Medicare and Medicaid Issues - Case Study Example

1. Using a few demographic variables, how would you describe the uninsured in the US' The 1999 Census Bureau report s that there are 42 million people in the United States that are without health insurance coverage, or 15% of the total population of the United States (247 million). This also represents about 17% of the population under 65 years of age. There are 10 million children (14%) that are uninsured, and 32 million (19%) of adults between 18 and 65 years of age. Current data from 2005 show that the largest racial group, the white, non-Hispanic group with a population of 166.6 million, has the largest percentage (69%) of employer-based insurance within a racial group, while the second biggest group, the Hispanic (40.8 million), has the lowest percentage (40%). The white group has also the smallest percentage of uninsured (13%), while the Hispanic has 34%, which is largest amongst the racial entities in the United States. It is also determined that 46.1% of the uninsured are female, while 53.9% are male. From these statistics we can conclude that the uninsured in the US represent a group that doesn't know racial or gender boundaries, although we can see lower statistical values from one group to the next. 2. What is the biggest strength and biggest weakness of the employer-based insurance system' The current employer-based insurance system has several strengths and weaknesses. One of the main advantages of the system is the fact that it represents the most effective mechanism for providing health insurance in a private health insurance market. In addition, the employees in a specific company are able to cross-subsidize the health insurance of one another employees on the basis of the existence of unions or group policies, broadening the coverage for both the frequently ill and health employees. The highly localized regulation of obtaining health care is also considered to be an advantage compared to the government-controlled health insurance systems, as many new systems such as the diagnosis-related group (DRG) system for paying hospitals and the resource-based relative value scale (RBRVS) were innovated by the employer-based insurance. Also, it is considered that the immediate connection between a group of individuals within an organization and the provider of health insurance corresponds to the desired state of health insurance by the employees. However, there are certain weaknesses, most prominent of which is the fact that the health insurance of several hundreds or even thousands of families is based upon a specific working position, and maintaining the same. This would lead to a undesirable working environment, as the employee might remain within a company not because of his or her wishes, but rather the affordable health care. The lack of choice concerning the benefits of the health insurance plan, the lack of privacy concerning the access to the employee's medical records by their employers and the lack of transparency on the side of the employers concerning the payment of premiums are also cited as some of the problems. In addition, the high administrative costs concerning the health insurance industry shows the apparent lack of efficiency of the employer-based insurance system. 3. Does Medicare's original vision still work' Created in 1965, the purpose of Medicare was to ensure financial stability of elderly Americans during their frequent medical necessities. This program was later expanded to include Americans with disabilities, and despite being added at a later period of time, today this category expends most of the finances allocated for Medicare. Over the years, Medicare has been restructured and expanded, encompassing the provisions of medical care necessary to satisfy the needs of its beneficiaries and research has shown that Medicare beneficiaries are amongst the most satisfied customers within the US health care system. The new Medicare part E would provide a less complicated way of obtaining low cost benefits and would also allow the government to negotiate the rates with health care providers such as hospitals and pharmaceutical companies, as well as allowing employers to save money on health benefits in retirement. Therefore, while today's Medicare has continued with its original purpose vision, despite its many financial problems, it has improved to fit the age of a more privatized health insurance, and at the same time providing more benefits at a lower cost for the aging and the disabled. 4. What is the biggest accomplishment and biggest limitation of Medicaid managed care' Medicaid since its conception has become the largest health insurance program in the United States. It is estimated that insures 1/5 of the children in the United States are insured by Medicaid and manages 1/3 of childbirths in the United States. It also manages 1/6 of drug costs, 40% of the long term care and 50% of the mental health services. Its list of beneficiaries has swelled from 4 million in 1966 to 47 million in 2002. Medicare benefits are afforded to children and pregnant women, as well as to adults with copayments no more than 3 dollars. In this system there are no premiums and no deductibles. This is perhaps the most important achievement of the Medicaid system. However, as the amount of beneficiaries grew, the amount of finances allocated to Medicare has also risen. Yearly expenses have risen from 400 million in 1966 to 257 billion in 2002, and as it is estimated that the number of beneficiaries will increase, as well as the price of prescription drugs, medical services and long term care, the pressure on the system has also increased, creating many opponents. The increasing cost, therefore, is Medicaid's biggest limitation. ESSAY QUESTIONS: 1. Some who are eligible for Medicare and Medicaid still face formidable barriers to accessing the healthcare services they need. In general, how are Medicare's major barriers different from Medicaid's' Which are more severe in your view' Eligibility for Medicaid began with covering very low income single parents and their children, as well as the elderly and the disabled. The most characteristic increase in eligibility is to include children and pregnant women. Since 2002, all deprived children under the age of 19 are covered by Medicaid. It should be stated however, that eligibility for adults represents a serious issue, as with the exception of pregnant women and parents with families, most low-income parents are ineligible for Medicaid. There are currently 39 states that have resolved this problem by implementing programs that allowed people with low incomes, but still high for Medicaid standards to receive medical care. People that are not parents are also excluded, however they comprise 62% of the uninsured adult population. One should state however, that the people that are eligible receive a substantial medical coverage ranging from impatient and outpatient hospital services to early and periodic screening and diagnosis. It should be mentioned that the medical services provided reflect the needs of the poor population. Despite this and the cost free enrolment, 72% of eligible children and 51% of eligible adults enroll. Beneficiaries for Medicare on the other hand have proven to be far more satisfied, as 87% of the Medicare beneficiaries have stated that they were satisfied with the services. Future policies however would change this, as the increase in the Federal budget deficit would require several actions, such as to Increase the capacity of Medicare beneficiaries to finance out-of-pocket health care costs, to reduce loss of finances in insurance administration through reducing the fragmentation of coverage between Medicare and supplemental coverage, reducing chronic conditions through increasing effective interventions, and to generally raise the level of quality of care. As the Medicare system progresses towards a system utilizing out of pocket payment, it was estimated that people with the age of 65 or over will have to pay $100 000, while people up to 95 years of age would have to pay up to $240 000. Even though these are viewed from the aspect of long term care, still a conclusion can be derived that even though there isn't a problem of eligibility, high costs would make Medicare undesirable, while Medicaid has to deal with certain issues like the non married adult population. In my opinion the more severe is the eligibility of Medicaid, as it is system that completely excludes a category of impoverished citizens, which constitutes 62% of the entire poor adult population. The out-of pocket payments are yet to be implemented and it may be some time before, or if, it is implemented. There is no current legislation advocated to change that policy of Medicaid. 2. Medicare and Medicaid both face significant financing challenges. How are these challenges different and which will be harder for policymakers to solve' The financial strain the Medicaid system places on the budget of each state is extensive, and this generally occurs when a specific program increases its number of people that includes. Medicaid funding has grown as a combination of enrolment and inflation, increasing 11% in the year 2000-2001, and increasing 13.4% to 2002. This financial pressure is relieved by using federal funds from several aspects, such receiving a federal matching payment which assist in funding the program, the states paying only a portion of the cost and to be completely reimbursed by the federal government. This has negatively influenced the relationship between the federal government and the local authorities, as many states have attempted to be reimbursed by the federal government for increasingly expensive projects creating misleading information about the actual necessary cost of the program. Several solutions have been proposed as to how to face the growing need for finances and at the same time not to deplete the state budget. One proposed model is the increase in federal funding, as the health costs are rising faster that the state and federal tax revenues. Nevertheless, the federal tax has a far larger tax foundation from the states, and it is far more dynamic in meeting the means of Medicaid programs. Also it is considered that states should be more regulated when spending on Medicaid is concerned. Namely, what the states might define as medical services may not be in it's entirely. More government oversight should make a more effective Medicaid system with proper funding allocated where it is needed the most. Medicare's is exists thought payments for health care services and administrative expenses, and receipt of taxes and other revenue, handled through the hospital insurance trust fund including Parts B and D The two different points are from a trust fund perspective and a budget perspective. So considering the annual report of the Medicare Board of Trustees to Congress it focuses on the financial status of the Medicare Trust Funds, tit consist these funds that have sufficient revenues and assets to enable the payment of Medicare benefits and administrative expenses.. Following the 2005 Medicare Trustees Report, total Medicare expenditures are projected to increase from 3.3 percent of GDP in 2006 to 13.8 percent of GDP by 2080. Also the share of total U.S. output was expended to devoted Medicare spending and so projected cost would seem to represent new approaching for the size of the current total cost of the Federal Government relative to GDP. But from the other hand, society should place less weight on consumption of material goods and continue to value improvements in health and longevity very highly. Medicare general revenues are projected to increase from 13.6 percent of Federal income taxes in 2010 to 57 percent by 2080. So thought these implications will reduce spending on other Federal programs, increased Federal borrowing, or increased taxes. But some outcomes aren't desirable such as their impact would have to be considered in relation to the effect of slowing the growth of Medicare spending and society will ultimately be the judge of Medicare's sustainability. From the previously mentioned, we can conclude that the financial structure of both Medicaid and Medicare are plagued by similar problems, concerning the constant increase in health care cost, far more than the rate of inflation, but also that there are several differences in funding. While Medicaid is mainly based on state budgets intervention, together with federal budget help, Medicare is solely based by federal funding and revised by federal committees. This would make solving the problems with Medicaid far more complicated, as many aspects, such as federal and local government should be considered before an effective change is put into effect. Read More