Identify the specific government health programs and organizations that are involved and analyze their role in the policy.
Order Instructions
Textbook: Patel, K. (2019). Healthcare politics and policy in america (5th ed.). Routledge
In Week 5, we will cover more of the political challenges that government healthcare programs face, such as the move toward privatization, the quality and rising costs of healthcare, the burden on state and federal revenues, and the ramifications of fraud and abuse. We will take a closer look at the impact of the aging population on the Medicare and Medicaid programs. We will also compare the relationship between the increase in the uninsured and the increase in Medicaid.
Your Learning Objectives for the Week:
Analyze healthcare financing in the context of spending and value.
solutions to improve quality of care in a rapidly changing healthcare system.
Government Financing of Healthcare
In a normal health care setting in an organization, the organization creates a budget based on prior expenses and revenues, and projected expenses and revenues. In many health care organizations, the executive team formulates a budget with input from various departments. In this process, there is a sense of connection between the budget and the actual financial operations of the organization. In regard to the budget operations of health care programs such as Medicare, this connection is not readily seen because the complexity of the budgeting process makes the link between planning, budgeting, and implementing less clear. One of the major problems is the involvement of multiple parties in the budgeting process. The inherent problem with government health care programs is the disconnection between government legislators, who decide the direction and financial aspects of the health care programs, and the federal and state agencies that are given the task of implementing the programs. Medicaid is a good example of a program with complexities in its financing. This problem also adds to the sometimes fervent debate on who should finance these programs. Medicare has been moving toward privatization in an effort to control costs and improve quality. The privatization of government health care programs can be seen as an attempt to reduce the costs of these programs and to improve the quality of the services by putting these programs on the same footing as private health care plans.
Private Versus Public Control
Within the last twenty years, there have been attempts to move Medicare and Medicaid programs toward privatization or at least have private insurance companies administer some components of these programs. One of the attempts was the implementation of Medicare Part C, or Medicare Choice, in 1997. Medicare Choice offered enrollees the choice to move from the traditional Parts A and B plan to a managed care plan administered through an authorized private insurance company. Medicare Choice was not as successful as expected because most of the Medicare recipients didn’t want to move away from the convenience of a fee-for-service (FFS) based health care plan. Another significant issue with the Medicare program as a whole is that it didn’t include a comprehensive prescription drug plan, which was an ever growing cost for Medicare recipients. The MA program was another attempt to privatize Medicare. The MA program, which came out of the Medicare Modernization Act of 2003, is a redesign of the Medicare Part C program. During 2003, Medicare still had 90% of its members in the traditional FFS plans, with only 10% in the Medicare Part C plans. The MA program was also intended to improve choice, quality, and access to health care for Medicare members. This parallels the rise in consumerism in the private health care sector. Consumers of health care wanted health care plans to give them more choice in the physicians they can see and more options in the types of health care benefits, such as preventive health and wellness programs. The intention of the MA program was to move Medicare members into supposedly more cost effective managed care plans, but this intent was not initially achieved. Enrollment has continued to rise since 2005, but the cost to Medicare averaged out to more dollars spent than for traditional FFS Medicare.
Issues Impacting Government Programs
One of the major issues impacting the future of government health care programs is the growing number of uninsured in the US population. In 2011, 16% of the population was uninsured, which accounted for 47.9 million US citizens. Among those under sixty five, 18% were uninsured, 20.5% received Medicaid or another form of public care. 51% of the nonelderly uninsured fell below 138% of the federal poverty level. As the ACA is implemented, these individuals will become eligible for Medicaid. Among the 49.1% uninsured, 54% are eligible for Medicaid, 37% are eligible for federal subsidies, and the remaining 10% are above the income limits for government support. Fraud and abuse is another issue impacting the future of health care. Medicare experiences billions of dollars in losses due to provider fraud. Medicare (provider) fraud reached such alarming rates that as a part of the ACA, measures were included to aggressively seek out offenders, strengthen current laws, strengthen enforcement, and strengthen the prosecution of offenders. The ACA created tools to improve provider and supplier screening to weed out false claims and created new laws requiring tougher sentencing for those committing fraud against government health programs. But, what happens if the ACA is ever repealed?
Select ONE health policy issue from the list below:
Medical Marijuana
Assisted Suicide and Euthanasia
Vaccines for Children
The Patient Protection and Affordable Care Act
Right to Health Care
Research arguments for and against the health policy and addressing the following:
Research the policy issue and present background information on the issue
Address the political, financial, and economic issues related to the health policy.
Discuss the specifics of who will be eligible and who will be responsible for providing services.
Discuss the impact of your proposal on recipients and providers of care; include eligibility requirements for receiving benefits, application process, expected benefits, requirements for a provider to be eligible.
Identify the specific government health programs and organizations that are involved and analyze their role in the policy.
Examine budgetary issues such who will be responsible for funding: state, federal, or a combination of both.
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