EXECUTIVEBRANCH RESEARCH PROJECT
Healthcareis one of the most contested issues in the American Societyespecially following the latest healthcare reforms which placedcritics and proponents on differing sides as heated debates wasexchanged between the Democrats and the Republicans. Medicare andhealthcare is one of the largest areas that are allocated asignificant chunk of the national and federal governments spending.In the United States, healthcare services are provided by differentorganizations that have distinct mandate from the federal andnational governments. The private and nonprofit sector operatesmajority of the hospitals compared to governments. Most of thehealthcare provision and funding is done through programs such asMedicaid, Medicare, Veterans Healthcare and Children’s HealthInsurance. In this context, populations under the age of 67 years areinsured by the employers, health insurance or the government (publicsector). Healthcare spending in the United States exceeds those ofother countries at international level.
However,not all Americans are covered by the government health insurance andin some cases others are not covered by their employers or cannotafford private health insurance. The problem has raised unprecedentedpolitical controversy at national level (Krugman,2005:2).Federal and State governments regulate the healthcare servicesthrough licensing of health care providers, approving and testingmedical devices and pharmaceuticals. The federal and Stategovernments have a great stake in regulating the health insurancemarket under the Medicaid and Medicare health insurance programs. Although the United health care system has implemented numeroushealth care programs, political debates aside, the healthcare systemfalls short of the expected Universal healthcare system (AmericanHealth Care Reform.org 2).
TheAmerican health system raises several questions on its efficacy ofaccessibility, efficiency, quality, sustainability andall-inclusiveness to the extent it has some element ofdiscrimination as particular individuals (immigrants) do not qualifyfor most of the health programs (government and private healthcareschemes). As indicated by the Institute of Medicine (IOM), the UnitedStates healthcare program does not guarantee health care’saccessibility to all. The argument that Universal Healthcare is notfeasible to all due to hidden costs of uninsured Citizens does nothold sense (Krugman,2005:1).A universal healthcare enhances spreading of costs and lowering ofhealthcare costs while enhancing quality services. However,individuals have a right to choose any health care program they wish.In addition, it is the fundamental obligation of the government toensure that all people have access to health care despite theircitizenship status, employment or another limitation. On the otherhand, the government should enact more cuts on the Medicare programto make it more accessible to all(Krugman, 2005:2).
Nonetheless,the healthcare reforms agenda is an essential aspect in solvingaccessibility and efficiency in the healthcare program expanding theMedicaid eligibility and subsidizing insurance premiums is a rightmove in the health care program. The government could do more onhealthcare program by providing incentive to the private sectors toprovide healthcare benefits, establishing healthcare insuranceexchanges, prohibiting denial of coverage and prohibiting healthinsurance firms from establishing annual cap on the amount spent onhealthcare. In addition, the government needs to have a specialprogram to cater for the immigrants and United States Visitors asespoused in the health care reform programs. In these ways, theUnited States healthcare program will be all-inclusive, accessible,efficient and sustainable (American Health Care Reform.org 1).
Federalexecutive agencies that regulate Medicare and Health in the UnitedStates
Centerfor Medicare and Medicaid Services (CMS)
Centerfor Medicare and Medicaid Services wasestablishedto protect the public against health risks as well as providingpublic with welfare programs. The mandate of the agency is toregulate and protect the public at different levels. Center forMedicare and Medicaid covers approximate 100 million people throughthe various health programs children health insurance (CHI),Medicaid, Medicare and regulating the health insurance in the marketplace(Centers for Medicare and Medicaid).The agency does not provide the actual health care coverageinsurance, but it ensures that the healthcare programs follows andapplies high standard in the provision of high quality health system.Since its inception in 1965, legislation has expanded its mandate andresponsibilities. Initially, the agency was mandated with overseeingthe Medicare, Medicaid and the Children healthcare program (AboutHHS, pg 1).
However,unlike in the past decades the agency oversees multiple healthissues. It is now in charge of the Medicare prescription Drug Act(MMA, 2003), the Deficit Reduction Act 2005(DRA) and the Tax Reliefand Care Act 2006(TRHCA). In addition, the agency oversees theMedicaid, Medicare, state Children’s Health Insurance programExtension Act 2007 (MMSEA) and others. Unlike its former traditionalroles, these several legislation has impacted on the role of CMS asoverseer of Medicare, Medicaid, and CHIP program. In a recentlegislation, the CMS was given the responsibility of implementing theAffordable Care Acts’ consumer protection and private healthinsurance provisions 2011(AmericanHealth Care Reform.org 2).
Underthese provisions, the agency is required to provide coverage optionsfor the uninsured citizens, supporting employers so that they canfinance retirees’ health benefits and establishing new requirementsfor private health insurance. In the same note, the agency is engagedin education programs to enable consumers assess their health optionsand determine their best health programs. The agency works with thestate and local governments in guiding on health policy andlegislation policies. For instance, in 2014, the agency is workingwith the state government in ensuring that there is an AffordableInsurance exchange in the market. In short, the agency works with thelocal and state government in implementing their various healthcarelegislation ensuring that all players in the healthcare systemadhere to the procedures and laws governing effective healthcareprovision.
Foodand Drug Administration (FDA
Foodand Drug Administration is another federal agency established by theDepartment of Health and Human Services (HHS). Its mainresponsibility is protecting and promoting public health throughsupervising and regulating food production safety, drugprescriptions, vaccines, blood transfusions, medical devices,radiation-emitting devices, cosmetics, veterinary and other healthrelated products. The agency, therefore, regulates and enforces lawsaimed at enhancing public health safety. Other regulations among itsregulations such as disease controls, sanitation, sperm donation andreproduction are not related to food and drugs but still fall underthe agency regulation. The scope of FDA regulation encompasses allreviewing the quality and health level of all drugs, food, blood andcosmetic products to ascertain their effectiveness before used by thepublic (FDA Overview).
However,the programs of regulations vary depending on the item and theregulatory mandate bestowed upon the agency by the state legislation.The agency implements various statutory regulations enacted by theUnited States congress. Through the powers bestowed on it by thestate, the agency has powers to address any gross violation ofstandard in given category of food or drug substances. In addition,the agency regulates all food and drug related advertisements toensure that they have been approved by the agency. In similar level,the agency monitors and approves all vaccines, blood or tissueproducts and biotechnology. This surveillance and approval scopeextends to cosmetics, veterinary and health devices used in hospitalsor by the public. The agency has strong links with state and localgovernments throughout in ensuring that regulations and laws arefollowed when dealing with the fore mentioned substances andproducts. Besides, the agency has strong working relationships withother agencies and departments in ensuring that a health regulationapplies across the American society.
CaliforniaDepartment of health care services
Thisagency is tasked with preserving and improving the health status ofall California society. The agency works closely with healthcareexperts, the county governments and alongside national health plansin providing safe health services to the Californians especially thedisabled and low income group. As such, the department fiancés andadministers health care delivery programs to the society. Among themany programs spearheaded by the agency are California Childrenservices program, disability prevention program, California Medicalassistance program and the genetically handicapped programs (TheCalifornia Partnership).As such, the California department of health services implementshealthcare plan in line with federal government directive. However,the department implements healthcare services depending on thedemographic characteristics of its population (AboutHHS, pg 1).
CaliforniaRural Health Policy Council
Themandate of this council is to establish and formulate rural healthpolicies within Californian state to guide the California Health andhuman services agencies on the health condition for the ruralcommunity. Its task is to receive suggestions and recommendations onhealth issues from the rural constituencies so that services can beimproved by the rural health service providers. In this respect, thecouncil promotes and supports collaborations, networking,communication and working relationship between state federalagencies, rural health service providers and the rural constituencyorganizations involved with health services for rural communities.
PomonaDepartment of Managed Health Care (California)
Thisagency is instrumental in establishing regulations in all cities andcounties of California. The agency regulates and manages allhealthcare plans operating within California (HMOs). Under thisagency, the urban and rural communities of Pomona are assured ofpatients’ rights laws that are followed with specific health plansfor particular groups in the Californian society. For instance, thePomona Valley, under the department of managed healthcare providesmedical assistance program from the disabled, the aged, children andthe teens. In addition, this departmental agency ensures that thereare local healthcare regulations and federal Medicare regulations onhealth insurance firms(Medi-Cal).
Centerfor Medicare and Medicaid
Inthe Pomona city, the CMS agency has local offices where it promotesand regulates Medicare and Medicaid. It provides assistance to thelocal healthcare facilities by strengthening their programs,enhancing efficiency, transparency, accountability and qualityservices to the locals (County Programs for the Medically Indigent inCalifornia). Together with the local government and community atPomona, CMS is involved in improving the capacity of key healthcareprograms and enhancing an interactive network among the major federalagencies regulating health services at the local level. As such, theagency has enhanced a corroborative effort between the HHS (Healthand human services department) and Center for Disease’s control andprevention to address drug and infection related problems at Pomona(Centers for Medicare and Medicaid).
Areflective analysis of public executive implementation in Medicare& Health
Thehealth care program is facilitated by many distinct agencies andprograms that operate under the regulations of Federal governmentlegislative acts. The ownership and management of healthcare systemare mainly under private, federal, state, county and citygovernments. No national wide medical facilities owned by thegovernment that exists in for the general public’s, but there aremany local government hospitals. Government spends heavily throughhealthcare programs inform of health insurance (InsuringAmerica`s Health: Principles and Recommendations).Many institutions and organizations have been established to manageand regulate the healthcare program this is done through Federal andstate level governments. Under these regulations, the governmentlicenses and approves medical services, pharmaceuticals, foods andthe health insurance companies. In order to implement theseregulations and policies, the government at Federal Level has theDepartment of health and human service that oversees various federalagencies involved in healthcare (AboutHHS, pg 1).These agencies regulate major healthcare issues such as Medicare,Medicaid, food, medical products, disease prevention and conductingmedical research. Local and state governments are assigned healthcare professionals who facilitates in the implementation thesefederal regulations and laws. States, counties and cities do not havea mandate to regulate the health insurance such as Medicare, Medicaidor any other acts regulations by the congress (United States NationalHealth Care Act – Summary 2).
Therefore,through the department of health and human services the federalgovernment manages, regulates and enforces health laws throughestablished federal agencies like the Food and drug agency (FDA) andthe Center for Medicare and Medicaid (CMS). There are more than 115programs across the nations these program cover health research,Medicare, Medicaid, financial assistance to low-income families,emergency programs and children health programs. Although each statehas other regulations and health programs, the federal programs formthe largest share of the implemented healthcare plans. For instance,in the state of California, most healthcare agencies reflect thefederal mandate of health regulations and plans this phenomenontranscends to the local cities and counties(Medi-Cal).In a broader sense, the healthcare system in the United States isimplanted as per the federal regulations to the basic unit of theAmerican nation. The federal government remains the sole overseer ofhealth care plans and policies other minor health plans may beenacted at state or county level, but such healthcare plans onlyexist to supplement or enhance the federal governments’ healthcarepolicies (AboutHHS, pg 1).
"AboutHHS" U.S. Department of Health & Human Services.Retrieved July 2, 2014.
"AmericanHealth Care Reform.org."American Health Care Reform.org.Retrieved July 2, 2014.
"FDAOverview"(PDF). USFDA.Retrieved July 2, 2014.
Krugman,Paul, "OneNation, Uninsured."TheNew York Times.(June 13, 2005). Retrieved July 2, 2014.
Centersfor Medicare and Medicaid, RetrievedJuly 2, 2014,fromhttps://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services
http://www.acf.hhs.gov/programs/cssRetrieved July 2, 2014
TheCalifornia PartnershipRetrieved July 2, 2014
"UnitedStates National Health Care Act – Summary."Thomas.loc.gov.Retrieved July 2, 2014.
"AmericanHealth Care Reform.org."American Health Care Reform.org.Retrieved July 2, 2014.
InsuringAmerica`s Health: Principles and Recommendations,Institute of Medicine of the National Academies of Science.Retrieved July 2, 2014
"H.R.676: United States National Health Care Act or the Expanded andImproved Medicare for All Act (Govtrack.us)."Retrieved July 2, 2014.