Government and Health Insurance: The Policy Process

This chapter reviews the evolution of government’s role in the U.S. health insurance system, and describes the roles of public and private stakeholders in the health policy process. It explores the key issues on the government’s health policy agenda, including the enactment and implementation of the Patient Protection and Affordable Care Act of 2010. By the mid-1920s, there was growing recognition that middle-income Americans needed help in financing the rising costs of hospital care and increasingly high-tech medicine. Like Medicaid, Medicare was enacted in 1965 to provide health insurance to segments of the population not generally covered by the mainstream employer-sponsored health insurance system. Although America’s balkanized institutions have often impeded movement toward universal health insurance, incremental policy changes expanding public coverage have frequently occurred. The 1981-1992 period highlights the role of the policy entrepreneur in defending and expanding Medicaid.