Medicare: A Case Study

Author Donald A Barr defines the Medicare program. “The federal Medicare program is our system of universal health insurance for everyone sixty-five years old or older paid through a general withholding tax” (Barr 131). Unfortunately, the United States Medicare system is financially unstable. “Medicare is spending more money than they are bringing in…Policymakers are looking at several different options that will alter the Medicare program significantly” (WPC 2). In turn, a high number of companies and organizations are investing their time and revenue into lobbying to make healthcare changes. Joe Eaton from the Center for Public Integrity shares “More than 1,750 corporations and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009” (Eaton). The objective for special interest groups is to pull financial resources together to be a force of influence. Granted there is strength in numbers, for example, the American Association of Retired Persons (AARP) “deployed fifty-six in-house lobbyists and two from outside firms to work the issue on behalf of its members. Also, American Medical Association (AMA), “spent $20 million overall in 2009 lobbying Congress on behalf of doctors” (Eaton). The AMA was successful in removing a $300 fee for physicians that participate in Medicare and Medicaid. Furthermore, the AMA advocated for budget cuts for higher income Medicare subscribers and payment cuts for Medicare biller’s

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

Medicare is another section that will feel some relieve from practices brought from the Act. As mentioned before, the cost of health care is expensive, therefore making it difficult for those under the Medicare plan to seek preventive services. Before moving forward on the effects of the Act on Medicare, one must first explain some of the benefits of Medicare. Medicare is the nation’s largest health insurance program, it serves more than forty-two million enrollees, and it was originally established to provide access to health services for the elderly (Carroll, 2009). One can grasp the idea that the nation, along with its government, has made constant efforts to support the health of all Americans. This especially true for the ever growing

Medicare is one of the largest health insurance programs in the world with an annual cost of $260 billion (Nesvisky, 2015). Nesvisky stated that providing universal health insurance to the aging and the disabled, Medicare accounts for approximately 17 percent of U.S. health costs, one-eighth of the federal budget, and 2 percent of gross domestic production (2015). Medicare was introduced in 1965 and remains to this date as the single largest change in health insurance coverage throughout U.S. history (Nesvisky, 2015).

The federal government provides health care insurance called Medicare. The program stared out strictly for those United States citizens who are 65 years of age and older. The plan has changed over the years to covering younger individuals with disabilities and diseases that are accepted by the program, like end-stage renal disease and young people with amyotrophic lateral sclerosis. Medicare covers over 49 million people as of the end of 2015 (Anderson, 2015).

Medicare offers prescription drug coverage to applicate that has Medicare. If not the applicate decide not to join Medicare Prescription Drug plan (Part D) when they first became eligible, or they have decided not to join a Medicare Advantage plan (Part C) or ant other Medicare plan there will be health plan offers Medicare prescription drug plan that will most likely help pay a late enrollment or penalty unless the applicate have other creditable prescription drug coverage.

Do you have some durable medical equipment, prosthetics, orthodics or associated supplies (DMEPOS) in your medical office supplied by a home medical equipment (HME) supplier? Such an arrangement is often called a loan or consignment closet.

Medicare is designed to give people of 65 years of age or older, people who are younger than 65 years of age but have certain disabilities, and people of any age with end stage renal disease, medical coverage. This is funded through the federal government. Medicaid is for low income adults, children, pregnant women, elderly adults, and people with disabilities medical insurance. This is funded jointly by the state and federal government. In the United States, Medicare costs increased by 4.5% in 2015, Medicaid spending increased by 9.7%, private health insurance increased 7.2%, and out of pocket spending increased by 2.6% (NHE fact page, 2017). Virginia has increased in Medicaid costs by 7.78% since 2015 (Medicaid and CHIP in Virginia,

The Pharmaceutical lobbyist has a very powerful impact on the outcome of Medicare Part D. They were the ones that wrote the bill and presented it to the House and ultimately, it was passed. However, the tactics that were used were extremely questionable and unethical. A Democratic Representative from Michigan stated: “I can tell you when the bill passed, there were better than 1,000 pharmaceutical lobbyists working on this” (Singer, 2007). The

Thank you for your letter of 06/28/17 in which you demand $50,000.00 for a Section 32 settlement of the matter subject to a Medicare set-aside.

The metropolitan classification program is used to determine home mortgage loans, loyalty pay program and varying policies within the Medicare program. The geographic established boundaries of a metropolitan area are representative of that area’s marketplace. Property data collected from the area is reported to bank regulators who will use the data to evaluate lending performance. The data collected could potentially cause bank regulators to consider altering lending practices to suit the area.

The referral system enacted between the physicians termed “ping-ponging”, is problematic. Such a problem can be classified as a crisis; crisis problem solving is instantaneous and addresses a present threat. In this case, failing to act promptly will cause untoward results, such as a decline in near-term performance (298). The financial performance of the hospital has begun to feel the negative effects of the physician's acquired referral system. The hospital has experienced above-average denials for Medicare reimbursements (320). As the case suggests, most of the patients are older, therefore, the likelihood of them having Medicare is high; a decrease in Medicare reimbursements can have catastrophic financial consequences.

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.

previously. My father was severely sick and i wanted to the pharmacy to get his prescription but they refused me because he's healthcare did not coverage for this particular prescription which was way expensive at around$ 450. I spoke to the pharmacist about my father condition.She insisted to give the prescribed and i did not know what to do called several time his healthcare coverage and did not helped me. At the present time i used to lived in Saint Paul Minnesota and one of City council by the name Dai Thao was happend to be there at time. He saw my frustration and Asked me that happened and told him that my father is sever sick and his healthcare is not covering the prescription. He immediately called Healthcare Coverage and told

The U.S. health care system is not a centralized control one like other developed countries. Therefore, leaving it very fragmented with many participants having a say about its governance. Health policy which is a set of course of action undertaken pertaining to health care affecting the public health, its financial services, quality care etc. does not escape the multiple governance (healthpolicy.org). Arriving to one health policy may even be more complex than the delivery of care. Different interest groups like pharmaceutical research, AARP, Physicians, etc. all feel that their issues are what is needed for the advancement of healthcare and the public. Needless to say, that they are many forces influencing health policy. We have the public sector, which is composed of the local, state and federal legislation, court ruling etc. Private sector that is composed of hospitals, agencies, accrediting organizations, health professionals, etc. Last but not least political forces, play even a bigger part in bringing a health policy to life. Thus, bring us to the purpose of this inquiry. How does the legislative process affect health policy and what role does a health professionals play in nurturing a bill into law in the U.S.?