US Health and Patient Reform

Over the past 30 years, America has disproportionately increased health care spending, although there were no objective reasons for improving the quality of services. Over the past decade, the cost of insurance per employee has soared more than doubled. A significant part of the population remains uninsured, and the proportion of such people is growing. The insurance market provided by employers is extremely monopolized, which impedes labor mobility and creates conditions for discrimination of patients both before and after the conclusion of an insurance contract, including in the form of denial of payments. The ever-increasing cost of Medicare and Medicaid is one reason for the acute US budget deficit .

The current medical system is characterized by unresolved interaction between the public and private sectors of the economy. Despite the fact that the state allocates huge sums to the industry, it does not have effective levers of control over the prices and costs of services and drugs.

As a result, medicine that is almost completely privately held, although it meets American ideals, is in fact prohibitively expensive and many poor citizens cannot pay for it, and often the state also does not protect them in any way. The United States is one of the few developed countries that do not have a universal health insurance system.

On March 21, 2010, the US Congress approved health care reform ^[2] ; part of its provisions was considered in 2012 by the Supreme Court to be contrary to the constitution ( en: National Federation of Independent Business v. Sebelius ). In 2015, before the Supreme Court considered a case on the legality of applying tax credits to people who purchase insurance on federal exchanges (and not just on established states) - this practice was recognized as legal ( en: King v. Burwell ).

The main element of the reform, which should begin in October 2013, is the introduction of the obligation of US citizens to purchase health insurance if they are not insured. At the same time, subsidies are provided for the poor ^[3] .

The reform is also intended to improve the conditions of medical insurance for citizens who already have a policy ^[4] . So, according to the bill, from January 1, 2014, employers and their insurers will no longer be able to refuse to provide health insurance or increase insurance premiums if, before the start of the employment contract, the employee has already confirmed a serious chronic illness (for example, AIDS , cancer , etc.) ^[5] .

Exchanges for policyholders will be created, thanks to which it will be possible to obtain a policy for those who could not get insurance from the employer. For insurance premiums in this case, a “ceiling” of 3-9.5% of the client’s income will be set ^[6] . Citizens will be able to purchase insurance without the assistance of employers in specially created centers for this. There will be administrative liability in relation to persons who refuse to acquire and companies that refuse to sell the policy ^[2] . Starting in 2014, such fines for citizens will amount to $ 95 or 1% of income and will gradually increase to $ 695 or 2% of income. The supply system for senior citizens with necessary medicines will be improved.

As a result, insurance coverage should cover 95% of the country's population (versus 84% ​​according to 2011 data) ^[6] .

Also expected that the reform will create 400 thousand new jobs. It will be possible to reduce the cost of an individual patient and invest more in medicine.

New taxes will also appear for wealthy citizens and pharmaceutical companies - in the amount of $ 409.2 billion by 2019. Thanks to the reform, it is planned to reduce the budget deficit by $ 138 billion over the next 10 years and another $ 1.2 trillion in the next decade. According to the authors of the bill, the effectiveness of the system as a whole will increase. Only as a result of a reduction in administrative expenses in insurance companies will it be possible to release $ 286 billion ^[6] .

The program is designed for 10 years and will cost the US budget 940 billion dollars ^[2] . According to the Congressional Budget Office in 2012, if the reform were canceled, the budget deficit would have grown by $ 109 billion over 10 years ^[7] . The “extended” nature of the reform will allow patients, market participants and the economy as a whole to adapt to it.

Opposition to the law and attempts to repeal it are based on the support of such forces as trade unions ^{[8] [9]} , propaganda centers of American conservatives ^{[10] [11]} , Republicans , associations of small business representatives and the Tea Party ^[12] . These groups are of the opinion that the law will frustrate plans to develop the existing healthcare system, that new insurance standards will increase public spending and increase the budget deficit ^[13] . Some object to the very idea of ​​universal health, viewing health insurance as a product that, like others, should not be subsidized ^{[14] [15]} . Repeatedly promised to "repeal and replace" this law, President Trump ^{[16] [17]} .

On May 12, 2016, Republicans achieved an important judicial victory: a federal court ruled that the Obama administration used the wrong methods to finance subsidies to the poor as part of the reform ^{[18] [19]} .

Due to the fact that the reform means an increase in state regulation, relies on a powerful federal government apparatus and requires large budget expenditures, the reform itself as a whole, as well as its individual provisions and / or stages in particular, have been repeatedly sabotaged by representatives of the Republican Party that controls the US House of Representatives . These contradictions ultimately led to the fact that the budget for the fiscal year 2014 was not agreed on time, and, consequently, to the suspension of the US government and state organizations from October 1, 2013 ^[20] .

From October 2013 to June 2014, according to various estimates, the number of adult Americans with health insurance increased by 8-10 million ^[21] .

On January 14, 2017, 6 days before the inauguration of Donald Trump , the US House of Representatives voted in favor of a resolution that would initiate the process of canceling Obamacare. ^[22]

On January 20, 2017, the incoming President of the United States, Donald Trump, in his early hours at the White House signed an executive decree that eases the regulatory requirements for government agencies that are introduced by the Affordable Health Insurance Act, based on which the Obamacare program works ^[23] .

At the end of June, the US President called on Republican senators to cancel the current health insurance system adopted by Barack Obama. Against this stand all 48 Democrats in the Senate. ^[24]

On July 28, the US Senate rejected a “truncated” plan to partially replace Obamacare's health care reform. The decisive vote belonged to Republican Senator John McCain. ^[25]

In October 2017, the Trump administration announced that it would end a series of payments to insurance companies, believing that they did not have the necessary Congressional approval. ^[26]

On December 15, 2018, a federal court in the Texas city of Fort Worth declared an unconstitutional reform of healthcare and patient protection in the United States. Judge Reed O'Connor, who made this decision, explained his abolition in 2017 of one of the main provisions of Obamacare - a mandate that obliges all U.S. citizens to buy health insurance. Supporters of Obamacare intend to appeal the verdict to the Supreme Court . ^[27]

• Kozlov K. USA: a brief overview of health care reform // Sberbank of Russia , 2010