300 PART FouR • PolicymAking
able to afford to offer their workers health insurance. In 2011, employer-provided health
insurance cost an average of $5,429 for single coverage and $15,073 for family coverage,
according to the Kaiser Family Foundation.The Problem of high costs. High medical costs are a problem not only for individu-
als with inadequate or nonexistent insurance coverage. They are also a problem for the
system as a whole. Over the last four decades, per capita spending on health care in the
United States grew at an average rate of 4.9 percent per year, even when corrected for
inflation. A main driver of the growth in health-care spending was new medical technolo-
gies and services.
In addition, people over the age of sixty-five run up health-care bills that are far larger
than those incurred by the rest of the population. As a federal problem, therefore, health-
care spending growth has been and will remain chiefly a Medicare issue, even after the
passage of the new health-care measures. In 2011, the government’s Medicare trustees
reported that the Medicare trust fund was projected to run out of funds necessary to pay
for all of its obligations in 2024. Such prospects explain why the issue of health-care cost
containment was important during the 2009 election debates.The international Experience. The Patient Protection and Affordable Care Act of
2010 attempts to provide universal health insurance for American citizens. The concept of
universal health insurance is not new. Throughout the twentieth century, most economi-
cally advanced nations adopted such systems. American progressives considered it unac-
ceptable that the United States could not do what these other nations had done—another
argument for placing reform on the agenda.health care: Policy Formulation
During the next step in the policymaking process, various policy proposals are discussed
among government officials and the public. Such discussions may take place in the media
and in the halls of Congress. Congress holds hearings, the president voices the administra-
tion’s views, and the topic may even become a campaign issue.
For more than half a century, liberals have sought to establish a universal health-
insurance system in this country. All attempts, however, went nowhere. After the 2008
elections, however, the Democrats were in complete control of Congress and the presi-
dency. Universal health insurance now appeared to be politically possible.
Unlike previous proposals, the new universal health-insurance plans did not provide
for a federal monopoly on basic health insurance. Instead, universal coverage would result
from a mandate that all citizens must obtain health insurance from some source—an
employer, Medicare or Medicaid, or a new plan sponsored by the federal government
or a state government. Low-income families would receive a subsidy to help them pay
their insurance premiums. Insurers could not reject applicants. A program of this nature
was adopted by the state of Massachusetts in 2006 in response to a proposal by then
Republican governor Mitt Romney.health care: Policy Adoption
The third step in the policymaking process involves choosing a specific policy from among
the proposals that have been discussed.
As president, Barack Obama largely delegated the drafting of a health-care plan to
Congress. Obama’s willingness to let Congress take the lead was a notable change. Recent
presidents, such as George W. Bush and Bill Clinton, had sought to push presidentialCopyright 2014 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
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