Health Policy Analysis Essay Paper

For years, many countries and states have attempted to develop health policies that would enable their citizens to have an access to health insurance. The United States’ Medicare and Medicaid are examples of such policies.

Health care issues in the United States have been a major concern since 1990s. At the beginning of 1915, ways of establishing the insurance program that is managed by the government began with various agencies contributing (National Academy of Social Insurance Study on Medicare and Disparities, 2008). This came about as many citizens of the United States found difficulties in coping with the high amounts of medical costs that were neither affordable nor predictable. Health Policy Analysis Essay Paper

The agencies came into agreement to establish the insurance agency to solve the problem. There was a great concern as to whether the insurance agency was to be publicly or privately funded. The United States’ government increment of the direct wage limits which consequently led to increment in fridge benefits made many people to opt for private health insurance. At the time, most middle income earners wanted to join private health insurance, but could not because they were expensive. This made them seek support from the government.

After numerous proposals, lengthy debates, and many considerations, the American Congress passed a bill that enacted the Medicare and Medicaid health programs under Title XVII of the Social Security Act in 1965. Many amendments were thereafter made on the Act to include specific disabled people with ages below 65 and people of all ages with specific kidney disease. Health Policy Analysis Essay Paper

Problem Statement

For many years, amendments have been made to the Medicare and Medicaid health policies to suit the United States citizens. However, there are many restrictions in the kind of people covered, illnesses covered, and medication given. These make it impossible for many low-income earners to access the health policies and therefore lend them to suffering and death.

Background to the Issue

Person and Illness Restriction

Medicare        

Medicare, the United States’ health insurance program, was initially designed for aged people who have attained sixty five years and above (Social Security Bulletin, 2000). After many amendments, Medicare covers many groups of people and illnesses. It covers people with disabilities who are younger than sixty five years and people of all ages who need regular course of dialysis or kidney transplant due to permanent kidney failure. Health Policy Analysis Essay Paper

Not all who have attained sixty five years and above qualify for Medicare program, but those who are legal residents of the United States or have stayed in the United States for five years and above, have worked or their spouses have worked in a job which covers Medicare for a period of ten years and above, and those who contribute to Social Security through monthly deductions (Extend Health, 2011). Past government employees and those who do not receive Railroad Retirement Benefits or Social Security payments are also eligible for Medicare.

The Medicare policy allows those who are sixty five years and above and their employers do not pay for their monthly contributions and aliens who have permanently resided in the United States and, whose prior to application, have resided in the United States for a period of not less than five years to voluntarily enroll. Health Policy Analysis Essay Paper

Medicare health policy also covers disabled people who qualify for Social Security Disability Insurance (SSDI) Payments. To qualify for Social Security Disability Insurance, one has to have attained 18 years and above but not more than 62 years, has to be unable to perform any work for a period of one year and above or expected to die due to mental or physical disability. It is not only the qualification for Social Security Disability Insurance that enables one to be eligible for Medicare insurance coverage, but also one to wait for five months before starting and additional 24 months before benefiting from Medicare, with an exception of Social Security Disability Insurance candidates with Amyotrophic Lateral Sclerosis who start benefiting from Medicare cover from the first month they receive their payments.

Medicare policy, however, does not cover all medical costs for those below the age of 65 who either have been receiving Social Security Disability Income payments for at least two years or have End Stage Renal Disease. Areas not covered for such people include copayments, premiums, and drug prescriptions. They are covered only when there are special arrangements which imply getting additional insurance cover from private medical insurance plan.Health Policy Analysis Essay Paper

Disabled persons and those with permanent kidney failure who require regular course of dialysis or kidney transplant are covered by Medicare until their health status improves or when their kidney transplant is successful without development of any serious complications.

Medicaid

Medicaid is a public health policy financed by both the state and Federal Government. It is designed to provide health insurance coverage to low income earners in the United States. Eligibility criteria for Medicaid health coverage is determined if a person meets certain income requirements. It covers families, children up to the age of 19 years, and pregnant women with low income.  It also continues to insure certain youths who continue aging outside the foster care system until the age of 21.

Those who are 65 years and above and disabled people of all ages qualify for Medicaid coverage only if their gross monthly income is below $589. In addition, they must also have saved or possess stock of at most $1,500. For couples, their monthly gross income should be $1,011 or less, and possession of at most $2,250.

In certain cases, people interested in Medicaid program may meet all eligibility criteria except that their monthly income may be more than the required limit. In such a case, they may apply for a Medicaid Spend-down Program. Medicaid Spend-down Program allows caseworkers in a county to determine and deduct an amount towards Medicaid. For such members to be covered in a given month, patients must provide the medical expenses incurred; same as the Spend-down amount.Health Policy Analysis Essay Paper

Medicaid Buy-In for Workers with Disabilities provides health care coverage for disabled citizens of ages between 15 and 65 years. It is designed to encourage working United States disabled citizens to get covered. To be eligible for this coverage, one must not have a gross countable income that exceeds 250% of the Federal Poverty Level (FPL) and have resources of not more than $10, 580. Candidates with a gross income more than 150% of Federal Poverty Level, have to pay monthly premiums to be eligible.

Medicare Premium Assistance Program enables Medicaid to assist low income Medicare beneficiaries with all or part of their Medicare costs. They include costs associated with Medicare Part A and Part B premiums.

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Breast and Cervical Cancer Project is a Medicaid program that covers eligible women who are screened with either breast or cervical cancer. To be eligible for the breast and cervical cancer coverage, women must have income below 200% of FPL. Those who are covered by the Breast and Cervical Cancer Medicaid project have an opportunity to receive the full Medicaid coverage in addition to the breast and cervical cancer treatment. Health Policy Analysis Essay Paper

Medicaid covers individuals with HIV and has about 212,892 people with HIV enrolled in FY 2007. This accounts for about less than 1% of the total people enrolled for the program, which is almost a quarter of all people diagnosed with HIV in the United States (CDC Prevalence Estimates – United States 2006, 2008). To be eligible for the HIV Medicare cover, a person must meet the low income category or fall in a group of disabled adults with dependent children.

Medication Restrictions

Medicare

In addition to person and illness restrictions, Medicare health care policy restricts the kind of medication issued to its members. Therefore, it is divided into four parts: Medicare Part A, Part B, Part C, and Part D.

Medicare Part A covers inpatient and skilled nursing facilities. Only people who meet certain requirements qualify to receive hospice and home-based care facilities in this category. While Medicare Part A covers blood transfusion services received when staying at the hospital, hospital stays including meals, rooms, general nursing, and other services received during hospital stay, critical hospital inpatients and mental health care up to a maximum of  190 life time, however, it does not cover everything or the total cost of most of the services.

In addition, Medicare Part A covers costs related to skilled nursing facilities including semiprivate rooms, skilled nursing care and services, meals, and rehab services (covered for a period of not more than one hundred days); first twenty days are fully paid and the rest of the days co-paid, home health services including part-time care for a skilled nurse, medical social services, health home services aids, physical or occupational therapy, medical social services, and home used medical equipment such as walkers, oxygen equipment, beds, and wheel chairs (Leonard, 2008).Health Policy Analysis Essay Paper

Patients with severe sicknesses who remain with at most six months to die are also covered by Medicare Part A. In such a case, Medicare Part A covers costs of buying pain relieving and symptoms control drugs as well as costs for counseling and guiding. It normally approves and pays professionals who visit patients at their homes to provide the services.

Medicare Part B covers doctor services, outpatient services, and many services not covered by Part A. They include laboratory tests and screenings; services that help prevent, effectively manage, and diagnose a medical condition; annual glaucoma tests; blood and urine tests, bone mass measurement to verify if a patient is at a high risk of bone breakage, cancer screening tests for cancer growth verification, diabetes tests for patients with high blood pressure, and cardiovascular screening.

Part B also covers health care provided at hospitals or homes by doctors. They include home health services done by part-time nurses, doctors, occupation therapists, and social medical workers. It incorporates costs associated with services rendered by equipment such as wheelchairs, walkers, beds, and oxygen gadgets and other services such as ambulance services, blood transfusion, emergency room services, eye glasses services, standard frame for cataract surgery victims, surgery, and chiropractic services. Health Policy Analysis Essay Paper

Preventive flu shots, hepatitis B, hearing balance, dialysis, pelvic examination, mentally challenged health care, nutrition therapy, mammograms, outpatient surgery, transplant and practitioner services, and drug prescription are all covered by Medicare Part B.

Medicare Part C, which is commonly referred to as Medicare Advantage, covers services covered by both Part A and Part B and others not covered by the two programs. It consists of a network of medical professionals and patients can only seek services within their network. It covers drug prescription but gives room for patients with blood prescription to enroll for other services it offers, such as the Medicare Health Maintenance Organization which allows patients to visit health professionals in their Health Maintenance Organization network, the Medicare Preferred Provider Organization plan which gives room for patients to seek medical assistance either within their Preferred Provider Organization network or outside but at extra costs, Medicare Private Free-for-Service plan which denies patients’ opportunity to seek referral to get services of medical professionals outside their Private Fee-for-Service network, and Special Needs plan that caters for medical needs of certain population such as those with chronic illnesses. Health Policy Analysis Essay Paper

Medicare also approves private agencies to cover services covered by Medicare Part C. Through this, Medicare Part C offers extra benefits in addition to those provided by Medicare Part A and B. In this regard, some agencies have lowered their copayments, some lowered charges, while others charge higher than the original Medicare (Gold, Hudson, Jacobson, & Neuman, 2010).

Medicare Part D, also known as Medicare Prescription Drug Coverage, is covered by private insurance companies approved by Medicare. People can join this plan by either adding it to their present Medicare plans, or subscribing and paying separate premiums. It covers all costs associated with prescribed drugs for various illnesses according to the plan taken. Health Policy Analysis Essay Paper

Medicaid

Though Medicaid does not directly provide health care, it ensures clients receive their desired health care services by paying hospitals, managed care plans, homes for nursing, doctors, physicians, and nurses for the services they offer. More than half of the amount of money spent by Medicaid, as shown in figure 1 below, is directed to acute health services which include services provided by physicians, services for hospital care, and services for drug prescription. Thirty percent is directed towards services associated with nursing home and many long-term health care services and support. More than fifty percent of all patients in nursing homes are covered by Medicaid, therefore covering half of the total costs of long-term health care (Center on Budget and Policy Priorities, 2008).

About 4% of Medicaid spending is directed towards what is known as disproportionate share hospital payments; costs incurred by Medicaid while reimbursing hospitals for the costs they incur but are not compensated when caring for patients who are not insured. The remaining percentage (about 5%) incurred by Medicare is for administrative purposes. Health Policy Analysis Essay Paper