Dual Eligibles

There is a connection between socio-economics and health.79 Therefore, it’s expected when a states decided to expand Medicaid for more low-income residents, and then that population of people tend to be sicker than the rest of the population (Gershon & Sullivan, 2014). These reasons for expanding Medicaid will transfer those individual’s off the exchange policy into Medicaid, especially those within 100%-133% FPL range. Medicaid expansion could cause the exchange risk pools to become healthier, which means a healthier-risk pool that may be a financial boom for insurance companies that have participated in the exchange. Insurers that participate in the exchange are subject under law, to loss of medical ratio’s; which prevents them from retaining more than a certain level of profit (Gershon & Sullivan, 2014). In cost savings, with a healthier- risk pool possibly can be passed down for other consumer’s to use.

Money plays a huge role in access, therefore it is a vital issue to discuss. Within the current system, lack of money results in lack of health care, which leaves thousands of people without any health care coverage. Between 2001 and 2005, the number of people paying for health insurance increased 30%, however income only raised 3% (Health Care Problems). Adequate income is a necessity and unfortunately that is not present. According to the National Conference of State Legislatures, the average annual premium across the country is $16,000. Currently, the average annual income in the United States is $51,107. Mint Money Management suggests that about 4-6% of one’s total income should be spent on insurance, including life, disability, and health insurance. However, the averages in the United States show that the average person spends about 31% of their income on health insurance, which is not financially beneficial. When this rise in health insurance is not parallel to the inflation of income, innocent people are left without a method to achieve health care. There is a program for those who can’t afford health insurance out of pocket nor have access to it, and that is called Medicaid. Issues still exist with the program. There is only so much funding, which leaves many still uninsured. Additionally, people with Medicaid have difficulty

There are major challenges faced by policy makers such as trying to control the cost of Medicaid spending because Medicaid is the biggest payer of these services. Policy makers must ensure that they are also keeping the individual served front and foremost in their decisions. Ensuring that quality services are met is one piece of the puzzle. As stated, unfortunately it seems that those who have lesser insurance or who cannot afford these services are provided with less than

The purpose of this paper is to give an overview of two federally and/or state funded programs. The programs that will be discussed are Medicare and Medicaid. In this paper will be information about who receives Medicaid/Medicare, the services offered by these programs, and those long term services that are not.

Medicaid, which is a separate federal funded insurance was intended to cover low-income, aged, blind, disabled individuals, parents, and their dependent children on welfare. However, the senior citizens are the population group most likely to be living in poverty, and only about half of these individuals have insurance coverage. The difference between 1965 and now, of course, is costs. Years ago spending more on health care in result covering more people were the whole point. The administration wants to broaden coverage, but cut spending.

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

Dual eligible beneficiaries are among the poorest and sickest of those covered by either Medicare or Medicaid and, subsequently, they account for a disproportionate share of spending in both programs. Yet unfortunately their care is disjointed, with little to no coordination. State and federal agencies, managed care organizations and advocates all agree that the misalignment between Medicare and Medicaid must be addressed. The varying rules, overlapping benefits and conflicting financial incentives between the two programs greatly affect the nearly 10 million beneficiaries nationwide who are dually eligible for both programs.

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,

As the government’s role in public health remains, major changes have been put into effect, precisely dealing with long-term care. Before the 1930’s, providing care for the elderly was exclusively a local and state run industry. However, after the great depression, a growing demand was placed on providing some type of insurance for that population. The Social Security Act of 1935 was established to assist with “Federal old-age benefits” and was signed into effect by President Roosevelt on August 15, 1935. (Home, 2015) Another major impact to long-term care has been the creation of Medicaid that went into effect in 1965 and was an amendment to the Social Security Act of 1935. “Title XIX of the Social Security Act is a federal and state entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources” Medicaid is a collective effort between state and the government to help provide insurance for eligible citizens. Among those covered under this insurance, are the elderly, disabled and pregnant. Medicaid is the largest source of funding for medical care. The new changes to Medicaid are ongoing and will be put into effect as part of Obamacare.

Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.

“15% of New Mexico’s general fund ($4.9 billion spent on Medicaid in NM) is spent on Medicaid and 61% of all federal funds received by New Mexico is for Medicaid” (KFF 2017). As reported by the KFF, adults and children make up “82% of Medicaid enrollment” while the elderly and disabled made up only “18% of enrollment.” However, there’s a disproportionate share of spending as “59% of expenditures” go towards adults and children, but “41% of expenditures” went towards elderly and the disabled Medicaid coverage. Similar examples of this inequality has led some members of congress to debate proposals to reduce federal Medicaid which would “reduce federal Medicaid spending by 41% nationally over the 2017-2026 period” (KFF 2017). This budget cut will increase the number of those uninsured, reduce healthcare access, increase the pressure on state budgets (will hurt poorer states like New Mexico the most), and can cause a decrease in economic activity at both a state and federal

     The preventative care also follows to Medicaid problems. As Medicaid only covers some people like children and people with disabilities, it only covers half of the medical expenses. For the elderly and the disabled, it doesn’t cover long-term nursing home care or prescription medications. (Reese) If things weren’t bad enough, Bush administration has opposed broad cuts to Medicaid by up to ten billion dollars. This is

Medicare and Medicaid are federal government fundraising programs set in place to help elderly citizens and patients. Medicare and Medicaid are for certain patients with afflictions who cannot afford health insurance acquire some type of medical treatment without worrying about the financial burden. Due to costly health care prices and programs, Medicare and Medicaid funding have been a major threat to the US economy (Riczo, 2014). In the hopes of finding a solution to the current health care struggles pertaining to patients seeking monetary assistance “on March 23, 2010, Presi3dent Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law” (Panning, 2014,

The purpose of this essay is to discuss Medicare Part D, as well as the influence of the various interest groups and governmental entities during this process. This essay will discuss both the policy process and the policy environment (the key players involved and other circumstances that shaped this policy-making effort), how stakeholder groups influenced the final outcome of Medicare Part D legislation, the specific strategies and tools that were used most effectively, and if the fact that Medicare Part D passed corresponds with my understanding of policy and politics.

There may be implications for federal pricing (Medicaid). Most of these challenges, if not all, require state or plan-specific solutions.