Analysis of Key Historical Events and Legislation in U.S. Healthcare

This essay provides an overview of significant historical events that have shaped the U.S. healthcare system. It begins with the Hospital Survey and Construction Act of 1946 (Hill-Burton Act), which aimed to improve hospital infrastructure and access to care. The essay then discusses the founding of the Joint Commission on Accreditation of Hospitals in 1952, highlighting its role in setting healthcare standards. It further examines the establishment of Medicare in 1965 under Title XVIII of the Social Security Act, detailing its expansion and impact on healthcare access for the elderly and disabled. The Medicare Modernization Act of 2003, including its prescription drug benefit (Part D), is also analyzed. Finally, the essay explores the Health Insurance Portability and Accountability Act (HIPAA) of 1996, focusing on its goals of modernizing healthcare information flow and protecting patient data. The essay concludes by underscoring the lasting influence of these events on the current healthcare landscape in the United States.

Running head: HISTORICAL EVENTS
HISTORICAL EVENTS
Name of the student:
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HISTORICAL EVENTS
Hospital Survey and Construction Act of 1946:
This act was also called the Hill-Burton Act which is the U.S federal law that had been
passed in the year 1946 during the 79th United States congress. Senator Harold Burton of Ohio
and Senator Lister Hall of Alabama were the main sponsorers. In the year 1945 in November,
the then president Harry S Truman had delivered a special message towards the congress. In this
message, he had stated a five part program that helped in improvement of the health as well as
healthcare of the Americans. This act had been found to have responded to the first of the
proposals of the president Truman which included constructions of hospitals as well as different
related healthcare facilities (Kisacky, 2019). It was designed in ways by which federal grants and
guaranteed loans were provided for improvement of the physical plant of the hospital system of
the nation. At the same time, funds were designated to the states for effective achievement of
about 4.5 beds per 1,000 citizens. The states were also found to have allocated the available
money to the various municipalities. However, the law provided for the rotation mechanism so
that the area which had already received funding gets moved to the bottom of the list for further
funding. The goods things were in order to get under such act, the healthcare centers had to
maintain five important aspects that in turn helped in ensuring quality service to all people
irrespective of their backgrounds. The healthcare centers were not allowed to discriminate based
on caste, creed, race, religion and others and that they had to provide free care to people who
could not afford to pay. The states and localities were also required in proving the economic
viability in question (Chung et al., 2017).

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Founding of the Joint Commission on Accreditation of Hospitals in 1952:
The joint Commission was renamed as the Joint Commission on Accreditation of
Hospitals in the year of 195. However, it was until the year 1965 when the federal government
found that the Joint commission accreditation was successfully meeting the Medicare conditions
of Participation, only then the accreditation was seen to have any official impacts. In the year in
1951, the joint commission accreditation of the Hospitals was mainly developed by the merge of
the Hospital Standardization Program with that of the different similar types of programs run by
the American College of Physicians, the Canadian Medical Association, the American Medical
Association, and the American Hospital Association (Cobb et al., 2018). In the year 1987, the
company had been renamed as the Joint Commission on Accreditation of Healthcare
Organizations. It again went a rebranding in the year 2007 and simplified the name to just the
Joint Commission which now had the tagline "Helping Health Care Organizations Help
Patients." The main mission is to improve the healthcare of the public continuously for
collaborating with the different stakeholders with the help of evaluating the different types of
healthcare organizations effectively and then inspiring them in excelling and providing safe care
of the highest value and quality to patients (Sheils et al., 2016). Their vision of this act is that all
people should get the scope of having experience the safest as well as highest quality best value
health care across all settings.
Title XVIII of the Social Security Act:
Medicare was mainly established in the year 1965 under the name of Title XVIII of the
Social Security Act. This was established as the federal health insurance programs for the service
users who are 65 years or older irrespective of their health status and income. Individuals would

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be paying taxes through the entire period of their working lives and these would make them
eligible for Medicare when they would reach the age of 65. In the present day, about 55 million
of citizens have been found to rely on Medicare for their health insurance. Initially, it mainly
formed a part of the Social Security Amendments of 1965, it helped in the establishment of a
health insurance program for complementing the retirement as well as survivors and disability
insurance benefits under the Title II of the Social Security Act (Kilgour, 2019). When it was first
implemented in the year 1966, it mainly used to cover most of the persons who were of the age
65 or over. In the year 1973, it was found that the following groups also became eligible for the
Medicare benefits like persons being entitled like entitled to Social Security or Railroad
Retirement disability cash benefits for at round about that of least 24 months, most persons with
end-stage renal disease (ESRD), and certain otherwise non-covered aged persons who were
elected for paying a premium for Medicare coverage. Moreover, people suffering from
Amyotrophic Lateral Sclerosis were also the allowed in waiving the specific 24 month waiting
period at the beginning of the July 2001. Mediocre initially consisted of two parts called the
Hospital Insurance (HI), also known as Part A, this was provided free of premiums to the
different sets of most eligible people and other ineligible people may had to pay premiums for
coverage (Buck, 2017). The other is the Supplementary Medical Insurance (SMI) called part B
that covered the pays for physician, home health, and other services, outpatient hospital and all
had to pay a monthly premium and later part C and D also came into being. On July 1 in 1966,
19 million people joined being followed by 46 million people in 2009 in both parts of A and B
and almost 11 million people had chosen to participate in to participate in a Medicare Advantage
plan.
Medicare Modernization Act of 2003:

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HISTORICAL EVENTS
The Medicare Prescription Drug Improvement and Modernization Act (MMA) of
2003 had helped in two ways. It had helped in the establishment of the outpatient
prescription or that of the part D program and also resulted in significant changes in the
reimbursement of the different types of physician dispensed outpatient drugs (which were
covered under the sections of the Part B). It was found that before the year 2004, Medicare
had successfully reimbursed different physicians for drugs under Part B at a lesser of the
billed charge or even to that of 955 of the average whole price if the medication (Olson et al.,
2016). Researches had shown in the different investigations carried on by the government
that physicians were purchasing these drugs at prices which are significantly lower than that
of the AWP (average wholesale price). For effectively addressing the overpayment of the
drugs, this act proposed a new methodology for the Medicare Part B reimbursement of most
covered drugs. Beginning in the year 2004 on January 1, most of the part B drugs
reimbursement witnessed reduction to 85% of their AWP from that of the 95% of the AWP.
Again in the beginning in the year 2005 on January 1. The reimbursement was found to have
been reduced by 1065 of the ASP or the average sales price or WAC or wholesale acquisition
cost. The MMA were also seen to enhance the physician reimbursement for Part B drug
administration service.
Health Insurance and Portability Act of 1996:
This act was mainly signed by the president Bill Clinton and was enacted by United
States Government in the year 1996. It was mainly proposed with three important aims. These
were modernizing the flow of the healthcare information and also stipulating how Personally
Identifiable Information maintained that were maintained by the healthcare as well as healthcare

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insurance industries need to be protected from fraud and theft and even helping in successfully
addressing various limitations on the healthcare insurance coverage. It had been also termed as
the Kennedy–Kassebaum Act or Kassebaum–Kennedy Act after two of its leading sponsors.
HIPAA was successfully enacted with an effort in protecting individuals who are covered by
health insurances and to set standards for effective storing and maintaining of the personal
medical data (Colorafi et al., 2016). It also helps by ensuring that the individual healthcare plans
are accessible, renewable and portable and also setting standards as well as the methods for how
medical data is shared across the U.S. health system for preventing fraud. It helps in preempting
the state law unless the regulations of the states are more stringent.

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References:
Buck, T. (2017). Poor Relief or Poor Deal?: The Social Fund, Safety Nets and Social Security.
Routledge. https://www.taylorfrancis.com/books/9781351910132
Chung, A. P., Gaynor, M., & Richards-Shubik, S. (2017). Subsidies and structure: The lasting
impact of the hill-burton program on the hospital industry. Review of Economics and
Statistics, 99(5), 926-943.
https://www.mitpressjournals.org/doi/abs/10.1162/REST_a_00654
Cobb, M. I. P. H., Zomorodi, A. R., & Gonzalez, L. F. (2018). Quality Improvement.
In Cerebrovascular and Endovascular Neurosurgery (pp. 41-48). Springer, Cham.
https://link.springer.com/chapter/10.1007/978-3-319-65206-1_6
Colorafi, K., & Bailey, B. (2016). It’s time for innovation in the Health Insurance Portability and
Accountability Act (HIPAA). JMIR medical informatics, 4(4).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112364/
Kilgour, J. G. (2019). The Social Security Program and Its Funding Problems. Compensation &
Benefits Review, 0886368719831873. https://doi.org/10.1177/0886368719831873
Kisacky, J. (2019). An Architectural History of US Community Hospitals. AMA Journal of
Ethics, 21(3), 288-296. https://journalofethics.ama-assn.org/article/architectural-history-
us-community-hospitals/2019-03

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Olson, A. W., Schommer, J. C., Mott, D. A., & Brown, L. M. (2016). Financial hardship from
purchasing medications for senior citizens before and after the Medicare Modernization
Act of 2003 and the Patient Protection and Affordable Care Act of 2010: findings from
1998, 2001, and 2015. Journal of managed care & specialty pharmacy, 22(10), 1150-
1158. https://www.jmcp.org/doi/full/10.18553/jmcp.2016.22.10.1150
Sheils, C. R., Dahlke, A. R., Kreutzer, L., Bilimoria, K. Y., & Yang, A. D. (2016). Evaluation of
hospitals participating in the American College of Surgeons National Surgical Quality
Improvement Program. Surgery, 160(5), 1182-1188.
https://doi.org/10.1016/j.surg.2016.04.034