Tag: Medicare

How the President Shapes Federal Health Programs

This post, part two of a series, outlines the extensive role of the federal government in U.S. health policy, primarily through the Department of Health and Human Services (HHS). It discusses the executive branch’s involvement in health regulation, funding, and policy formation, emphasizing the significance of HHS programs and leadership roles.

This is the second post in a series helping us understand the federal government’s role in health policy in the United States. In short, its role is extensive and expensive. You can read the first post here.

The Constitution does not specifically say the government controls or provides healthcare. The Preamble hints with “promote the general welfare”.

Considering how basic and unorganized medical science was in the late 18th century, it’s not surprising they did not consider it in the plans for the new government.

I am publishing a series of posts based on

Congress and the Executive Branch and Health Policy

by Julie Jovner at KFF, an independent source for health policy research, polling, and news, an endowed national nonprofit organization.

Ms. Jovner’s article explains how the three branches of government work together, why the Department of Health and Human Services (and therefore its Secretary) is so important, and the budgeting and regulation processes.

This series is nonpartisan and objective. I made minimal edits to improve readability but retain meaning. I insert comments in parentheses to add clarity.

The photos are for illustration only and are not in the KFF article.

The Executive Branch

This post focuses on the executive branch of government, The White House including the President and his Cabinet, especially the Secretary of the Department of Health and Human Services.

The President

The executive branch carries out the laws made by Congress and operates the federal health programs, often filling in details Congress has left out through rules and regulations.

Federal workers in the health arena provide direct patient care, regulate how others provide care, set payment rates and policies, conduct medical or health systems research, regulate products sold by the private sector, and manage the billions of dollars the federal government spends on the health-industrial complex.   

Although most of the executive branch’s health policies are implemented by the Department of Health and Human Services (and to a smaller extent, the Departments of Labor and Justice), over the past several decades the White House itself (through the President) has taken on a more prominent role in policy formation.

President Donald Trump visited NIH on March 3, 2020 and toured the National Institute of Allergy and Infectious Diseases’ Vaccine Research Center (VRC) to learn about research on a vaccine for the novel coronavirus SARS-CoV-2.

Department of Health and Human Services (HHS)

Most federal health policy is made through the Department of Health and Human Services except for several key areas.

Exceptions include the 

  • Veterans Health Administration, run by the Department of Veterans Affairs;
  •  TRICARE, the health insurance program for active-duty military members and dependents, run by the Defense Department; and the 
  • Federal Employees Health Benefits Program (FEHB), which provides health insurance for civilian federal workers and families and is run by the independent agency the Office of Personnel Management.   

The health-related agencies within HHS are roughly divided into the resource delivery, research, regulatory, and training agencies that comprise the U.S. Public Health Service and the health insurance programs run by the Centers for Medicare and Medicaid Services (CMS).  

The Surgeon General oversees the U.S. Public Health Service (USPHS) Commissioned Corps, an elite group of over 6,000 uniformed officers who are public health professionals. The USPHS mission is to protect, promote, and advance the health of our nation.

The U.S. Public Health Service

Ten of the 13 operating divisions of HHS are part of the U.S. Public Health Service, which also plays a role in U.S. global health programs. They are:  

  • The Administration for Strategic Preparedness and Response (ASPR)
  • The Advanced Research Projects Agency for Health  (ARPA-H)
  • The Agency for Healthcare Research and Quality (AHRQ)  
  • The Agency for Toxic Substances and Disease Registry (ATSDR)  
  • The Centers for Disease Control and Prevention (CDC)  
  • The Food and Drug Administration (FDA)  
  • The Health Resources and Services Administration (HRSA)  
  • The Indian Health Service (IHS)  
  • The National Institutes of Health (NIH)  
  • The Substance Abuse and Mental Health Services Administration (SAMHSA)  

CMS

The Centers for Medicare and Medicaid Services (CMS) is by far the largest operating division of HHS. It oversees not just the Medicare and Medicaid programs, but also the federal Children’s Health Insurance Program (CHIP) and the health insurance portions of the Affordable Care Act(ObamaCare).

Together, the programs under the auspices of CMS account for nearly a quarter of all federal spending in fiscal 2023, cost an estimated $1.5 Trillion in fiscal 2023, and served more than 170 million Americans – more than half the population.  

KFF’s website content is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license that allows for the sharing of our information with proper attribution and without alteration.

End of KFF article

The President’s Cabinet and other Agency Heads

As you can imagine, the leadership organization of HHS is large and complex. At the top is the Secretary, who is a member of the President’s Cabinet , approved by the Senate.

Other key leadership positions, all of which are appointed by the President include

  • U.S. Surgeon General
  • Director of the CDC
  • Commissioner of Food and Drugs (FDA)
  • Director of the NIH
  • Director of the National Library of Medicine
  • Administrator of CMS
James H. Shannon Building (Building One), NIH campus, Bethesda, MD
James H. Shannon Building (Building One), NIH campus, Bethesda, MD

Looking ahead-Congress

In the next post in this series, we will consider Congress’s role in overseeing these agencies and, most importantly, funding them.

“How Congress oversees the federal health care-industrial complex is almost as byzantine as the U.S. health system itself.

Jurisdiction and responsibility for various health agencies and policies is divided among more than two dozen committees in the House and Senate.”

KFF

Exploring the HEART of Health

I took the cover photo for this post at the Reagan Presidential Library in California. It is a replica of the Oval Office during his administration.

Thanks for getting through another post that’s maybe more informative than inspiring. I hope you learned something.

Thank you for reading this post. I strive to make them worth your time.

I share information and inspiration that sparks transformation in your body, mind, and spirit.

You can follow this blog in two easy ways. One is to put your email address into the box below.

Another way is to follow me on Facebook, where I share new posts, timely topics, photos, and an occasional cartoon.

Watercress Words by Dr. Aletha

Dr. Aletha

What to Remember in November

Daylight Saving Time ends on November 3, causing sunsets to arrive earlier. In November, individuals can adjust health insurance plans during open enrollment periods, including Medicare and the Health Insurance Marketplace. Additionally, November 5 is Election Day, where voters select electors for the Electoral College, culminating in Inauguration Day on January 20, 2025. Please vote, it matters.

Daylight Saving Time ends November 3

Some of us will be in new time zones. Maybe not completely new, but our time will change by one hour as Daylight Saving Time ends and we resume standard time on November 3.

That means sunsets will come even earlier than they have been, and there will be fewer daylight hours until the first day of winter, December 21. If you live south of the equator, you welcome more sunshine instead.

For most people, “falling back” is less disruptive to sleep than “springing forward.” To make the adjustment a little easier, you can adjust your sleep/wake schedule gradually in the mornings and/or evenings a week before the change.

Otherwise, when the time changes you can enjoy sleeping an extra hour (if you can) or waking up earlier than usual until your body adjusts

Photo by Ketut Subiyanto on Pexels.com

Health Insurance Enrollment for 2025

Many people have a chance to change their health insurance in November.

For Medicare recipients, October 15 through December 7 is open enrollment where we can change from regular Medicare to an Advantage Plan. Or, if you are already in an Advantage Plan, you can switch to a different one.

Medicare is available to anyone at age 65 and certain other people.

Medicare health plans provide 

Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare. These plans are generally offered by private companies that contract with Medicare. They include 

Medicare Advantage Plans (Part C), Medicare CostPlans,Demonstrations/Pilots, and Program of All-inclusive Care for the Elderly (PACE).

Medicare Part D covers prescription drugs.

a Medicare Advantage plan offered by UnitedHealthcare

If you aren’t eligible for Medicare or an employer-sponsored insurance plan, you may get coverage through the Health Insurance Marketplace, with open enrollment starting November 1. This program was established by the Affordable Care Act, also known as ObamaCare.

If you are covered by an employer-sponsored health plan, you may be required to sign up for next year’s coverage, especially if you want to change coverage options. Otherwise, you may automatically be enrolled into the same plan.

Whatever plan you choose, you should carefully evaluate your options, especially out-of-pocket costs. In a previous post, I reported on the problem of medical debt which often occurs due to unexpected expenses not covered by insurance.

A less expensive insurance plan could cost more if it requires higher deductibles and co-pays than you would with a plan with higher premiums. You should consider the cost of anticipated health care as you choose coverage while planning for unexpected medical expenses.

Photo by Edmond Dantu00e8s on Pexels.com

November 5-United States Election

The official day to vote is Tuesday, November 5, but millions of people have already voted. My husband and I voted on Halloween, a first for us.

But technically, we do not elect the President and Vice-President that day. Here is how it works.

Timeline of key presidential election dates
  • Nov. 5, 2024—Election Day
    The voters in each state choose electors to serve in the Electoral College.
  • By Dec. 11, 2024—Electors appointed
    The executive of each state signs the Certificate of Ascertainment to appoint the electors chosen in the general election.
  • Dec. 17, 2024—Electors vote
    The electors in each state meet to select the president and vice president of the United States.
  • Jan. 6, 2025—Congress counts the vote
    Congress meets in joint session to count the electoral votes.
  • Jan. 20, 2025—Inauguration Day
    The president-elect is sworn in as president of the United States.

Source: The National Archives and Records Administration

Let’s all do our part to ensure a fair, safe, secure, and trustworthy election. Be careful what you share on social media; don’t believe everything others share.

Remember that elections involve people, and people make mistakes. A mistake is not cheating. Recognized mistakes should be acknowledged and corrected. Unsubstantiated accusations, threats, and violence are unacceptable. Cheating should be proven and guilty people held accountable.

Remember the people running elections in your community are your neighbors, and treat them as such. Consider volunteering yourself.

January 6, 2021 happened once, it doesn’t have to happen again.

Photo by cottonbro on Pexels.com

Exploring the HEART of Health

Thank you for reading this post. I strive to make them worth your time.

I share information and inspiration that sparks transformation in your body, mind, and spirit.

You can follow this blog in two easy ways. One is to put your email address into the box below.

Another way is to follow me on Facebook, where I share new posts, timely topics, photos, and an occasional cartoon.

Watercress Words by Dr. Aletha

Dr. Aletha