For this project, you will select a state, national, or international policy in which the United States is involved to critically analyze, interview a stakeholder of the policy, perform substantial re

Running Head: MEDICARE POLICY OF 2019 0

Medicare Policy of 2019

Maria Williams

Southern New Hampshire University

05/10/2020

Medicare Policy of 2019

Purpose

The purpose of the Medicare program is to provide health insurance for people who have attained 65 years of age and over. Medicare is also intended to assist people below 65 years but have specific disabilities through health insurance. The health insurance program is also aimed at increasing affordable quality healthcare services among people across all age groups affected with End-Stage Renal Disease (Centers for Medicare and Medicaid Services, 2020). People with a disability aged below 65 are also eligible for Medicare.

Scope

The scope of Medicare includes provision of health insurance coverage for the aforementioned populations. It concerned with the health interests of minority or underrepresented individuals such racial or ethnic minority groups, rural populations, the disabled, and members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) (CMS, 2020). The Ministry of Health (MOH) CMS office actively takes part in health-policy development, regulations, planning, and coordination of minority healthcare initiatives through stakeholder engagement (CMS, 2020). Besides, the CMS of Minority health researches, collects, and analyzes data to identify target groups and identify healthcare disparities; eliminate barriers to affordable healthcare; and develop appropriate solutions (CMS, 2020). Medicare is also applied to collect data and share knowledge on the quality, access, and costs of the available healthcare services relating to minority groups and the eligible populations.

Stakeholders

The main stakeholders of the Medicare healthcare program are healthcare workers and institutions such as physicians and nurse managers, and public and private healthcare facilities. Other stakeholders include health insurance companies; pharmaceutical firms and suppliers of the required healthcare resources such as wheelchairs; government institutions and healthcare organizations such as the MOH, Centers for Disease Control and Prevention (CDC) (CMS, 2020). Beneficiaries such as minority groups and races, and the eligible populations such as people of age 65 and older, and disabled individuals aged below 65 years are also part of the Medicare stakeholders.

Constituents

Medicare consists of three parts namely Part A. Part B and Part C. Part A is concerned with hospital insurance and covers hospital-based inpatient care. Services covered include critical hospital access, skilled nursing facilities, and hospice care for some healthcare homes ((CMS, 2020). Formally employed people pay for the premiums through payroll taxes. Part B covers medical insurance. The services include doctors’ and outpatient services. It further covers some services not covered in Part A such as physical and occupational therapy, and specific home care services (CMC, 2020). Part D covers prescription drugs and is available for all Medicare-eligible populations. Eligible populations have to apply for Medicare-approved plans offering Medicare prescription drug coverage (CMS, 2020). Premiums for Part D are paid on a monthly basis.

Development of Medicare

Medicare was signed into law in 1965 by the then President Lyndon Johnson with the intention of ensuring that senior citizens in America experience the benefits of modern medicine. Since then, Medicare has undergone several amendments including 1972 inclusion of people with disability and minority groups. The total national spending on Medicare currently consists of about 20% of the US total national expenditure on healthcare, and 14% of the total federal budget, which has significantly filed the financial gaps in diabetes healthcare services (Lee, 2018). Medicare was idealized in the theme of political incrementalism. Its eligibility restriction to the elderly populations and benefits to hospital care, and integrating healthcare services with Social Security the Congress sought to enact Medicare as the first federal health insurance program. The American Medical Association (AMA) attempted to resist it as being 90% evil and 1% effective citing the possible negative impacts on private practice (Lee, 2018). Even President Ronald Reagan cautioned in 1962 that after Medicare enactment, other laws would follow that would undermine people’s fundamental freedoms.

Even though Medicare was more popular in the Congress than previous healthcare Bills, there was a shortage of one vote for the crucial House Ways and Means Committee, implying that it could not pass the Congress. However, Democrats enacted Medicare when they were the majority both in the Senate and Congress in 1965. Medicare was expanded in 2019 to include prescription drugs in Part D. From the incrementalism perspective, it was anticipated that the law could later be amended to have a wider coverage to include even children and other populations. The original intention behind Medicare as a healthcare insurance for the elderly was a political strategy for enactment of another federal healthcare insurance program that would expand perpetually to the national or even global scale. The total budgetary allocation for Medicare was $793,741.7 million that were distributed equitably in four main areas of operation (CMS, 2020). A total of $3,543.9, $770 was allocated for program management, and HFAC-discretionally respectively (CMS, 2020). Furthermore, $411,084, and $378,343.8 were allocated for grants to states for Medicaid 1 and payments to Health Care Trust Funds respectively (CMS, 2020). The 2019 budget included a $45 million increment proposal for promotion of quality and effective healthcare, and fraud and waste prevention initiatives.

Rationale for choosing Medicare

My choice of Medicare is based on its crucial roles of ensuring health insurance coverage for people of 65 years and older, people living with disability, and patients with End-Stage Renal Disease. My interest in the policy has also been drawn from the challenges that the people who supported the Law experienced before it could be enacted. While there are high standards for future healthcare expectations such as the America Healthy People 2020, the efforts made in order to ensure that the standards are achieved are not enough. In as much as there are many health policies and initiatives including Medicare aimed at increasing access to quality health, healthcare disparity across races and socioeconomic settings still exist (Dickman, Himmelstein & Woolhandler, 2017). My main interest in this policy is to study the approaches that those who supported Medicare used to succeed despite overwhelming opposition even from healthcare policy-makers and leaders. I would then figure out the best ways of pushing important healthcare policies to ensure that they are accepted and legislated.

Evaluation

Medicare Merits and Demerits

The merits of Medicare include the consideration for everybody including those who do not pay premiums for Part A. All citizens can benefit from Medicare hospital insurance without paying premiums. The medical insurance option in Part B of Medicare is optional meaning its coverage depends on an individual person’s decision depending on socioeconomic factors or the type of family (CMS, 2020). Furthermore, the monthly premium for Part B is $144.60, which is fairer and cheaper than ACA’s Silver Plans whose monthly premium was $1,123 in 2015 (Shawahna, 2020). Furthermore, Medicare has a broad eligibility scope in Part A and B, which include all citizens aged 65 year and older, any permanent US citizen or legal permanent residents who meet the required eligibility criteria such as disability. Besides, Medicare has been accepted broadly by many stakeholders in the healthcare industry (Shawahna, 2020). For instance, 90% of US physicians appreciate Medicare; Medicare can be used in all the 50 states of Columbia; and Parts A and B can be used in Puerto Rico, Guam, American Samoa, and Virginia Islands.

There are several out-of-pocket costs associated with Medicare. People must meet Part A deductible requirement of $1,408 for every benefit timeframe before being covered, and people could incur additional costs of $704 daily for inpatient hospital stay lasting more than 90 days (Shawahna, 2020). Medicare’s Part B includes a $198 annual deductible after which people must also cater for 20% of the Medicare-approved expenditure for covered products (Shawahna, 2020). The number of service providers for Medicare Advantage is limited to specific providers approved for each plan, which means that one could incur additional costs if they settle on providers of their choice. Furthermore, there are overwhelmingly high numbers of service providers for some Medicare Advantage, which increases confusion when choosing healthcare plans. Medicare advantage only offers state-specific services, which disadvantages frequent travelers from one state to another.

Extent to which Medicare Meets the Needs of Target Populations

Medicare successfully provides healthcare insurance to most of the target populations that include senior citizens and people living with disability. There is still a big number of people who have are eligible but not covered under Medicaid. For instance, one out of five people in the US who are eligible are not covered under Medicare (Barbash, Rak, Kuza & Kahn, 2017). Most of the affected people are immigrants who meet legal citizenship requirements. The poor coverage can be attributed to bureaucratic policies requiring procedures such as documentation that significantly obstruct equitable access to quality healthcare services. Furthermore, the interests of minority groups such as the disabled populations under the age of 65 years have not been met fully. For instance, in 2018, only 12.7%, 9.3%, 10.3%, and 67.6% of people with multiple disability, physical disability, cognitive impairment, and general disabilities who were eligible for Medicare benefited from the program (Barbash, Rak, Kuza & Kahn, 2017). The inefficiency in Medicare coverage for the eligible population can be attributed to inefficiency in allocation of resources, ineffective documentation approaches, and corruption among healthcare stakeholders (Barbash, Rak, Kuza & Kahn, 2017). Furthermore, the eligible populations are required to cater for 20% of the covered products, which makes the program exploitative to the population that it is supposed to protect from financial exploitation.

Unintended Impacts

Enrollment to Medicare means that all covered services are to be provided in accordance with Medicare policies, and with selected providers. The presence of predetermined providers means that the eligible populations do not have a choice regarding the type of healthcare services to seek or the physicians to consult. Consequently, people from minority races such as Black Hispanics or Asians who may opt for traditional medicine instead of the modern medicine will not experience satisfaction with the Medicare program (Barbash, Rak, Kuza & Kahn, 2017). Besides, Medicare does not cater for all expenditure. Consequently, the eligible populations are often required to cater for uncovered costs, which impacts negatively on the economic states of the socio-economically underprivileged communities.

References

Barbash, I. J., Rak, K. J., Kuza, C. C., & Kahn, J. M. (2017). Hospital perceptions of medicare’s sepsis quality reporting initiative. Journal of hospital medicine, 12(12), 963-993.

Centers for Medicare and Medicaid Services. (2020). Medicare. CMS. Retrieved from https://www.cms.gov/Medicare/Medicare

Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. The Lancet, 389(10077), 1431-1441.

Lee, F. E. (2018). The 115th Congress and questions of party unity in a polarized era. The Journal of Politics, 80(4), 1464-1473.

Shawahna, R. (2020). Facilitating ethical, legal, and professional deliberations to resolve dilemmas in daily healthcare practice: A case of driver with breakthrough seizures. Epilepsy & Behavior, 102, 1-14.