Deliverance: A Study of Medicaid and Managed Care Essay

Under Medicaid, "except for those over age sixty-five, the federal government would only provide benefits to persons not in state hospitals, to shift financial burden to the federal government, states had to send the patients back into the community." (Davoli, 2003).

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

Critically analyze the implications of the state’s decision to opt out of Medicaid expansion on the citizens of the state.

In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current

The Affordable Care Act promotes Medicaid expansion. Medicaid expansion is needed in North Carolina to insure the disabled and those that live below the poverty level receive adequate healthcare coverage. The resistance of North Carolina legislature in the promotion of Medicaid reform has retarded Medicaid expansion to its uninsured residents. The cooperation of the North Carolina legislature and its support of the Affordable Care Act is necessary for successful Medicaid reform. This paper reviews the impact of the Affordable Care Act 's lack of implementation in North Carolina.

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

The Medicaid program has impacted our hospitals and the economy of the state of South Carolina. There are a lot of pressures for most of the hospitals in the state dealing with bad credit, pay cuts, and financial pressure. According to U.S. News (2012), "the Supreme Court upheld the President, Patient Protection, and Affordable Care Act because it was the big key to a health care law expansion of Medicaid." This program is based on lower-income individuals and children that are below

In a traditionalist state, such as Texas, the financial toll that Medicaid would have on its taxpayers was on the frontlines. The Texas legislature was worried about whether or not its taxpayers would face a tax increase to cover the increased cost of those covered by Medicaid. These taxpayers would inadvertently pay for the hospital bills of those who are uninsured in Texas through an average $1,800 rise in the cost of their premiums (Rapoport, 2012). In support of expanding Medicaid, Texas would receive federal funds in order to ease the cost that accompany the expansion. Since Texas decided not to expand Medicaid, Texas “would be leaving billions and billions of federal dollars on the table” according to Anne Dunkelberg (Rapoport, 2012). Not only does this monetary incentive give Texas an extra push to participate towards expanding Medicaid but it would also help the residents of the state to get insured. Texas legislators understood that this monetary incentive would not fully cover the cost of the newly enrolled Medicaid recipients. In the end, they would have to rework the annual budget and increase taxes in order to cover these extra recipients.

In 2006, the state of Massachusetts set out to close the gap in the number of uninsured citizens within its borders. The number of uninsured non-elderly adults in the state was nearly 17% (Chandra, 2011a). The same author said executives in the state realized the growing problem and were earnestly looking for ways to promote individual responsibility. One primary way of closing this gap has been through the development and implementation of what was called the Massachusetts Commonwealth Connector: a consumer-driven internet based healthcare market place. Although proposed in 2006, it wasn’t until 2008 that the system was rolled out at the state level (Chandra, 2011b).

There are some problems that must be addressed in the expansion of the Medicaid policy to include; social, economic, ethical, legal and political. First, the social impact of having health insurance removes the burden off of parents, people with chronic diseases, children and the disabled. If access to health insurance is unavailable our nation’s health care costs will continue to rise,

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

The health care reform debate between 2008 and 2010 led to the passage of Patient Protection and Affordable Act. It was reminiscent of opportunities for reform that have occurred on a cyclical basis throughout American history. These opportunities occurred most notably in the presidential administrations of Franklin Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson, Richard Nixon, and William J. Clinton. (Rich, Cheung, Lurvey, 79). We have to look at recent opportunities that have expanded today.

According to Ingols and Brem (as cited in Swayne, Duncan, and Ginter, 2006), Massachusetts is known across the world for computer technology, education, and health care. In the words of the authors, Massachusetts' "health care expenditures per capita were between 27 and 29 percent higher than the national average from 1990 to 2000." At the time, there was a general consensus that Boston's health care was relatively expensive as a result of the region's cutting edge and high quality services (Ingols and Brem, 2006). During the 1990s, a number of healthcare insurance plans at the national level chose to merge in an attempt to further enhance their ability to compete effectively. This trend according to Ingols and Brem (as cited in Swayne, Duncan, and Ginter, 2006) was also replicated in Massachusetts where the eventual formation of three large competitors had far-reaching consequences. One consequence of the increasing power of these three formations in the marketplace was reduced payments.

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

State governments have long been involved in reimbursement for health care services, and their involvement has increased through participation in the Medicard Program. Recently, the continued growth of third-party expenditures for reimbursement has fostered a number of