Financial Effects On Patients And Care Providers
Financial institutions in healthcare are vital for the continuity and access to healthcare services. The government invests in financial institutions to promote continuity, quality, and sustainability of healthcare services. Medicare and Medicaid are long-standing healthcare financing institutions that focus on vulnerable populations. These institutions serve different populations. Recent Medicare expansion has faced varying acceptance rates, and some states have failed to adopt the expansion. This essays analyses Medicaid and Medicare, the populations they serve, the acceptability of Medicare expansion in US states, the role of FNPs when dealing with Medicaid and Medicare patients. Financial Effects On Patients And Care Providers
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Medicare and Medicaid
Medicare and Medicaid date back to 1965 when US President Lyndon B. Johnson signed the legislation that allowed Medicare and Medicaid programs. The primary drivers for passing the legislation were the economic security of the nation and the increasing need for social security (Pestka et al., 2020). Healthcare access was a significant problem, and poor access to healthcare services was a leading cause of high mortality and morbidity among US citizens. The low-income families were affected most, and healthcare institutions exploited them. There was also a need to standardize the care quality in healthcare institutions to ensure the healthcare costs matched the quality of healthcare services they provided (Galan, 2020). The original Medicare program comprised two parts, A and B: health and medical insurance. In 1972, the law expanded the Medicare program to increase program accessibility making it accessible to other individuals besides older adults. Individuals covered the disabled, end-stage renal disease (ESRD) requiring dialysis or kidney transplant, and elderly above 65 years (CMS, 2021). Medicare has expanded to include other programs through legislation such as the Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) (Galan, 2020)Financial Effects On Patients And Care Providers. Medicaid gave medical insurance to individuals getting cash assistance and other benefits, such as those employed but earning significantly low wages.
Populations Served by Medicare and Medicaid
Medicare and Medicaid offer different healthcare services. The primary target populations for Medicaid are low-income families, children, palliative care patients, pregnant women, and physically challenged individuals of all ages (CMS, 2021). Medicare offers its services to individuals above 65 years old, those with 24 months of social security disability benefits, and individuals with end-stage renal disease or amyotrophic lateral sclerosis (CMS, 2021). Older adults, people with disabilities, and permanent disabilities such as ESRD are eligible for Medicare and Medicaid. Medicare and Medicaid services are not limited to these populations, and their programs are far-reaching and serve other populations. States determine their population needs and tailor these programs to meet these needs. MMA (a Medicaid program) changed access to prescribed drugs and increased community drug reimbursement rates and healthcare financing (Pestka et al., 2020)Financial Effects On Patients And Care Providers. The program changed drug payments and access, outpatient department flow, and hospital admissions (Li et al., 2021). The premium adjustments in prescription drugs also decreased disparities between wealthy and low-income families. Medicare and Medicaid roles are often confused because they both serve vulnerable populations. Unlike Medicare, Medicaid offers health insurance services to the populations getting some cash assistance.
State Medicaid Expansion Status
Medicare and Medicaid have varied acceptance in the various US states. Heated debates regarding their effectiveness and efficacy have created the acceptance disparities of these programs. Georgia State is one of the states that have not adopted the Medicaid expansion in the US. Other counties that have not adopted the expansion are Texas, Florida, and South Dakota.
Reasons for not Adopting Medicaid Expansion
Medicaid expansion was targeted to reduce the number of poor, uninsured individuals who did not attain eligibility for the Medicaid program. The expansion includes individuals with salaries above the mark but not reaching the eligibility level for tax credits and childless adults. Individuals with salaries above the mark are subject to taxation and other benefits such as healthcare insurance and tax credits. Thus, they have access to healthcare services compared to this group. By January 2021, 12 states had not adopted the Medicaid expansion, limiting adults’ access to these services. One primary reason for not adopting Medicare expansion is the lack of a clear funding plan. States such as Missouri ruled out the expansion because it was passed using a voting measure but lacks an elaborate funding process (Sanchez, 2020). Some states argued that they were not allowed enough time or participation in the program’s planning. Some states, such as Texas, cited that the programs are poorly managed, financially burdening, and unsustainable (Sanchez, 2020). Including the new group in the insurance coverage significantly reduces uninsured rates in all demographics but places a heavy burden on the existing scarce financial resources (Mazurenko et al., 2018)Financial Effects On Patients And Care Providers. These programs increase reliance and dependence on the government, which can strain its resources for other sectors’ development. Other states, such as South Dakota, opted out of the expansion for fear of the government’s inability to sustain the program’s funding, leaving the burden to the state governments.
Medicaid expansion to cover these individuals would significantly decrease the rates of uninsured individuals. Failing to adopt Medicaid expansion will significantly affect healthcare costs, access, and utilization. Financial implications include non-adjusted funding from the federal government and decreased progress in these states (Sanchez, 2020). In addition, the uninsured rates will remain significantly high in these states hence the need for change. However, these states provided reasonable arguments for their failure to adopt the expansion. The federal government should devise robust funding strategies and consult these states in planning the expansion to increase the program’s acceptability.
Role of the Nurse When Interfacing with Medicare and Medicaid Patients
Medicare and Medicaid are vital financial institutions for primary care. They increase healthcare access to vulnerable populations. As an FNP, the nurse acts as a patient advocate promoting access to healthcare services. The FNP plays various roles. One of the primary roles is increasing the population’s knowledge of these healthcare financing programs (Jorgensen, 2019). Increasing individuals’ knowledge helps them seek these services. The federal government carries out Nationwide structured campaigns to increase healthcare insurance coverage in the US. Insurance increases access to primary and advanced healthcare. FNPs also ensure individuals eligible for these programs receive the services. FNPs are patient advocates, and ensuring patients have insurance covers helps ensure care continuity (Jorgensen, 2019). FNPs should ensure they implement cost-effective interventions when dealing with these patients. FNPs advocate for the effective use of healthcare resources to minimize and exclude resource-extensive activities and help reduce the high healthcare costs of more than seventeen percent of US GDP (Jorgensen et al., 2019)Financial Effects On Patients And Care Providers. Hence, advanced practice nurses have major roles when dealing with Medicare and Medicare patients.
Conclusion
Medicare and Medicaid have been long-standing healthcare financing institutions targeting vulnerable populations such as the poor, elderly, pregnant, and disabled patients. Recent Medicare expansions target childless and poor adults who earn above the Medicaid program’s limit but live in poverty. States that have not adopted Medicaid expansion cite a lack of a clear funding plan for the program, lack of involvement in making the decisions regarding the program, poor management, and fear of federal funding failing to sustain the program. FNPs promote Medicare and Medicaid by facilitating access to healthcare by sharing the information, advocating for the rights of these patients, and utilizing resource-sensitive activities that reduce healthcare resources wastage.
References
Centers for Medicare and Medicaid Services (CMS), (2021). CMS’ Program History. https://www.cms.gov/About-CMS/Agency-Information/History
Galan, N., (2020). What are Medicare and Medicaid? MedicalNewsToday. https://www.medicalnewstoday.com/articles/what-are-medicare-and-medicaid
Jorgensen, A. L. (2019). Nurse influence in meeting compliance with the Centers for Medicare and Medicaid Services quality measure: early management bundle, severe sepsis/septic shock (SEP-1). Dimensions of Critical Care Nursing, 38(2), 70-82. https://doi.org/10.1097/DCC.0000000000000340
Li, M., Yuan, J., Dezfuli, C., & Lu, Z. K. (2021). Impact of Medicare prescription drug (Part D) coverage expansion on utilization and financial burden of benzodiazepines among older adults: an interrupted time series analysis. BMJ Open, 11(12), e053717. http://dx.doi.org/10.1136/bmjopen-2021-053717
Mazurenko, O., Balio, C. P., Agarwal, R., Carroll, A. E., & Menachemi, N. (2018). The effects of Medicaid expansion under the ACA: a systematic review. Health Affairs, 37(6), 944-950. https://doi.org/10.1377/hlthaff.2017.1491
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Pestka, D. L., Zillich, A. J., Coe, A. B., Farris, K. B., Adeoye, O. A., Snyder, M. E., & Farley, J. F. (2020). Nationwide estimates of medication therapy management delivery under the Medicare prescription drug benefit. Journal of the American Pharmacists Association, 60(3), 456-461. https://doi.org/10.1016/j.japh.2019.12.002
Sanchez, D. (2020). Impacts of Medicaid Expansion in Two Early Expansion States and the Case for Medicaid Expansion in Missouri (Doctoral dissertation, University of Missouri–Kansas City). https://hdl.handle.net/10355/75287 Financial Effects On Patients And Care Providers
