Evolving Coverage of the Medicare Program

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When it started, the Medicare program of the federal government involved two coordinated plans available for elderly people aged 65 and over. The first one consisted of the hospital insurance plan. It included hospital and related services. On the other hand, there was the voluntary supplemental medical insurance plan. Such partial contribution provides, in part, for physician’s fees and the cost of medical services (U. S. Census Bureau, the Official Statistics, 1998). However, history proved that the original group of persons covered by the Medicare program is not the only one who needed medical coverage.

The decreasing status of health of a big chunk of the American population indicated that there are a lot more members of the population who are not receiving the health care services they need to ensure their health (Andersen, Rice & Kominski, 2001; Brayton Purcell LLP, 2007). Thus, Medicare found itself being transformed over the years in order to expand its coverage to include under its umbrella certain other categories of persons deemed eligible for government-funded health care coverage. Between the period of 1970 and 1974, Medicare coverage was expanded to include persons with disabilities even though they are below 65 yrs.

old (Andersen, Rice and Kominski, 20001). Specifically, Medicaid expanded its coverage to include “disabled beneficiaries of any age after 24 months of entitlement to cash benefits under the social security or railroad retirement programs and to persons with end stage renal disease” since July 1973 (U. S. Census Bureau, the Official Statistics, 1998). After four decades of evolving and expanding its coverage, the Medicare program succeeded in casting a wider net to include 42 million people, composed of people who are elderly or with permanent disabilities (The Henry J.

Kaiser Family Foundation, 2007). The Medicare program proved itself to be a valuable service for most poor people of the country, because it ensured that the elderly and those with permanent disabilities would receive basic health services (Andersen, Rice & Kominski, 2001). After the expansion of the coverage of the government program, these beneficiaries included individuals who are aged, pregnant, disabled, blind, or those families with dependent children (U. S. Census Bureau, the Official Statistics, 1998).

Basic health services under the Medicare program are provided in all states. Some states even provide automatic application when they elect to provide eligibility to all cash welfare recipients (U. S. Census Bureau, the Official Statistics, 1998). While the program is formulated and budgeted at the federal level, the determination of eligibility and the implementation of the program are devolved at the state level. In determining the eligibility of citizens to the government program, states are required to follow strict guidelines set by the federal government.

This arrangement enabled the program to be implemented under the discretion of the individual states, while at the same time making sure that the federal policy is implemented. The determination of eligibility of the American population is left to the individual states; however, there are specific federal guidelines that ensure the fairness of the eligibility criteria adopted by the respective states. In addition, these guidelines regulate the health services provided by the respective states to program recipients (U. S. Census Bureau, the Official Statistics, 1998).

Thus, the Medicare program is able to assist families who could not afford the cost of health care insurance (Andersen, Rice & Kominski, 2001). While cold facts still support the conclusion that private health insurance provides the best coverage to people, it cannot be denied that government-funded health care programs, such as Medicare and Medicaid coverage serve as effective counterparts of private health insurance coverage. These government programs provide rates of services that equal those provided by private institutions.

These programs likewise provide the needy with access and use of medical services that are comparable to those available to the privately insured (Long, Coughlin & King, 2005). More importantly, these programs serve as reliable sources of health care coverage at that point in their lives when they need medical care the most (Long, Coughlin & King, 2005). The Medicare program is an effective way of providing health care coverage to those who need it the most. However, there would be no serious contradiction to the proposition that current governmental programs on health care administration are far from being sufficient.

The rate of uninsured population never decrease with the passing of time, and yet the rising cost of health care services further aggravates the situation and raises the number of uninsured people even more. The Uninsurance Problem The government’s problem on uninsurance consists mainly in the continuous rise of the number of people who are uninsured. Statistics provided by the Annual Social and Economic Supplement (ASEC) to the Current Population Survey (CPS) in the year 2003 shows that there were 43. 6 million Americans who had no health insurance in that period. This huge number constitutes 15.

5% of the entire American population (Brayton Purcell LLP, 2007). The demographics of the insured and uninsured population show the sources of insurance for those who belong to the former group, and the underlying reasons for the people’s classification in the latter. Health insurance coverage of the people who are lucky enough to receive coverage comes from multifarious sources. These sources include government subsidy, private employers, and personal funds. In the year 2003, employment-based health insurance supported the health care coverage of a large majority of the insured population, which amounted to 60.

4% (Brayton Purcell LLP, 2007). A much smaller percentage amounting to only 26. 6% of the insured population relies on government-provided health coverage (Brayton Purcell LLP, 2007). Negative Effects of Uninsurance The big part of the population that has no access to health care services due to lack of health care coverage has more chances of being found in poor health if compared to those who do have coverage (Butler). In particular, the uninsured population suffers most from their condition on the aspect of preventive care.

This includes dental care and cancer screenings (Brayton Purcell LLP, 2007). Data for 2003 alone shows that the uninsured suffers from inadequate or total absence of preventive health care services, such as dental care, flu shots, mammograms, and many others. In the said year, 15 million uninsured adults did not have dental care and 3 million uninsured adults did not have mammograms. In addition, flu shots and cancer screenings for prostate and cervical cancers were not made available to 27 million and 7 million uninsured adults, respectively. (Brayton Purcell LLP, 2007).

Clearly, those members of the population who have no health care coverage have less access and opportunity to use medical services, vis-a-vis those members of the population who have health care coverage (Hadley and Holahan). Consequently, the uninsured population has higher mortality rates, since they receive less preventive or therapeutic care. Moreover, they are commonly diagnosed at more advanced states of a disease, making recovery more difficult. The uninsured also have higher number of deaths among them because they receive less therapeutic care after diagnosis (Hadley and Holahan).

Another aspect of the problem of uninsurance is its prevalence. Many states of the union are beset with problems regarding the high uninsurance rates among their respective jurisdictions. In 2003, Texas, Louisiana, Mississippi, and New Mexico had the highest rates of uninsured working adults, with 27%, 23%, 22%, and 22% uninsured population respectively (Brayton Purcell LLP, 2007). Fortunately, there are also other states such as Minnesota, Hawaii, Maryland, and Iowa, which had low rates of uninsured people with 7%, 7%, 8%, and 9%, respectively (Brayton Purcell LLP, 2007).

Even more depressing is the fact that three years did little in increasing the number of people covered by government-based health insurance. While in 2003, 26. 6% of the insured population depended on government-provided health coverage (Brayton Purcell LLP), in 2006, such rate only increased to a meager 27%, which represents a . 4% difference among government-supported insured population (U. S. Census Bureau). Three years did no do much good in causing a significant change in the number of insured people in the country (U. S.

Census Bureau, 2007). In 2006, the United States Census Bureau reported the number of insured and insured members of the population. In 2006, only 67. 9% had private health insurance based on their employment (U. S. Census Bureau, 2007). Comparing this figure to the insurance rate in 2003, which was 60. 4%, there appears to be no significant change in the number of people who are covered by private health insurance. Causes of Uninsurance There are several factors that cause the massive lack of insurance coverage in the country today.

These factors primarily include the increase in health care cost and lack of sources of funds (The Henry J. Kaiser Family Foundation, 2007). The increase in health care cost is caused by the significant increase in medical spending. This increase in spending is due to the development of new technologies and the spread of existing ones (The Henry J. Kaiser Family Foundation, 2007). In addition, there is an increased demand or need for medical spending. Indeed, in a span of less than a decade, or between1996 and 2003, more and more people from the poor population spend more than 10 percent of their income on health.

Their percentage in the population has increased from 26 percent to 33 percent within the aforementioned period. Moreover, spending on prescription drug also increased, and it now contributes to 14 percent of the growth in medical spending. This aspect already forms 10 percent of the total health spending of the people (The Henry J. Kaiser Family Foundation, 2007). The increasing cost of health care has bee n consistent since 1970, at a rate that is faster than the rate of increase of the United States gross domestic product.

Indeed, there is an average of 2. 5 percentage points on the difference between the rates of increase of health care cost, compared to the U. S. GDP (The Henry J. Kaiser Family Foundation, 2007). A necessary corollary to one of the causes of massive uninsurance in the country, namely, the rising cost of health care, is lack of sources of funds (The Henry J. Kaiser Family Foundation, 2007). It is worth noting that there are only limited sources from which people could source their funds to be allotted for health care coverage.

These sources include public programs, private funds, and out-of-pocket, or individual funds (The Henry J. Kaiser Family Foundation, 2007). Public programs, such as the Medicare Program, form the public sources of health care funds. These programs are implemented through the enactment of legislation and the delegation of tasks to specific agencies. On the other hand, private funds often come from private employers. In other cases, private insurance are undertaken by the individuals themselves, with funds coming from their own pockets (The Henry J.

Kaiser Family Foundation, 2007). All the above sources of funds are affected by the increase in health care costs, since all these sources feel the weight of the additional burden. Since the government, private employers, and individuals find it more difficult to finance health care coverage due to the increased cost, the rate of the uninsured population also increases (The Henry J. Kaiser Family Foundation, 2007). The enormity of the spending involved is illustrated by the fact that 16 percent of the country’s GDP is spent on health care.

This amount to $2 trillion or $6,697 for the health care services of each person in 2005 figures (The Henry J. Kaiser Family Foundation, 2007) Insurance coverage of many suffers due to the increase in health care cost. The increase in costs commonly reflected in the demand for higher insurance premium seriously outweighs the rise of the workers’ earnings. Thus, workers are put into the dilemma of either foregoing health care coverage entirely or cutting larger portions of their income in order to afford health care coverage (The Henry J. Kaiser Family Foundation, 2007).

Universal Insurance Coverage The fact that the Medicare program, while it does provide quality health care coverage to many people, still falls short of covering all who need such coverage, leads one into thinking of other initiatives and suggestions that could solve the nation’s problems on uninsurance. For example, it is a good idea to develop of a strategy to achieve universal insurance coverage (Wolman and Miller, 2004). Universal health care is defined simply as the concept that all Americans must have access to affordable and quality health care (American Medical Student Association, 2007).

Thus, it is a positive step to establish a firm schedule within which universal insurance coverage would be achieved by a specific time period (Wolman and Miller, 2004). Conclusion. Changes and reforms in policy are necessary to provide better health care services and improve health care administration (Barr, 2002). These changes, which are formulated by the federal and state governments, and adopted by health care facilities, aim to improve the provision of health care service and better meet the needs of patients (Barr, 2002). The Medicare program illustrates how changes in policy could benefit the American citizenry.

Since the signing into law of the Medicare and Medicaid health coverage programs on July 30, 1965, poor persons who were eligible for federally supported, state-run welfare programs were given health care coverage. Vital federal guidelines were established so that states would be guided in the implementation of these programs, with the ultimate goal of assisting families who could not afford the cost of health care insurance (Andersen, Rice and Kominski, 2001). The United States government did well when it provided the Medicare program. Indeed, it proved to be a very useful service, especially to the poor members of the population.

However, it should be noted that the limited coverage it offers at present, there are still many people who fail to receive health care services (Andersen, Rice and Kominski, 2001) and there is still a serious need for the government to enact better policies that could address this concern. References American Medical Student Association. (2007). Universal Health Care. 2007. Retrieved December 4, 2007, from http://www. amsa. org/uhc/ Andersen, Ronald M. , Rice, Thomas H. and Gerald F. Kominski. (2001). Changing the U. S. Health Care System. San Francisco: Jossey-Bass.

Barr, N. (2002). Reforming pensions: Myths, truths, and policy choices. International Social Security Review 55(2), 3-36. Brayton Purcell LLP. (2007). Medical Issues Include Uninsured Workers and Inadequate Health Care. Retrieved October 28, 2007, from http://www. braytonlaw. com/news/mednews/051404_healthcare. htm Hadley, J. & Holahan, J. (2004). The Cost of Care for the Uninsured: What Do We Spend, Who Pays, and What Would Full Coverage Add to Medical Spending? The Kaiser Commission on Medicaid and the Uninsured. Retrieved October 28, 2007, from http://www. kff.

org/uninsured/upload/The-Cost-of-Care-for-the- Uninsured-What-Do-We-Spend-Who-Pays-and-What-Would-Full-Coverage-Add- to-Medical-Spending. pdf Long, S. K. , Coughlin, T. , & King, J.? (2005). How Well Does Medicaid Work in Improving Access to Care? Health Services Research 40(1), 39-58. Mason, D. J. , Leavitt, J. K. , & Chaffee, M. W. (2007). Policy and Politics: A Framework for Action. Elsevier, Inc. The Henry J. Kaiser Family Foundation. (2007). Health Care Costs A Primer. Retrieved October 28, 2007, from http://www. kff. org/insurance/upload/7670. pdf. The Henry J. Kaiser Family Foundation. (2007).

Medicare and Medicaid at 40. Retrieved October 28, 2007, from http://www. kff. org/medicaid/40years. cfm>. U. S. Census Bureau. (2007). Historical Health Insurance Tables. Retrieved October 28, 2007, from http://www. census. gov/hhes/www/hlthins/historic/hihistt4. html U. S. Census Bureau, the Official Statistics. (1998). Statistical Abstract of the United States: 1998. Retrieved October 28, 2007, from http://www. census. gov/ Wolman, D. M. & Miller, W. (2004). The Consequences of Uninsurance for Individuals, Families, Communities, and the Nation. National Health Reform and America’s Uninsured, 397-403.

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