Summary: Change In Healthcare

More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering

1. Throughout history, a number of reformers have sought to improve the quality of medical care. What common thread connects them? Why did some fail? What were the successful able to see/do that others weren’t?

Health System Reform in the United States: Impact of Rising Premiums and Opportunities for System Improvements to Enhance Access to Healthcare Services

States’ rights, the fight for the unborn and their right to life, and resistance to gun legislation, tend to be some of the top issues for conservative Texas voters. The last time a Democrat carried the state of Texas was in 1976, when Jimmy Carter won the Presidential election. During the 2004 presidential election, then President and Republican candidate, George W. Bush, won with 61.09% against 38.30% votes for the Democratic candidate John Kerry. However, in the more recent Presidential elections that were held in 2008 and in 2012, the very popular Democratic candidate, Barack Obama, did not win the majority vote for Texas. Thus, looking at this information, it can be said that the state of Texas tends to lean more towards the Republican side.

When contemplating health care policy changes, several economic issues in health care must be considered. These include the financial issues affecting the health sector and have an impact on health policies. Policy makers face unending challenges due to the health sector revenues that are always rising. Another challenge is decreased funding and failure of the health insurance services.

Texas is currently dominated by the Republican culture with a popular belief in conservatism that has lasted for many years. Democratic and Liberal groups are also present in the Texas but play as the minorities. Although demographics through the years show that a change in the dominant party could very well be eminent, Texas remains a red state for the time being. Currently the population is estimated at 24.5 million and is dominantly Anglo with minorities including African American, and Hispanic. In the coming years though, it is estimated to change where as the Hispanic population will surpass become the new majority.

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

I do not believe Texas with its changing demographics and social climate will be on the brink of another switch in party dominance anytime soon as immigration, guns and education are major factors. The demographics of Texas deal with the rising growth of the minority population throughout the years. In my opinion, I think minorities make up roughly half of Texas’s overall population. According to utexas.edu, “[a]s the reality of demographic changes set in during the late 1990s, part of what defined many Republicans as moderates was an emphasis in both rhetoric and policy toward increasing the party's appeal to Latinos and other ethnic and racial minorities”. Although the Democratic Party is known for receiving votes from minorities, the Republican

One reason I do not think Texas is turning blue because of its response to this past election between Donald Trump and Hillary Clinton. While Texas does have a big presence of Democrats in all its major cities, it did not seem to help Clinton since Trump still won Texas. Hilary won Dallas, Houston, Austin, San Antonio, and El Paso along with every county bordering Mexico, but even with all this Donald Trump earned 38 electoral votes with 52.2 percent win over Hillary’s 43.2 percent (Texas Results,

They argue that nearly 70 percent of Texas physicians are reluctant to see Medicaid patients due to low reimbursement rates (7). They claim this to be the prime reason why patients seek primary care services at the emergency department (7). In contrast, supporters of Medicaid expansion argue that uncompensated care is the fundamental basis for Medicaid expansion, as increasing the number of people with Medicaid coverage will lower the unreimbursed costs to the hospitals (7).

The decision to reject Medicaid expansion by the former and current governors of Texas has left at least one million low-income earning nonelderly adults Texans uninsured resulting in the loss of several millions of dollars in uncompensated health care services extended to this vulnerable demographic, coupled with high insurance premiums (Mangan, 2015) which begs for the expedient conception and implementation of a statewide solution to address this unsustainable economic burden and create a more healthy, and productive society in the great state of

If Texas expands Medicaid coverage, the largest number of newly eligible Texas would be adults without children. Currently, these individuals are not covered under Medicaid. In addition, parents who have incomes at or below 133% of the federal poverty level (FPL), up from 12% previously. With a 90% federal reimbursement rate going forward, for every $10 of health care services obtained under the program, the State pays $1 and the federal funds pay the other $9. It is estimated that the State would contribute about 15.6 billion, while the federal

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

Government/Payers: There is a medium level threat from the government and payer forces. Payers, including managed care organizations and insurances, conduct a cost/benefit analysis of every new product and services that is introduced and performed. The ACA mandate has forced the population healthcare pay model that is to be used for Medicare and Medicaid reimbursement, but the insurance industry has also adopted the underlying idea of managed-care. As a result of the mandate we should also expect to see a decrease in self-pay patients, as a huge proportion of the self-pay patients that were uninsured become insured. Based on the future trends of healthcare delivery reimbursement there will be a need to decrease costs while simultaneously increasing

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.