The Role of the Private Sphere in US Healthcare Entitlements: Increased Spending, Weakened Public Mobilization, and Reduced Equity

Colleen M. Grogan 1
  • 1 969 E. 60th Street, School of Social Service Administration, University of Chicago, Chicago, IL 60637, USA
Colleen M. Grogan
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  • Colleen M. Grogan is a Professor in the School of Social Service Administration at the University of Chicago. She is currently working on a book titled America’s Hidden Health Care State, which examines and exposes the historic evolution of public health care spending through private entities in the US health care system and the intent behind America’s submerged health care state. Another project underway focuses on the potential of community-based organizations to address problems of political inequality. She has written several book chapters and articles on the political evolution and current politics of the US Medicaid program. Grogan is Editor of the Journal of Health Politics, Policy and Law, the Academic Director of the Graduate Program in Health Administration and Policy (GPHAP), and the Co-Director of the Center for Health Administration Studies (CHAS) at the University of Chicago.
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The private sphere has always been an important component in US healthcare entitlements. Since the ACA further embeds the role of private actors, how private actors make claims on the state, and how the state reacts to these claims, becomes even more important, because such claims significantly shape US healthcare entitlements. The extent and increase of private benefits and contracting with private health plans is explicated for each healthcare entitlement program. The politics of how private inclusion shapes healthcare entitlements is examined with three main implications: it (1) creates a dominant discourse of health care deficits and spending crises; (2) submerges the role of government and may diminish mobilization for claiming entitlements; and (3) reduces equity in the distribution of costs and benefits. I conclude by highlighting that there are simple policy designs to address these problems, but the political dynamics of private inclusion will likely work against such policy logics.

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