PAM- Medicare

Who does medicare cover?

elderly

disabled

ESRD patients

What were the effects of medicare?

dropped uninsured rates

poverty rates decreased during this time period

Parts of Medicare

A: hospital in patient; skilled nursing facility; home care

B: Physician services; outpatient/same-day facility - $170

C: Medicare Advantage Health Plan

D: Prescription drugs - $33

What does medicare not cover?

nursing home care

dentures and dental care

eyeglasses

hearing aids

How is supplemental health insurance used?

Medicare enrollees use other plans to supplement insurance coverage

Part C paid by Center of Medicare/Medicaid Services

pays most of Part C premium to private health insurer

managed care plan- has smaller set of physicians offered

How is Medicare financed?

PART A

PART B & D

HOSPITAL CARE

pay as you go system

current workers pay for current retirees

employees and employers split payroll tax- 2.9% and + .9% for high income workers

PHYSICIANS AND DRUGS

federal tax revenue covers 72% of the costs

elderly premiums cover the rest of the costs with high income individuals paying more

going to run out by 2028

Issues with Medicare

Medicare spending keeps increasinng

fewer baby boomers paying taxes

elderly advantaged by medicare due to spending

What are the repercussions of Medicare costs continuing to grow?

more people are retiring; elderly living longer; medical costs are rising

if we wait, taxes would have to increase astronomically

other taxes would have to increase

government would cut other programs or go into more debt

Possible Medicare Restructuring Policies

increase eligibility age from 65 to 67

Increase premiums for part B and part D

raise payroll tax by 1%

medicare into premium support plan; everyone turns into part C

change cost sharing rules for medicare and restrict medigap

PAM-Medicaid

Federal government establishes minimum requirements for the Medicaid program

Each state decides what to include beyond federal government requirements; determines how to pay for its share of cost; determines how much to pay physicians and hospitals; ADMINISTERS PROGRAM

Federally mandated groups:

Young children: 0-17

Pregnant women ( < 133% of poverty line)

NOT FEDERAL: Low income adults depending on state

blind and disabled with low income

low income Medicare beneficiaries

levels of restriction

Restrictive states: adults without children are not eligible for medicaid

Some restrictions: parents are eligible if income is less than 50% of poverty line

Expansive states: adults eligible if income is <133%

What does Medicaid cover?

hospital care

outpatient care

long term nursing home care

home care

lab tests and other medical benefits

OPTIONAL: prescription drugs

Medicaid basic facts

enrollment has quadrupled

spending has increased

spends least amount on children and most on disabled

elderly, blind, and disabled make up 50% of medicaid spending

Medicaid for children has led to long term improvements in health; government makes $2 for every $1 spent in Medicaid

Medicaid Spending

federal government's share of spending is based on state's per capita income

fed gov pays 60% of overall Medicaid nationaly

states spend twice as much on Medicaid than higher education

Medicaid and Physicians

Medicaid pays MD's 50% less than private insurers do; pays hospitals 46% less

Reprucussions:

physicians don't accept new medicaid patients- 36% denied in 2015

Medicaid VS the Block Grant System

What is block grant system?

What are the advantages of this system?

What are the disadvantages of this system?

Much like capitation: Federal government provides fixed amount of money to states based on some formula; states would then decide what to cover

rise at rate of inflation

account for population growth

14-27 million fewer people would have been covered

would've saved $800B by repealing ACA expansions and growing grants at less than the medical cost growth rate

would have addressed social determinants of health