Table of Contents
- Part 1: Definition of the Policy Issue
- Price for a
- How the Issue Is Affecting the Policy Arena
- The Current Politics of the Affordable Health Care Provision to the Low-Incomers and the Aged
- The Level in the Policy Making Process of the Affordable Healthcare Provision for the Low-Income and the Elderly
- Part 2: Policy Analysis Framework to Explore the Issue
- a. Social Analysis
- b. Ethical Analysis
- c. Legal Analysis
- d. Historical Analysis
- e. Financial/Economic Analysis
- f. Theoretical Underpinnings of the Policy
- Part 3: Policy Options/Solutions
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Part 1: Definition of the Policy Issue
The policy issue that is discussed in this paper is the provision of affordable health care insurance for the low-income earners, the aged, and single-parent families. Most people in these social groups live on modest means that are often hardly adequate to cover the costs of their basic necessities, for example, health, or support the simplest quality life. Therefore, the Medicaid Health Insurance Program (Medicaid) would best suit these people. The program has been created by the federal government while the state administers it. It helps in paying medical services, especially of the low-income earners.
Medicaid was introduced in 1965; today, every state has developed its unique program according to the federal guidelines. The federal guidelines are broad, and this fact allows the states to design and administer services that suit their objectives. As a result, the eligibility for Medicaid, as well as the benefits that follow, varies from one state to another. In 2014, the program was providing the health insurance coverage for over eighty million Americans with low income. Besides, each month, it serves more than 31 million children, 19 million adults, 5 million seniors, as well as 9 million individuals living with disabilities. More than 50 percent of all the enrollees are children though they only constitute 20% of Medicaid spending. Less than a quarter of the enrollees are seniors and people, who are disabled in various ways; yet, they account for almost 60 percent of the program spending (Center on Budget and Policy Priorities, 2015). Nevertheless, there has been some health reform that has changed certain features of the Medicaid program coverage, eligibility, and financing.
How the Issue Is Affecting the Policy Arena
The issue of the rising health care costs is a burning problem in the US. Therefore, Medicaid federal funding has been categorized differently in order to meet the spending and needs of different groups. These groups can be divided into the optional and the mandatory (the medically needy) categories. Because the states are flexible in determining the groups that should be covered under the program, the expanded health reform was significant for covering those social groups that had not been considered in the scheme previously. Moreover, because of the program’s flexibility, the eligibility in the non-expansion states is still preserved for working parents, whose incomes are at 45 percent of the poverty line. On the other hand, the non-disabled adults who do not have children still cannot benefit from the unexpanded coverage program that is currently offered in some states.
Moreover, not all low-income earners in the US are eligible for the Medicaid program; for example, childless adults are not eligible in the states that have not expanded their health reform, regardless of how poor such people are. Legal immigrants are also not eligible for the coverage during their first few years in the country, no matter their life and health conditions (Center on Budget and Policy Priorities, 2015). Medicaid has become a counter-cyclical program, the enrollment of which continues to expand in order to meet the needs of all citizens following the effects of the economic downtown.
The Current Politics of the Affordable Health Care Provision to the Low-Incomers and the Aged
Medicaid is playing a vital role in insuring individuals with low-income in the US, especially after the implementation of the Health Reform Law. Importantly, the Affordable Care Act (ACA) covers the poor, as well as low-income American adults, because it has expanded Medicaid to people with income at 138 percent of the poverty line. When the Supreme Court, in 2013, upheld the decision regarding the health reform, the states got an opportunity to decide whether they wanted to expand their programs or not. In fact, after President Obama signed the Patient Protection and Affordable Care Act in 2010 following a prolonged Congressional debate, the implementation was gradual. Evidently, the most important aspects of the act include the Medicaid expansion.
Consequently, several states have expanded their Medicaid programs in order to serve both the poor and low-income earners. The expansion has been viewed as a good financial deal for the various states because the federal government will meet 95 percent of the financial costs for a period of ten years from 2016 to 2025 (Center on Budget and Policy Priorities, 2015). If the federal government covers the cost of expansion, more individuals will be included in the program, and the number of the uninsured will significantly reduce. The Congressional Budget Office (CBO), for instance, estimates that the nonelderly without insurance will fall to nearly 11 percent when the Affordable Care Act is fully implemented (Aaron & Burtless, 2014). The expansion will allow the states, as well as other localities, to save substantially on the uncompensated care, particularly for the uninsured (Center on Budget and Policy Priorities, 2015).
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The Level in the Policy Making Process of the Affordable Healthcare Provision for the Low-Income and the Elderly
The issue has been already passed and ratified. First, in 1965, the Congress came up with Medicaid as a public health insurance scheme aimed to allow for the provision of coverage for the low-income families. Then, in 2010, the Affordable Care Act was signed, and its content includes some Medicaid expansion.
Part 2: Policy Analysis Framework to Explore the Issue
a. Social Analysis
There has been a public realization that there are significant challenges that have to be encountered in the process of re-engineering the health care system of the United States. Therefore, the Medicaid agencies began to search for health delivery strategies that could connect patient with community-based public health, as well as social services. These attempts will help them benefit not only from the existing but also from the new funding strategies and well as policy options that enhance the effective service linkages. It is notable that social factors such as socioeconomic status, individual behavior, as well as physical environment, significantly impact the health outcome and even more than medical care does (Magnan et al., 2012).
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However, most of the current health care expenditures focus on medical services. Moreover, the planning, financing, and delivery of social services is done in isolation. Due to significant misalignment of resources, there have been the calls for developing a new vision system that would be helpful in integrating social and health services. Such a system must be able to coordinate, finance, and assess social services. The federal and state-level policy environments may favor the integration of social and health services because the Affordable Care Act now extends Medicaid to millions of vulnerable Americans, who are in a position to benefit from the integrated services. In addition, many Medicaid agencies and service providers now support the strategies that address unmet social needs of patients. New initiatives that would help integrate social and health services need to learn from the current programs that coordinate social services.
The social framework includes the states’ creating measurable goals that are based on the current needs, situations, and priority. The existing resources of the Medicaid program can be helpful in providing insights regarding the social goals to be targeted. Apparently, the states have been pursuing different goals because of different patient populations. In addition, they have had to determine the types of social services that they need to enhance by identifying both the current gaps and opportunities. In this case, local governments or consumer organizations can help identify the areas where the needs have not been met. For instance, there are cases when communities have the necessary resources, yet they suffer from ineffective linkages between patients, neighborhoods, and providers of resources. Identifying the existing investments in the Medicaid program that could be relocated is another way of supporting the integrated care. A state can prioritize its opportunities using an asset-based approach that considers the strengths and resources of a given community. Regarding the implementation, a road map with clear developmental stages may be used for steering new ideas, as well as expand and bring them to operation. Importantly, the supporters of the hospital insurance program for the elderly have argued and believed that integrating it into the social security is bound to make it legitimate. Since the elderly have the right to enjoy the social security benefits derived from their contributions during the working years, it is only appropriate to note that they (the elderly) have the right to hospital insurance. These considerations persuaded the idea of introducing the national health insurance for the elderly.
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b. Ethical Analysis
Health care reforms are often characterized by ethical issues regarding justice as various groups including individuals, communities, and the legislature strive to provide-quality health care to as many people as possible without compromising their basic rights. The Supreme Court decision that was made in 2012 upheld that the Patient Protection and Affordable Care Act (PPACA) was constitutional. Thus, it guides the states, employers, insurers, as well as consumers, on what is expected from them. For instance, PPACA does not allow insurers to deny cover to an individual because of the pre-existing conditions. Organizations are also not to expand the Medicaid eligibility, subsidize insurance premiums, and give incentives so as to be allowed to offer the health care benefits. In addition, the PPACA does not allow insurance companies to drop clients who become fall sick. The act, thus, may improve the health outcomes at a reduced cost. Americans have four ethical goals that they want to derive from the systems such as Medicaid. Firstly, all citizens want high quality health care. Secondly, they want the freedom to choose when, where, and from whom to find the health care services. Thirdly, Americans want their health care to be affordable so that some resources are set aside for other things. Finally, they want other citizens to share not only the costs but also the benefits that are derived from health care. Even though Americans have common goals concerning health care, significant differences still occur because of different priorities associated with the goals. This issue causes social injustice because people are not treated with the same moral concern (Grace & Willis, 2012). A society where those who are stable financially are able to help those with low income is considered both moral and legal (Knadig, 2011). In a social contract, there is always a balance between individual rights and overall good of the society (Sorrell, 2012).
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c. Legal Analysis
PPACA is viewed as a government’s takeover of the health care system because it mandates all citizens, as well as legal residents, to have health insurance whether from the private insurers or from Medicaid or Medicare (Werhane & Tieman, 2011). However, it must be noted that the act does not require the government to take control of the health system. Instead, it strives to improve access and efficiency through a number of mandates, to which the states, insurers, and health care providers are required to adhere (Sorrell, 2012).
d. Historical Analysis
President Franklin Delano Roosevelt was the first president of the United States to articulate the concept of the right to health care. In his address to the Congress in 1944, he talked about what he considered a set of basic rights and claimed that a proper and sufficient health care, as well as the ability to have good health, was critical (Roosevelt, 1944). The debate on whether the right to adequate health care exists has continued to date; some people claim that it does not exist. Even though the right to health care has never been clearly recognized in the U.S. legislature, the closest has been the Health Care Reform and its amendments (The Patient Protection and Affordable Care Act). However, it is worth noting that the foundation for health-insurance system was laid between the 1930s and 1940s. The first systems such as the National War Labor Board (NWLB) and the Internal Revenue Service (IRS) faced high inflation. Other systems such as the National Health Planning and Resources Development Act (NHPRDA) followed in the 1970s. In the 1980s, there was the Tax Equity and Fiscal Responsibility Act (TEFRA) followed by the Health Insurance Portability and Accountability Act (HIPAA). Immediately before the Affordable Care Act, t the Medicare Reform Act (MRA) was issued.
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e. Financial/Economic Analysis
There have been popular arguments that the centrally planned economies are bound to fail. An example is the collapse of the socialist economies of the Western Europe that passed away between the 1980s and 1990s. According to Sade (2012), PPACA is the latest concatenation that is being used to fix the failed policies in the health care provision in the United States. The lengthy act is said to be suffering from not only Gordian complexity but also several internal contraindications. This fact provides room for making future amendments. The studies conducted by the Congressional Budget Office for Medicaid and Medicare Services indicate that PPACA’s main goals were to promote universal coverage and reduce associated costs. By 2010, the number of uninsured had been expected to drop by 50 percent; however, there still were approximately 23 million uninsured Americans (Sade, 2012). The cost of the act’s full implementation in the 2014-2024 period is expected to reach $2.7 trillion (Sade, 2012).
f. Theoretical Underpinnings of the Policy
Initially, the Medicaid program covered the blind, single-parent families, people with disabilities, children who are under eighteen years old from families with income below the poverty line, and the aged. However, the program has expanded with time and now covers all children and even pregnant women. In addition, families with parents who are not employed can also be qualified for the help. To qualify for Medicaid, an individual has to meet a set of federal and asset standards. The program began with paying the health care services of people who were in need, but could not work. The Patient Protection and Affordable Care Act (PPACA) ensures universal and cheap health care in the United States.
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Apart from various groups that the Medicaid program covers, the other important stakeholders include the states and federal government. In such a manner, the federal government provides the states with funds required for the implementation of the program. It is important to note that the states enjoy the flexibility in choosing the best Medicaid option that suits them based on the health care objectives. There is a nursing position for Expanded Medicaid because, in a bid to promote social well-being, the system gives an opportunity for the nurses to visit patients at their homes and communities with the aim to provide home-based and personalized attention.
Part 3: Policy Options/Solutions
The Medicaid program should not change the idea that it covers low-income earners because this category of the U.S. citizens comprises individuals who cannot meet the ever increasing cost of the health care services. What needs a radical change is the fact that immigrants cannot qualify for the program until after five years of staying in the country even if they currently meet the requirements. The period could be reduced to 24 or 36 months. There is also a need for partial change; especially, the program should not bar families without children from being eligible for the help. The theoretical underpinning for the solutions is that American citizens pay for health insurance in order to enjoy a good health care in their old age. However, the recent negative economic changes may bar people from enjoying their old age, especially if they fail to meet the state requirements. Being a universal need, good health care should be granted to everyone despite their economic situations. Besides, Americans always strive for social justice, so the poor and the elderly should not be left out of the health insurance provided by the government.
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The health advocacy aspects and leadership requirements for no change should help authorities understand the need for equal opportunity and empowerment. For a partial change, there has to be the clarity of purpose. Those to be subjected to the partial choice must know the reasons for this decision. Where there is a need for any radical change, it will be important to put people first by ensuring equal opportunity, listening to complaints, and considering confidentiality.
The clarity of purpose in partial change must be set at the stage of inter-professional collaboration. Apparently, the stakeholders get to know what they are supposed to do and what they are not supposed to do. In the case of radical changes with professional collaboration, any complaints are considered, and appropriate actions are taken. Moreover, there has to be equal opportunity for every professional involved in the change process.
Where there is no change, status quo is to be maintained. This issue can be detrimental in a fast evolving world, where there is an urgent need to remain up-to-date with changes. The failure to change may be costly in a long run. Partial change is beneficial because it sets limits for each stakeholder. However, this option can be disadvantageous if the stakeholder is assigned a change process that one cannot manage. Radical change can cause some complaints that may hinder the working unity; however, with equal opportunity, each stakeholder may work towards achieving the long-term objectives. Such efforts will require close team cooperation for the end result to be less costly because of each stakeholder’s pulling towards a different directio
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