Medicare Benefit Analysis

The Patient Protection and Affordable Care Act (Obamacare) had mame dramatic changes in the field of the health care system, especially in Medicare, that will seriously take effect in American seniors. Indeed, much of the health law’s new spending is financed by spending reductions in the Medicare program. In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.( Elmendorf, letter to Speaker Boehner). About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage to a rasonable

Medicare Part D is prescription drug coverage. It’s the newest part in Medicare. It adds prescription drug coverage to original Medicare, some Medicare cost plans, some Medicare PPS plans, and Medicare Medical Savings plans. Beneficiaries choose the drug plan and pay a monthly premium.

With the implementation of the ACA, many states have expanded their Medicaid programs to include a larger population of low income individuals and families that were not able to obtain health insurance prior to the law. Some of the issues that state legislators struggle with are the overall cost of providing services for the additional recipients, staying within budget, determining an adequate approach of offering quality care, and providing adequate coverage for each recipient. Even though the cost of Medicaid expansion within each state has increased the budget for the program, new appraisals has shown that Medicaid programs spend less per enrollee than commercial health insurance and much of the increase in Medicaid expenses originate from the increase in enrollment in the programs (Coughlin, Long, Clemens-Cope, & Resnick, 2013).

Politicians knew they had to find a way to make Medicare solvent or, it would consume all tax dollars collected, but finding a way to rein in costs and make healthcare affordable for all Americans wasn’t going to be an easy task.

The first concern that is affected by cost shifting lies in the Medicare system. Medicare is provided to individuals who are 65 and older to obtain adequate healthcare, as well as decreasing financial worries. The government’s involvement in controlling the healthcare system can be a major disadvantage to the Medicare system, as well as private insurances. Reimbursement from private insurances and Medicare can be affected so severely that obtaining access to Medicare can become a major issue. Furthermore, the repercussion is illustrated by Dr. Lichter’s statement, “Either something happens or the healthcare system is threatened.” Without cost containment, there will be major shifts of costs to private payers and Medicare beneficiaries” (Hayes, 2008).

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).

Notably, the elderly populace is growing rapidly, and will reach 3.4 million or 12.8% of the population. Eventually, in the next thirty years older adults will comprise of 20% of the total population due to the aging of 76 million baby boomers (Olson, 2001). Seeing that, entitlement programs and means-tested benefits, are presented, in order to bolster this increment of older adults. Accordingly, around 96% of the American workforce is secured by Social Security and it is likewise estimated that 58 million American will receive a total of $816 billion in Social Security benefits (Moody and Sasser, 2015). In fact, today 56 million or 17% of the population is enlisted in Medicare (Leonard, 2015). Therefore, this has presented an open deliberation about the eventual fate of Medicare and Social Security and regardless of whether changing Medicare and Social Security to means-tested benefits, instead of entitlement programs can resolve the policy issues.

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.

Medicare and Medicaid has been providing huge benefits for senior citizens and low income families. The one question nobody seems to answer is how are we going to afford this type of insurance? Maya Rockeymoore argues in her article, “Groundless Fears about Medicaid and Medicare,” that we are able to afford this as long as we make good decisions. Rockeymoore claims that we need to keep Medicare and Medicaid or our country will fall apart.

The U.S has many payer systems which many believe it to be its downfall among other countries. This may be because many view it more as an economic business and not an overall wellness plan. The United States’ main public program of funding is Medicare, which once followed a standard form of payment. It is now envisioned as a futuristic model that encompasses the payments of providers. Medicare is a national social insurance program that is run by the government since 1966. Also unlike Great Britain system, the program provides health care to Americans over 65 years of age for those who have paid their work dues in the system. Medicare has also extended its reach to those Americans who may be veterans or disabled. Another huge form of payment to providers is through Managed care which can be beneficial to physicians in the fee for service and capitation aspect. While this form of payment is similar to Great Britain’s programs, their execution of it remains vastly different. Managed Care is a type of healthcare system with health care plans that has restrictions on its selection of facilities and health care providers at a reduced cost for the patient. Rather than come to a conclusion about better ways to negotiate with payers, U.S providers continue to rage war against

The Health Affairs published an article in about a proposed Medicare reform regarding the high levels of use of Medicare although there was little impact on individuals. Though this article dates back to 2002, the issue still remains true to this day. In this article, the authors explain that the high level of Medicare spending was mostly due to the increase number of physician visits, specialist consultations, and hospital stays, especially among those that had chronic illnesses. Although the spending is higher among such Medicare patients, this did not mean better effective care or health care outcomes. On the contrary, according to the article, more than 20% of the total

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.

Due to the upcoming presidential election, the two major political parties, and their candidates, have been focusing on the primary problems that the nation will face. Chief among those problems is the future of Medicare, the national health-insurance plan. Medicare was enacted in 1965, under the administration of Lyndon B. Johnson, in order to provide health insurance for retired citizens and the disabled (Ryan). The Medicare program covers most people aged 65 or older, as well as handicapped people who enroll in the program, and consists of two health plans: a hospital insurance plan (part A) and a medical insurance plan (part B) (Marmor 22). Before Medicare, many Americans didn't have health

The growing concern regarding the financial security of Medicare is one of particular interest to the nearly 72 million baby boomers that become eligible for this government-assisted, and tax-payer bolstered, program over the next two decades. According to the U.S. Census Bureau (2010), there will be a rapid increase in baby-boomers between 2010 and 2030, as the entire baby boomer population move into the 65 years and over category (p.3). Political and financial revisions must be made to ensure the security of Medicare as the numbers of individuals paying into this program are soon to be surpassed by the number of individuals drawing-off this program (U.S. Census Bureau, 2010). The elderly are also at a disadvantage with transportation to health care visits, picking up prescriptions, and rehabilitation services. There needs to be an establishment of access not only to primary care providers, hospitals, and rehabilitation services, but access to other aspects of the health care system for the elderly population.

After four decades of failure to enact a universal healthcare program, advocates decided to refine their approach in the 1950s, and the strategy that ultimately led to the passage of Medicare and Medicaid was formulated. Wilbur Cohen and I.S. Falk recognized that a health insurance plan focused on Social Security beneficiaries would be much easier to sell than a plan for all Americans. By limiting its benefits to the elderly, Medicare could be portrayed as a program for people who met two important criteria: they had greater need for healthcare coverage and they were especially deserving of public assistance. Because of their age, seniors have relatively high medical costs--when Medicare was passed, average healthcare expenses for people sixty-five or older were twice the average expenses for younger persons. (Orentlicher, D. (2012).