Exam 3 Ch 15 Flashcards
Typically, CDC would lead the federal response, but during COVID-19
states were left on there own
Case STudy
“Even before coronavirus, vaccines
were politically contentious”
All told, the percentage of unvaccinated children has increased fourfold
since 2001” (435).
- “Following measles outbreaks during the 1970s, states began to mandate
vaccines for children attending public schools…In the end, all but two states
– Mississippi and West Virginia – allowed for religious or philosophical
exemptions” (436). - “In 2019, there were almost 1,300 cases of measles in the United States, the
most since 1992” (437). - “Making the case clinically is not the same as making it politically” (437).
What 2 states DO NOT allow for vaccine exemption?
Mississippi and West Virginia
Public Health
In 1900, average life expectancy at birth in US was, and now is
Area of medicine that deals with protection and improvement of citizen health and hygiene through government agencies
47.3 years, now 78 years/3 decades
NYC created the nation’s 1st board of health in 1805 for
Yellow fever outbreak
Average state went from receiving — of its public health budget from Washington in 1950 to
1% to 35% by 1978
In resposne to 2007 recession…
“State and local health departments cut 55,000 positions between 2008 and 2017”
For most of the nation’s history, elected officials believed that …
local government should serve as health and welfare provider
Almhouses -
places where local communities provided food and clothes for low income
By 1860, most states established…
mental hospitals and homes for blind and deaf
What in 1935 did FDR and Congress create?
Social Security Act
Social Security
Joint federal-state program for unemployment
AFDC/Aid to Families with Dependent Children - original federal ssistance program for women and their children under New Deal
Medicare and Medicaid were created in… and what are they?
1965
Medicare - fed. health program for elderly
Medicaid - joint state and fed. health program for low-income, elderly, and disabled
These are entitlement programs - guarantees unlimited assistance for those who meet the requirements
Poverty line
Annual income level where families cannot afford needs, fam of 4 = 30,000
The state that is the least generous in Medicaid eligibility is? What percentage?
What are the most generous?
Least - Alabama, 13%
most - Connecticut, Massachusetts, Minnesota, 133%
By 2016, federal and state gov spent how much on medicaid?
$550 billion
By 2006, every state received at least…
1 waiver for a portion of medicaid, 7 million were additionally insured
By summer 1996, more than 40 states received
statewide waivers that allowed them to vary the work requirements for AFDC recipients
Temporary Assistance for Needy Families - passed in 1996, provide fed assistance in block grants
Affordable Care Act, what is it?
Obamacare approved by Congress in 2010.
*Medicaid expansion (South Carolina made this optional for state in 2012)
*Individual mandate (eliminated by Congress 2017)
*Parents can keep their children on their insurance until 26
- # of young adults w/o health insurance declined from 3 to 1 million
In 2017, Trump and Congressional Republicans…
failed to pass a new bill that would repealed several parts of the Obamacare
2020, Republican attorneys from 20 states, led by Texas…
challenged Obamacare but failed.
How many states under federal law, can choose to run the exchanges/ own online health insurance?
17
Beyond Medicaid FActs
as of 2016, states had promised $587 billion more
in retiree health care than they had assets set
aside” (450).
* “Between 2010 and May 2020, 128 rural hospitals
closed nationwide, predominantly in states that
hadn’t expanded Medicaid” (451).
* Texas accounted for 26 of the rural hospital
closures between 2010 and 2020.
CHIP (Children’s Health Insurance Program)
A joint federal-state program designed to expand health care
coverage to children whose parents earn income above the
poverty line but still are too poor to afford insurance.
* “Fourteen states allow children living in families earning up to
300 percent of the federal poverty level to qualify for CHIP”
(452).
– New York: 400 percent
– Idaho and North Dakota: only two states less than 200
percent of the poverty level
* “Between 1999 and 2013, CHIP coverage grew from 2 million
to 8.1 million, cutting the uninsured rate for children in half”
(453).
How many states allow children living in families earning up to 300% above poverty line to qualify for CHIP?
14
What is the most generous state?
What is/are the least generous?
most - New York - 400%
least - Idaho and North Dakota, < 200%
Because of the Affordable Care Act…
Number of uninsured Americans expected to drop by 1/2 from 45 to 23 million 2012-2023
In California, insurers offering policies through the state insurance exchange…
raised premiums for 2017 by average of 13%
Managed Care
An arrangement for the provision of health care whereby an
agency acts as an intermediary between consumers and health
care providers.
Long-Term Care
– “Nearly 10 million Americans now use some form
of long-term care” (456).
– “States long-term-care bills…may reach as much
as $346 billion by 2040” (457).
- Protecting Public Health - how many states passed laws for what? and how many allow exemptions for religious reasons
– “At least 29 states have passed laws that require
insurers that cover prescription drugs to include
coverage of contraceptives” (461).
* 21 states allow exemptions for religious reasons
