Medicare : A Largest Health Insurance Program

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

With enactment of the Medicare Modernization Act (MMA) in 2003, Medicare began moving toward value-based payments, and the introduction of Affordable Care Act (ACA) in 2010 meant that Medicare accelerated its use of value-based payments as a means of improving outcomes and managing overall costs (Wofford, 2015).

Suitable health care would not be possible for the elderly population in America without the assistance of Medicare Part A. Medicare did not come about easily. Currently Medicare spending is more than what is being collected, questioning future solvency. There are many challenges with sustaining Medicare into the future. Medicare’s past struggles, present outcomes, and future challenges confirm that a national health plan is ever evolving to meet the needs of the current population and spending inflation.

Medicare is health insurance that mainly covers seniors over the age of 65 and disabled people who qualify for Social Security/Disability. Medicare is funded Medicare is funded through 2 trust fund accounts held by the U.S. Treasury. The funds can only be used by Medicare.

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

The ACA included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aims to improve efficiency and quality of patient care and reduce costs including accountable care organizations (ACOs), medical homes, bundled payments, and value-based purchasing initiatives”(Cubanski & Neuman, 2016, p. 2).

Please read and review the outside and background sources/readings listed in your Syllabus. Please select one healthcare issue (policy/position/topic) that is of interest to you and discuss how it should be addressed politically and as a healthcare policy. Be sure to include the economic impact of such. Support your position with outside sources.

Medicare, which was first enacted by Congress in 1965, is a popular, yet failing, program because of a rapidly increasing population of retirees and their increasing costs; despite program’s flaws, Medicare is difficult to change because of the political influence of the elderly, who approve of the benefits they receive from the program. Medicare provides health benefits to citizens who are eligible for social security benefits(Fiorina, Peterson, Johnson & Mayer 2009). The program is embraced by the public, but Medicare’s increasing cost makes it difficult to sustain. Due to its popularity, the program is also very difficult to change, but without limitations the program will continue to decline in the future.

Person eligible for Medicare include individuals ages sixty-five and over, those with disabilities, and those with end-stage renal disease (Hammaker, 2011). here are three basic entitlement categories: persons 65 years of age or over who are eligible for retirement under Social Security or the railroad retirement system, persons under 65 years of age who have been entitled for at least 2 years to disability benefits under Social Security or the railroad retirement system, and persons with ESRD who do not otherwise meet the age or disability requirements. The latter two groups together are known as the "under 65" enrollees (Petrie, 1992).

Medicare, enacted on 1965 is a government funded health insurance program which covers the elderly, the disabled and people with end stage renal diseases. With Medicare covering specifically the elderly and the disabled, the cost is usually on the higher side. Medicare has been in action since the last 50 years. Many even approve of expanding Medicare instead of ACA, as Medicare is government funded while ACA has much commercial involvement. Medicare is heavily subsidized and is universally

Having been instituted on July of 1965 by President Lyndon, Johnson, for 50 years now, Medicare has served as a means of of health insurance for individuals 65 and above. This program has served as a means of getting healthcare to the elderly despite their financial situation. Going back as far as 1912, America had long been aspiring to establish a health insurance policy for Americans, but alas, none of these projects ever got real momentum. That was until 1945 when Harry Truman was elected into office. Truman believed health care for every American was an urgent matter so he requested that congress create a National Health Insurance Policy, which would help every American pay for meticulous things such as routine doctor visits, dental care, and other necessities. Despite his dedication, Truman’s plan deteriorated and nothing was accomplished. Finally, in 1965, Lyndon B. Johnson signed for legislation to establish what we all know today as Medicare.Since then, the program has experienced countless changes coming to cover far more Americans. At the time, it only consisted of Part A and B, but over the years, but has come to include C and D as well. Despite having been created in order to help a wider population, the program has been proven to have aspects of it that ultimately harm consumers.

Medicare covers over 47 million Medicare Beneficiaries. This includes 39 million seniors and 8 million people under 65 receiving social services disability insurance (SSDI) payments due to permanent disabilities (Kaiser Family Foundation 2010). Medicare accounts for 12% of federal spending, 23% of national health spending, and is critical part of policy discussions related to the federal budget and the 2010 Health Reform Law (Kaiser Family Foundation 2010). Medicare’s financial problems affect the entire budget, and are largely responsible for projected increases in federal deficits (Peter G. Peterson Foundation 2010).

The Affordable Care Act has enable Medicare & Medicaid Services(CMS) to link Medicare’s payment system to a value-based purchasing system to improve healthcare quality1. Hospital Value-Based Purchasing (VBP) which is part of the Centers for Medicare & Medicaid Services; the program allows

What is Medicare insurance? Medicare is a federal health program for an individual between the age 65 and older. Medicare has also helped certain younger people who suffer from some type of disability and also help an individual with kidney failure and need to place on a dialysis machine or need an organ transplant. Medicare insurance was created in the year 1965 it was signed by president Lyndon b, Johnson to help those Americans at the age of 65 who was not covered by health insurance received some types of insurance this insurance will be called Medicare. In the year 1972, Medicare starts to expand their program to people with disability and also patient suffering from kidney failure that required dialysis or needed an organ transplant to save their life. Medicare was designed to give the American people a choice how they want to manage their care that why Medicare insurance created two separate insurance called Type A and Type B. The insurance benefit of Type A generalized coverage, hospital care, skills nurse facility care, nursing home, hospice, home health service. The Medicare insurance of type B coverage service for supplies needed for diagnosis or treating a patient and also coverage preventive & screening for a patient that want to check for potential illness, for example, Mammogram & HIV screening. The insurance benefit of Type B cover ambulance service, inpatient and outpatient service, partial hospitalization, laboratory test and limited outpatient

Medicare is a program created by the Social Security Act of 1965. It is a federally run medical health insurance program aimed at medical coverage for senior citizens over 65 years of age. Over the years, the program has expanded to cover other beneficiaries such as individuals with disabilities and has also evolved to add prescription drug benefits. The program has been immensely successful in bringing health services to millions of senior citizens and individuals with disabilities. Despite this success, Medicare has faced a myriad of challenges most importantly budgetary projections that predict a rise in Medicare cost due to the “Baby Boomers” becoming eligible while having fewer workers per retiree to fund Medicare. The government has turned to managed care plans in cost saving measures and to bolster the quality and efficiency of their Medicare. While this summary might not exhaustively delve into the complicated web of Medicare but it will highlight what is looming in the horizon; the struggle to find new and innovative ways to finance Medicare for future generations without burdening beneficiaries or taxpayers.