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Health Care essay: Insurance, Medicare, Medicaid

 

Over the recent years the numbers of uninsured Americans has significantly increased. The 2.2 million recent growth of uninsured is mainly due to age and income changes. At that, most Americans believe that insurance coverage and access to healthcare system are the issues that should be prioritized, and it is the direct responsibility of the federal government to ensure medical care for those citizens that lack insurance, even through raising taxes.

Today, the US society faces the ongoing dilemma of “whether the government should make a major or a limited effort to provide health insurance to the uninsured” (The Henry J. Keiser Family Foundation 1). However, no option has yet got overwhelming support. This indicates that the issue is rather challenging to the society and solid national program is required to present an appropriate solution. There is a high percentage of adolescents that seem not to care about their futures.

Earning and depositing good cash now is a discouraging factor affecting their decisions on federal or state insurance programs. Such strive for immortality is reasonable to a certain extent, however upon retirement the times may change and health problems worsen. Indeed, we are divided almost by half, while there are more co-citizens that would rather not pay additional insurance premiums or taxes to benefit those uninsured.  Consequently, uninsured face more problems with an access to healthcare options, and overall risk their lives in the long run (The Henry J. Keiser Family Foundation 2). For instance, in accordance with The American Cancer Society’s New Advertising Campaign (2007),  “When it comes to dealing with cancer, any delay in detection or treatment, as is common among the uninsured or poorly insured, can be fatal” (as cited in NY Times Editorial 1).

Medicare, as nationwide single-payer health care system, is referred to a social insurance program managed by the US government, which aims to provide health insurance coverage to everyone aged 65 and above, or people that comply with special criteria. In addition, Medicare covers many residency training programs intended for the US physicians. Medicare operates.  The core Act in the US Social Security legislation, - US Social Security Act, was passed by Congress in 1965 (Booske et al., 2005).

As a branch of the (HHS) Department of Health and Human Services, Medicare and Medicaid Centers (CMS) administer Medicare, (SCHIP) the State Children's Health Insurance Program, Medicaid, and (CLIA) the Clinical Laboratory Improvement Amendments. In close cooperation with the Treasury and Labor Departments, CMS implements provisions on the insurance reform with regard to the 1996 Health Insurance Portability and Accountability Act (Booske et al., 2005).

The Social Security Administration is in charge of determination of Medicare eligibility and Medicare premium payments. The Chief CMS Actuary is in charge of providing cost-projections and accounting information to the Medicare Board of Trustees while assisting them in the assessment of the finances distributed for the health part of the program. On annual basis, the Board issues reports providing relevant data on the financial state of affairs of the Medicare Trust Funds (Booske et al., 2005).

The Medicare program initially presupposes that CMS should contracted with private companies to act as intermediaries between the government and medical companies in the matters, involving  payment and claims processing, clinician enrollment, call center services, fraud investigation etc.

In part, Medicare is funded through payroll taxes imposed in accordance with the (1) Self-Employment Contributions Act of 1954 and (2) (FICA) Federal Insurance Contributions Act. The tax rate imposed on the employees is equal to 2.9%, wherein 1.45% is deduced from the employee and 1.45% is covered by the employer respectively. Due coverage is withheld from the salaries, wages and other compensations relevant to employment. Up till December 31, 1993, the law allowed maximum amount of wages subject to the Medicare tax annual imposition. However, since January 1, 1994, the compensation limit was cancelled. Self-employed individuals should pay the whole 2.9% tax from his/her net earnings, though half of the tax is deducted from the income subject to the income tax purposes (Booske et al., 2005).

In 2007 alone, 43 million Americans benefited from Medicare health care coverage which made the program the largest nationwide healthcare payer. According to the forecasts, by 2031 Medicare enrollment will constitute 77 m., after the baby boom generation will enroll in full.

Originally, Medicare program consists of two parts, namely: Part A is referred to hospital insurance), while Part B refers to medical insurance. In rare exclusive cases, the original Medicare program has covered prescription drugs. Since January 2006, Medicare Part D has enabled comprehensive drug coverage. In addition to this, there are so-called Medicare Advantage Plans, generally referred to as Medicare Part C, which enables Medicare beneficiaries to receive all their benefits under Part A, B and D respectively. Finally, all Medicare benefits are regarded as medical necessity (Mobley L, et al., 2005).

The state should develop and implement flexible and available insurance program to benefit all social groups and reduce the increasing numbers of uninsured. I am quite confident in the positive impact and wide public support of such incentive on both federal and state level. Also, I strongly believe that the program will be developed by the authorized team of experts including wide public coverage, social security and insurance experts, doctors and medical staff, and NGOs. Every interested citizen will have an opportunity to express their support or opposition to its statements. In a transparent and unbiased manner our citizens will have an opportunity to express their views within a nationwide survey that would include the most challenging questions that are presently faced by the uninsured. I am sure, that the campaign will find the right and comprehensive approach to the opponents, and therefore they will also be able to benefit from the given options within a program.

The program will get wide media coverage and will become one of the most widely discussed issues on TV news, newspapers, TV shows and Internet. Te related webpage will have an open forum to enable every stakeholder express freely and make own contribution to our overall success (Kenny, 2002).  

Finally, the implementation process will necessitate additional funds. And my plan is to indulge business structures and state reserve budgets to support the program’s initial promotion and subsequent implementation. On the federal and state level we are facing similar problems related to uninsured, therefore our common action will only succeed in mutually beneficial cooperation among all the interested stakeholders. Each stage of the program has its timeline, budget, expected outcomes, and action plan; therefore the program is overall realistic and will be most effective in the long run. Last but not least, the program will benefit every uninsured citizen of our country to boost prosperity of future generations.


References

Booske B, Frees D et al., 2005, “Problems encountered by Medicare beneficiaries in managed Care plans”, Academy Health, Academy Health Meeting, 22: Abstract No. 3625.

Kenny, G. 2002, The importance of nursing values in inter-professional collaboration, British Journal of Nursing, Vol. 11, Iss. 1, 03 Jan 2002, pp 65 – 68

Mobley L, et al., 2005, “Voluntary disenrollment from Medicare managed care: market factors”, Health Care Financing Review. Spring: 26(3): pp. 45-62.

The Henry J. Keiser Family Foundation (2007) Public Opinion on the Uninsured, Retrieved  Mar 1, 2010 from http://www.kff.org/spotlight/uninsured/upload/Spotlight_Jan06_Uninsured-3.pdf

 

 

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