Medicare Executive Summary

Kaiser Permanente s a company that was registered to deliver healthcare services to individuals who are geographically distributed. The organization is dedicated to increasing the medical quality for its members and their immediate environment. The firm has been operating for sixty years, it evolved from programs that were operating in the industrial sector especially shipyards, construction, and steel mill workers in the late 1930s (Kaiser, 2015). In 1945 it was opened for the enrolment of the public who wanted to get their services. The enterprise started with one surgeon and a hospital that had twelve beds in Mojave Desert. The managing director (MD), Sidney Garfield, observed the young people who were involved in different development projects. The MD took a loan to cater for his expenses as he started building the Project of Colorado River Aqueduct since he noticed an opportunity. As the operations begun, most individuals were not in a position of

Medicare provides federal health insurance coverage to millions of elderly, and disabled Americans. As of 2015 data by the Kaiser Family Foundation, Medicare covers 55 million people. Medicare covers people age 65 and older, people younger than 65 with certain disabilities, and people of all ages with End-Stage Renal Disease, or amyotrophic lateral sclerosis (Medicare, 2015). Medicare consists of several different components, including: Part A, Part B, Part C, and Part D. This Federal health insurance program, Medicare, is financed by several sources, including taxes, revenue, and premiums. Each part of Medicare has different eligibility requirements and provides different benefits, and covered services.

Someone reviewing Medicare’s interest-group history around 1990 would have determined that the platform presented prior to Part D was on the right path to being progressively operative at guiding prices and handling the dissimilar interests of Medicare beneficiaries and providers along with taxpayers. Today, however, the interest-group politics of Medicare looks far less favorable. The last two decades of Medicare’s development have weakened the program’s independence from the concentrated interests that profit from it, including interests that had little role within Medicare at its inception. What was once a relatively stable corporatist arrangement now looks like a messy scrum of ever more competing interests, deploying ever more money and

Medicare Part D Drug Plan was created by Congress in 2003 to aid the elderly, disabled, and sick persons in affording their medication. Coverage for the drug plan went into affect January 1, 2006. This plan was called the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) (Cassel, 2005). The final bill that passed, was influenced by drug-company and health insurance lobbyists and focused mainly on the needs of those industries instead of the seniors it was meant to serve (Slaughter, 2006). These plans are operated by insurance companies and some private companies that have been approved by Medicare. Part D is optional only if a person carries health insurance that includes prescription coverage. If at retirement

On December 8, 2003, President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act of 2003 (Pub. L. 108-173).  This landmark legislation provides seniors and individuals with disabilities with a prescription drug benefit, more choices, and better benefits under Medicare. It produced the largest overhaul of Medicare in the public health program's 38-year history. The MMA was signed by President George W. Bush on December 8, 2003, after passing in Congress by a close margin. One month later, the ten-year cost estimate was boosted to $534 billion, up more than $100 billion over the figure presented by the Bush administration

Medicare is a health insurance program purposely created for people over sixty five (65) years of age. However the service is open to people with certain disabilities or permanent kidney failures. The process of choosing the right Medicare involves having to weigh different plans on account of benefits of their cover. Different types of Medicare plans are important in: Inpatient hospital care, outpatient services, doctor visits, home health care, prescription drugs, and care in a skilled nursing facility among others. In addition, the program covers the cost of health care but does not cover all medical expenses including cost of long term care. If one ought to choose an original Medicare coverage, one may buy a Medicare supplement policy from a private insurance company to aid in coverage of costs that are not supported by Medicare. Most of these Medicare expenses are covered by a part of the pay role offered to workers by their employer. This paper covers different Medicare plans; A, B, C, D and their influence towards my decision on the best preferred option.

The passage of the Medicare Drug Price Negotiation Act will also inadvertently increase access to many types of medications for individuals who qualify for Medicare Part D. There is a clause within the bill that would establish rebates to be paid by pharmaceutical companies for low-income beneficiaries. These rebates, in addition to lowered costs, would considerably lessen the financial burden placed on low-income beneficiaries. This will allow more individuals greater access to expensive medications. As an example, each year, financial reasons hinder about 16% of diabetic Part D beneficiaries from filling at least one of their prescriptions (Williams, Steers, Ettner, Mangione, & Duru, 2013). This increase in access will help mitigate the occurrence of cost-related nonadherence to prescription medications, and other such consequences

In a study using Medicare administrative data, the cost of services delivered by APRNs and physicians was analyzed and found the cost of delivered by APRNs was 11-29% lower than the same care performed by physicians. Even after adjusting for lower reimbursement rates for APRNs, the study found an 18% cost

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

The purpose of this bill was to make alterations to the Social Security Act allowing pharmacists to be recognized as healthcare providers. Pharmacists would practice, under the direction of CPAs, with in the Medicare Program (part B) (U.S Surgeon General Report 2011). The legislation motion illustrated the value of pharmacists at the lawmaking level. The bill was cleared from the books. There was a second attempt in August of 2001. The bill was referred to a subcommittee on health but eventually was also cleared form the books. In August of 2004, a new bill, the Medicare Pharmacists Practitioner Service Coverage Act was presented to the House of Representatives. The goal was also to allow pharmacists to provide practitioner services within the part B Medicare program. There was some progress with this bill because the modification that would add pharmacists to the lists of non-physician practitioners that are currently being reimbursed for services was considered. Unfortunately just like before, the bill was referred to the subcommittee of health and there was no further actions taken. Since July of 2011, there have been three pharmacy‐related bills that have been introduced into the 112th Congress, 1st Session (Appendix 2). All of the bills push to allow pharmacists to be more involved in clinical care through the expansion of their current scope of practice. The Medication Management Therapy Benefits Act of 2011(H.R. 891) is a bill that was designed again to propose a change to the part D Medicare portion of the Social Security Act. This act suggests that medication therapy management (MTM) and prescription drug plans (PDP) be handled by qualified medical professionals including pharmacists. In order for this to happen, pharmacist would have to be recognized as healthcare

The major purpose of this work is to completely discuss about the Medicare Part D which will set an influence on the different interest groups and all the entities of government which have been set under the policy changing process. There has been a complete set environment which involved and shape the policy to make efforts as to how all the groups of the stakeholders are influences with the Medical Part D. All the legislation and the specific strategies are made in correspondence to the politics. (Powell et al., 2015). The Medicare Part D is also said to be Medicare prescription drug benefit which directs to setting the United States Federal government programs to work on the subsidizing costs of all the drugs of prescription which insure premiums for the Medicare in US. There is a great enactment which has been based on Medicare Modernization Act of 2003. In December 2003, there are major Medicare Prescriptions which have become into the Improvement and Modernisation Act to become a proper law. There has been a great benefit from the drugs which provides an entire coverage to all the disables and the elderly people who could not have the ability to manage it.

Since its establishment in 1965 we have seen Medicare change as people’s needs change however being a federal program these changes do have an incredible amount of lag time. One of the first major changes to Medicare occurred in 1972 when President Nixon signed the Social Security Amendments of 1972 which extended coverage to individuals under age 65 with long-term disabilities, expanded benefits to include some chiropractic services and speech and physical therapy. During this time we see the American public growing tired of the Vietnam Conflict and lack of support and care for those returning Marines and soldiers with severe disabilities. As the protests escalate and the peace initiatives fail a key piece of legislation is signed showing government support and a willingness to extend health care benefits to this growing and vocal population of veterans (The Vietnam War, 1999). Also included in this Amendment is the encouragement of the use of Health Maintenance Organizations, President Nixon’s administration caught in the scandal of Watergate and pending hearings appeased the left and proposed the HMO Act, which Congress passed in 1973 (Phillips, 2003).

The passage of prescription drug benefits under George W. Bush, although less than predictable, was largely due to the coupling of Kingdon’s three streams—problems, politics, and policies—resulting in the formation of a “window of opportunity” to push this important policy initiative forward. There were many culminating events leading up to prescription drug benefits becoming a reality. In the policy stream, the Balanced Budget Act (BBA) of 1997 induced the formation of the National Bipartisan Commission on the Future of Medicare, which proposed both “premium support” and later, prescription drug benefits. The proposal of prescription drug benefits for the elderly was advanced by Clinton, who suggested that prescription drug benefits be bundled

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).