Health Care Reform 2010 Health And Social Care Essay

Published Date: 23 Mar 2015

US healthcare system was inefficient despite of spending 15% of GDP during 2006 which was more than three times than in 1960. Ten years back, the health care system of USA was announced to be broken and in future it didn't improve. Managed care did not make visible the fixes promises. The rates of premium are increasing. The irritation of patients as well physicians flourish. The study shows that about 45 million people in Americans are still uninsured.

In the coming future, these issues will get worse and new challenges will come on the screen. New technology is making place and it is making the things efficient, but the cost of treatment as well new test is higher then before. Doctors are making the lives of people lengthy so now more people require the medical treatment then before. As the age of baby is increasing so they are demanding the better treatments.

Owing to the increased cost, employers will not accept the status quo. Sp they exclude the benefits for new hiring. Others might leave the business of insurance business completely and will contribute only to cover the costs but will not give coverage by themselves. The number of uninsured people in America will increase because of these changes. Disenfranchised middle class will rise in results of these changes. Employers will go for and favor this modification.

The health care system of American splits the population into two groups first is insiders and second is outsiders. Insiders are those who are insured and they have good insurance so they get everything modern. No matter hoe expensive the medicine and treatment is. Outsiders are those who have poor insurance plan or nothing at all. They receive very little out of their insurance plans. About 47 million Americans are uninsured and the number is growing day by day.

Insurance companies currently deny covering people with pre-existing conditions. People who have severe medical conditions like AIDS, cancer and other such diseases were not covered by the insurance companies. These people are at high-risk and that's why not covered by companies. Major employers are cutting their costs in healthcare spending to compete in the global challenging market. [2] Employers are denying paying insurance premiums to these workers due to high premiums and the current economic situations. Employers are shifting the economic burden towards the employees like deductibles and co-pays. Almost half of the bankrupt people are due to the high medical costs and this cost is directly or indirectly affects the economy. Hence, government has to pay more. One more problem in the current system that doctors are not paid according to their service quality. Doctors are paid very less as compared to other countries of globe like in United Kingdom, doctors are paid for 95% while in US only 30%. Lot of people even did not go to doctor due to high costs of tests, treatment or follow-up after the treatment. These higher costs associated with healthcare also stopped Americans visiting physician regularly for checkup. Also doctors do not know the history of patients due to not visiting them regularly. Americans also have high ratio of chronic diseases. This is also leads to more spending on healthcare and its availability to poor people. United States is the only country among the developed countries whose all citizens do not have access to its citizens except South Africa [3] .

Medicare and Medicaid are two of government programs which provide medical as well as health related services to the specific group of people in USA. Both of them are different but are managed by the centers of Medicare and Medicaid which is a division of US Department of Health and Human Services.

Medicaid is a program which includes means tested health and medical services for specific individuals and families who have low income and limited resources. It is primarily looked after at federal level, but each stat develops its own standards like eligibility standards; determines the amount, type, period and scope of the services; setting the rate of payment for services; administers its own Medicaid programs.

As mentioned above that States is the final decision authority of planning of service which will be provided under their Medicaid program. But there are some necessary requirements which must be matched by the States to receive funding from Federal. Following are the mandatory services:

Impatient and Outpatient hospital services

Prenatal care

Children Vaccines

Service of Physician

Facility of Nursing services for individuals aged 21 or older

Services of Family planning with supplies

Rural health clinic services

Home health care for persons eligible for skilled-nursing services

Laboratory and x-ray services

Pediatric and family nurse practitioner services

Nurse-midwife services

Federally qualified health-center (FQHC) services and ambulatory services

Early and periodic screening, diagnostic, and treatment (EPSDT) services for children under age 21

Besides the above, the states can add more 34 optional approved services and can receive the Federal matching funding. Although each state has the authority to set the eligibility criteria for getting the Medicaid services but basically the program has been started to help the people with low income. Other requirements may include age, pregnancy, disability, other assets and citizenship.

Medicaid does not pay money to the individuals. Medicaid program works like a program provide treatment to the individuals and gives payment to the health care providers. State makes the payment while states receive reimbursement from Federal Government. Medicare is a Federal health program of insurance. It pays for elderly and certain disabled Americans to hospitals and medical care.

The program is divided into 4 parts: Part A, B, C and D. But two main parts for hospitals and medical insurance are Part A & B. Part A may be known as Hospitals Insurance, pays for the hospital stays and it includes meals, supplies, semi private rooms and testing. It also pays for home health care.

Part B which is known as Supplementary Medical Insurance. It pays for physicians visits, home health care costs, outpatient hospitals, and other services for aged and disabled. It covers durable medical equipments, certain vaccinations, blood transfusion, lab and diagnosis tests, X-rays, chemotherapy, hormonal tests and eyeglasses. Part B requires a certain premium which caries each year.

Part C is also known as Medical Advantage Plan because it allows the users to design a custom plan that can be more helpful and align to the needs of their medical needs.

Part D includes the prescription drug plan. It is administered by one of many private insurance companies. Eligibility for Medicare requires a US citizen or continuous 5 years legal resident of US must be at least 65 years old or under 65 and disables or any age person with End Stage Renal Disease. Payroll taxes which are collected through Federal Insurance Contributions Act and Self Employment Contributions Act are the major elements of funding for Medicare.

US healthcare reforms bill 2010 will cost $940 billion over the period of ten years. [4] This bill will cover 32 million American people who are uninsured. Health Insurance can be purchased through state-based exchanges and financial subsidy will be offered to the income below 133 percent and 400 percent of poverty level in US. Tax relaxations will be offered to the small business to purchase employee insurances. People who are availing subsidies will not be eligible for Medicare, Medicaid and also for employer covered insurance. New tax will be imposed in 2012 at rate of 3.8 percent on income of families making over $250,000 per year. Insurance reforms will be introduced and insurance companies won't deny to the people and children with pre-existing conditions. Medicaid will expand to include 133 percent of the poverty level in United States. In 2014, everyone must purchase a insurance or face the annual fine fees. Employers who have more than 50 employees must provide insurance to their employees or face a fine on the basis of per worker. Illegal immigrants can not avail insurance even if they pay their own money. Abortion insurance will be paid by private money and it will not be subsidized by federal or tax payer funds.

Republican offered an alternative program on the basis of four common-sense reforms which can be afforded by people of US named as Common-sense healthcare reform. It includes that all businesses and families can buy insurance across US. The second point is that individuals, small businesses and trade associations can acquire insurances at lower costs by combine efforts. It also allows states to lower costs by creating innovative reforms. The last reform is to finish the lawsuits which must be obeyed by doctors because of getting sued by Police. This will end the high cost tests and other procedures which are actually not required by the patients.