Medicare and Medicaid

It is important that we all understand the basics of the Medicare and Medicaid programs as we will all eventually come of age where it is necessary to seek their assistance. The purpose of this paper is to give a brief history of how the program came about, the various plans for each program, issues that affect cost and access to the programs, how the political arena is affected and finally a conclusion with final thoughts on the total information.

The idea for a national health insurance program was first introduced by President Truman in 1945 but so much debate went back and forth that it was two decades later and a different president before they were actually signed into law. President Johnson signed them into law in 1965 with Harry Truman being the first enrollee. Starting in 1972 several changes were made over the next couple of decades. For example, in 1972 disabled persons under the age of 65 and those with end-stage renal disease become eligible for coverage and services expanded to include some chiropractic services, speech therapy and physical therapy.

Payments to HMOs were authorized and the Supplemental Security Income (SSI) program was established for the elderly and disabled poor, SSI recipients were automatically eligible for Medicaid. These were just the changes made in that year alone. The 1980’s saw the most amount of changes to the programs with hospice benefits added, prescription drug costs covered, federal civilian employees covered and other changes (SeniorJournal. com, 2008). The 1990’s saw some changes in the healthcare system as a whole during the Clinton administration and then a stall during the Bush administration.

Now that we have started the Obama administration and healthcare is on the top of everyone’s list along with the economy it will be interesting to see what he does. Medicare has several different plans which make up the total program. Part A is hospital insurance and is already paid for by the taxes you pay during your working years. Part B is health insurance and usually requires a monthly premium and covers what Part A does not. For example Part A covers inpatient hospital stays while Part B covers outpatient procedures. Part C is

Medicare Advantage, formerly known as Medicare + Choice. Medicare Advantage is very much like a private health insurance plan, offering managed care, PPO, and fee-for-service coverage options. It is only available in certain regions of the country, and the premium is higher than that charged for Part B, but it does offer the convenience of packaging Part A, Part B, and additional coverage into one neat bundle. The Prescription Drug plan also requires a monthly premium and as of 2006 is eligible for anyone who has Medicare. This is also known as Plan D.

Medicare is for people 65 or older, under 65 with disability and (surprisingly enough) anyone who is on kidney dialysis or has had a kidney transplant (Medicare Overview, 2005). This last point surprised me when I read it because I did not know that this was a special category all its own. Eligibility for Medicaid works a lot differently than for Medicare because there is no set age (Medicare Advocacy, 2008). In fact this program is directed towards low income families and individuals who meet eligibility requirements set up by the states.

Some of the criteria look at disability, income, citizenship and who lives in the household with you. If you meet the criteria then Medicaid sends payments to the health provider instead of directly to the beneficiary. This program can supplement what Medicare does not pay if it meets the requirements. Medicaid also works differently than Medicare because there are no plan distinctions. One item is clear, you have to be eligible for Medicare in order to be eligible for Medicaid.

This program works hand in hand with Medicare, it does not act as an alternate. This means that these two programs are not in competition with one another. They work together to provide a total benefit package for those in need of their services. An aspect of Medicare and Medicaid that is important to look at is disease management because this affects budget and financial costs for both patient and government. Before we can look at the issue itself we need to be able to define what Disease Management is. According to Wikipedia. rg (Wikipedia, 2008) disease management is “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. It is the process of reducing healthcare costs and/or improving quality of life for individuals by preventing or minimizing the effects of a disease, usually a chronic condition, through integrative care. ” The Centers for Medicare and Medicaid (CMS) organized a study to determine if disease management programs helped reduce costs for long term care for chronic conditions.

Approximately 300,000 Medicare participants took part in about 35 programs. The idea was to assist these Medicare patients with chronic illnesses such as COPD, severe heart conditions, cancer and other conditions between office visits to prevent hospitalizations. The goal was to reduce the costs that accumulate with hospital visits, help the patient to have a better quality of life and the program save money (American Journal Health Pharmacy, 2009). The program worked as follows: health care providers were supposed to work with patients in return for receiving a small fee from CMS.

The purpose of the health care providers working with the patients was to maintain the best quality of life with their chronic conditions and attempt to keep them out of the emergency rooms and from severe complications. In exchange for the small fee from CMS the idea was to lower overall costs in eliminating higher emergency and hospital bills. Unfortunately one of the first problems was the lack of compliance on the part of the patient. Without patient compliance the health care providers were not able to assist in health care management.

Another issue was that despite the variety of the programs 28 of the 35 programs did not save money and in fact cause Medicare to spend more than they were prior to the study. The final results of the Medicare Health Project was that Medicare beneficiaries had a variety of needs at various levels and the cost saving problem could not be solved with generalized programs. It is important to both Medicare programs and their beneficiaries that cost saving programs are developed that actually work and assist them. The reason that this is important is to save money for patients is to help them overall with financial reasons.

Also saving money for the Medicare program means that the program is able to do more for more people for a longer period of time. This means that access to healthcare is increased which is an issue very important to the average citizen as well as the governement. One of the President’s top issues whenever he is in office is ensuring that any American who so chooses has access to healthcare at a reasonable price with excellent coverage. According to new President this is the exact goal of his plan. He wants to offer everyone the ability to keep their coverage or cheaper costs or to choose a new plan that will meet their needs and their budgets. Medicare’s goal is to assist those within its system by helping them achieve the best possible care for a feethat works within their budget. The goal for everyone should be to help cover as many people as possible so that we all have the chance to access healthcare when we or our loved ones reach the age of coverage. Another major issue in healthcare that needs to be addressed is the ability for everyone to have access to quality healthcare.

An article titled “Medicaid and Medicare: Trends and Issues Affecting Access to Care for Low-Income Elderly and People with Disabilities” (O’Brien, 2005) addresses the cost issues that beneficiaries face and how this issue will only get worse despite the various attempts to make the system work. These life saving attempts affect both private and public health programs. The issue facing beneficiaries is that their share of the costs rises but they struggle to afford these costs in this tough economy. Unfortunately there is no end in sight about these costs going down anytime soon only up.

Medicaid and Medicare are programs designed to assist those with low income and yet they are becoming limited to that group of people because the premiums are taking a higher percentage of their limited income. The article goes on to outline a Medicare Savings plan that would reduce out of pocket costs but most beneficiaries are unaware of the program and all the aspects such eligibility and requirements that are involved. This savings plan can also affect how their benefits work with other Plans in the program. Another program is the Managed Care in Medicaid.

Premium costs are increasing in this area well but coverage has decreased for the beneficiary. Cost is directly related to the access of healthcare and that is why this is one of the most important issues there is in this country today because if costs are too great to pay then access is limited and more people have to go without the proper treatment that they need. This treatment includes preventative as well as maintenance. It is also discouraging that even though the costs are rising the benefits usually decrease so you pay more for less.

It is a shame in a country as rich as ours that we are unable to find out how to balance healthcare cost spending with quality care. At this point healthcare is still a political topic that each president struggles to deal with during their term. It is important to create as much access as possible for those that can afford it and those that cannot afford it. This is a national issue that affects each one of us and it is important that we all get involved in trying to find and develop a workable solution for everyone.

It can only benefit the country and health programs if we are able to create greater access to health care early on in someone’s life and we encourage and train them to stay healthy throughout life. This can reduce a lot of the risks that we all face in our older years. We all want to be around for as long as possible and access to healthcare is just one step towards that goal. Making affordable plans available through both public and private programs is one of the first steps to making this happen How does all this information work together to give us an understanding of the political realm of healthcare?

Well, first we know that those who run these programs are suppliers and have certain goals they want to accomplish. We, as the demanders, need to make it known what our needs are through special interest groups, state representatives and any other means necessary. Health insurance companies are going to have a large impact on how these programs progress in the future as well as large hospitals and medical organizations. Everyone wants to make sure that they are receiving their share of the pie and in so doing so the real meaning of what they are to accomplish gets lost.

For example, if the hospital is not receiving enough benefits from Medicaid it may start refusing patients who only have this type of coverage. Of course if you have Medicaid then you already have Medicare but if the benefit isn’t there for the doctors and staff then how will they get paid. In 2007 there was a bill passed that was designed to allow companies, both private and public, to barter for lower drug prices. Up until this point drug prices had been more expensive under the Part D prescription program than they were under Medicaid.

The problem came in when you had two different political parties trying to create the bill. According to a journal article (Akron Journal, 2007) the Democrats failed to include (it does not mention Republicans but I am sure that they had a hand in it as well) what is called a drug formulary. This formulary would give the companies of list of the most commonly prescribed drugs that work adequately and can be offered at a lower price. The problem is that drug companies are more than willing to lower prices on drugs that are rarely used and not as effective as others but keep the prices higher on everyday drugs that people cross the country use. The expected goal of this legislation was to lower costs but unfortunately politics and special interests got in the way and prevented it from being as effective as it could have been. During my research for this paper it was amazing to see how many different articles there were and the controversy that surrounded these programs. A lot of the animosity was directed towards Washington and both political groups by the American people, sometimes in particular by the seniors since they are one of the most affected groups.

The study of the Medicare and Medicaid programs has been very enlightening and has opened my eyes to issues I was not aware existed. In fact even though they are backed by the government they have the same issues as the private organizations as well. I find it interesting that programs such as these designed for the poor and elderly who are on fixed incomes have trouble meeting the needs of their customers and once again money is the issue. In fact according it is the government’s issue concerning the cost that will actually limit the access to healthcare that these people have.

How do we make healthcare work and affordable for everyone especially those with limited incomes? This paper has given me the opportunity to explore the world of Medicare and Medicaid and have a better understanding of how they came about, how they work and some of the issues facing us in the future. Now this paper dealt with only a couple of issues and certainly is not comprehensive about the individual programs or all of the issues that we are facing in our nation today that relate to healthcare.

It is important for each person to determine their situation and then to research how different programs apply to them, how their insurance company works and how their medical facilities operate so that they can determine if they are being given the quality of care they deserve as well as the access to the best healthcare. This applies to all patients of any income and any race not just the ones who can afford the top of the line healthcare. It is our right as Americans to receive the type of healthcare we need to be as healthy as possible whether it is preventative maintenance or follow through on an existing medical condition.

These programs are no where near perfect and it will be interesting to see how or if they develop over the next four years with President Obama promising big changes and sweeping reform in the healthcare system. He has promised to make healthcare available and affordable to every American by cutting healthcare costs and reforming already existing programs. Hopefully with these changes we will not see a decrease in the quality of care but an increase of both quality and access for all.

Health care administration involves numerous aspects, all of which aim to provide quality health care services to all. Primarily, it is the government that enacts policies and initiates programs and projects designed to fulfill this enormous burden (Barr, 2002). The …

The delivery of quality health care services to all is the ultimate goal of all aspects of health care administration. The government thus enacts policies and initiates programs and projects designed to fulfill this enormous burden (Barr, 2002). Considering the …

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