Medicare: Health Care and Affordable Care Act

Medicaid and Medicare was created and called the Social Security Act of 1965 to provide coverage for medical treatment for qualified individuals and their families. Medicaid is a program that is jointly funded and managed by the federal and state governments that reimburse hospital and physician for providing care to qualified patients who cannot afford medical expense. To qualify for Medicaid he or she must be a United States or resident citizen which, includes low income adults and their children, people with certain disabilities and senior citizens.

Medicaid and Medicare is overlooked by the Center for Medicare and Medicaid, they monitor how the states funded programs” (Center for Medicare and Medicaid Services, 2010. pg 2). The states administered the programs and each state sets their own guidelines for those who can qualify for Medicaid. Three Major Factors In the past five years Medicaid and Medicare have had some changes to their delivery of health care. The Deficit Reduction Act (DRA) of 2005, (HCAHPS) Hospital Consumer Assessment of Healthcare Providers and Systems implemented in 2006 and in 2010 President Obama signed into law the Patient Protection and Affordable Care Act.

These changes will continue to affect anyone who is thinking about retiring or already on Medicaid or Medicare. The first major change to Medicare and Medicaid came from the Deficit Reduction Act of 2005 significantly changes of policies would shift the cost to the patients and also limiting the health care coverage for low-income families. DRA will reduce federal Medicaid spending by the cost of premiums; cost sharing of benefits and assets transfers of would make up about half of the savings for Medicaid and Medicare.

“DRA will reduce federal Medicaid spending by $1. Billion over the next five years with 70 percent coming from the increased cost sharing and the remaining 30 percent from premiums” (Kaiser Commission, 2006). This means higher co-payments for medical treatments and increased in non-preferred drugs. The states can vary the cost for the premiums, what type of services the patient can receive and can categorize prescription drugs as “optional. ” For example, states are required to cover hospital and physician appointments, they can limit his or hers stay at the hospital or how many times a patient can see his or hers doctor.

Then the patients are only covered for medical necessities. DRA also changed long-term care services, anyone who applies for Medicaid is to reveal all assets more than $2,000 and DRA can look back for the past five years of applying and see if the applicant has transferred any assets below fair market valve. The applicant needs to convert his or hers assets to exempt assets and keeping the applicant’s house from foreclosed, should give a lien to Medicaid to provide health care coverage for the applicant.

If the applicant has transferred assets below fair market valve, the DRA can penalize the applicant and even postpone the applicant eligibility to receive Medicaid or Medicare. “Moving the start of penalty period from the date of the assets transfer to the date of application” (Kaiser Commission, 2006 pg 1) causing an increase in funding for Medicaid and Medicare. Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) is a measurable and publicly reporting on patient’s perspectives of the medical treatment. HCAHPS will provide a national standard for collecting and reporting patients’ perspectives on care” (Franciscan Health System, 2007pg 2).

This program is part of the Hospital Quality Alliance (HQA) and Center for Medicare and Medicaid Services (CMS), the goal is to improve quality of health care by direct incentives to reward delivery of superior quality of care. CMS will be rewarding the top performing hospitals by increasing to their payment for Medicaid patients. HCAHPS survey is sent out within six weeks of the patients discharged, there is 27 questions elating to communication with the staff, cleanliness, pain management, communication about medicines, discharge information and if they would recommend the hospital.

The data is to Premier Incorporated to categorize the date, and then place this information on the website http://. wwwhospitalcompar. hhs. gov and available to the public. Health Quality Alliance and Center of Medicare and Medicaid Systems have awarded over eight million to hospitals who have shown improvements in the care of their patients.

The final factor is the newly signed law by President Obama, called the Patient protection and Affordable Care Act. This law is to give people the rights, benefits and protection against the health insurance companies and holding them responsible. The insurance companies and no longer deny coverage with pre-existing conditions, not lifetime limit on people who have a costly conditions like cancer, cancel his or hers policy without proving fraud and cannot deny claims without a chance of appeals.

The new health plan will have no out of pocket cost to us, keep young adults on parent plans until the age 26 and he or she can choose a primary care doctor. Improving quality and lowering cost for seniors who need prescription drug coverage. “The law requires insurance companies to justify their premium increases to be eligible for $250 million in new grants. Insurance companies with excessive or unjustified premium increases may not be able to participate in the new health insurance Exchanges in 2014” (Healthcare. 2010).

The Affordable Care Act will lower the cost of insurances premiums to families and business, providing better health care coverage. How Medicare and Medicaid evolved For the past 45 years Medicare and Medicaid continual to change and provide healthcare coverage for the elderly and low-income. Over the years, Medicaid and Medicare have added several new programs to help with disability, young families with chronic illness and people with cancer. Center of Medicaid and Medicare tried to keep up with the needs of health care coverage and but was getting deeper into debt.

The government needs new policies to lower cost of medical treatment and drug prescriptions. In the past five years Medicare and Medicaid have gone through new policy changes and implements of new laws, like Deficit Reduction Act and Affordable Care Act. The new laws will help build and strengthen Medicaid and Medicare by cutting cost to the deficit and adding more years into the program. Conclusion The first program to provide health care coverage to the senior citizens and low-income was created in 1965 called Social Security Act but later became know as Medicare and Medicaid.

The program have been modified and reformed by new laws like the Deficit Reduction Act, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) and Affordable Care Act. Each new modification was trying to strengthen the program and trying to cut cost of premiums for patients to get the medical care they need. In 2010, President Obama and the Congress passed the new health care reform, called Patient Protection and Affordable Care Act. This reform is holding health care providers and insurance companies more responsible and giving more rights to the patients with no out of pocket expenses and lower drug prescriptions.


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