The healthcare delivery system in the U.S. is complicated and more expensive than in neighboring Canada and other countries. Some people go into debt or file for bankruptcy because of their inability to pay medical bills (Banegas et al., 2016). To provide people with affordable health services, the government of the U.S. developed programs for its citizens that ease the financial burden that results from high prices of healthcare interventions and pharmaceuticals. While both Medicare and Medicaid are a means of providing financial support to those who are incapable of paying their medical bills, they have foundational differences and should be visibly distinguished from each other.
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Medicare and Medicaid History and Target Populations
Since private health insurance does not address the challenges with access to treatment for many groups of the U.S. population, the government was forced to expand its participation in financing healthcare (Marmor, 2017). With these goals, in 1965, Medicare and Medicaid national health insurance programs were established (Marmor, 2017). Medicare is the U.S. national health insurance program for people 65 years of age or older. It was created to work with citizens of retirement age who want to overcome their health-related issues (Marmor, 2017). Some people under the age of 65, such as people with disabilities, individuals with persistent renal failure, or amyotrophic lateral sclerosis can also participate in the Medicare program (Marmor, 2017). Despite these limits in coverage, Medicare has a vital role in U.S. healthcare.
It is essential to know the boundaries of the program and how it is financed. The insurance helps pay for medical care, but it does not cover all expenses, and not all costs for long-term treatment are reimbursed (Marmor, 2017). The program relies on funds deducted from corporate income tax, progressive tax, and payroll tax (Marmor, 2017). As part of this initiative, hospitals receive up to half of their budgets from Medicare funds (Marmor, 2017). Most often, the program is used for some preventive services, to undergo inpatient treatment, or to be able to call a doctor at home for some therapeutic procedure (Marmor, 2017). It is also possible to have a diagnostic examination or spend a short time in a nursing home (Marmor, 2017). Unfortunately, the program does not cover lengthy hospitalizations and is not designed for disabled retirees who need pharmaceuticals or medical equipment.
Medicaid is an American state medical care program for people in need of financial assistance. The program is implemented at the state level with the support of federal authorities. Medical assistance is provided to people with incomes below the official poverty line, but this characteristic is not the only criterion that is assessed. The program assists U.S. citizens and foreigners residing legally in the country. A significant part of the participants are children from low-income families or their families as a whole. The most substantial expenses are targeted at those who are in long-term care homes, as well as medical care for the disabled. While Americans fully support the Medicare program, since workers are charged income tax, and upon retirement, they receive the necessary assistance, Medicaid is effectively a charity program.
The former U.S. president Obama, as part of his Affordable Care Act (ACA), attempted to introduce a Medicaid expansion to assist more low-income Americans. It meant that states had to increase their healthcare expenditures to provide the necessary financing (Miller, Altekruse, Johnson, & Wherry, 2019). The Supreme Court, however, decided that it was illegal to force states to expand their programs (Miller et al., 2019). Left with the freedom to make their decisions, 14 states chose not to expand Medicaid (Miller et al., 2019). The primary argument that was used against the expansion was that it would put the U.S. economy at significant risk (Miller et al., 2019). Private hospitals also shared their discontent because the ACA would result in a decrease in their profits (Miller et al., 2019).
The number of states which adopted expansion is more than the ones that refused. From the 37 states that favored adoption, including the District of Columbia, three have yet to implement the expansion strategy (The Kaiser Family Foundation, 2019). Iowa, where I am from, implemented the expansion on January 1, 2014 (The Kaiser Family Foundation, 2019). Today, American society is waiting for the rest of the states to join as it would result in favorable health outcomes for millions of people.
My Role When Interfacing Medicare and Medicaid Recipients
As a nurse leader, I will have to battle both prejudice and management pressure to be able to deliver the best service to patients. My role will be to facilitate effective communication between the hospital and patients, and ensure that insured clients receive the same service like the ones who pay the full price.
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Conclusion and Implications for Nursing Practice
Both Medicare and Medicaid have an impact on hospital budgets and financing. As private hospitals strive to make more profit, nurses will experience cuts in resources. Such events may create difficulties in relationships between healthcare providers and Medicare/Medicaid recipients.
Banegas, M. P., Guy Jr, G. P., de Moor, J. S., Ekwueme, D. U., Virgo, K. S., Kent, E. E.,… Yabroff, K. R. (2016). For working-age cancer survivors, medical debt and bankruptcy create financial hardships. Health Affairs, 35(1), 54-61.
The Kaiser Family Foundation. (2019). Status of state Medicaid expansion decisions: Interactive map. Web.
Marmor, T. R. (2017). The politics of Medicare. New York, NY: Routledge.
Miller, S., Altekruse, S., Johnson, N., & Wherry, L. R. (2019). Medicaid and mortality: New evidence from linked survey and administrative data. Retrieved from National Bureau of Economic Research. (w26081).