Medicare Expansion

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.

One of the states that have not participated in the Medicaid expansion is Florida. States that are opting out in the Medicaid expansion can leave several citizens uninsured and their health will be at risk. Currently, since the America’s Supreme Court has given the states more flexibility relating to the Affordable Care Act, some states are opting out of the Medicaid expansion plan that is intended to give low-income citizens in the state dependable healthcare. To reasons the state of Florida opting out the Medicaid expansion, the governor of Florida stated, that Floridians are more interested in economic growth and employment, better quality of education for their children, and that they keep the cost of their living low. Florida State is

Medicare enrollees in Utah have saved about $78 million on prescription drugs due to the ACA. Coverage for both brand name and generic drugs will continue to increase until the coverage gap is closed. The ACA also allows Medicare beneficiaries to seek preventive services without worrying about cost, due to the lack of deductibles and copays. This aids in detecting and treating health problems early on. In Utah in 2014, 220,972 individuals with Medicare used free preventive services. In addition to that, fraud is at a minimum due to tougher screening procedures, penalties, and technology developments.

The Affordable Care Act was put in place by President Obama in 2010, providing Americans access to affordable health insurance. But South Carolina’s governor, the republican Nikki Haley is still rejecting the Medicaid expansion. My paper has detailed information on why Governor Haley and republicans made their decision to opt out of the expansion. Also, alternate approaches to expanding access to care and implementing or reconsidering the state’s decision of opting out of the expansion. Finally, recommendations to the state legislature to convey opting out of Medicaid expansion.

States are being pressured to expand Medicaid to families earning up to $30,000 a year, just like the Affordable Care Act permits. While several respected governors have agreed to expand the program, many other governors and state legislators are cautious. These officials do not want to deny Americans their access to health care, however they do want to slow the expansion of a program that will provide them with limited access to quality care while destroying state budgets. One of the strongest arguments that can be made against the expansion of Medicaid is the fact that States simply can not afford it. The appeal to states to expand Medicaid is that the federal government will cover 100% of the cost through 2016 and eventually lowering to

Fifty years ago, Lyndon B. Johnson signed the Medicare program into law. “It has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses.” (Hamel, Blumenthal, Davis, & Guterman, 2015, p. 479). With the encouragement of George W. Bush, congress passed the Medicare Modernization Act of 2003 (MMA). The MMA extended Medicare to include prescription-drug coverage, known as Medicare Part D. In 2013, Medicare covered the health care expenses for 52.3 million Americans, costing $583 billon. Originally, Medicare had difficulty controlling costs; physicians and hospitals were

enrolled in the new program. The $8 billion includes the state share of costs for both newly eligible adults and the additional Medicaid participation among currently eligible populations that would result from expansion. If all states implemented the Medicaid expansion, federal spending would increase by $800 billion, or 21 percent, compared to the ACA with no states implementing the expansion (Holahan, et al., 2013). Therefore, although the increase in spending per state is relatively small, the cost to our nation is exponential. With the national debt growing day by day, many believe that an exponential increase in national spending is a difficult thing to justify.

In 2010, the United States took the first tangible step toward universal health care coverage, with the legalization of the Patient Protection and Affordable Care Act of 2010. According to the U.S. Census Bureau’s most recent report the total population of the United States is nearly 309 million people (U.S. Census Bureau, 2010). In 2009, it was estimated 49 % of the population was covered under an employer sponsored insurance plan (Kaiser Family Foundation, 2009). The same 2009 data reported an additional 29 % of the population was covered under some form of government or public program (Kaiser Family Foundation, 2009). Leaving 17 % of the U.S. population vulnerable without any form of health insurance coverage (Kaiser

Medicare is the Federal government’s largest program and provides health care benefits to individuals that are 65 years old or old (Elmendorf, 2013). This program covers over 50 million Americans, including over 8 million disabled Americans (Raising Medicare's Eligibility Age: A Costly Benefit Cut for Senior, 2014). With the baby-boomer generation coming to the age of Medicare eligibility there is an estimated drastic increase in the number of individuals participating in Medicare for their health insurance (Elmendorf, 2013). With this being said some, including the Congressional Budget Office (CBO), believe that increasing the minimum age of eligibility will save the Federal government money (Meyerson,

Bill Haslam, the Tennessee state governor, announced that the state of Tennessee would accept the Medicaid expansion offer. The Medicaid expansion expands Medicaid eligibility to the region’s underserved populations living near or below the poverty line. The Medicaid expansion offer looked to be a major win for the state; however, others disagreed with this idea. Some of Tennessee’s lawmakers decided to deny the federal government’s Medicaid offer, even though many others wanted the offer to be accepted. The deal’s breakdown might be the result of “squabbling along party lines” which is a common theme at all levels of government. Although the deal was denied, it is still possible that the bill could still be passed with the help of the governor. The likelihood of Tennessee reviving its Medicaid expansion is a difficult one considering the state would have to fight. The Medicaid expansion could offer the state low-income citizens medical insurance, the state would come out of the deal with a net financial gain, and the state hospitals would come out on top.

Effective May 30, 2018, the Virginia General Assembly approved Medicaid Expansion as a part of the 2019-2020 budgets. Virginia’s Governor Northam signed this approval into law on June 7, 2018, and as a result, approximately 400,000 low-income adults now qualify for health insurance (Norris, 2018). The General Assembly vote ended a “long-running partisan stalemate” with some Republicans joining the Democrats in support (The Associated Press, 2018). The Kaiser Family Foundation reports that Virginia is the 33rd state to approve the Medicaid Expansion (The Associated Press, 2018).

From recent studies suggests that Medicare provides health insurance to 48 million Americans. Medicare also plays a significant role in determining the price for most medical treatments and services provided in the U.S. They set what is considered a “fair price” for services renders from routine check-ups to heart transplants. If the calculations were correct, some doctors spend more than 24 hours on average performing medical procedures. With is over-calculation the U.S. healthcare costs are sky rocketing. Medicare updates

Within the world today there are different types of health care facilities to serve the different types of individuals and health care conditions. Temple Living Center East is a long-term care facility that serves the individuals who requires prevention, healing, and rehabilitative nursing care services for non-acute, long-term environment for the elderly. Temple Living Center East will be working on updating the secure unit for the individuals who require special care because of the diagnosis of Alzheimer’s. There will be several tasks that should be completed before the

health care system is driven in 2030 (ACL). Medicare has many challenges ahead and while trying to be sustainable under the constant changes of an ever demanding and costly health care system. Almost all Americans over the age of 65 are enrolled in Medicare, for some Medicare is a second insurance that acts like a backup, but for most of the older Americans, this is the only possibility to get access to health care in the United States. With the increasing number of beneficiaries and increasing costs of health care, how will Medicare improve/better manage access to

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.