Healthcare reform in two states

Running head: MEDICAID PROGRAM 1

Medicaid program

Brittany Ranck

Rasmussen College

Author’s Note: This paper is being submitted on Thursday, April 20, 2017 for Laura De La Cruz class, Healthcare Planning and Policy Management.

Medicaid program

PART ONE

1. Purpose of the program

The US government established the Medicaid healthcare program with intentions of making healthcare accessible and affordable to the citizens. The program was perceived as one of great importance because in the US there are a high number of people who belongs to the low-income class and hence could not afford healthcare services which are relatively high. After the establishment, different US states embraced the program into their respective healthcare industry and the program is normally operated independently in various US states. For example, I come from Illinois, and in this state, the Medicaid program that offers health care assistance has been branded as Illinois Medicaid Program. The program is jointly funded by the US national government and the federal government program. The program's main purpose is to pay for necessary medical individuals who cannot access or afford health care services, and they are citizens or legal aliens of Illinois (Thompson, 2012). The Illinois Medicaid program pays for medical services for children and their caregivers, parents, pregnant women, persons with disability, the blind, and also citizens older than 65 years. The services that are catered for by the Illinois Medicaid program is the physician bill, hospital bill, long-term care, drugs, medical equipment, laboratory tests, family planning, x-rays, and transportation among other health care services.

1. Effectiveness of the program

The Illinois Medicaid program cannot be classified as one that is very efficient. The reason is that, despite the program being targeted to help low-income earners and people in need of medical assistance like the disabled and the old, the program has not been able to prevent people from middle-income class to enjoy free health care services. In Illinois, there are a big number f people from the middle-income class who are not supposed to benefit from the program, but they end up benefiting. The reason is that the program has not set limits on the extent that the program can accept when it comes to the classes of people that should enjoy the services. For example; the program allows pregnant women to enjoy the service. The program does not put into consideration whether the woman is financially capable or not and this paves the way for fraud to take place in the Illinois healthcare service delivery (Rudman, et al., 2009). This is also the same case when it comes to caring givers or parents of a child who has been born disabled. The reason is that despite the child being with a disability, the parents might have ample financial ability to take care of their child's medical bills and the program only left for the low-income earners and those extremely poor individuals.

Luckily, according to Quinn, et al., (2016); the Illinois Medicaid program cannot be said only to have failed. The program has achieved numerous goals especially when it comes to making healthcare affordable not only to the low-income earners but also to the middle and high-income earners (Thompson, 2012). The reason is that the program has also strived to make sure that the government funds has been used to provide quality medical services available at different healthcare facilities. Thus, the funding has made it possible for the industry to lower the cost of healthcare in Illinois. But for the people, who fall under the set required income level, they enjoy free medical services, and this has made over 85% of poor people in Illinois to be beneficiaries of the program.

1. Viewpoints or opposing views to the program

Since the Illinois state government established and implemented the Illinois Medicaid program, different stakeholders have shared different viewpoints and ideas about the program. There are individuals who have been in support of the program while others have emphasized that the program is not good enough and that it should be amended. For example; the people under the poverty level support the idea that the Illinois Medicaid should be for the low-income people who unfortunately happens to occupy a big percentage of the population as compared to middle and high-income earners. The reasons provided for this viewpoint is that the middle and high-income earners can afford the high cost of healthcare and also the amount demanded by the insurance companies (Pressman, 2015). Thus, the program should target only the individuals who cannot afford healthcare and only relies on the government for assistance. The people who are from the low-income class, as well as humanitarian agencies, have been in the front line claiming that the program should work only for the poor individuals as they are the ones in dire need of medical assistance.

Another reason why the Illinois Medicaid program is said to be a good program and that should continue supporting the low-income earners is because the middle and high-income earners heavily rely on low-income earners. The latter is in the sense that the middle and high-income earners search for low-income earners to work for them and hence the health of the low-income earners should be the state's priority. The reason is that when the low-income earners are of bad health, and they cannot afford medical services, the middle and high-income earners would also be affected because they would not have enough people to hire and this economic status will be compromised (Pressman, 2015). This is an opinion that was once shared by the Illinois State governor. By making the program to be only for the low-income, disabled, and the aged was a way that the state and national government was trying to bridge the wide gap that has always existed between the rich and the poor. This is not forgetting the reality that diseases further makes the level of poverty to exceed and hence offering medical services to the poor people is also a way of making sure that the poor are in good state of health so that they can be empowered to improve their livelihood.

Some individuals share a different point of view that Illinois Medicaid program should not only be for the poor and the aged. Some people from the middle and high-income earners claim that the Illinois state government has the ability and resources that can enable them to establish a program that can cover even the individuals from the middle and upper-income earners (Pressman, 2015). These people claim that the fact that they have worked hard to improve their economic status is not a good enough reason to lock them out of the program. They share the feeling that they are also a part of the Illinois community and establishing a program that offers services to a particular group of people is a form of segregation.

PART TWO

From: The Managing Director

Cc: Head of the department

To: All the staffs

Date: April 19, 2017

Subject: Healthcare programs

Since the healthcare programs were established and implemented into the system, we as health care professionals can do little to avoid the programs and hence it is our duty to make sure that the programs work efficiently. The reason is that effective working of the programs would help us to perform even better and have medical bills that have affected the industry and as paid through the programs. I am on the realization that it is tough for healthcare professionals to keep up with all the programs offered through the government. But, in every challenge, there is always a solution, and this is the reason why I am providing you with important tips that will help you deal with healthcare programs challenge.

As you all know, there are different programs, but the difference is that they do not work the same. Some are easier to operate as compared to others. This is information that even the patients are not aware of, and hence it is our duty to inform the patients. Comparing the many health programs that there is in the industry today, Medicaid is one of the most effective and easy to use programs. Also, it is a program that has many benefits that the customers can benefit from regardless of the social and economic backgrounds. The reason is that the program has diverse options and this means that it is for every member of the society. With a Medicaid program, patients can enjoy low cost services, and the program is available in almost all the medical facilities including our facilities. Thus, when offering services to clients, it is important that you offer them advice so that they can choose the Medicaid program as their selected health care program. This way, the patients will be able to enjoy the benefits that come along with the program, and we as healthcare providers will be able to experience the convenience of the program.

Thank you

References

Lee, N. R., & Oral, O. P. (2014). The Changing Face of Healthcare Fraud and Abuse in America

Pressman, S. (2015). Defining and Measuring the Middle Class; https://www.aier.org/sites/default/files/Files/Documents/Standard/WP007-Middle%20Class.pdf

Quinn, K., Weimar, D., Gray, J., & Davies, B. (2016). Thinking about clinical outcomes in Medicaid. The Journal of ambulatory care management, 39(2), 125.

Rudman, W. J., Eberhardt, J. S., Pierce, W., & Hart-Hester, S. (2009). Healthcare fraud and abuse. Perspectives in Health Information Management, 6(5)

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Thompson, F. J. (2012). Medicaid Politics: Federalism, policy durability, and health reform. Washington, DC: Georgetown University Press.

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