in health insurance is not a cheap venture. Tax credits will definitely alleviate the burden imposed upon the employers who do not earn big. Under the provisions of the health reform law, small business employers may obtain a tax credit of up to thirty-five percent (35%) of the premiums they will pay for their employees. This provision takes effect immediately. However, effective 2014, the tax credit available to the employers shall be up to fifty percent (50%) of the premiums. 2. The Individual Mandate In the debates that preceded the current health reform law, a focus on the individual market was emphasized. In the individual mandate setup, everyone is mandated to buy health insurance to be covered and to be protected. Under a system of individual mandate, it is not anymore the sole province of the employers to worry about providing insurance to their workers. Every citizen in the United States is mandated to obtain insurance protections, especially if they are not part of any group insurance plan. If not, then a penalty may be imposed as a consequence of the neglect or refusal to obtain protection. Generally, the good side of this individual mandate is to ensure that every person gets financial assistance in case of exposure to risk or any health-related eventuality. At present, the costs of hospitalization and getting treatment are not cheap. Health insurance can mitigate the excessive financial burden of the medical bills. We can also look into the prospect of securing the insurance pool through the individual mandate. This is because any insurance system will rely heavily on the pool of people who contribute through their premiums to shoulder the costs of those who have been exposed to risks. The problem with the individual mandate is that it leaves too little of a choice to the citizens. Somehow, it really is an intrusion into the privacy of every American people. This is because the choices given are between paying for an insurance coverage and paying the penalty for refusing to do so. Thus, even if for all intents and purposes the health insurance will help the individual, such impositions will remove the empowerment of the people. With the enactment of Affordable Care Act, individuals are now mandated to purchase health insurance. Otherwise, those who shall fail to obtain a health insurance, or do get one but failed to maintain it, will be required to pay an income tax penalty. The income tax penalty increases annually. For example, when the above system is implemented starting 2014, the penalty may be based on the percentage of the income of the individual. Thus, in 2014, 1% of the income shall be subjected as penalty. The year after that or in 2015, 2% of the income shall be the basis. The formulas for assessing these penalties for individuals who remain uninsured have been reconfigured by the Reconciliation Act. The requirements on individual mandate will apply only to individuals who are not yet covered by any health insurance. Thus, those who are part of group health plans need not enroll individually. Taxes shall also be imposed, effective in 2013, to make individuals who earn high income to pay an additional 0.9 percent in the Medicare payroll. These taxes shall also be imposed to self-employed individuals. Starting later this year, the millions of Americans who are uninsured at due to their pre-existing conditions may now be temporarily given some protection. People who shall fall in this category shall be provided affordable insurance through a subsidy of the government in a temporary national high-risk pool. This subsidy or high-risk pool shall be removed by 2014 because by that year, insurance companies shall already be prohibited from excluding people from the coverage due to pre-existing conditions. The Affordable Care Act also expands the coverage of the Medicaid. The law extends the coverage of Medicaid to families that have income within the 133% range of the poverty level. People can also look forward to the provisions that remove the lifetime limits on insurance coverage. The law also removes serious illness as one of the grounds for the cancellations of the policy. The law also gives another option to American adults who are 26 years old and below. They are given the chance to stay as part of the insurance policy of their parents. However, this option shall only be upon the election of the parents. 3. Health Plan and Insurers In the implementation of the Affordable Care Act, health plan providers and insurers are not anymore given the sole determination of how they will do their business. Thus, companies that focus too much on the profit shall be required to incorporate a bit of compassionate allowance for their policyholders. As stated in the discussion of individual mandates, insurance providers are mandated to extend the coverage of their policies, relax certain requirements and get rid of certain restrictions in their policies and premiums. 4. Health Providers and Health Industry Involvement The Affordable Care Act did not forget to involve the health care providers in its provisions. In the pertinent provisions, the law provided for the participation of groups in the implementation of the health care reform system. a. Health Providers in General One of the more relevant changes brought by the law is that effective in 2012, Accountable Care Organizations or ACO that are able to reduce their costs in caring for their patients shall be given a share in the savings they were able to make. This provision aims to make health care providers more efficient in their delivery of services. Efficiency must be underscored in its effectiveness with the use of minimal resources and not in the haste in the performance of duty. For an organization to qualify as ACO, it must agree to be responsible for the care it shall extend to the beneficiaries of Medicare. There must also be a sufficient number of primary care physicians in their membership and utilize evidence-based medicine. The law also requires that the organization be able to report on the quality and the costs of the services provided. There will also be a voluntary pilot program in Medicare to be implemented in 2013 wherein all providers (hospital services, physician services, outpatient requirements) involved in a single case of a patient shall be covered in a bundle payment. There is also additional funding provided in the amount of $250 million spread over ten years. The funding shall be used to counter fraud and abuse in the enforcement of the provisions of Affordable Care Act. b. Physicians The regulations on the role of the physicians are largely related to the application of the provisions of the Stark Law. There shall be an implementation of a protocol for disclosures required under the Stark Law. Thus, physicians who intend to make a referral of their patients to institutions where they have financial interests shall be precluded or discouraged from doing so. Furthermore, the Affordable Care Act also removes the provision in Stark Law that provides an exception to physician-owned hospitals. Aside from these, physicians are required to inform their patients of other entities that may be approached in terms of health services that are not related to the referring physicians. There is also a significant emphasis on physicians providing primary care services. Primary care physicians are given an increase in Medicaid payments beginning in 2014. This will effectively motivate the likes of family physicians, pediatricians and internists. c. Hospitals The performance and achievements of the hospitals shall be measured under the Affordable Care Act, and be rewarded accordingly. Under the law, by 2013, payments in “diagnosis-related group” or DRG shall be reduced by one percent (1%). This amount shall be withheld upon payment and shall go to a pool of withheld funds. These funds shall be distributed among hospitals that are able to perform with exceptional quality to their patients. It is also equally significant to mention the additional requirements imposed by the Affordable Care Act to non-profit hospitals. These hospitals are generally tax-exempt. They are only further obliged to regularly conduct an assessment of the needs of the community where they operate. This is to enable the non-profit hospitals to deliberate properly and respond to the needs identified by the hospital. These hospitals are also obliged to come up with their own financial assistance policies. At the very least, they must charge qualified patients to the extent of the amount that they will charge to insured individuals. Considering that these hospitals are not required to pay tax to the government, they are expected to carry out a significant role in the delivery of health care services to those who are most in need. The Reconciliation Act of 2010 has a mention of “disproportionate share hospital” or DSH. Starting in 2014, the payments on DSH are reduced by seventy-five percent (75%). However, the payments shall increase subsequently depending on the number of its patients without insurance coverage. It also covers the amount for health care provided that is left unpaid. d. Clinical Laboratories There is an additional reduction to the Clinical Laboratory Fee Schedule or CLFS of clinical laboratories. In the implementation of the Affordable Care Act, the reduction of CLFS by 1.75 % points beginning 2011 to 2015 is meant to serve as an alternative option to raise revenues. The law also sets up a project wherein payments for complex diagnostic laboratory tests shall be made separately. This mechanism includes certain requirements to qualify for payment. To qualify, the Food and Drug Administration must approve the tests. There must be no other alternative test that generates equivalent performance. This project shall commence in 2011 and shall be conducted in two years. Another equitable provision found in the Affordable Care Act is its mention of the rural laboratory services. Reasonable costs shall be imposed for identified clinical laboratory tests that are performed in the rural areas. This way, people in the rural parts of the country are given access to these tests without imposition of high costs. e. Pharmaceutical Manufacturers The Affordable Care Act provides for the imposition of excise taxes on sales by pharmaceutical manufacturers. This is supposed to be immediately effective and is expected to generate for the government $2.3 billion per year. However, the enactment of the Reconciliation Act of 2010 delayed the implementation until 2011 but raising $2.5 billion annually by then. A 2.3 percent sales tax shall be imposed in the year 2013 on device manufacturers. Increased transparency among pharmaceutical and device manufacturers is also implemented in the law. Beginning 2012, these manufacturers are required to disclose the payments they give to hospitals, physicians and providers, publicly. This transparency should help in minimizing the expenses claimed by the manufacturers in adjusting their costs. 5. Public Health Provisions a. Preventive Care and Maintenance There is one idiom often quoted that we must not forget in addressing health care issues. “An ounce of prevention is better than a pound of cure." This may be, perhaps, the cheapest and most effective measure in any preventive health care system and services. Little has been said in the past on the aspect of the health care system that puts forth the costs and benefits of preventive health services. This has long been overlooked in the system. This may be attributed to the attitude of insurance companies to answer only for actual exposure to risks. Such as system may be called as reactionary. Thus, the individual still largely shoulders the costs of preventive health maintenance. It is high time that effective mechanisms to share the costs of prevention services be implemented in the system. This will signify that the health reform system is holistic. This will give way to a system that really cares about the health of the people because the intervention happens at the stage where the health threat can still be prevented. Consequently, first steps may be taken already to review how services can be structured to accommodate preventive health care services. The Affordable Care Act establishes an interagency council through the Interagency Working Group on Health Care Quality. Basically, the council is tasked collaborate, cooperate and consult with other agencies and departments to develop strategies consistent with the health care system. One significant and specific task that the interagency council takes on is its role in promoting health policies. It is through this that the council can make significant changes through prevention and health promotion strategies in a nationwide scale. There is also a provision in the law that creates the Prevention and Public Health Investment Fund. This is established to constitute a national investment that will sustain the efforts for preventive care and public health. It is also the goal of the Affordable Care Act to increase the access of the people to clinical preventive health services. This is done through the programs that include prevention education campaigns. This includes the efforts to conduct School-Based Health Clinics and oral health promotion. The law is also clear in extending Medicare coverage for wellness visits, without added payments or deductibles. The coverage also extends to efforts of developing personalized prevention plans for individuals. In some cases where co-insurers or deductibles are required, these will be waived under Medicare if the individual shall avail of preventive services. The Secretary of Health and Human Services (HHS) is given the mandate to provide funding for research that focuses on the best practices for public preventive health services. The Secretary is also tasked to award grants to qualified entities that shall successfully promote community health aspects and at the same time prevent the occurrence of chronic diseases. Even the Centers for Disease Control and Prevention are given the same authority. This is to encourage private entities to engage in public health interventions through research and studies. These studies will improve the literature on public health. At the same time the people who shall be asked to participate in the study shall benefit too. The Affordable Care Act established also the United States Preventive Services Task Force (USPSTF). It is through this task force that standards on preventive services shall be determined. The USPSTF shall rate services. The services classified as ‘A’ or ‘B’ are mandatorily part of insurance companies and health plans coverage. A special and separate task force is also created to address community health care services. The Community Preventive Services Task Force or CPSTF is the one responsible for providing recommendations on the health interventions needed. Their recommendations have to be taken into account by primary care physicians, employers and community groups, among many others. Other provisions equally relevant to efforts of preventive health services are the requirement to put under Medicaid coverage the pregnant women who are undergoing counseling to stop their use of tobacco. There is also coverage in pharmacotherapy. Incentives are also extended to participants, who are at the same time beneficiaries of Medicaid, in programs that promote healthy and active lifestyle. Even fastfood chains are covered by the intent of the law, as they are required to indicate in their menu or boards the calorie counts of their dishes. These efforts should be lauded because the system is taking its course a notch higher. By engaging in preventive health services, the government is not solely reacting anymore to health problems. The government’s effort is also on avoiding the occurrence of such health issues. b. Expanding the Workforce The law mandates that by the year 2011, there shall be more scholarships to be extended for primary care providers that work in areas where the workforce number is very low. This is to serve as an incentive to the individual professionals who wholeheartedly want to serve their community through the public health care system. Furthermore, training programs for primary care providers and nurses shall specifically address these shortages, starting July 2011. The Affordable Care Act also mentions the need to address the shortage in nurses. This is done through further educational opportunities and loan assistances. Retention grants may also be extended to motivate participation in the nursing profession. A national commission shall review such shortages and needs in the health care workforce. This way, resources and efforts can be properly strategized to meet the inadequacies. c. Special Focus on Cancer Several provisions of the Affordable Care Act are devoted to the issue of cancer treatment. Cancer awareness campaigns have informed the public that being struck with this disease is not an ordinary ordeal. Aside from the pain and suffering associated with the disease, the treatment is also difficult to obtain because of its expense. Thus, the health reform law aims to make cancer treatment more accessible. This can be connected to the policy earlier mentioned where insurance providers are prohibited from excluding individuals due to pre-existing conditions. The law also emphasizes on the need to prevent the disease, or at the very least, detect it early. Those coming from the low-income bracket of the population can seek assistance through Medicaid. Tax subsidies may also be extended in certain instances. People can also look into the possibility of engaging in clinical trials. Providers are obliged to include these trials in the coverage. d. Information Campaign An information system shall be established to assist individuals who want to file complaints and appeals as regards their insurance policies. Furthermore, health insurance providers shall be required to justify any proposal to increase their premiums. This way, the public shall be properly apprised of additional impositions that may burden them. They will also be given sufficient opportunity to protest or negotiate. D. Discussion on Some of the Provisions of the Affordable Care Act 1. Provisions Immediately Taking Effect Significant is the fact that there are some provisions of the Affordable Care Act that take effect immediately or within six months from the date it took effect. These changes include the provisions on tax credits and prohibitions on discrimination. Within this year, health plan providers are prohibited from imposing various discriminatory provisions they implement in selecting the policyholders. For example, providers cannot anymore make salary as a basis in evaluating their clients. Health plan providers are not anymore allowed to deny insurance coverage to children with pre-existing conditions. This is to ensure that no unfair discrimination is made against those who really need help in their specific situations. Immediate also is the implementation of prohibiting policy providers from removing insured from coverage simply because the insured got sick. 2. Provisions Taking Effect in 2011-2014 There may be provisions that take effect immediately. However, some of the provisions will have to wait some time before they are fully implemented. The implementation period is spread out from 2011 to 2014. Perhaps, some period of transition is required for some of these provisions so that they will be fully implemented by the persons or agencies concerned. Systems may still require some preparation to incorporate them. Entities such as insurance policy holders and hospitals have just been given notice of the legal provisions and their compliance will have to spread on a certain period. One significant provision that takes effect a year from now 2011 is the requirement that policyholders be able to get the value of what they pay as premiums. This is through the imposition on individual and small group market providers the expenditure of eighty percent (80%) of the premiums paid for medical services. For large group market providers, the imposition is at eighty-five percent (85%). If the insurers are not able to meet these thresholds, they will extend the remaining amount to policyholders as rebate. This remarkable change shall ensure that insurance companies are able to profit from their venture but not to the extent that the individuals become mere contributors to the fund of insurance companies. Once again, the concept of the insurance is to pool the risk and share the burden. If there is not much exposure to risk and consequently no heavy burden, then the individuals must also share in the extra funds. The profit must be incidental, not the main goal of the insurance industry. Also starting in 2011 is the provisions on new investments and doubling of patients. This is with particular reference to primary care providers. The law aims to fund the increase in the number of primary care practitioners. This is to ensure that there are more than enough doctors, nurses and physicians to respond to the patients in need. This move will also go hand in hand with the goal of increasing the patients attended to by the Community Health Centers. The time interval before the designated date of implementation should provide sufficient period for preparation. Another change that we can expect 2014, quite a long time from now, sis the health insurance exchanges that the various states will implement. Under this system, small employers and individuals are given the opportunity to purchase health insurance for costs that are within their means. This is the answer of the present system to the problems raised above regarding possible job losses if employers with low-skill or low-income employees are required to obtain the optimum coverage. Conclusion We may already have legislations like the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 to prepare for or look forward to in the next months and into the next two to five years. At the very least, we must laud the efforts and initiatives introduced by these laws into our health care system. We cannot deny the fact that the emphasis given on primary care services is very significant to many communities and health centers in the country. The subsidies and programs extended to employers and individuals serve as promise that the insurance system shall be made available to everyone. There are also steps taken to improve the quality and performance of the health system. The law even gave strength to prevention and wellness campaigns and activities to emphasize long-term health care of the people. Remarkable too are the provisions in the law that recognizes the role of the people who execute the public health policies such as nurses, primary care providers, health professionals and organizations. There is definitely promise in the health reform laws. Their provisions are remarkably impressive. Taken together and properly implemented, these will definitely be a big improvement in the current health system employed in the United States. We also want these provisions to serve their main purpose and that is to improve the health outcomes of the citizens and residents of the United States. With citizens possessing healthy bodies and sound minds, the nation will only have room for improvement. We only need to wait and see if the laws will be able to live up to its name and ideals. We surely do not want this to fail. In the end, we want the people to benefit from this reformed health care system. The debate over health care is definitely far from over. This issue will continue to be pondered upon by critics and discussed in the media. There are still some who will keep convincing people about alternatives that are not equally viable. However, we cannot always seek for debates and speaking engagements. Those things improve our body of literature but it does nothing to actual improvement of the system if no first step is taken. This is why it is better to first embrace the current set of legislations laid before us and see how it works or improve from where we stumble. What we are called for to do is to always be wary of the many consequences that will reveal itself in the future. From there, wisdom and prudence must be sought to guide our decision-makers in taking the right path. References Baicker, Katherine & Levy, H. (2005) Employer health insurance mandates and the risk of unemployment. Employment Policies Institute. Dorfman S.L. & Smith S.A. (2002). Preventive mental health and substance abuse programs and services in managed care. Journal of Behavioral Health Services and Research, 29(3), 233-258. Hoffman, B. (2003). Health care reform and social movements in the United States. American Journal of Public Health. 93. Obama, Barack. (2009) Address to a Joint Session of Congress. Retrieved from http://www.realclearpolitics.com/articles/2009/02/obama_address_to_congress.html Woolhandler, S., Campbell, T. & Himmelstein, D.U. (2003). Costs of health care administration in the United States and Canada. The New England Journal of Medicine, 349. 768- 775 World Health Organization Regional Office for Europe’s Health Evidence Network (January 2004). What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services. Retrieved from http://www.euro.who.int/document/e82997.pdf. Read More