Medicare and Managed Care
The U.S. government started initiatives to make medical assistance to as many citizens as possible. This program is one such initiative by the government. Medicare is a health program under the federal government that covers individuals who are 65 years and above. It also includes younger people with various disabilities. Also, people with renal diseases that require dialysis and any other medication are covered by this program. Medicare was created in 1965, ("What is the History of Medicare? | National Academy of Social Insurance", 2017). At this time, many people above 65 had difficulties accessing health care. In essence, this program came as a relief since people were able to access medical services as it became a universal right once they reach 65 years.
Medicare is divided into five groups. First, it is a hospital insurance that covers inpatient hospital care. Secondly, it is a medical insurance that takes care of non-hospital medical expenses. Such include x-rays, blood tests and consultation among others. Thirdly, it offers Medicare Advantage plans. In this case, an individual is provided all the other services of Medicare in one plan. It is also a prescription drug coverage, which covers prescription drug expenses. The Medicare program covers 55 million people, which is one in six Americans. With that in mind, it is quite evident that the government is having challenges with making this initiative a success.
Challenges Medicare Faces
Financing the Medicare programs is one of the biggest challenges the government is facing. With the increase in population, more and more people are becoming eligible for this program. In this case, the government faces a hard time since this program consumes a significant part of the budget. Due to this, the quality of health care is jeopardized.
An increasing number of beneficiaries have chronic illnesses. These diseases take up enormous medical costs. Research by the Urban Institute states that by 2030, a third of the beneficiaries will have heart diseases and half of them will suffer from diabetes. With such trends, affordability of medical services is likely to become a great challenge, especially in the future. As a result, it is will to be a great challenge for people to access
Beneficiaries under the Medicare problem face high medical costs. The rising medical expenses reduce access to health care since not many people can afford. Currently, beneficiaries pay nearly 30 percent of the health care costs from their pockets. Also, wealthier beneficiaries are expected to pay more. The main aim of this program is to reduce the cost of health care especially for people above 65 years. However, more and more costs are imposed on the people as time goes by.
Four Reputable Articles on Challenges Facing Medicare and Managed Care
According to an article on the Health Affairs blog, Medicare is facing great challenges. The author wonders whether this program is doomed. The program is projected to run out of resources by 2028 (Giterman, 2016). As much the government is focused on helping seniors, it is still facing financial hardships and medical debts. The recommendation, in this case, is for the government to improve the status and terms of the program. As a result, its viability will be enhanced.
MediCity news has focused on the overpayments on citizens under Medicare. In essence, there are several complains that the government overpromised and under delivered. More than 17 people have enrolled in this program, with great hope that the government would save the cost of healthcare. Unfortunately, the program has turned out to be increasingly expensive. Currently, for those eligible, it costs a total of $150 million (Parmar, Baum, Preston, & Versel, 2017). The government has many strides to make towards improving the overpayment status of the Medicare system.
According to an article on The Independent, President Donald Trump has broken his promise of negotiating for drug prices. According to the remarks made earlier last month, he is considering going back to the 2003 laws that restricted the federal government from negotiating drug prices using Medicare (Garcia, 2017). The president suggested that he would oppose anything that made it harder for smaller pharmaceutical companies. He was meant to negotiate drug prices, but he did the opposite. In this case, the drugs will continue being expensive for taxpayers under Medicare.
Patients under Medicare are being denied coverage for physical therapy (Jaffe, 2017). The main issue of concern is that they should not be denied coverage simply because their condition is not improving. An article by NPR speaks of the legal disputed passed as a result of Medicare patients being turned away when they do not get better.
Future of Medicare
Evidently, there is an increasing number of eligible beneficiaries of this program. The government is, therefore, likely to increase its spending on health care. Despite the many challenges that are experienced at the moment, all hope is not lost. Medicare fee paid to doctors is expected to fall to make this service cheaper. The government should conduct proper planning for the future success of this program. As much as increasing population is an expected future challenge, the government can put reforms to manage this. All in all, Medicare is expected to continue serving citizens efficiently.
Medicaid and Managed Care
Medicaid is a joint federal and state program that was started to assist citizens with low income. Initially, it was started to help people in need yet they were unable to work ("What is Medicaid?” 2015). It covered the blind, the aged and the disabled among others. It has expanded to cover children and pregnant women. The Medicaid program was signed in 1965 together with Medicare. However, it was meant to assist low-income citizens. As much as Medicaid supports a significant number of low-income earners, it is facing it has great challenges that limit its success.
Challenges Medicaid Faces
Medicaid takes up a significant part of the budget. With the increasing number of eligible individuals, the government faces a great challenge in delivering health care. Due to financial constraints, the government struggles to keep up with the high costs of medical care. As a result, the government tries to reduce the cost of care by reducing benefits and cutting payment rates to doctors.
Medicaid faces a great challenge of unstable eligibility, which limits the quality of care. Different states have different eligibility rules for Medicaid (Rosenbaum, 2016). Eligibility is closely tied to family income. It is, therefore, challenging to determine individuals who are medically needy. In this case, inconsistent eligibility proves as a great problem for the government to offer quality care.
Reaching medically underserved communities is another challenge that the Medicaid program faces. Many beneficiaries of this program have a hard time accessing health care since a significant number lives in medically undeserving areas. Another cause for this is that for a long time Medicaid has faced staff shortages. As a result, many people have the challenge to access health care services.
Four Reputable Articles on Challenges Facing Medicaid and Managed Care
With the increasing population of beneficiaries of Medicaid, management of the programs has become quite challenged. Citizens are not satisfied by the services offered under this program. Moreover, there is a rising concern of improper payments. According to a report by the Government Accountability Office, the jointly funded program is spending a significant portion of the budget inappropriately. Over 10 percent of the federal Medicaid payments were improper (Suderman, 2017). Most of the funds go to services that are not medically necessary, fraud and services not render. Such a situation is an immediate cause for alarm.
In an article on Medpage Today, the author wonders whether this program is helping the wrong population. The Medicaid budget is expected to rise from $371 billion to $624 in 2026 (Firth, 2017). The Medicaid program was initially started to assist low-income citizens. With the skyrocketing costs of Medicaid, this begs the question; is Medicaid helping the right population?
An article in Civil Beat states that the current government is making plans to change the Medicaid funding. Two methods were proposed under the changes. First is the block grant where the state is given a specific amount for the program the other is per capita method where a specific amount is allocated to an individual (Kozak, 2017). As much as this process is meant to reduce the government spending on the program, it will block care. In this case, the state is left to fend for itself in case of a shortfall. As a result, any people will not access healthcare services.
According to the Washington Post, currently, an increasing number of doctors will not take Medoc aid patients (Lee, 2017). Most claim that it is bureaucratic and over regulated. Also, they do not have enough income out of it. Such a scenario is unfortunate for low-income earners since an increasing number of doctors is not willing to treat these patients.
Future of Medicaid
With the plans of the current government, the future of Medicaid is uncertain. Currently, there are block grants where each state is in charge of its Medicaid affairs. The future is expected to take this line; however, it poses great challenges since many people will not get access to affordable health care. Doctors will also receive low income. As much as the government hopes to reduce the expenditure on health care, it should also consider the low-income earners since this program is meant to assist them. All in all, despite the challenges, this program is expected to grow through proper reforms.
In conclusion, Medicare and Medicaid are significant programs that are meant to assist millions of citizens. Many challenges affect it including lack of funds and increase in population. With various reforms in place and proper planning, these programs are likely to become a success now and in the future. All in all these programs are always changing but for the better of citizens.
References
Firth, S. (2017). Is the Medicaid Expansion Helping the Wrong People?. Medpagetoday.com. Retrieved 2 February 2017, from http://www.medpagetoday.com/publichealthpolicy/medicaid/62845
Garcia, F. (2017). Trump promised to negotiate drug prices – then he made a big U-turn after meeting Big Pharma lobbyists. The Independent. Retrieved 2 February 2017, from http://www.independent.co.uk/news/world/americas/donald-trump-big-pharma-prescription-drug-prices-lobbyists-medicare-negotiations-a7557726.html
Giterman, S. (2016). The 2016 Medicare Trustees Report: Is Medicare Doomed?. Health Affairs. Retrieved 2 February 2017, from http://healthaffairs.org/blog/2016/07/12/the-2016-medicare-trustees-report-is-medicare-doomed/
Jaffe, S. (2017). Legal Dispute Continues Over Medicare Coverage Of Physical Therapy. NPR.org. Retrieved 2 February 2017, from http://www.npr.org/sections/health-shots/2017/01/30/512005133/legal-dispute-continues-over-medicare-coverage-of-physical-therapy
Kozak, K. (2017). Health Beat: Trump's Medicaid Block Grants Might Just Block Care. Civil Beat News. Retrieved 2 February 2017, from http://www.civilbeat.org/2017/02/health-beat-trumps-medicaid-block-grants-might-just-block-care/
Lee, M. (2017). Paul Ryan’s claim that ‘more and more doctors just won’t take Medicaid.' Washington Post. Retrieved 2 February 2017, from https://www.washingtonpost.com/news/fact-checker/wp/2017/02/01/paul-ryans-claim-that-more-and-more-doctors-just-wont-take-medicaid/?utm_term=.61d3e0ce69a3
Parmar, A., Baum, S., Preston, J., & Versel, N. (2017). CMS never recouped millions in Medicare Advantage overpayments - MedCity News. MedCity News. Retrieved 2 February 2017, from http://medcitynews.com/2017/01/cms-medicare-advantage-overpayments/?rf=1
Rosenbaum, S. (2016). The Medicaid Managed Care Rule: The Major Challenges States Face. Commonwealthfund.org. Retrieved 2 February 2017, from http://www.commonwealthfund.org/publications/blog/2016/may/the-medicaid-managed-care-rule
Suderman, P. (2017). More Than 10 Percent of Federal Medicaid Payments Last Year Were Improper. Reason.com. Retrieved 2 February 2017, from http://reason.com/blog/2017/01/31/more-than-10-percent-of-federal-medicaid
What is Medicaid?. (2015). Dhss.alaska.gov. Retrieved 2 February 2017, from http://dhss.alaska.gov/dhcs/Pages/medicaid_medicare/default.aspx
What is the History of Medicare? | National Academy of Social Insurance. (2017). Nasi.org. Retrieved 2 February 2017, from https://www.nasi.org/learn/medicare/history
