Medicare: Health Insurance in the United States and Social Security

The Social Security Administration assists the CMS in the administration of Medicare by enrolling new beneficiary, collecting premiums, and maintaining the master beneficiary record. When you apply for SS at age 65 you will also be enrolled in Medicare or you can apply for it separately on the SS website if you are not going to begin taking SS retirement payments.

In today’s world, healthcare is provided in one of two ways. Most developed countries provide it free. Either the required care itself is free or one pays for it with free insurance provided by the government, known as not-for-profit. The alternative is obviously for-profit. In such systems, individuals pay for services either out of pocket or using private insurance provided by their employer. In which case, part of the payment for policy premium is generated through payroll deduction. Furthermore, the healthcare system can be considered either as a closed or an open system, for which the United States (U.S.) has both. The U.S. healthcare system when compared to the French system has its similarities and differences. Funding for healthcare

The report provides a good data compilation, but provides little insight into the meaning of the data. Although the report provides little analysis, tax-exempt hospitals have provided significant amounts of financial assistance and other community benefits. [What remains to be seen, however, is whether insurance expansions under the ACA thereby decreasing pool of uninsured patients will cause these numbers to decrease in the future. Tax-exempt hospitals could further struggle to justify tax-exempt status.]

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. Part of the new legislation added the clause that the tax-exempt hospitals in the United States (close to 60% of the total) will need to fulfill some additional requirements to continue enjoying their federal tax-exempt status in the country. Briefly, the requirements include developing community health needs assessment and a financial assistance policy to determine which patients qualify for treatment under ACA, putting a cap on the amount that can be billed to patients directly for healthcare and implementing new procedures for billing and fee collection (Lewis Roca Rothgerber et al. 2013).

Public not-for-profit hospitals are dependent upon tax-based support for their government sponsors and from patient revenues. Capital budgeting can be financed through government bonds that must be voted upon during elections. Under these circumstances, it is difficult to maintain current equipment and capital

According to the American Hospital Association the cost of equipment, services, and information services has risen drastically. A huge problem for hospitals now is that there has been an enormous increase in patients who have Medicare or Medicaid. The Hospital Association states that “60% of all admissions. Neither program fully reimburses the cost of hospital care.” Not only is the hospital not getting paid the full amount through the health insurance, but they have also seen a jump in people who do not have insurance and cannot pay for their hospital expenses this averages out to about six percent of hospital expenses. Hospitals must assume these costs as a part of their charity pay. These costs are then calculated and increase the costs of health care for people who pay for it, in order to cover these costs.

In a traditionalist state, such as Texas, the financial toll that Medicaid would have on its taxpayers was on the frontlines. The Texas legislature was worried about whether or not its taxpayers would face a tax increase to cover the increased cost of those covered by Medicaid. These taxpayers would inadvertently pay for the hospital bills of those who are uninsured in Texas through an average $1,800 rise in the cost of their premiums (Rapoport, 2012). In support of expanding Medicaid, Texas would receive federal funds in order to ease the cost that accompany the expansion. Since Texas decided not to expand Medicaid, Texas “would be leaving billions and billions of federal dollars on the table” according to Anne Dunkelberg (Rapoport, 2012). Not only does this monetary incentive give Texas an extra push to participate towards expanding Medicaid but it would also help the residents of the state to get insured. Texas legislators understood that this monetary incentive would not fully cover the cost of the newly enrolled Medicaid recipients. In the end, they would have to rework the annual budget and increase taxes in order to cover these extra recipients.

America spends 2.5 times more on healthcare than most developed countries yet still ranking 51st in life expectancy in the world (Baum, 2015). The Affordable Care Act (ACA) was implemented January 1, 2014 by President Obama to expand coverage to millions of individuals in need. It consists of two separate pieces of legislation: the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (Centers for Medicaid and Medicaid Services, 2016). Although the ACA will give health benefits to millions of uninsured Americans, hospitals are receiving less compensation because of the high demand of health care from over qualified recipients. Through the Children’s Health Insurance Program and also the Social Security Act, states are able to pilot a test approach that could extend coverage up to 200 percent of the poverty line (Sommers, Kenney, & Epstein, 2015). Such a large increase in the size of the population that is now eligible to apply for the ACA comes with a sizable amount of fiscal responsibility from the states and puts an immense strain on the amount of money guaranteed to pay for the services provided (Sonier et al., 2013). Given the lack of funding from the Medicaid program, absence of reimbursement strategies, and budget of healthcare in America’s Gross Domestic Product (GDP),

Ozark Medical Center (OMC) in West Plains, Missouri is one of them. It is considered a Disproportionate Share Hospital or ‘DSH’ and provides charity care. As Jennifer Davidson describes it in her Health and Wealth Update story on KSMU, “Charity care is healthcare that isn’t paid for, usually because the patient doesn’t have money or insurance” (p.1). Today the DSH designated hospitals do not receive the same amount of federal funds (DSH payments) they did before the ACA from 2010 was enacted. A supreme court decision in 2012 ruled the forced Medicaid expansion, which was included in the ACA, unconstitutional for all states and as a result the expansion is now an option for the states. However, Jennifer Davidson explains that when the remaining parts of the ACA were passed, “it included a 75 percent cut in those DSH payments. That’s because another part – the Medicaid expansion part – was supposed to make up for that reduction. So: more people covered by Medicaid, less charity care – and less need for DSH payments” (p.1). There are also cuts in the ACA to Medicare payments, which in addition to the reduced DSH payments could affect a hospitals finances by a large percentage. In Jennifer Davidson’s story, Ozarks Medical Center’s CEO David Zechman explained that “OMC could see a 60% reduction in its bottom line if Medicaid doesn’t get expanded”. OMC is not the only small rural hospital in Missouri which sees

Carol Liebau discusses in her article, “ObamaCare Limits Patient Choice”, that hospitals such as Cedars-Sinai and the Mayo Clinic are high-priced and under competitive pressure because of Obamacare. Insurance corporations are in a larger hurry than ever to cut costs (Liebau). However, Americans are coming to realize that those hospitals aren't just thoughtless profit centers. They are pricey because they provide advanced medical care or they offer the specialized treatments that the most ill patients require. Many Americans who had plans they could afford and had access to leading healthcare providers, find that under ObamaCare, they are being excluded from high-quality care unless they want to pay much more for

The Hospital Fairness and Transparency Act, state of Massachusetts, I feel it is important for communities’ to be aware, and to ensure their taxpayer dollars are instead dedicated to safe patient care and necessary services in the Commonwealth, and in other states as well. I find it admirable that Advocates actually provided legislators with a list of hospitals with funds stored in offshore accounts and will urge legislators to demand greater transparency by passing the HPTFA. Today communities are asking more questions related to healthcare facilities finances in their communities. Massachusetts health care costs

Furthermore, the Disproportionate Share Hospital (DSH) payments are required by the federal government for the state’s Medicaid program to issue an extra financial aid to hospitals that are serving an excessive number of Medicaid beneficiaries and low-income people without insurance. To cover the costs, eligible states will obtain a yearly DSH allowance from the federal reserve. However, since the implementation of the ACA, the law demanded a cumulative cut on federal DSH’s fund allocations that began in the federal fiscal year (FFY) 2014 up to FFY 2018 due to the presumptive growth of people with health care coverage, which resulted in lower unpaid care expenses. The DSH’s allotment interruption is scheduled to continue until the FFY 2025 (Snyder & Rudowitz, 2015). Moreover, the main supply of financing for the non-federal share of Medicaid is derived from approximately 40% of the state funding and about 60% from the local government ("Financing," 2012).

Also by rejecting the Medicaid expansion community-based providers, including hospitals are casualties. Hospitals will continue to provide care to the uninsured without sufficient compensation, increasing shift costs to the privately insured. This also has a chilling effect on enrollment in private insurance plans through the new federally facilitated marketplace. Opposing the Medicaid expansion also ignores the real needs of the uninsured and the massive financial burden shouldered not only by the hospitals but taxpayers and businesses. (Stultz, 27)

Financing health services in the United States is very important and involves an excessive amount of health institutions and activities. Health services are supported by several methods to create revenue that most hospital, clinics, and treatment centers use for daily operational costs (World Health Organization, 2006). These methods are: general taxation of the state, county, or township/municipality, Medicare or Medicaid or other socialized health insurance plans, voluntary and private health insurance and lastly, donations to health charities accepted from non-profit organizations, donations

Apart from the Affordable Care Act, there has been increased government and court involvement in the determination of how healthcare issues are run, like the recent denial of the nonprofit tax exemption status to some hospitals in Chicago (Bergen 2). These hospitals, which include the Northwestern Memorial Hospital and the Prentice Women’s Hospital, are known to provide important healthcare services to patients who cannot afford to pay the expensive costs in private hospitals (Bergen 2). These unfavorable healthcare policies among others are bound to be more frequent and the resultant problems may promote the emergence of other bigger ones unless immediate action is taken.