Healthcare Reform and Its Effect on Dual Coverage on Medicare and Medicaid - Essay Example

Healthcare Reform and Its Effect on Dual Coverage on those on Medicare and Medicaid Introduction Health care reform is the federal health law passed by congress with an aim of increasing accessibility to health care for all Americans (Mason et al., 2013). It is an extension of the existing health insurance scheme and is focused on providing health insurance coverage to more people previously not covered by Medicare and Medicaid (Kronenfel, 2011). It creates legal protection for the clients and establishes means through which clients can acquire full information before taking insurance cover. Health care reform in U.S. is of great concern to the state because the state spends more than 14% of its GDP on health care insurance while the quality of health care in the U.S. is ranked the poorest among the developed according to the Commonwealth Fund report in 2008 (Gruber, 2011). Although Medicare program has been in operation since 1965 to cater for health needs of the elderly persons aged 65 years and above and the disabled persons, it was not able to cover all the medical expenses. Some Medicare enrollees spend about 25% of their annual income on health care due to high deductible policies and core-payments (Kaiser Family Foundation, 2008). This document examines various reforms on the health care and its effects on the elderly and those with dual coverage with an emphasis on quality and availability. Medicare programs and Medicaid health care Medicare health insurance is provided by the U.S. federal government for the persons aged 65 years who had subscribed to Medicare services before attaining the retirement age (Gruber, 2011). The Medicare program is also available to "younger persons with disabilities or those with end-stage renal disease or amyotrophic lateral sclerosis" (Kaiser Family Foundation, 2008). The program enables the elderly persons to spread the risk over many health insurance providers in order to provide protection to the vulnerable group. Medicare covers a proportion of the approved health care costs for the persons with disabilities and the elderly persons while the clients have to use other means to clear the outstanding balances (Mason et al., 2013). The service does not cover some charges such as long-term health care services, vision care, dental and hearing. The financing of Medicare Part A is made through payroll tax revenue levied on employers and workers while part B and D are funded by Medicare enrollees’ premiums and general fund revenue (Mason et al., 2013). Medicare covers Hospital Insurance (Part A), Medical Insurance (Part B), Health Plans (Part C), and drug prescriptions (Part D) (Kronenfel, 2011). "Medicaid is a government insurance program for Americans covering all persons with low-income earnings" irrespective of their ages (Kaiser Family Foundation, 2008). It is financed by both the state and federal government, but it is managed by the state. The state caters for half of the Medicaid program and is a means-tested, social protection or needs-based social welfare program (Kronenfel, 2011). Unlike the Medicare program that targets people with disabilities and those aged 65 years and above, Medicaid targets only persons with low income but have wider coverage than Medicare (Mason et al., 2013). Medicaid program offers two types of coverage that includes "community Medicaid (covers those with little or no medical insurance) and Medicaid nursing home coverage (caters for all nursing home expenses for all those who are eligible)" (Thorpe & Philyaw, 2010). Medicaid program was available to most of the people irrespective of age, social, economic and racial background as long as their income was above federal poverty level and lacked past dependence. On the other hand, Medicare was meant for persons with disabilities and those aged 65 years and above (Kaiser Family Foundation, 2008). Insurance companies did not provide health insurance cover to individuals with "pre-existing conditions such as asthma, cancer, heart defects," etc., and set up a limit on the dollar value to those applying for insurance cover (Thorpe & Philyaw, 2010). Due to the stringent requirement for subscription to the health insurance Medicare was too expensive and did not cater for all medical expenses thus giving the elderly persons the burden to use out of pocket cash to clear the remaining balance. Health care reform The health care reform aimed at increasing citizen’s enrolment for health care coverage through public and private sector insurers. It focuses on increasing state subsidies for insurance premiums in order to reduce the individual cost to less 10% of their income (Mason et al., 2013). The subsidies and other policy requirements will result to reduction of cost for health care services and increase the enrolment of new clients (Thorpe & Philyaw, 2010). The new policies provide incentives to the insurers to ensure those insurers meet clients’ claims promptly under the prevailing conditions (Gruber, 2011). Also, the reform aims at expanding the base of health care providers to offer the elderly patients with more opportunities to choose the insurance cover that suits their needs. Furthermore, the policy change targets to improve the quality of health care and increase the accessibility of the healthcare services (Kronenfel, 2011). The change imposes various cost-saving measures that will minimize the cost of health care on the elderly persons through reduction of cost of medical equipments and pharmaceutical firms among other measures (Mason et al., 2013). After it has been fully implemented the health care reform is estimated to reduce the medical fees deficit by over $140 billion (Kronenfel, 2011). Closing the coverage gap The Affordable Care Act introduces more benefits to the elderly drugs by offering discounts on Part D or Medicare drug prescription coverage to make it more affordable once the clients gets into the coverage gap also known as “donut hole” (Mason et al., 2013). The discounts are provided by Medicare on the specified brand-names drugs, particular generic and brand-name drugs. The Medicare enrollee pays for the drugs prescription out-of pocket until the bill reaches the coverage gap when the Medicare starts offering the client discounts on the cost of drug prescription as long as the cost is within the coverage gap. Reduction in Drug Prescription Cost Initially, the high cost of drug prescription compelled the elderly persons to cut back on the use of drugs due to escalating out-of pocket bill. Therefore, it exposed the elderly persons to health risk since most of them could not afford to foot the medical bill above particular point (Thorpe & Philyaw, 2010). However, the health reform has helped in reducing the “donut hole” by about fifty percent of brand name drug prescription and some discounts on generic drug prescription (Mason et al., 2013). The trend will increase gradually until the year 2020 when it is expected that the elderly persons cannot incur more than 25% out of pocket contribution for the drug prescription (Thorpe & Philyaw, 2010). The change will increase the accessibility of drugs to the elderly by lowering the cost of drug prescription. It will also improve the quality of drug prescription to the elderly because discount is applicable for specific drugs brand names whose manufacturers have subscribed to the program and have complied with terms set by Centers for Medicare and Medicaid Services (CMS) (Kronenfel, 2011). Also, the program grants discounts to clients who opt to purchase “lower-cost generic prescription medications while in the donut hole” (Mason et al., 2013). Diversification of Health Insurance Services Health care reform has resulted to diversification of health insurance to both public and private health insurers (Thorpe & Philyaw, 2010). The elderly persons will have the option to visit their primary health care providers for routine annual medical check-up, and the cost will be settled by the Medicare program. This will help in early recognition of diseases among the elderly persons due to increasing accessibility of health services (Mason et al., 2013). Furthermore, the quality of health care services will increase since elderly persons can undergo free annual check-up services offered by the trusted service providers. Elimination of Co-payment In 2011, the health care reform eliminated the co-payment policy that was made on most of the preventive care. Initially, the elderly persons had to pay annual deductibles for physicians and additional of 20% on the cost of each service offered such as cancer screening, immunization, colonoscopies, etc. (Kronenfel, 2011). The elimination of core-payment will increase health care accessibility among the elderly and improve the quality of health services because even those who skipped the services due to lack of funds can now get those services at an affordable cost (Thorpe & Philyaw, 2010). The state is responsible for ensuring the quality of services to the elderly enrollees is of a high standard. Dual eligibility Medicare dual eligible are persons qualifying for both Medicaid and Medicare health insurance programs. "Full-benefit dual eligibles have no cost sharing in Medicare Parts A and B" since the state pays for hospital deductibles (PartA); coinsurance, monthly premium and deductibles (part B) as well as 20% copayment under the Medicaid program (Mason et al., 2013). Full-benefit dual eligibles are exempted from costs under donut hole monthly premiums, all co-payments in drugs apart from nominal co-payments and annual deductibles. The governments assist in paying fees for the cost of drugs for the full-benefit dual eligibles under the Medicare Modernization Act (MMA) (Thorpe & Philyaw, 2010). Therefore, dual eligibles enjoying the full-benefits have all medical expenses taken covered by Medicaid and Medicare programs. Clients can access all medical services without out of pocket contributions for the services subscribed to (Gruber, 2011). Therefore, reform has increased medical accessibility to the poorly elderly persons through double coverage policy by paying for all medical cost provided through Medicaid and Medicare programs. They can get quality services since all health care services are provided for which otherwise could not be affordable. Conclusion The U.S. government’s mission to increase accessibility and quality of health care among the citizens has been boosted by health care reform. The reform has reduced various imitations hindering accessibility and quality of health insurance policy. It supports medical research to ensure high-quality medical services. Citizens subscribed to both Medicare and Medicaid enjoys additional benefits since the two programs cover different services. Furthermore, the reform has extended insurance coverage to persons above 65 years who do not qualify for Medicare. As more people attain the age of 65 years, they will be able to enjoy the full-benefits of dual coverage on Medicare and Medicaid program if their income dollar is lower than the federal poverty level. References Kaiser Family Foundation, (2008). Medicare Now and in the Future. Retrieved August 26th, 2014 from Http://kff.org/health-reform/issue-brief/medicare-now-and-in-the-future/ Kronenfel, J. J. d. (2011). Medicare. USA: ABC-CLIO Mason, D, J., Leavitt, K. J. & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare, (6th Ed.). USA: Elsevier Health Sciences. Gruber, J. (2011). Health Care Reform: What It Is, Why It is Necessary, How It Works. Farrar, Straus and Giroux. Thorpe, K. E. & Philyaw, M. (2010). Impact of Health Care Reform on Medicare and Dual Medicare-Medicaid beneficiaries. Cancer Journal, Vol.16 (6): 584-7. Retrieved August 26th, 2014 from Http://www.ncbi.nlm.nih.gov/pubmed/21131789 Read More