Medicare and Medicaid Programs Essay

Introduction

Medicare is a program supporting individuals over 65 years with medical care in the United States. Additionally, it continuously provides support for people with specific disabilities and also individuals who are having kidney failure (Reaves et al., 2014). Medicaid, on the other hand, is an administered program in states providing medical support for a wide variety of individuals. Each state administers Medicaid individually thus creating inconsistencies of the program in the country. There are however specific rules used in justification of how much money an individual receiving Medicaid can contribute and be eligible. Also, there are also certain different rules for the people in children and nursing homes and even those at home living with disabilities. The list of regulations is long showing which people are eligible for what services (Reaves et al., 2014). The Affordable Care Act also known as the Obama care includes numerous changes in Medicaid and Medicare and even the changes in payments, how the enrollment is done and also the eligibility.

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Medicare Overview

Medicare and Medicaid are among the most long-term social programs that provide distinct services to various groups of individuals in the United States history. Medicaid eligibility rules have been criticized and termed as confusing because it is a state-administered program thus its rules varying from state to state. These, therefore, pose a significant program for the individuals enrolled in Medicaid and often move from state to country. Lyndon Johnson was the president behind the creation of Medicaid and Medicare in the year 1965. From that time, the two programs have undergone numerous changes such as the passage of the ACA in 2013 following a debate over healthcare reform on all levels of the government in the United States. The advocates of this Act believed that the legislation would go a long way in addressing the Americans lacking health insurance.

The Push for Medicare

The push of creating a national health plan began just recently a century ago. From the beginning, individuals thought Medicare was a "sickness insurance program." The rising concerns that large population segments mainly casual laborers could not afford in paying the medical bills instigated the push for this program. Medicare was however in its planning stages, but the American Medical Association opposed this plan from the start. This is because most of the Americans thought that the medical care was a private transaction of the medical practitioners and the patients, thus thinking there was no need for the government's intervention in that relationship.

When President John Kennedy pushed for a healthcare plan, Medicare acquired a lot of political support despite it later facing defeat in 1962. This is because various legislators felt there was lack of support in the private area. Some proposals were offered, offering choices of accepting government health insurance, private healthcare plans or being run by the states. Choosing of the individual plans meant receiving an increase in their social security benefits. The sections covered in Medicare cover hospital insurance, advantage plans, medical insurance and prescription drug coverage.

Benefits of Medicare Program

Medicare benefits come in four parts. Part A ensures it provides help in paying for inpatient hospital care, hospice care, and some skilled nursing facilities. This part is usually a premium-free for numerous people (Jiang et al., 2016). The beneficiaries in this part pay monthly premiums to qualify for the program. Part B of this plan helps in outpatient hospital care, paying doctors and some other care that part A does not cover for instance occupational and physical therapy.

Part C ensures numerous PPO's HMO's and other similar healthcare organizations are offering health insurance plans to the beneficiaries in Medicare. However, they have to provide similar benefits in the original Medicare program provided in part A and B. Organizations in part C have a permit to offer additional benefits for instance vision and dental care. However, to control costs, part C plans can limit patient's choice of hospitals or doctors to only those who are members of their networks.

Part D of the Medicare program provides a prescription for the drug benefits in various private insurance organizations. Throughout the 21st century, the Medicare program has continuously provided health insurance needed by seniors and individuals with disabilities as much as they try to regulate the costs. The market competition and high demand have caused private and public healthcare surge costs in the United States.

The Push for Medicaid

Medicaid was launched almost at the same time with Medicare. During the 1950's the government formed a category of welfare for the individuals with permanent disabilities. It came into law in 1965 just like Medicare despite it initially being a supplemental program (Rajaram et al., 2015). Later it developed into a more significant health insurance program, and by the 20th century, all states required families under the Federal Poverty line be eligible for the Medicaid program.

From its inception, numerous states chose to provide services under Medicaid going beyond federal guidelines. The choice has therefore led to expansion and also an increase in the importance of the healthcare. From the beginning, Medicaid has been a program providing health insurance for individuals living with low incomes (Rajaram et al., 2015). The government expanded Medicaid through creating a health insurance program for the State's children allowing the state to receive federal money used in expanding Medicaid. They also established a separate fund for children not insured because of their families' illegibility.

Medicaid is known to provide healthcare for pregnant women living on low incomes. The program assists with pre and postnatal care and delivery thus reducing financial barriers used to access the required health services. Medicaid's role has been to provide health coverage for individuals with low incomes.

Challenges of Medicare and Medicaid

Medicare and Medicaid have faced various difficulties from inception. However, the government has initiated new ways of controlling abuse and waste in the two programs (Alley, Asomugha, Conway & Sanghavi, 2016).

Fraud

Research has been conducted extensively into the matters of fraud found explicitly in the Medicare program. This is because the program holds millions of people and dollars thus being an attractive target for reasons other than its intentions. For instance, it pays higher amounts compared to other market rates for some services. The limited administrative capacity in preventing fraud is also another major problem. 10% of Medicare funds are lost to fraud, waste, and abuse (Centers for Medicare and Medicaid Services 2015).

Controlling Costs

Medicaid is known to be among the most significant item in the budget of a state despite the beneficiaries lacking political clout. During economic downturns, the expenses typically surge due to the increased enrollment when people lose their health benefits and their jobs too. This usually puts a state in a quandary due to the struggle of keeping up with high costs and reduced tax revenues (Centers for Medicare and Medicaid Services 2015). States have tried to cut costs by reducing the payment rates of doctors and hospitals and their benefits which consequently have detrimental effects on the individuals enrolled thus making it harder to acquire medical care.

Better Oversight of Managed Care

According to recent research, a fraction representing more than half of the individuals enrolled in Medicaid get medical care from privately managed organizations. Despite insures touting their ability in offering budget predictability; many questions remain on how well the organizations can control their costs and improve quality at the same time. Health plans in managed care are paid in monthly rates covering each enrollee's medical aids (Alley, Asomugha, Conway & Sanghavi, 2016). The past government however proposed rules of limiting the administrative costs and setting standards that ensure the enrollees have unlimited access to doctors and hospitals. A new report has however noted inaccuracies of Medicaid managed care plans whereby numerous doctors listed in the directories were absent since they were not from that location and also were unavailable in the plan's network.

Conclusion

In conclusion, the Medicare and Medicaid programs came into light to enable the government to have excellent control in all the individuals that were recipients of the program. The two programs have policies stating that the enrollees of the plans have a right to quality care and have maximum security as they receive the care. The programs ensure that the uninsured have a right to medical care or treatment in any medical facility which is required to honor the rules set forth by the government. Any individual can apply for any of the programs in case they are in jobless situations or if they want to acquire any medical assistance in whichever way.

References

Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2016). Accountable health communities-addressing social needs through Medicare and Medicaid. N Engl J Med, 374(1), 8-11.

Centers for Medicare and Medicaid Services. (2015). Accountable care organizations (ACO). Retrieved from http://www. cms. gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index. html.

Jiang, H. J., Boutwell, A. E., Maxwell, J., Bourgoin, A., Regenstein, M., & Andres, E. (2016). Understanding patient, provider, and system factors related to Medicaid readmissions. Joint Commission journal on quality and patient safety, 42(3), 115-121.Rajaram, R., Chung, J. W., Kinnier, C. V., Barnard, C., Mohanty, S., Pavey, E. S., ... & Bilimoria, K. Y. (2015). Hospital characteristics associated with penalties in the Centers for Medicare & Medicaid Services hospital-acquired condition reduction program. Jama, 314(4), 375-383.

Reaves, E., Musumeci, M. B., Jacobson, G., Perry, M., Kolb, N., & Saulsberry, L. (2014). Faces of dual eligible beneficiaries: Profiles of people with Medicare and Medicaid coverage. The Henry J. Kaiser Family Foundation. July 3, 2013.