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Hospital insurance (HI) b. II. and generational equity (Morone. hospice c. Litman. & Robins. Supplemental Medical Insurance (SMI) . Medicare Overview A. periods of policy activism have accelerated creating a state of crisis and debates regarding the welfare state.Medicare Policy Issues I. The medical providers did received a monetary benefits from Medicare program. but still it was subjected to objection due to high growth rate of health care costs in US. 2008). home health. Supplemental Medical Insurance (SMI) b. Part B a. Introduction Medicare was passed in 1665 after overcoming many heated discussions and strong opposition to become the largest federal health care program.2. Due to Medicare’s political and fiscal insecurity in the previous year. skilled nursing. Medicare officials accepted to pay a reasonable price to the providers and evaded direct fiscal control medical personnel and facilities. Outpatient. Inpatient. Funding – 75% general revenue and 25% premium payments 3.9% of all covered earnings and 0 premiums 2. health care reform. Structure of Medicare 1. Funding . physician services c. Part D a. Part A a. In order to avoid the tag of government bureaucracy. The result of the negotiations leads to formation of new allegiances and nurtured interests from providers who have been protesting against governmental interference.
Government Site for Medicare. dental. and health wellness programs b. Part C a. Department of Health & Human Services. Private Fee-for-Service (PFFS) Plans f. Medicare Policies 1. Funding – 77% general revenue and 14% premium payments and 9% state funded (Rettenmaier & Saving. Health Maintenance Organization Point of Service (HMOPOS) Plans i. Vision.S. Preferred Provider Organization (PPO) Plans c. hearing. 2. 4. 2011) B. Special Needs Plans (SNP) (The Official U. Freedom of Information Act (FOIA) a. Allow out of network services for a higher cost d. Prescription Drugs c.S.b. 2007). The Affordable Care Act a. Protect Privileged Information (U. Medical Savings Account (MSA) Plans i. Privacy Act Issues b. Medicare Advantage Program i. Medicare deposits money into the account to pay for health services e. 2009). Savings and increased quality of care .
Board of Trustees reports on financial status 2. 2008) III. fraud. Fight waste. Combat fraud and misinformation i. Taxes 1. Authorized by Congress 2. Hospital Insurance Trust Fund 3. Cost Impact of: . Medicare Trust Funds 1. Law required Medicare to cover preventative physical examinations (The White House. Prescription drug benefit b. Improvement. and Modernization Act a. 2010) A. Medicare Prescription Drug. Income tax paid on Social Security B. Accountability through the health care system 4. Supplementary Medical Insurance Trust Fund (Centers for Medicare & Medicaid Services. Payroll Taxes 2. Interest earned on trust fund investments A. Premiums from recipients 3. and abuse ii. Routine Patient Care Costs c. Medicare Budget 1.b.
1989-Medicare Fee Schedule (Litman. 2011). (Centers for Medicare and Medicaid Services. and Modernization Act (MMA) (Litman. Total Health expenditure reached $509 billion in 2009 i.2008) 2. et al. (Centers for Medicare and Medicaid Services. 2003-Medicare Prescription Drug. Supplemental medical insurance trust fund (SMI) ii. et al. National health expenditure of $2.5 trillion in 2009. Governments Role in Medicare . Medicare regulatory weight reduced by $1 billion.A. 2011). 5. 1972-End stage renal disease (Litman. et al. 2008) B. Hospital Insurance trust fund (HI) 4. et al. Projected Costs of Creating and Implementing a Replacement or Revised Policy 1. 2008) 3. et al. Past Policy Decisions Surrounding Medicare’s Policy Administration 1. 1983-Medicare Prospective Payment System (PPS) (Litman. 2008) 6. Improvement. et al. Medicare Advantage Plan (Part C) 3. 6. 2008) 5. 2010-Patient Protection and Affordable Care Act (PPACA) (Litman. 2006-Medicare + Choice becomes Medicare Advantage (Litman. 2008) 4. Saving of $350 million through Medicare fraud prevention IV. Affordable Care Act of 2010 2.
Policymaking. administrative arrangements 1. Medigap b. Medicare beneficiaries c. Patient Protection and Affordable Care Act (ACA) a. fee-forschedule D. open-ended payments 2. Republican revolution. Impact of Special Interest Groups to Medicare A. particularly for low-income individuals 1. prospective payment system. Medicare Advantage options V. Politics over its enactment 1.A. Part D drug benefits b. Improvements to benefits. Modernization Act a. Inflationary formula. Regulation Revolution 1. Market-based reform. regulatory regime 2. Funding. democratic control B. 1995 Managed Care Plans 2. Ideological and partisan divisions 2. Budgetary controls: 1983. Debates. Free check. fiscal pressures C. National Association of Insurance Commissioner (NAIC) . reform 1.
Increase payments for those who treat Medicare patients 1. American Medical Association b. Pharmaceutical Research and Manufactures of America (PhRMA) B. Medicare beneficiaries c.2. Medicare Patient Empowerment Act a. Secondary insurance (AARP) b. National Specialty Medical Associations VI. Consumer Advocates (Family USA) 2. Medicare savings program (MSPs) a. American Hospital Association 2. Policy Desire Versus Outcome . Medicare supplements (American Association of Health plans) b. Medicare part D a. Health Care and Education Reconciliation Act a. Medical Associations b.
Policy Desire 1. Medicare fraud 3. Medicare has been the sources of health care coverage to millions Americans. Reducing cost of prescription drug costs 3. Since its inception under President Johnson. Policy Outcome 1. Medicare trust fund running low 2. It is a federally operated program and the budget is set and approved by Congress at the start of fiscal year.A. Reducing cost of health care 2. & Robins. Conclusion Since 1965. Medicare has gone through modifications with new policies and procedures which in turn have impacted the program and its service. Medicare enrollment expanding VII. There are four distinctive and differently beneficial parts of Medicare program namely Part A. C. Supplement out-of-pocket expense for elderly B. Prescription drug spending increase 5. (Morone. Litman. Some of the already passed policies have been influenced by special groups but as the process of passing polices is length. The purpose of development and implementation of this program was to aid Americans over 65 years or with disability. 2008). majority of the remained unpassed. Medicare spending increasing each year 4. . and D. B.
S. (2008). 159(6). NY: Delmar Cengage Learning .cms. Reflections on the National Association of Insurance Commissioners and the implementation of the patient protection and affordable care act.. J. Retrieved from http://familiesusa. 116(2). 303-350. T.).medicare. Litman. M. (2008). Public Health. Sources of Advantageous Selection: Evidence from the Medigap Insurance Market. 2043-2060. Retrieved from http://www.References American Medical Association. (n. J. Morone. (2011). Clifton Park. Retrieved from EBSCOhost.org/ama/pub/advocacy/current-topics-advocacy/practicemanagement/medicare-patient-empowerment-act. A. Journal of Political Economy. L. D. & Robins. & Silverman. Keane.. (2008). Health politics and policy (4th ed.gov Centers for Medicare & Medicaid Services.d. Retrieved from http://www.org/issues/medicare/rx-drugs/ Fang. How is Medicare Funded..gov/Publications/Pubs/pdf/11396. (2011). T. Medicine & Ethics. P. 39(3). Retrieved from EBSCOhost.page Centers for Medicare & Medicaid Services (2011). Retrieved from http://www. L. H. and the Elusive Target of Human Rights. The Patient Protection and Affordable Care Act. Journal of Law.ama-assn.pdf Families USA.. Gable. (2011).). University of Pennsylvania Law Review. 340-354 JOST. Fact Sheet.
The Affordable Care Act: Strengthening Medicare. P. 518. H. & Saving. J. S. 1. combating misinformation and protecting Americas senior. Retrieved from http://olpa.gov/navigation/medicare-basics/medicareBenefits/part-c. A. (2011). 108-173 (H. Improvement.R. Retrieved from http://www. Retrieved from http://www.hhs.asp Rettenmaier. (2011).S. Medicare Prescription Drug.gov/foia/ . Retrieved from http://www. Government Site for Medicare.aspx The White House.L. 2473). Department of Health & Human Services. Medicare Advantage (Part C). (2010).R. H. FOIA (Freedom of Information Act.S.nih.gov/legislation/108/publiclaws/medicare. 299. (2007). The Structure of Medicare.medicare. Retrieved from http://www.od. 1068. T.org/pub/st299?pg=4 The Official U. R.Office of Legislative Policy and Analysis. Publication no. and Modernization Act of 2003. (2009).gov/the-press-office/affordable-care-act-strengthening-medicarecombating-misinformation-and-protectingU.R.ncpa.whitehouse.
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