The Medicare Part D Lobbying: A Case Study

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 healthcare industry relies heavily on the government and legislators to pass new laws. Political issues involving moral values are difficult to resolve because they are based on opinions rather than facts. Each branch of government plays an important role in writing, discussing and voting on proposed bills. Separate branches are meant to provide checks and balances to prevent a monopoly of power within the government. The purpose of this paper is to discuss the legislative process and the end-of-life issue of active and passive euthanasia.

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.

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

AARP, American Association of Retired Persons, is considered by Human Events as one of the most powerful lobbies. Many websites state that the focus of AARP is not the seniors, nut the money involved. The tactics the AARP are considered “scare tactics.” American Association of Retired Persons used scare tactics by scaring the seniors into thinking their Medicare benefits were going to be taken away from them by congress without their support. Obamacare was highly supported by the members of AARP, why? The AARP convinced its members without Obamacare their Medicare would be reduced. However, this was not the case, it did not protect Medicare benefits, and it actually cut 500 million each year.

The Medicare bill was signed into law on July 30, 1965 by President Johnson. The signage came long after an attempt by President Truman to develop a national insurance fund that could be utilized by all Americans. During the signing of the bill, President Johnson explained that with the Medicare program an individual can insure themselves against illness that may present during their senior years. Additionally, he commented that there were more than 18 million low income Americans who are greater than 65 years of age and cannot afford to treat their illnesses. The Medicare program is overseen by The Centers for Medicare and Medicaid Services (CMS), and has evolved over time. Medicare now covers individuals under the age of 65 who

Author Donald A Barr defines the Medicare program. “The federal Medicare program is our system of universal health insurance for everyone sixty-five years old or older paid through a general withholding tax” (Barr 131). Unfortunately, the United States Medicare system is financially unstable. “Medicare is spending more money than they are bringing in…Policymakers are looking at several different options that will alter the Medicare program significantly” (WPC 2). In turn, a high number of companies and organizations are investing their time and revenue into lobbying to make healthcare changes. Joe Eaton from the Center for Public Integrity shares “More than 1,750 corporations and organizations hired about 4,525 lobbyists — eight for each member of Congress — to influence health reform bills in 2009” (Eaton). The objective for special interest groups is to pull financial resources together to be a force of influence. Granted there is strength in numbers, for example, the American Association of Retired Persons (AARP) “deployed fifty-six in-house lobbyists and two from outside firms to work the issue on behalf of its members. Also, American Medical Association (AMA), “spent $20 million overall in 2009 lobbying Congress on behalf of doctors” (Eaton). The AMA was successful in removing a $300 fee for physicians that participate in Medicare and Medicaid. Furthermore, the AMA advocated for budget cuts for higher income Medicare subscribers and payment cuts for Medicare biller’s

One of the fear factors in the health care reform debate is cost. The United States at present has a costly system, and there is genuine worry that covering millions of additional people will increase costs significantly. It is not how much the United States devotes on health care that is vital, it is also how constant that quantity is increasing.

The Pharmaceutical lobbyist has a very powerful impact on the outcome of Medicare Part D. They were the ones that wrote the bill and presented it to the House and ultimately, it was passed. However, the tactics that were used were extremely questionable and unethical. A Democratic Representative from Michigan stated: “I can tell you when the bill passed, there were better than 1,000 pharmaceutical lobbyists working on this” (Singer, 2007). The

As nurses we strive to always practice in the best of our ability. One way that that we can further our efforts is to utilize our voice through health-care lobbying. The best approach to health-care lobbying is to first understand the legislative process. Consequently the purpose of this paper is to distinguish the legislative process as well as convey the benefits of health-care lobbying to not only the workers but the patients.

The purpose of this essay is to discuss Medicare Part D, as well as the influence of the various interest groups and governmental entities during this process. This essay will discuss both the policy process and the policy environment (the key players involved and other circumstances that shaped this policy-making effort), how stakeholder groups influenced the final outcome of Medicare Part D legislation, the specific strategies and tools that were used most effectively, and if the fact that Medicare Part D passed corresponds with my understanding of policy and politics.

Senator Ted Kennedy struggled to reform U.S. health care going back as far as 1971 (Furrow, 2011p. 476), through the brain tumor that ended his life in 2009. Furrow traced Kennedy's contributions through U.S. health care reform to the first year of the Obama administration, even though Obama "did not push universal health care particularly forcefully" on the campaign trail until Kennedy endorsed him (Furrow, 2011, p. 474). Kennedy, according to Furrow (2011), was "at least a strong tailwind, combining with grass roots pressures to push Obama in the direction of tackling major health care reform" (p. 475). The picture emerges of a senior politician pursuing a lifelong objective, teaming up with interested parties to leverage progressive innovation at a critical opportunity that had eluded generations of policymakers. Ironic today, Furrow (2011) attributed the Massachusetts reform as providing the "test case" (p. 473) and "prototype" (p. 474) for federal health insurance policy that originally appeared as the Affordable Health Choices Act, provisions of which became the core of the Patient Protection and Affordable Care Act (ACA) later in 2009. Furman's model case study reveals the persistence and collaboration it takes to move a law of the scope of ACA through Congress, even given the political weight and power of a Ted Kennedy. It took the combined effort of the labor movement, the nonprofit sector, and sympathetic legislators through Kennedy's career

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 proposal was dead and so was the idea of managed care. The debate of healthcare continued and there were new initiatives introduced to control cost and improve quality of care. According to Wang, “improving healthcare quality includes many methods. Pay-for-performance (P4P) and public reporting (PR), of hospital quality data have become two strategies to improve the quality in healthcare”. While, the Health Security proposal did have a report card to monitor the quality of the plans it did not have any metrics to monitor the quality of care or patient outcomes. The proposal had failed to provide universal access to health care, there was not equitable sharing of benefits and burdens.The Health Security proposal fit a combination of politics on Oliver’s analysis. It was a combination of entrepreneurial and incrementalism politics. According to Oliver (2006), “Incrementalism is a natural byproduct of “interest groups politics” that occurs when both benefits and costs are concentrated. With clear winners and losers, the level of conflict is high and the outcomes of any single proposal is highly unpredictable” (p. 211). The proposal was incremental at best because there were going to be 40 million uninsured American left without coverage and it did not do enough to provoke system wide cost containment (McLaughlin & Zellars, 1992, Cantor, Long & Marguis, 1995). Oliver defines

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.