Ch. 17 Welfare and Health Care

StudyBlue printing of Ch. 17 Welfare and Health Care html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; font-weight:bold; color:#808285; position:relative; border-bottom: 1px solid #c5c5c5; } .logo-blue { color:#70adc4; } .logo-desc { font-weight:normal; font-size:19px; color:#cccccc; margin-top:50px; position:absolute; display: none; } .back-button { position:absolute; top:20px; right:20px; font-size:13px; line-height:25px; color:rgb(0,175,225); font-weight:normal; } .back-button a { color:rgb(0,175,225); } .instructions { padding:0; margin:0; width:100%; position:relative; color:rgb(100,100,100); } .step-holder { border-left:1px solid #ededed; margin-left:20px; } .steps { padding:15px 0; float:left; width:24%; border-right:1px solid #ededed; text-align:center; } .steps-01 { } .steps-02 { } .steps-03 { } .steps-04 { } .label { padding:5px 10px; } .print-button { } .print-button a { background-color:rgb(0,175,225); color:white; line-height: 19px; padding:9px 8px 5px 30px; font-size:14px; text-decoration:none; background-image: url(images/printer.png); background-repeat: no-repeat; background-position: 7px 50%; -moz-border-radius: 5px; -webkit-border-radius: 5px; } .print-button a:hover { background-color:black; } .theNote .content { width: 8.0in !important; margin: 5px auto; padding:20px; background-color:white; } .theNote .header { border-bottom: 1px dashed #C8C8C8; font-size: 17px; padding: 0 0 10px; line-height: 19px; color: #00ADE1; min-width:500px; } .theNote .body { font-size: 14px; line-height: 19px; padding: 10px 0; } .theNote{ padding:6px 0; clear:both; background-color: rgb(200,200,200); } .theNote h3{ color: rgb(100,100,100); } .theNote h1, .theNote h3{ background-color:white; padding:2px 20px; width:8.0in !important; margin: 0 auto; font-size: 15px; } .theNote h1{ padding-top: 10px; font-size: 15px; } .theNote h1:first-child{ font-size: 20px; } .theNote h3 { font-size: 14px; font-weight: normal; } #options { border: 3px double #ccc; padding: 5px 12px; margin: 10px 50px 10px 20px; float: left; } #info { border-top: 1px solid #ccc; padding-top: 5px; font-style: italic; } li { margin: 5px 10px 5px 25px; } ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } Ch. 17 Ch. 17 Social Welfare and Health Care Policy Congress-bogged down, states on unchartered path of health and welfare innovations Poor in U.S. (except homeless)- relative deprivation Relative differences in wealth-profound and worsening (highest amongst all developed nations) Poverty line, or poverty threshold- gov. stat to measure poverty (set at 3x amount of income necessary to purchase food). 2009- family of 4 at 22,050 and 10,830 for individual. 2007: 13% population officially “poor” Almost 25% blacks officially poor, 20% state of Miss. And 7% New Hampshire. 10.5% whites poor. Hard to calculate: don’t account for regional cost of living differences, variations in state’s ability to provide resources, decline in inflation-adjusted min. wage, change in consumption patterns, cost of housing, energy, and health care, benefits like food stamps, earned income tax credit, value of off the books income and barter income. Poverty line from 1963 calculations! 9.7% over 65 poor (used to be just for old- they have interest groups) 1/3 african American kids in poverty!!! 18% children as whole Social Security and Medicare helping old but more and more poor kids-issue Conservatives: poor get what they deserve, against natural law to give out aid, creates permanent “underclass” Liberals: agree with most of country that gov. should held poor bc conditions outside of their control put them in this situation Western Europe has social service programs 1 st and they are better: 1. Federalism 2. States want attractive business market (low taxes-limited social spending). Controversial nature of redistributive policies- taking from 1 group to give to other-issue Foundation- FDR- 1930s- Great Depression-25% unemployment rate- assistance, job creation, and social security Reform in 1980s-obligations attached to welfare-make ppl responsible-conservatives saw need to help and liberals saw need to reform. Behavioral dependency- by choice (young, male, minority, and urban- typical welfare). Conservatives want more behavior from poor- get married and stay married or have kids later. Liberals more interested in helping with less restrictions. Family Support Act of 1988- conservative principle of responsibility with liberal promise of relief 1996- Clinton signed to end largest welfare program- Aid to Families with Dependent Children (big challenge given local gov. to help poor). Replacing AFDC, TANF- max state discretion (set standards and benefits to help ppl get empoloyeed!) 1996 Welfare reform bill- Personal Responsibility and Work Opportunity Reconciliation Act- previously welfare fed. Deal now local Social Welfare Programs- “entitlement programs”- gov. spending programs with eligibility criteria: 1. Direct cash transfers- directly give money (gov. checks), 90% went to single parent homes with absent dads (disability checks). Afdc (from 1935, old program) used to give money to kids whose dads had died. Ppl’s issues with afdc was that is caused ppl not to marry or them to break up and encouraged young moms who weren’t working to have babies, promoted migration of poor to states with better benefits, and kept permanent poor- generations. Lifetime limit of 5 yr to receive benefits, up to 2 yrs to find work. Hardship exemptions- up to 20% get, physical, mental disabilities. 2006 TANF amendments, states must show 50% of beneficiaries are engaged in work or work related things (20-30 hrs/wk depending on age of kids and 35-40 hrs for 2 parent homes). States are exploring new options such as caps for moms who have babies are getting benefits, setting up savings accounts for college, home, or business, and getting sick ppl into help. Post employment offered by some states- keep job, get promoted. Other states offer child care, transportation. Supplemental Security Income (ssi)- financed and operated by national gov., state officials say who is eligible. SSI combined 3 existing programs- Old Age Assistance, Aid to Blind and Aid to Disabled. Ppl who can’t work (age, kids with disabilities, they have disabilities). Earned Income Tax Credit- refundable fed. Income tax credit, money to working individuals and fams, created in 1975 to encourage work and offset Social Security Burdens. General Assistance- state/local program, ppl who don’t quality for direct cash or in-kind transfer programs (nonworking but physically able poor, not offered in all states.) 2. In-Kind Programs- payment of noncash social welfare benefit, food stamps or clothing. Food stamps- debit cards to purchase food by national gov. Established in 1964, benefit levels uniform across state. Working and nonworking poor eligible if income is low enough. Medicaid- health care assistance for poor. 57% national funded, 43% state funded. More than 20% state budgets, super expensive!! Provides free health care to uninsured poor and is principal sources of assistance for long-term institutional care of physically and mentally disabled and elderly. Medicare is different- entitlement program for care of those 65 and over. Medicaid-1965-scandal with doctors doing unneeded surgery, etc. S-CHIP (State Children’s Health Insurance Plan)- funded by fed and state, fams who earn too much for Medicaid but can’t afford insurance. 2009 as part of economic relief efforts program was reauthorized and enhanced. States have flexibility to make own plans. Housing programs- provides rent subsidies poor take to apts or helps pay for public housing. States and U.S. dept. of Housing and Urban Development. Child Nutrition- school lunch program. Head Start, energy assistance for low income fams, legal servies, family planning, foster care, etc. Under TANF, states have flexibility to offer in-kind aid to help move welfare ppl into jobs (child care, transportation, etc). Recent reform sending from more cash to in-kind. 3. Social Insurance- jointly funded benefit program made available by gov. to citizens as a right of its citizens, distinguished from public assistance programs by fact that recipients (or their relatives or their employeers) contribute financially through the Social Insurance Trust Fund, est. by SSA of 1935. Pay in advance for future well being. Social Security- Old Age, Survivors, Disability, and Health Insurance run entirely by nat. gov. paid through pay roll on employees and employeers, monthly checks sent electronically to retired, largest entitlement program. Medicare- fed. Health care, hospital, and prescription drug benefits to ppl over 65 in exchange for montly premium and copayments. Created in 1965 through amendment to Social Security Act. Costs escalated bc growing prescription drug costs, ballooning health care bills, and growing pop. Unemployement compensation- SSA of 1935, requires employeers and employees to contribute to trust fund administered by states, those who lose job through layoff or dismissal could draw combined state and fed unemployment benefits as long as 59 wk during economic crisis. Worker’s compenstation- SSA, financed by employers, administered by states, established insurance for workers and their dependents to cover job related accidents and illness, cost associated with price of health care escalated rapidly. Goals of social welfare: wellbeing fams and kids and ending dependency 2 approaches moving clients welfare to work: “work-first” strategies- immediate job searches, others more concerned with long term reduction of poverty- job skills. Privatization of public assistance programs- not always best- Texas- nothing got done. 35 states deny TANF benefits to convicted drug felons and growing # of states require general assistance recipients to undergo drug tests. Nation’s annual health care bill- 17% econonomy- highest in world Aging U.S., expensive medical technology- MRI, obesity, and economy lead to more expensive! Fraud: medicare overpayments may run as high as 25%. Growing number of uninsured in U.S., 18% of ppl under 65! Uninsured Americans have to be near bankruptcy to qualify for Medicaid. U.S. health system actually somewhat inferior to those of other developed nations (mortality, patient safety, equity, efficiency). Uninsured can go to emergency rm or free clinic for free (dr.s get money back from the uninsured from higher payments of those who do pay… wtf). 2 tier system of insured and uninsured in quality of care. State Medicaid expected to grow at rate of 8% (cost) annually for next ten yrs. Tennessee 47 th for state health rankings… more expensive. Vermont and Hawaii 1 st ! Several states wanting to pool Medicaid and medicare money to care for both those eligible. Tennessee: far reaching health reform. 1994 ,TennCare replaced Medicaid as health care program for poor. Pharmacy and dental under 2006 “cover tn”. Participants share cost on sliding income scale. TennCare makes health care providers think before ordering expensive costs bc their profits depend on keeping expenditures under cost celing. Former gov. Ned McWherter implemented Tenn Care. Rising costs in 2005 threatened to take all states revenue, over 300,000 TennCare dependents removed.