Two major forces acting against each other when it comes to government healthcare programs such as Medicare and Medicaid.
Textbook:
Patel, K. (2019). Healthcare politics and policy in America (5th ed.). Routledge
There are two major forces acting against each other when it comes to government healthcare programs such as Medicare and Medicaid. On one end, you have the forces pushing to privatize the programs and to relinquish the government’s role in providing healthcare. On the other end, you have the forces wanting to expand these types of programs.
Based on your understanding of the topic, answer the following questions:
Explain the positive and negative aspects of these forces that act against each other, in case of government healthcare programs such as Medicare and Medicaid.
How do these two forces play a part in the development of healthcare policy relative to government healthcare programs?
The main government programs include Medicare and Medicaid, as well as the Children’s Health Insurance Program (CHIP) and Veterans Health Administration (VHA) Program. According to the Centers for Medicare and Medicaid Services (CMS), 100 million people are covered through Medicare, Medicaid, and CHIP. And, while Medicare is a social insurance program financed by payroll taxes, Medicaid is an entitlement program, where eligibility is based on income. These programs are not considered ‘universal’ healthcare, but they account for over one-third of all healthcare expenditure. As such, Medicare and Medicaid are the centers of many state and federal budget discussions, making them topics for political debate. These programs become hot topics during presidential and congressional election years; and during major budgetary decision making at the federal and state level. Programs like Medicare, Medicaid, and the CHIP make up a significant portion of the overall healthcare industry. As we shall see in this course, there is not an area of healthcare services that is not influenced directly or indirectly by these programs. Another underlying issue includes the regulations that provide oversight to programs such as Medicare, Medicaid, and CHIP, which we will discuss further in this course.
Additional Materials
For more information, please review the following:
Kaestner, R., & Lubotsky, D. (2016). Health insurance and income inequality. The Journal of Economic Perspectives, 30(2), 53-77. doi:10.1257/jep.30.2.53
PORTELA, M., & SOMMERS, B. D. (2015). On the outskirts of national health reform: A comparative assessment of health insurance and access to care in puerto rico and the united states. Milbank Quarterly, 93(3), 584-608. doi:10.1111/1468-0009.12138.
The Politics of Government Programs
The extent of government involvement in healthcare has been a matter for ongoing political debate for several decades, going back to the inception of healthcare insurance. Is access to affordable healthcare a right? This question has been at the heart of political debate for as long as healthcare insurance has been in existence. It may be beyond the scope of this course to delve deeper into this question, but it can be stated that the move from the existing government programs to programs that provide coverage to all would be a significant challenge. Physicians for a National Health Plan (PNHP), for example, advocate for and endorse a single payer national health insurance. PNHP supports legislation that would expand Medicare to include all citizens of the United States. The group believes that healthcare is financed through a single, public-payer; but the delivery of care remains private. There are several issues that have to be addressed if the US is to move to more extensive government healthcare programs. Two opposing ideologies contribute to the ongoing political debate about the government involvement in the management of healthcare programs. The debate for or against universal healthcare is also a debate about private versus public control of the largest industry in the US. This is rooted in the long standing ideological debate between those who believe in big versus small government. It is not that one group or another is right or wrong. The debate, as alluded to above, has to do with who is going to pay for it and who will control or manage it.
Overview of the Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA), was passed in 2010. The PPACA provides new rights and protections for patients, expanded insurance choices through the creation of health insurance exchanges, new ways of controlling insurance costs, improvements to Medicare; and new tax credits for small businesses. Some key features of the PPACA included the following:
Patient Bill of Rights (2010): Under this provision, patients will be protected from abuses by insurance companies, such as ending preexisting condition exclusions, allowing young adults to remain covered by parents until the age of twenty six, ends arbitrary withdrawal of coverage by insurers, ends lifetime limits on coverage, among other protections.
Medicare (2011): It provides preventive care services for enrollees, 50% discount to cover the gap in prescription drug coverage, establishes the centers for Medicare and Medicaid services innovation center to research new ways of delivering care, improve care coordination to reduce hospital readmissions; and establishes the independent payment advisory board (IPAB) to address waste, cost of care, and quality.
Accountable Care Organizations (ACOs) (2012): These organizations are established to improve the coordination of care for Medicare recipients. ACOs bring together doctors, hospitals, long-term care facilities, and other healthcare organizations to lower the cost of care and improve the overall quality of care.
Health Insurance Exchanges (2014): They will be set up at the state and federal level, though state participation is optional. Exchanges allow individuals, families, and small businesses to “shop” for health insurance by comparing plans nationally and across individual states. Information will be available on coverage and benefits, as well as eligibility for tax credits and government programs.
Medicaid (2014): It expands eligibility to disabled individuals in all states; all individuals under the age of sixty-five will be eligible at 133% of the federal poverty level.
Additional Materials
For more information, please review:
Monahan, C. H. (2017). Private enforcement of the affordable care act: Toward an “implied warrant of legality” in health insurance. The Yale Law Journal, 126(4), 1
Custer, W. S. (2014). Private health insurance exchanges. Journal of Financial Service Professionals, 68(3), 30.
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