Despite rapid medical advances, children in this country still face significant barriers to adequate health care, including unequal access to insurance and health care. There is great need and opportunity in our nation at this time to advocate for the advancement and prioritization of pediatric health care. Children remain vulnerable to the challenges of poverty, violence, firearms, mental health, and health care access. Social workers play an important role in assisting children and families who face health care crises by providing supportive services, advocacy, culturally grounded assessment, trauma informed care, and evidence-based interventions to improve healthcare outcomes and quality of life. The Patient Protection and Affordable Care Act (ACA), signed into law in 2010, has increased access to pediatric health and behavioral health services. While the future of this law is uncertain at the time of this writing, social work is and will continue to be an important discipline to assist children and families in the areas of health promotion and adaptation to illness and injury.
Barbara L. Jones and Casey Walsh
Jean K. Quam
Arthur J. Altmeyer (1891–1972) was an administrator in Washington, DC from 1934 to 1953. He was a leader of social welfare policy and helped design and implement the Social Security Act of 1935.
Candyce S. Berger
The U.S. health care system is a pluralistic, market-based approach that incorporates various public and private payers and providers. Passage of Medicare and Medicaid, combined with rapid advances in technology and an aging population, has contributed to rising health care costs that typically increase faster than general inflation. This entry will review health care financing, exploring where the money is spent, who pays for health care, what the reimbursement mechanisms for providers are, and some issues central to the discussion of reform of health care financing. To effectively advocate health care reform, social workers must understand health care financing.
Cynthia Moniz, Stephen H. Gorin, and Terry Mizrahi
National health care reform in the United States, from its introduction into the public policy agenda at the turn of the 20th century through policy debates and legislative proposals more than a century later, has achieved limited success with universal coverage for health and mental health services. Opposition to government-sponsored health care has always been present. The extent of the opposition has depended on the type of reform proposed and the era in which it occurred. Medicare and Medicaid reform in the 1960s greatly expanded access and coverage for older adults and low income individuals and families. But, the first true effort to reach universal coverage occurred with the passage of the Affordable Care Act in 2010.
Mark J. Stern
Between 1950 and 1980, the United States developed a welfare state that in many ways was comparable to those of other advanced industrial nations. Building on its New Deal roots, the Social Security system came to provide a “social wage” to older Americans, people with disability, and the dependents of deceased workers. It created a health-care insurance system for the elderly, the disabled, and the poor. Using the tax system in innovative ways, the government encouraged the expansion of pension and health-care protection for a majority of workers and their families. By 1980, some Americans could argue that their identification as a “laggard” in the field of social provision was no longer justified.
Lee Kaufer Frankel (1867–1931) was a chemist and developer of family casework practice. He is known for his contributions to health insurance, family services, and Jewish welfare. He was an instructor at the New York School of Philanthropy and was instrumental in establishing the Training School for Jewish Social Work.
Victoria M. Rizzo, Sojeong Lee, and Rebekah Kukowski
In 1965, Titles XVIII and XIX of the Social Security Act were passed, creating Medicare and Medicaid and laying the foundation for U.S. healthcare policy. Originally, Medicare was created to meet the specific medical needs of adults aged 65 and older. In 2022, individuals with end-stage renal disease, amyotrophic lateral sclerosis (ALS), and other disabilities may also receive Medicare, regardless of age. Medicaid was established to provide a basic level of medical care to specific categories of people who are poor, including pregnant women, children, and the aged. As of 2010 as part of the Affordable Care Act (ACA), states are provided with the opportunity to expand Medicaid to close the coverage gap for public health insurance. This entry provides explanations of Medicaid and Medicare and associated social healthcare programs in the United States. An overview of significant programming developments and trends, future directions, challenges, and controversies as of 2021 are also provided.
Heather A. Walter-McCabe
This article describes the complex healthcare policy and financing systems in the US within a historic and political context for how the US arrived at these systems. It also provides an overview of frameworks useful for articulating how social work may have an increased influence on policies impacting the healthcare system along with specific arenas ripe for social work interventions towards healthcare system improvements. Social workers have the obligation, through the National Association of Social Workers Code of Ethics, and the requisite skills, to participate in the healthcare policy process ensuring that they not only have a place at policy making tables, but that members of communities impacted by these policies have an opportunity to assist in setting the healthcare policy agenda and programs to best serve them.