domestic policy
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Chapter 19. Domestic policy. Providing Affordable Health Care for All. Health care a central theme of Barack Obama's presidential campaign About 16 percent of U.S. 2007 GDP spent on health care Over 60 percent of all personal bankruptcies in 2007 due to medical costs - PowerPoint PPT PresentationTRANSCRIPT
Chapter 19
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Providing Affordable Health Care for All
Health care a central theme of Barack Obama's presidential campaign
About 16 percent of U.S. 2007 GDP spent on health care
Over 60 percent of all personal bankruptcies in 2007 due to medical costs
About 16 percent of population uninsured during a portion of 2007 and 2008
Many denied due to arbitrary definition of pre-existing condition
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Domestic Policy Making More than half of government expenditures
made on Social Security, health care, education, and immigration
Many designed to address economic inequality To evaluate, must address questions involving
conflicts between freedom and order and freedom and equality
State and local governments must also have capacity to carry out national programs
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The Development of the American Welfare State
Most controversial purpose of government promotion of social and economic equality Conflict between freedom and equality Most modern nations welfare states
Social welfare policy based on concept governments should provide for basic needs of members
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A Human Tragedy
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The Great Depression Initiatives related to the New Deal and the
Great Society dominated national policy until reforms in 1980s and 1990s Extended protective role of government
The Great Depression longest and deepest setback of U.S. economy in history Began with stock market crash Oct. 24th,
1929 and ended with start of WWII One in four workers unemployed; more
underemployed7
The New Deal
Franklin Delano Roosevelt, accepting nomination at Democratic Presidential Convention:
“I pledge you, I pledge myself to a new deal for the American people.”
Were programs imaginative public policy or source of massive government growth without matching benefits?
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The New Deal’s Two Phases
First phase aimed at boosting prices and lowering unemployment Civilian Conservation Corps (CCC)
Second phase aimed at aiding “forgotten people” Social Security program
Despite programs, poverty and unemployment persisted until WWII
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The Great Society President Lyndon B. Johnson re-
elected in 1964 with landslide Used support to promote Great Society
programs to combat political, social, and economic inequalities
Vital element was War on Poverty Economic Opportunity Act (1964)
designed to end poverty in 10 years A hand up, not a handout
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Retrenchment and Reform
Despite Great Society’s programs, poverty declined but did not disappear
Ronald Reagan used presidency in early to mid 1980s to re-examine social welfare policy Shifted focus from economic equality to
economic freedom Questioned whether government alone
should look after less fortunate
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Retrenchment and Reform
Reagan’s policies abolished some programs and redirected others Felt state and local governments could
provide social services more efficiently than national government
Congress blocked some cutbacks, but overall spending on social welfare programs fell to mid-1970s levels
George H.W. Bush’s presidency continued President Reagan’s approach
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Retrenchment and Reform
President Bill Clinton’s proposals aimed at reforming system while protecting basic fabric of safety net
President George W. Bush’s administration greatly expanded welfare benefits for seniors with Medicare drug program
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Social Security Government social insurance
programs protect individuals from various kinds of loss, regardless of need First example was workers’ compensation Social security and Medicare also social
insurance programs These programs examples of
entitlements14
Origins of Social Security
Social insurance programs began in Europe as early as 1883
In U.S., needs of elderly and unemployed left to private organizations and individuals until Great Depression
In 1935, President Roosevelt signed Social Security Act
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Social Security Act Act had three approaches:
Social insurance for elderly and disabled, and unemployment benefits
Grants-in-aid to the states to help destitute
Federal aid to the states to provide health and welfare services
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How Social Security Works
Most people think of retirement benefits when thinking of Social Security Program provides other services
Contributions not set aside for individuals but used to fund “pay as you go” system Program began with more paying into fund
than taking out (nine workers to one beneficiary)
Today’s program closer to three workers for each beneficiary
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Will Social Security Remain Solvent?
Baby boomers begin to retire in 2010 Current projections show fund exhausted
by 2037 Politicians face dilemma: lower benefits or raise
taxes to fund program? Current workers’ benefits will be paid by
future participants Solvency depends on growth of base What happens when birthrate falls,
unemployment rises, mortality declines, and/or economy falters?
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Figure 19.1
Day of Reckoning
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Who Pays? Who Benefits?
Congress established automatic cost-of-living adjustments (COLAs) for Social Security in 1972 Changes in payments and wages subject to
tax tied to Consumer Price Index (CPI) Stagflation in 1970s jeopardized fund
solvency President Reagan and Congress agreed
to painful solution in 1983: increased taxes and reduced benefits
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Social Security Reform Changes in 1983 protected Social
Security but future still a concern Majority of adults (61%) in 2009 poll
believe program will not have enough funds to pay for benefits throughout their retirement
In 2000 and 2004, both Republicans and Democrats proposed reforms that involved private investment of payroll taxes
President Obama opposes privatization
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Public Assistance Public aid to individuals with demonstrated
need Some refer to programs as welfare Not all are programs for the poor
Social Security Act has categorical assistance programs Old age assistance for needy elderly Aid to the needy blind Aid to needy families with dependent children Aid to the totally and permanently disabled
These programs have become entitlements administered by the states
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Poverty in the United States
Since 1960s, poverty level calculated as three times cost of minimally nutritious diet for given number of people in a family for a set time Critics believe calculation not accurate
because changes in other costs have lowered proportion of income used for food
Measuring poverty one way to measure public policies’ effectiveness in promoting equality
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Census Estimates in 2008
39.8 million, or 13.2 percent, of Americans live in poverty
19.0 percent of persons under 18 live in poverty
9.7 percent of people over 65 live in poverty
One in two poor Americans live in a family with a woman head of household
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Figure 19.2
The Feminization of Poverty
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The Poverty Level Poverty threshold determines number of
people who live below threshold amount Poverty guideline income level at which a
family is eligible for government help Some believe factors other than income
should be used to determine poverty Use of poverty as indicator reflects
ambiguities in notion of equality
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Welfare Reform Original poverty programs lacked work
incentives A 1994 poll showed 59 percent of Americans
believed welfare recipients taking advantage of system
Personal Responsibility and Opportunity to Work Act reforms enacted in 1996 Designed to “end welfare as we know it” Abolished Aid to Families with Dependent
Children (AFDC) Replaced AFDC with Temporary Assistance to
Needy Families (TANF)27
Features of TANF Adult recipients must be employed within
two years States have burden of job creation
Families can receive no more than five years’ benefits in a lifetime
Control of welfare program design and implementation devolved to states Federal support via block grants totaling
$16.5 billion a year Economic stimulus plan added $5 billion
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Figure 19.3
Families on Welfare, 1955-2008
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Status of TANF Reauthorized in 2006 and being
reexamined in 2010 Questions remain about program
How did system fare in 2008 recession?
To what extent should states be able to consider job training and education as work?
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How Have Recipients Fared?
The number of families on welfare has declined
Large numbers of those formerly on welfare have found work Many jobs do not have good
benefits and involve long commutes Many families still living below or
close to poverty level
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Recession Raises Questions
To what extent do recipients maintain eligibility for other programs?
What happens to TANF benefits if recipient loses their job?
What happens to program as states shift money from job training to benefits as more need arises?
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Health Care U.S. only major industrialized nation
without universal health care Many programs exist, providing a
patchwork quilt of care Medicare Medicaid Children’s Health Insurance Program
(SCHIP) And now, President Obama’s health care bill
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Cost and Access Most agree U.S. health care system
needs fixing Two main issues: cost and access Access issues include:
Nearly 47 million people (16 percent) had no health insurance in 2008
Many more under-insured Numbers vary by age, race, and income Supply of physicians does not meet demand
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Figure 19.4
Poverty in the States
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Cost and Access Health care sector significant part
of U.S. economy In 2008, $2.4 trillion spent on health
care, more than 16 percent of GDP Fastest growing sector: prescription
drugs As proportion of GDP, U.S. spends
more on health care than other nations with more comprehensive care
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Dealing with Cost and Access
Any reforms must democratize health care and control ballooning costs Dilemma of balancing greater equality of
coverage with a loss of freedom of choice in markets for health care and doctors
Private sector already addresses this balance in many ways, but also seeks to limit risk
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Medicare Social Security Act amended in 1965 to
include Medicare for those over 65 National health insurance first proposed by
President Truman in 1945 Medicare program had two
components: Part A for hospitalization Part B for physician’s fees
Program has expanded over years to cover other services
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Medicare Compulsory insurance funded by payroll
tax and premiums deducted from Social Security
Participants can also purchase private sector Medigap plans
Medicare Prescription Drug, Improvement, and Modernization Act passed in 2003 Private sector companies provide
competing plans for seniors to choose from Cost of program continues to increase
faster than rate of inflation39
What are the differences between Medicare Parts A, B, C and D?
Medicare Part A, Hospital Insurance; Medicare Part B, Medical Insurance; Medicare Part C (Medicare Advantage), which was formerly known as Medicare + Choice; and Medicare Part D, prescription drug coverage.
Generally, people who are over age 65 and getting Social Security automatically qualify for Medicare Parts A and B. So do people who have been getting disability benefits for two years, people who have amyotrophic lateral sclerosis (Lou Gehrig's disease) and receive disability benefits, and people who have permanent kidney failure and receive maintenance dialysis or a kidney transplant.
Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.
Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.
Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
Medicaid Main program to provide health care
to Americans with low incomes Since 1965, costs have risen from
$0.4 billion to $336 billion Single largest public program in nation
Program run and financed jointly with states Eligibility and services vary widely by
state42
Medicaid Participants fall into four groups:
Children under age 21 (29.8 million, or 48 percent in 2008)
Adults (5 million) Blind and disabled (6 million) Aged who are also poor (6.1 million)
Last two categories account for over half of Medicaid expenditures
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Health Care Reform President Obama signed Patient
Protection and Affordable Care Act March 23, 2010 Compromises required to balance goal of
equality of access with desire for freedom from government intervention
Notable provisions in bill include protections for coverage despite pre-existing conditions and mandatory participation Bill includes subsidies and tax credits to help
individuals and small businesses pay for coverage
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Health Care Reform Critics of bill concerned about cost – an
estimated $940 billion over 10 years Some, including Congressional Budget
Office, believe bill will pay for itself Those wary of “big government” troubled
by additional regulations and bureaucracy Is mandating individual coverage
Constitutional? Others anxious about effect of reforms on
Medicare45
Elementary and Secondary Education
Historically, state and local governments have primary responsibility for schooling in U.S.
Today, federal government contributes around 8 percent of expenses
Most significant federal involvement has come in recent years
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Concerns Motivating Change: Equity
Most Americans believe social and economic equity can be found through equality of educational opportunity Brown v. Board of Education (1954) Elementary and Secondary Education
Act of 1965 (ESEA) Individuals with Disabilities Education
Act (IDEA) 47
Concerns Motivating Change: Equity
Programs have decreased, but not eliminated, differences in student achievement Significant gaps in math, reading,
and overall graduation rates between advantaged and disadvantaged groups
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Concerns Motivating Change: National Security and
Prosperity To remain competitive globally, U.S.
must have highly educated and skilled workers First federal program the National Defense
Education Act of 1958 (NDEA) Studies relating education to economic
competitiveness began in 1970s A Nation at Risk released in 1983
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Values and Reform At center of current debate is
dilemma of freedom versus equality Equality of opportunity to get good
education Freedom to choose where to live and
what your children will be taught Charter schools and school vouchers
two proposals designed to address problems
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The No Child Left Behind Act of 2001
George W. Bush’s 2000 presidential campaign focused on education
Act designed to reform the Elementary and Secondary Education Act
Most significant component requires states to guarantee proficiency in reading and math by 2014 Along the way, must make Adequate Yearly
Progress in all student groups
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Implementing NCLB NCLB initially praised for highlighting
educational inequalities and need for qualified teachers for all
Critics now charge its requirements mean teachers “teach to the test”
Other critics charge federal government did not allocate enough funding to address existing inequities
Some question if low-performing students “pushed out” to increase scores
NCLB not reauthorized in 200752
Immigration One of most important problems
facing America Immigrants make up around 13 percent
of population; of those, 30 percent here illegally
Twenty-three percent of noncitizens live below poverty line
Americans have mixed feelings about how to approach illegal immigration
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Immigration Foreign workers should apply for
and receive a permanent resident card (“green card”) May eventually apply for citizenship Federal policy limits total number of
people receiving green card each year
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Permanent Resident Status
Priority given to Reuniting families Workers in occupations needed in U.S. Refugees who face persecution in
home countries Mix of persons from a diverse set of
countries Welfare reforms in 1996 prohibits
legal immigrants from participating in safety net programs for five years
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Illegal Immigration Illegal immigrants get most attention in
policy debates If caught, penalties range from being
asked to leave country to imprisonment Most come from Mexico and other Latin
American countries Geographically concentrated in western
states and large urban areas Provide cheap labor in agriculture and
manufacturing56
Illegal Immigration Never eligible for safety net
programs American-born children are Can enroll in public schools and get
treated in hospital emergency rooms Policy debates focus on better border
security with Mexico and sanctions on businesses that hire illegal immigrants
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Undocumented Santa
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Immigration Reform Unsuccessful bill proposed in 2007 would
have allowed illegal immigrants to stay if they met certain conditions Citizenship possibility led conservative critics to
accuse supporters of “offering amnesty” Immigrant groups did not like provisions
addressing temporary workers and change in focus from reuniting families to needed workforce
Union workers feared immigrants would drive down wages and take jobs away from Americans
Liberals did not like E-Verify program requirement
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Immigration Reform Polls show many Americans support
some sort of “path to citizenship” Obama administration supports
major provisions of bill and plans to attempt similar immigration reforms
Given recent battles in Congress, success unlikely
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Benefits and Fairness Two kinds of benefits provided by
national government: Means-tested benefits Non-means-tested benefits
Some question fairness of non-means-tested benefits
Reform debates may center around making more affluent pay for programs
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