Medicare Expansion Of The New Program

Since the late 1980s, Medicare has reimbursed physician services using the Medicare Physician Fee Schedule (MPFS), which encompasses 10,000 procedure codes. Each code is assigned resource-based relative value units (RVUs), which are designed to reflect physician work, practice expense, and malpractice expense. To adjust for local differences in cost of living, each RVU is modified using geographic practice cost indexes (GPCIs) and then converted to dollars using a “conversion factor.” This system rewards physicians who produce a high volume of services; not surprisingly, Medicare Part B expenditures have grown rapidly.

In a survey conducted in 2003, it highlighted that the recurrent problem is the reimbursement rate from Medicaid to the physician (O’Shea, 2007). The Center for Studying Health System Change (HSC) show that 21% of physicians that state they accept Medicaid have reported they will not accept a new Medicaid patient in 2004-2005(O’Shea, 2007). This number would only logically be assumed to have risen in 2013 A survey conducted by the U.S. National Health reported that researchers have found two standout trends among Medicaid beneficiaries: they have more difficulty getting primary care and specialty care and they visit hospital emergency departments more often than those with private insurance (Seaberg, 2012). The lack of primary and specialty care access is mostly contributed to the following barriers; unable to reach the MD by phone, not having a timely appointment with the MD and lastly unable to find a specialty MD that will accept Medicaid. In a recent report released by the Partnership to Fight Chronic Disease, it stated that about 30% of Medicaid patients experience “extreme uncoordinated care”, there is a strong correlation between this situation and higher Medicaid spending and less quality of care given (Bush, 2012). After January 1st 2013, healthcare providers have experienced a 2% reduction in payments for Medicaid beneficiary, this will only create more of a problem for these patients to seek the

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

The Medicaid expansion will cost the federal government between 15-20 billion dollars in the first six years, but the federal government is paying for 93% of the direct expansion costs. But with the expansion, the greater majority of people will be able to pay their own medical bills, which means the state and local governments will save millions of dollars.

The Affordable Care Act was put in place by President Obama in 2010, providing Americans access to affordable health insurance. But South Carolina’s governor, the republican Nikki Haley is still rejecting the Medicaid expansion. My paper has detailed information on why Governor Haley and republicans made their decision to opt out of the expansion. Also, alternate approaches to expanding access to care and implementing or reconsidering the state’s decision of opting out of the expansion. Finally, recommendations to the state legislature to convey opting out of Medicaid expansion.

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).

As previously illustrated, there are both advantages and disadvantages of Medicaid. However, being a beneficiary of Medicaid increases access to health care. As a result of the program, adults were 70% more likely to have a regular place of care, “55% more likely to have a regular doctor than the adults who did not gain coverage;” and the utilization of preventative services have increased (Garfield & Paradise, 2013). Furthermore, access to speciality care such as physical therapy; podiatry and hospice remain unattainable. In a multiple city audit, researchers found that only 34% of Medicaid beneficiaries were able to “secure an appointment for urgent” specialist care, compared to 64% of those privately

Texas ranks number one with the highest uninsured rate in the nation, accounting for nearly 6 million people (1). The federal government has nearly $100 billion for Medicaid expansion, out of which $15 billion is needed for expansion in Texas (1). Opting out of Medicaid expansion has left 1.5 million eligible Texans without health insurance (2). Consequently, a 300 percent increase in costs for primary care services, being provided in the emergency department, has been observed (1). Similarly, most hospitals are facing nearly $3-5 billion in losses due to uncompensated care (1).

Implementation of the ACA would require an extensive expansion of the Medicaid program to low income adults in each state.³ The Congressional Budget Office projects that a previously 30 million uninsured Americans, approximately 92% of the legal, non-elderly population, will have coverage by 2022.³ The federal government will pay for 100% of the costs of expanding Medicaid programs until 2016, and then gradually fade their contribution to 90% by 2020.³ Currently, expansion of the Medicaid program is voluntary and several states have stated that they intend to turn down their share of the billions of dollars that has been made available to each state solely for the expansion of this program.³ States deciding to not expand their Medicaid program will not only exclude many poor, vulnerable families from access to an important health care program, but will also exclude themselves from an economic stimulus for their state and thereby decrease the strength of their health care delivery systems by not allowing them to be more financially stable for the long

This paper will discuss the early years and failed efforts that transformed the Medicaid program into what is seen today. A comparison between Medicaid and Medicare will be brief but is necessary because there are significant and critical differences between these government-funded insurance options. The substantial growth of Medicaid expenditures and beneficiaries are important and these trends will be looked at in detail. There have been provisions related to the unanticipated expansion of this program which will be reviewed. Attempts to expand Medicaid eligibility further need to be addressed (example: Patient Protection and Affordable Care Act). Stigmas that are associated with receiving Medicaid will be reviewed. I will share my

The Medicare Access and CHIP Reauthorization Act (MACRA) was initi-ated by the U.S. Department of Health and Human Services to bring about big changes in quality of care by altering payment methods of doctors. MACRA was signed into law in April 2015 by former President Obama. The Medicare Access and CHIP Reauthorization Act (MACRA) is bipartisan legislation that was passed quietly by Congress without controversy. MACRA significantly alters how the government pays physicians and doctors who treat Medicare patients. It is transforming the way Medicare pays doctors and hospitals for their services by moving away from the traditional fee-for-service method and towards a new payment method that is based on how successful treatments are for

Medicare may not be perfect but until this program is changed it is what we have currently. Medicare has gone through changes since its inception in 1965. The most significant legislative change to Medicare--called the Medicare Modernization Act or MMA--was signed into law President George W. Bush, on December 8, 2003 (CMS, 2013). In a country with a complex healthcare system, a healthcare system that is a hot political stand for every presidential candidate and for each side to have valid arguments for and against is to be expected. But to say that Medicare is heading for disaster can be a stretch. Baby boomers who are entering Medicare eligibility age should not fret; there will be doctors there to service them and Medicare to pay those doctors.

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).

Medicaid expansion is seen as a huge problem in this case it takes place among the 50 states. The environment includes the 50 states such as California, Texas, New York and New Jersey. Medicaid expansion offers financial protection. It also addresses the uncompensated care problem which involves paying and reimbursement for service rendered. Medicaid expansion also provides customers access to affordable coverage, as well as customers taking up that cover, which is a moral duty of the government. Medicaid also supports politically powerful interest groups who support expansion. The expansion of Medicaid helps rural hospitals stay afloat in states like Colorado, which added 400,000 people to the health insurance program under

An Urban Institute analysis found that if all states expanded Medicaid to individuals at or below 138% FPL, more than 15 million adults will be eligible to enroll (Kenney, Dubay, Zuckerman and Huntress, 2012). If a state failed to implement the expansion, it faced the possible loss of all federal Medicaid funding, making it an offer the states could not refuse. However, the U.S. Supreme Court ruled that Congress could not intimidate states into expanding Medicaid. As a result, the ACA Medicaid eligibility expansion is now optional for each state. States still await official guidance from CMS, including revised ACA regulations to match the court’s ruling. It is also likely that states may opt into or may subsequently opt out of Medicaid eligibility expansion at any time in the future. Although the Supreme Court upheld the ACA as constitutional, it determined that the Medicaid expansion would be a state option rather than mandatory (Kaiser Family Foundation, 2012). At the same time, 4.3 million adults in the United States are currently eligible for Medicaid but not enrolled (Kenney et al., 2012). Because of state expansion discrepancies and past experiences with enrollment among eligible populations, the Congressional Budget Office has projected that only eight million will enroll in the first year (2014) and only 11 million two years after implementation (Congressional Budget Office, 2013).