Policy, Goals and Options
Healthcare in America just like the immigration system it needs a complete overhaul. In many political and not so political quarters the notion of health care reform has been attacked as being, ‘the Obama scare’ ( Peter,2011). Already, when health care delivery in America is assessed, it would appear that it is cheaper to die than live with a health condition requiring long term care. Precisely, the health scare of the average American citizen is being able to afford the cost of it. Even with government supplemented healthcare known as Medicaid it is impossible to continue living with a disease if there is no insurance coverage for treatment. Surely, with this background knowledge of what Medicaid offers the American poor the author of this document posits that instead of healthcare reform, which only enhances accessibility of quality healthcare for the rich, let congress examine the philosophy contained in Medicaid reform.
Nursing: Medicaid Reform instead of Healthcare Reform: Change from the inside out
Introduction
It is quite clear that healthcare is synonymous to health insurance since it is a service for which the consumer must pay just the same as rent, water, light, car insurance and more. The difference is that with health care unlike education, law enforcement, fire services and transportation consumers must have coverage to access services available to the public. Someone can dial 911 and receive access to a police officer or rescue without insurance coverage. Similarly, the only coverage anyone has to acquire in using public transportation is the required fare or its equivalent in a bus pass.
Then, why is health care in America so scary and outside the reach of the average citizen? United States of American is a leader in scientific research and has excellent medical services. However, the life expectancy of Americans is rated twelfth in the world for 2012 (Uwe, 2012). This is the first time ever in its history. Therefore, can it be said that healthcare reform is capable of addressing this issue? Definitely, it is the writer’s opinion that it cannot.
Context
Background to Issue and significance of the problem
Medicaid is government funded health insurance offered to the poor or people who due to some financial difficulty cannot provide health insurance coverage for themselves. From statistics some 65% of Americans do not have health insurance ( The Health Insurance of America, 2012).This means just like any other social service there is a bureaucratic structure through which government funded insurance, called Medicaid, is provided to this large uninsured community. There is a qualification criterion as well as limitations regarding what is offered.
Presently, the scenario in American health care system is that there is a great disparity between availability and accessibility to quality health care. A few wealthy people are privileged to the best healthcare and those who serve in the military, while the majority die from lack of accessibility to what is available to them. The barrier is adequate health insurance coverage. Sadness and grief surrounds a realization that in a country with the most sophisticated health care interventions, pregnant women, the elderly and children have very little opportunities to doctors who would offer the most appropriate care for their condition. Can health care reform answer these issues concerning accessibility to quality health care for all?
The situation of health care in America is similar to being invited out to dinner at the best restaurant in town. There is a variety of dishes to activate the appetite. Then, your host tells you that you will have to pay for your meal. Those who cannot afford it will be given $10 to spend, but cannot have any fish, beef, pork, liver or turkey. They can purchase only chicken and rice. Just think of this analogy operating within the health care system of a great country like United States of America.
Obviously, Medicaid coverage is the $10 offered to purchase the meal. People who have the money will enjoy all the delicacies on the dinner table, which represents quality healthcare. Medicaid recipients ($10 people) in this disparity are there to simply gather up the fragments and they are the majority. Where does the problem lie in this disparity? Clearly, it has nothing to do with the dinner, servers, restaurant neither the host. It is the limited $10 access to what is available on that dinner table. Can healthcare reform correct this issue without Medicaid reform?
Adequate insurance coverage allows the health care recipient to enjoy quality health care services. However, even when employers or individuals are willing to purchase health insurance it is beyond their means in a society where healthcare is so costly and health insurance premiums are unbelievably high.
Research has shown where low cost health insurance premiums range from $ 200-500 per month for families and individuals. Most of them do not cover vision, dental and prostheses. To access such services another plan is required for which extra premiums must be paid (US Census Bureau, 2011). In the presence of rising unemployment and a healthcare reform program focused on cutting back expenditure, how can the average citizen live out their life span under such a harsh healthcare system?
The United States Census Bureau, recent reports indicate that over 40 million of the uninsured in America are citizens. Some 9.7 million do not have their citizenship and could be considered residents, students or simply undocumented immigrants. However, in relating these estimates the Census Bureau did not specify whether they fit into any of the categories mentioned above (US Census Bureau, 2011).
Ironically, further studies have revealed that one fifth of the uninsured population in America can afford health insurance, but not quality healthcare. Based on their income they can afford small premiums, which do not allow access to better care. It also indicates that one quarter of these uninsured people are eligible for Medicaid coverage. The other 56% must receive financial assistance from charitable organizations. The most astounding discovery is that sick people are considered "uninsurable" because of the type of illness they are afflicted by. This accounts for 5 million of the uninsured population (Pear, 2008).
Subsequently, the argument supporting exorbitant premiums is that the costs of treating the uninsured must be accounted for. It would mean allowing other providers such as charitable organizations and relatives to be peoviders. More importantly, it is claimed that this cost is channeled to higher insurance premiums and higher taxes for taxpayers in America. The real deal is why a wealthy country like United States of America cannot provide free health care for citizens like Canada? Why do citizens have to undergo the ordeal of almost no healthcare without health insurance coverage? Why do taxpayers pay taxes and employees social security? Is this money just going to build prisons and roads? Soon there may not be any people left to fill prisons neither walk the streets, because they will all die from lack of accessibility to basic healthcare.
Previous actions and solutions
The proposition being advanced in this discussion is affordable healthcare within Medicaid reform, rather than health care reform from without. In reference to Medicaid it entails allowing accessibility to quality health care through adequate coverage. Is this possible with Medicaid reform? Sure! It is!
Attempts at providing affordable health insurance have been undertaken by both private and public sectors. Private sectors have been employers’ insurance coverage, which has been declining during the past decade due to escalating costs. Also, private insurance companies such as BlueCross and BlueShield extended coverage to individuals as well as companies. In case of public coverage this has been provided through Medicaid and Medicare, mainly, along with TRICARE, veterans’ health care and Indian health care.
The solutions to accessible health care provided by these services can be likened to giving a person a fish for a day and leaving him/her hungry for the rest of his/her life. Employers’ insurance coverage expires upon termination of services or retirement whichever occurs first. Private insurance continues once the person is employed and in great health to pay the premiums.
Medicaid expires when it is considered that the person’s financial position has become better to afford his/her own insurance. Public assistance is a temporary gesture and once conditions have changed in a person’s life he/she is no longer eligible. Veterans due to their distinguished services to the country maintain healthcare benefits throughout life. Medicare Advantaged plans are accessed by persons over the age of 65 years old (Gary, 2003).
Policy, Goals and Options
Medicaid Policy
Medicaid program acts as a health insurance policy for US citizens or legal residents who cannot afford to pay for healthcare. To be eligible for Medicaid the individual must have high medical bills, a recipient of State Supplemental Income (SSI) and meet the financial requirements as a low income earner. The Medicaid standards income retainment to quality has 10 levels, ranging from $8,000- 25,000 annually for regular households without disabilities/ children and $9,000- $30,000 for those with disabilities without children ( The health Insurance of America, 2012).
A very significant feature of Medicaid policy it its Medicaid managed care component. While acting as a subsidiary health insurance, Medicaid recipients are enrolled in a private insurance plan to assist in their care. Usually, it covers dental insurance, but no dentures neither cosmetic surgeries. From research, however, as of 2008 many states have not been enrolling Medicaid recipients in Medicaid managed care programs due to cuts in federal healthcare subsidies among states.
It must be noted that even though Medicaid is a national program the coverage varies from state to state. For example, Medicaid funds could be acquired to help pay employer health care premiums in Alabama, Alaska, Arizona, Colorado, Florida, and Georgia, from January, 1st 2012 ( Uwe, 2011). Also, applying the asset criteria for Medicaid eligibility in long-term care impacts more states than others since politicians/ senators are held responsible to citizens for re-election to office within these individual states while confirming to federal legislation (The Health Insurance of America, 2012).
The Deficient Restriction Act, 2005 has extend Medicaid's "lookback" period for all asset transfers from three to five years, changing start of the penalty period transference of assets ‘ from the date of transfer to the date when the individual transferring the assets enters a nursing home becomes eligible for Medicaid coverage’ (The Health Insurance Association of America, 2012). It also causes the individual who has a home equity above $500,000 ineligible for Medicaid in a nursing home facility. Some states have increased the threshold to $750,000 (The Health Insurance of America, 2012)
Healthcare Reform Policy
Opposing politicians have referenced American, 2010-2012, healthcare reform concept policy merely a political jargon or propangada,signifying nothing. The policy aims at attempting to narrow gaps between affording health care and accessibility to the highest quality available to the public. This should be achieved by expanding public and private sector insurance companies’ ability to provide coverage for individuals and corporations as well as small businesses (CNN, 2010).
During this expansion program individuals should be enabled to freely access health care specialists and receive better quality care at affordable costs. Definitely, this is a phenomenal undertaking, which looks great on paper. Commendably, the theme, ‘improved health insurance coverage’ is recognized within the health care reform policy. However, can this be accomplished outside the boundaries of comprehensive Medicaid reform?
Precisely, the Patient Protection and Affordable Care Act (Public Law 111-148) which was legislated by President Barack Obama on March 23, 2010 outlines specific guidelines for this health care reform policy concept implementation. In combination the Health Care and Education Reconciliation Act signed into law on March 30th, 2010 is perceived as a production of the health care reform efforts of the Democratic 111th Congress under President Obama‘s political administration ( Uwe, 2011). How applicable are these laws to the derailed health care system in America, known to be the worse in developing countries around the world?
Even though it includes immense healthcare provisions effective over a four years period, could it be said that these legislations are comprehensive enough to really allow easy access to quality health care? In 2012 citizens are still refused coverage and cannot see a specialist if their insurance does not allow them.
Just imagine that this healthcare reform policy is extending ‘ Medicaid eligibility for people making up to 133% of the federal poverty level (FPL), subsidizing insurance premiums for people making up to 400% of the FPL ($88,000 for family of 4 in 2010) so their maximum "out-of-pocket" payment for annual premiums will be from 2% to 9.5% of income providing incentives for businesses to provide health care benefits’ ( Gerald, 2003), but this does not mean that through Medicaid coverage they now can access the best specialist in the country and long term care is covered without fear of losing assets. Yes, the argument has been who must pay for healthcare in America?
The legislation goes on to ‘ prohibit denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual coverage caps, and support for medical research’ ( Peter,2010) along with some well-intended accessibility to Medicaid and no clear provisions to quality healthcare.
In my opinion health care reform means nothing without Medicaid reform. Medicaid reform is not just lowering the accessibility to poor healthcare through Medicaid, but redesigning Medicaid, lifting it off the poverty philosophy, making it a well-deserved healthcare intervention policy for all US citizens to access quality health care.
Goals and Options
Goals are linked to options when considering healthcare reform from a Medicaid reform perspective. It is moving from the known to the unknown and not blindly towards the known from not knowing. Everyone knows that healthcare in America is a mess. No healthcare reform can clean it up. The goal of healthcare reform in America must be providing quality healthcare for all citizens irrespective of race, ethnicity, gender or social status. The only way this can be achieved is through universal health coverage implementing a self-sufficient Medicaid system.
The structure of a self-sufficient Medicaid system is the option available for the present healthcare reform, which really is no reform. The money federal government has been extending to private insurance companies, that create a hike in insurance coverage, must be funded to Medicaid. If the word Medicaid has been too much affiliated with poverty a survey could be conducted to obtain suitable a replacement for the concept.
Eliminate private health insurance companies from the healthcare system. They exploit Americans by creating social disparities among healthcare recipients. Institute federal funded healthcare insurance under a revised Medicaid policy. Allow it to function in providing healthcare for Americans by allowing tax dollars to pay directly for healthcare and not individuals into health insurance and back to the federal.
Medicaid reform makes the federal accountable for providing citizens, residents and visitors with quality healthcare while in this country. Then there would be no deficits. The passage of funds away from Federal Reserve towards private sector investors for an important social service as healthcare is catastrophic. This explains the plight of the uninsured in America and inaccessibility to quality healthcare even though the best is available.
Recommendations
It is highly recommended that instead of healthcare reform there should Medicaid reform. Change must occur from inside out. Let Medicaid be the nation’s insurance for quality healthcare. Instead of lower the poverty level for more impoverished American to afford some healthcare under Medicaid; let Medicaid be universalized with services for everyone in America irrespective of race color or creed.
Conclusion
The foregoing exposition advanced the proposition that instead of healthcare reform in America there should be Medicaid reform. It was noted that the Patient Protection and Affordable Care Act (Public Law 111-148) signed into law by president Obama in March, 2010, did nothing for the American healthcare system because it merely created a phenomenon whereby more people are made to feel that they could never be able to afford quality healthcare in their life time.
In fulfilling the goal of providing more affordable health insurance to the public, the reform legislation merely outline measures to lower the income eligibility for Medicaid coverage. If this is the case then why not make Medicaid reform the priority instead of healthcare reform. It is quite clear that Medicaid is carrying the nation’s healthcare cost, especially among the poor. Eliminate poor healthcare, Mr. President by replacing the “Obamascare “with a practical affordable healthcare system for all by implementing the Medicaid reform measures suggested by this proposition.
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