Introduction to Healthcare Policy in the U.S.

Introduction to Healthcare Policy in the U.S.
John E. Clark, PharmD, MS Assistant Professor University of South Florida | College of Pharmacy Department of Pharmacotherapeutic & Clinical Research

Credit & Acknowledgement
Jacqueline Wiltshire, PhD, MPH, Assistant Professor, USF College of Public Health, Tampa, Florida

Learning Objectives At the end of this lecture, student should be able to: Define policy competence Define public policy and health policy Identify the roles of the 3 branches of government in policymaking Identify and compare forms of health policy Explore factors influencing health policy in the US

The Role & Importance of Policy Competence in the Pursuit of Health
“Many public health practitioners fear getting involve with the policy world. There is no question that public health practice is valuable and fulfilling when the task is to gather data, issue reports, and find solutions that modify individual behavior. However, if the nation is ever to achieve optimal population health, then the public health dialogue must include the policy dimension. To advance the health of the population, the public health system must train a work force capable of, and ready to embrace, policy leadership as the inherent and critical element of the profession”. Source: Beaufort B. Longest: Health Policymaking in the United States, p.236

What is Policy Competence?
Abilities to analyze the impact of public policies on one’s domain of interest or responsibility and exert influence in the public policymaking process. Understand the policymaking process as a decision-making process Understand a particular type of decision making include context, participants, and processes

Health Policymaking in the United States, Fifth Edition, 2010
Health Policymaking in the United States, Fifth Edition, Beaufort B. Longest

What is Public Policy? “Authoritative decisions made in the . . .
Legislative (Congressional), Executive (Presidential), or Judicial branches of government (Supreme Court) . . .that are intended to direct or influence the actions, behaviors, or decisions of others”. Source: Beaufort B. Longest: Health Policymaking in the United States, p6.5

Executive Orders of Governor Rick Scott (2016)
# Executive Order declares violation of ethics re: M. Wayne Smith. 2/05/2016 # Executive Order declares State of Emergency due to heavy rain re: Broward, Collier, Glades, Hendry, Lee, Martin & Palm Beach Co. 2/03/2016 # Executive Order declares Public Health Emergency re: Zika Virus. # Executive Order amends re: Christopher John Smith. 2/01/2016 # Executive Order assigns the 6th Circuit to the 13th Circuit re: Jennifer Jeske Greene.

What is Public Policy? Health policies are public policies that pertain to or influence the pursuit of health. Health policies are authoritative decisions made within government that are intended to direct or influence the actions, behaviors, or decisions of others pertaining to health and its determinants.

Different Forms of Health Policies
Health policies can affect groups or classes of individuals, such as physicians, the poor, elderly and children OR Types or category of organizations, such as medical schools, HMOs, nursing homes, pharmaceutical companies, and employers.

Forms of Health Policies
Laws 2010 Affordable Care Act (ACA) 1965 Medicare and Medicaid Law Rules and Regulations Operational Decisions Determining eligibility for Medicare & Medicaid Judicial Decisions The U.S. Supreme Court’s ruling in 2012 to uphold the (ACA)

Judicial Decisions: Whole Women’s Health v. Cole
The petitioners in Whole Woman’s Health v. Cole claimed a Texas law enacted in 2013 would force about 75 percent of the state’s abortion services to close. Two provisions in the law required that doctors at clinics have hospital admitting privileges within 30 miles of the clinics, and that clinics have facilities equal to those of an outpatient surgical center. Texas officials believe the laws protect the health of the women seeking abortions by guaranteeing better care.

Categories of Health Policies
Regulatory Call on government to prescribe and control the behavior of a target group by monitoring the group and imposing sanctions if it fails to comply E.g., the government’s control of the rates at which it reimburses hospitals for care provided to Medicare patients Allocative Involves the direct provision of income, services or goods to a group of individuals or organizations E.g., continuation of health insurance coverage for unemployed workers in the American Recovery and Reinvestment Act of 2009

Principle Features of U.S. Health Policies
Government as subsidiary to the private sector Its fragmented, incremental, piece-meal reform Pluralistic and special interest group politics Decentralized role for the states Impacted by presidential leadership

1. Government as Subsidiary of the Private Sector
Healthcare is not seen as a right of citizenship or primary responsibility of gov’t Americans prefer market solutions over gov’t intervention Private sector plays a dominant role Government responds to most-cited problems Government spending conformed to filing gaps in private sector

2. Fragmented, Incremental, and Piece-meal reform
Mix of gov’t and private insurance give rise to a complex & fragmented system of health care financing in which: Employed are insured by voluntary insurance through employee and employer contributions Elderly are financed through Social Security tax revenues The poor are insured through federal, state, and local revenue Special populations (Veterans, Native Americans) insured directly by the federal gov’t

3. Pluralistic and Interest Group Politics
Role of interest groups and incremental policies result from compromises designed to satisfy demands of Interest groups (e.g., AMA, AARP, AHA) Employers Consumer groups Manufacturers of Technology Alliances (diverse interest groups form alliances among themselves & members of legislative body)

4. Decentralized Role of the States
Most incremental policy actions originate at the state level State finance much of the health care for the poor and disabled (e.g., Medicaid, SCHIP) Quality assurance & oversight of health care practitioners and facilities Regulate health care costs and insurance carriers Health personnel training Authorization of local gov’t health services

5. Impact of Presidential Leadership
Americans look to presidential leadership for major changes in health policies Presidents can influence outcomes through compromise Lyndon B. Johnson help pass Medicare & Medicaid Harry Truman helped pass the Hill-Burton Hospital Construction Act Barack Obama helped pass the Affordable Care Act

Summary Health policy are authoritative decisions made within gov’t intended to direct or influence the actions, behaviors, or decisions of others pertaining to health and its determinants Authoritative decisions are made in legislative executive, and judicial branches of gov’t Health policies can take the form of laws, rules and regulations, operational decisions & judicial decisions Health policies can be broadly defined as regulatory or allocative Health policies are driven by the private sector, piece-meal reform, special interest groups, decentralized role of the states, and presidential leadership

Questions What is health policy? What forms do health policy take?
Compare and contrast the two basic categories of health policies. Discuss the connection between health policies, health determination, and health What are the principle features of US health policy?

Resources Longest, B. B. (2010). Health Policymaking in the United States, Health Administration Press. Shi, L., Singh, D. A. (2011). Essentials of the U.S. Health Care System, Jones and Bartlett Publishers Inc.

John E. Clark, PharmD, MS, FASHP
Medicare and Medicaid: Healthcare Policy for the Retired, Elderly, and the Poor John E. Clark, PharmD, MS, FASHP Assistant Professor, College of Pharmacy University of South Florida

Learning Objectives Describe the Medicaid healthcare program
Identify the eligibility requirements for Medicaid List the services covered by Medicaid Describe how Medicaid is financed Describe the impact of healthcare policy on how Medicaid is Financed How is the US healthcare system organized today? What kind of healthcare system do you think we had? 26

Creation of Medicare and Medicaid
Before 1965, only private health insurance available Americans were against government-sponsored health care except for special classes – poor, and now seniors Original Medicare bill started in 1957 AMA discredited it Liberal congress people said “humiliating” to elders States resisted implementing 1965 – Lyndon Johnson made top priority Medicare and Medicaid born together Medicaid had stigma of class that Medicare did not have Medicare expanded to cover disabled, ESRD Over the years, has caused state/federal budgets to grow astronomically 1997 – Originally HCFA – now CMS Medicare/Medicaid brought more regulation How is the US healthcare system organized today? What kind of healthcare system do you think we had? 27

Comparisons Between Medicare and Medicaid
Category Medicare Medicaid Coverage Covers all elderly persons, nonelderly disabled persons on Social Security, and nonelderly persons with end-stage renal disease Covers only the very poor Income No income/means test Income criteria established by states (means test) Class No class distinction Public welfare Services Part A for hospitalization and short-term nursing home stay Part B for physician and other outpatient services All services are covered under one program Uniformity Nationally uniform program Program varies from state to state

Comparisons Between Medicare and Medicaid
Category Medicare Medicaid Laws Title 18 of the Social Security Act Title 19 of the Social Security Act. Financing Part A financed through Social Security taxes Part B subsidized through general taxes, but the participants pay part of the premium cost. Financed by the states, with matching funds from the federal government according to each state’s per capita income. Which of the following people are likely to qualify for Medicare or Medicaid, and which would he/she qualify for? A poor but non-disabled 20-year-old in Mississippi? A 70-year-old disabled person in New Orleans? A 30-year-old blind person who lives in New York?

Medicare and Medicaid History
Medicare, Medicaid was enacted as a federal-state program in the 1960s to provide medical services for the indigent. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Medicare has evolved into Original Medicare – provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States.

The Medicare and Medicaid bill passed in 1965 consisted of two parts: Part A covered hospital services Part B covered doctors' services Added Part D – covers prescription drugs Part C – Medicare Advantage The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

What is Medicaid Created by Congress in 1965, Medicaid is a public insurance program Medicaid is an “entitlement” program, which means that anyone who meets eligibility rules has a right to enroll in Medicaid coverage. Medicaid is a counter-cyclical program. In other words, its enrollment expands to meet rising needs during an economic downturn, when people lose their jobs and their job-based health coverage. Medicaid is funded jointly by the federal government and the states. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Who Does Medicaid Cover?
In 2014, Medicaid provided health coverage for 80 million low-income Americans over the course of the year* And in any given month, Medicaid served: 31 million children, 19 million adults (mostly low-income working parents), 5 million seniors, and 9 million persons with disabilities The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States *Congressional Budget Office (CBO) estimates

How Does Medicaid Operates
Each state operates its own Medicaid program within federal guidelines. States have a great deal of flexibility in designing and administering their programs. Medicaid eligibility and benefits can and often do vary widely from state to state. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Who is Eligible for Medicaid?
Medicaid is an “entitlement” program, which means that anyone who meets eligibility rules has a right to enroll in Medicaid coverage. States have guaranteed federal financial support for part of the cost of their Medicaid programs. In order to receive federal funding, states must cover certain “mandatory” populations: children through age 18 in families with income below 133 percent of the federal poverty line ($25,975 for a family of three in 2013); pregnant women with income below 133 percent of the poverty line; parents whose income is within the state’s eligibility limit for cash assistance that was in place prior to welfare reform; and most seniors and persons with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

States may also receive federal Medicaid funds for the costs of covering additional, “optional” populations, including: pregnant women, children, and parents with income above “mandatory” coverage income limits; seniors and persons with disabilities with income below the poverty line; “medically needy” people — those whose income exceeds the state’s regular Medicaid eligibility limit but who have high medical expenses (such as for nursing home care) that reduce their disposable income below the eligibility limit; and poor non-disabled adults without children. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Medicaid eligibility currently varies significantly from state to state. States have broad flexibility to determine which groups they will cover and at what income levels. While 28 states and the District of Columbia have expanded Medicaid coverage under health reform to parents and childless adults up to 138 percent of the poverty line, eligibility levels remain low in the remaining states. In the typical non-expansion state, Medicaid eligibility is now limited to working parents with incomes at 45 percent of the poverty line and is not available at any income level to non-disabled adults without children. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Who is Not Eligible for Medicaid?
Not all low-income Americans are eligible for Medicaid. Childless adults — that is, those over 21 who are not disabled, not pregnant, and not elderly generally not eligible for Medicaid in the 22 states that have not adopted the health reform expansion, no matter how poor they are. Legal immigrants are barred from Medicaid for their first five years in this country, even if they meet all of the program’s eligibility requirements. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

What Services Does Medicaid Cover?
Medicaid does not provide health care directly. Instead, it pays hospitals, physicians, nursing homes, managed care plans, and other health care providers for covered services that they deliver to eligible patients. Hospitals, physicians, and other health care providers are not required to participate in Medicaid, and not all do. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

What Services Does Medicaid Cover?
acute-care services such as hospital care, physician services, and prescription drugs (67%) nursing home and other long-term care services and supports (30%). low-income uninsured patients physician, midwife, and certified nurse practitioner services inpatient and outpatient hospital services; laboratory and x-ray services; family planning services and supplies; rural health clinic/federally qualified health center services; nursing facility and home health care for adults over age 21; and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for children under age 21.

How Is Medicaid Financed?
Medicaid is financed by state and federal governments The federal government contributes at least $1 in matching funds for every $1 a state spends on its Medicaid program, whatever those costs may be. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Impact of Healthcare Policy on How Is Medicaid Financed?
State policies have a large impact on the amount the federal government spends on Medicaid, not only because states are guaranteed federal Medicaid matching funds for the costs of covered services furnished to eligible individuals, but also because states have broad discretion to determine who is eligible, what services they will cover, and what they will pay for covered services. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

SUMMARY Created by Congress in 1965, Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. Medicaid is funded jointly by the federal government and the states. Each state operates its own Medicaid program within federal guidelines. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

SUMMARY State policies have a large impact on the amount the federal government spends on Medicaid, not only because states are guaranteed federal Medicaid matching funds for the costs of covered services furnished to eligible individuals, but also because states have broad discretion to determine who is eligible, what services they will cover, and what they will pay for covered services. The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

CASE STUDY You are a member of the governor’s state Medicaid Advisory Group. The Medicaid Director of the state of Florida has been given a charge by the governor to slow the state’s rising Medicaid bill (cost). The following are your main options; what are the pros and cons of each? Convince the legislature to cut the eligibility levels Impose administrative burdens (policies) making it more difficult to apply for coverage Cut benefits Cut reimbursement Cut pharmaceutical costs Reduce fraud and abuse Impose co-pays Encourage more managed care Cut long-term care costs The elderly and the poor were among the most medically needy in society and were the least likely to be covered by an employer's health insurance plan. To keep doctors from opposing a newly proposed legislation - which led to Medicare and Medicaid - legislators agreed that the government would reimburse doctors at their "usual, customary, and reasonable rate" for taking care of the elderly and the poor. This means doctors stood to gain a great deal from Medicare. The bill was passed in 1965 and consisted of two parts: Part A covered hospital services Part B covered doctors' services In addition to Medicare, Medicaid was enacted as a federal-state program to provide medical services for the indigent. Although both programs started small, expenditures in Medicare and Medicaid grew dramatically in the late 1960s as the programs began to gear up. Since then, Medicare has evolved into Original Medicare - provided by the government - and Medicare Advantage - provided by private insurance companies that contract with the government to provide this insurance to seniors. By 2001, Medicare and Medicaid made up 32 percent of all healthcare expenditures in the United States

Introduction to Healthcare Policy in the U.S.

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