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Healthcare Policy

The United States Department of Health and Human Services (HHS) is a Cabinet-level agency that is responsible for providing essential healthcare services to the nation. It was formed in 1979 when the former Department of Health, Education and Welfare was renamed and reorganized. The HHS is led by the secretary of health and human services, a position that is appointed by the president and approved by the Senate. The history of public healthcare policy in the United States didn't begin until the 1920s. Prior to that, doctors had limited knowledge about the causes and treatment of disease. Because the practice of medicine required very little equipment, most doctors treated patients at home. In 1900, the average American spent $5 annually on healthcare (the equivalent of about $100 in 2012).

The 20th century brought advances in medical treatment. Hospitals were transformed from being places where the poor went to die into places that frequently restored health. As healthcare became more effective, it also became more expensive. Hospitals were concerned about their lack of patients, a situation that became worse during the Great Depression. Baylor University Hospital in Dallas devised a system where individuals could pay a small fee each month in exchange for a free hospital stay if they became ill. Baylor initially offered the program to a group of Dallas public school teachers. The idea was successful and grew into the employer-sponsored health plan known as Blue Cross.

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The onset of World War II led to the rapid expansion of Blue Cross as employers offered fringe benefits to lure wartime workers. At a time in history when other countries were establishing national healthcare systems, the healthcare policy of the United States depended on employers to provide health insurance. In addition to non-profit Blue Cross, many for-profit private insurance companies began to offer healthcare plans. By the 1960s, 70 percent of Americans were covered by a health insurance plan provided by their employer. The situation was far from ideal since only people with good jobs had health insurance; those who were poor, unemployed or self-employed had no coverage. Insured workers who retired from their jobs ended up with no healthcare coverage at the time in their lives when they needed it most. In 1965, Congress addressed the lack of healthcare coverage for the poor and elderly by proposing legislation that led to the establishment of the Medicaid and Medicare programs. The legislation took the form of amendments to the Social Security Act of 1935. This New Deal social welfare legislation provided benefits to retirees and the unemployed as well as temporary assistance to needy families.

To gain support for the new healthcare policy from the medical establishment, the bill promised that doctors would receive their usual rate for services delivered to patients covered by Medicaid and Medicare. The Medicaid health program is funded and administered by states, with some funding provided by the federal government. As the largest source of funding for healthcare for people with limited incomes, Medicaid serves low-income adults and children who are U.S. citizens or permanent residents. The details of Medicaid coverage vary by state. Medicare is a federal program that is administered by the HHS. It provides coverage for people age 65 and older, younger people with disabilities and people who are in the final stages of kidney disease. Basic Medicare (also known as Parts A and B) coverage includes hospitalization and healthcare provider services. Medicare Advantage (Part C) offers the option of health plan coverage for Parts A and B from a private insurance company. Medicare Part D helps cover the cost of prescription drugs.

The Affordable Health Care Act for America was signed into law by President Obama on March 23, 2010. The law rolls out a series of health care reforms over four years and beyond. Key provisions include restricting health insurance providers from restricting coverage based on patients' medical history, requiring employers to provide health insurance for employees or pay a surtax, and a subsidy to low- and middle-income Americans to help buy medical insurance. Under the new law, Medicaid will be expanded to include more low-income families.

Healthcare Policy Careers

As the principal federal agency responsible for protecting the health of the nation, the Department of Health and Human Services (HHS) touches the life of every U.S. resident. MPA careers with the HHS make a difference in communities, states and the entire nation.

Job Title: Public Health Policy Analyst (Policy Branch Chief)

Estimated Salary: $123,758 to $155,500 per year

This public health policy analyst position is located in the Office of Global Affairs (OGA), an agency within the HHS. The policy branch chief is the OGA focal point for policy issues related to human services and public health. Responsibilities include developing and evaluating domestic and international policies both on behalf of the HSS and for other U.S. government agencies. The policy branch chief leads a small team that conducts research and analysis to support HHS policy decisions and must maintain working relationships with a wide range of domestic and international healthcare agencies and organizations. Some of the policy issues that are addressed by the policy branch chief include diseases, health coverage, maternal and child health, international emergency preparedness, pandemic planning, urban health, and human rights.

Job Title: Director, Office of Direct Service and Contracting Tribes

Estimated Salary: $119,554 to $179,700 per year

The director of the Office of Direct Service and Contracting Tribes (ODSCT) is one of two primary health liaisons responsible for more than 550 tribes that are currently recognized by the federal government. Responsibilities include strategic planning and evaluation of tribal health support systems provided by the Indian Health Service (IHS). The ODSCT director prepares progress reports as required by law and requested by congressional committees. The position requires frequent communication with tribal leaders, HHS agencies and the Department of the Interior. The director serves as the focal point for development of IHS policy and is responsible for management and direction of ODSCT staff. Qualified tribal candidates are given preference for this position.

Job Title: Social Science Research Analyst

Estimated Salary: $89,033 to $115,742 per year

This social science research analyst position is with the Centers for Medicare and Medicaid Services (CMS) Agency in HHS. Responsibilities include direction, coordination and implementation of major CMS research projects. The social science research analyst must also prepare status reports, briefing papers and healthcare policy analysis reports and make policy recommendations. The analyst is expected to serve as a subject-matter expert both within the CMS and when working with other government agencies. Qualifications for the position include experience in social science research and knowledge about health insurance claims and related data.

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