1

Medicare:Policy Issue Presentation

2

Introduction

Overview of the Medicare program is presented.

Presidents signing health care bills into law and a video of speech given by President Obama on Health Care Reform.

Budget Projections—1999-2010 provided; Saving Budgets for 2011-18 included.

Special interest groups effectiveness is established, and

Actual outcomes are revealed herein.

3

Medicare…from idea to law

President Lyndon B. Johnson Signing Title XVIII of the Social Security Act; the Medicare Bill,

(circa 1965)

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Medicare Benefit Coverage Explained

Inpatient care in hospitals such as critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals.

Doctor’ office visits and services.

Inpatient care in a skilled nursing facility, not custodial or long term care.

Hospice care services.

Home health care services.

Prescription coverage

(Corning, 1969)

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Medicare Plans

Medicare Benefits:

Part A-Hospital

Part B-Doctor’ Visits

Part D-Prescription

Medicare

Part A

Hospital

Part B

Doctors Visits

Part C

Part D

Prescription Coverage

Ranzino Renda, (2012).

6

Projected Costs

In 2012, the Fiscal Year budget is $777 billion—$10.2 billion dollar less than the Fiscal Year 2011 spending levels(CMS, 2012).

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Are Costs Really

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Projected 10 Years Spending Effect

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CMS Projected Costs

PROGRAM 2010 2011 2012 +/- 2012

Medicare 451,702 495,242 475,510 -19,732

Medicaid 272,771 276,249 269,365 - 6,884

CHIP 7,887 9,169 9,981 + 812

State Grants & Demonstrations 531 615 518 - 97

New Health Insurance Programs 6 5,344 3,802 - 1,542

Innovation Center n/a 546 801 + 255

Total Net Outlays 732,897 787,165 759,977 - 27,188

Medicare and Medicaid Budgets 2010-1012: In the Millions—Current Law (CMS, 2012, p.51).

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The Urgency of Health Care Reform VideoPresidential Speech: March 10, 2010

http://www.youtube.com/watch?v=v9wwyB0kVSE

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Health Care Reform Bill Becomes LawMarch 23, 2010

President Barack Obama Signing the Health Care Reform Bill into Law

(circa 2010)

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President Barack Obama’s PromiseJune 8, 2010

“This new law recognizes that Medicare isn’t just something that you’re entitled to when you reach 65; it’s something that you’ve earned. It’s something that you’ve worked a lifetime for, having the security of knowing that Medicare will be there when you need it. It’s a sacred and inviolable trust between you and your country. And those of us in elected office have a commitment to uphold that trust – and as long as I’m President, I will.”

“And that’s why this new law gives seniors and their families greater savings, better benefits and higher-quality health care. That’s why it ensures accountability throughout the system so that seniors have greater control over the care that they receive. And that’s why it keeps Medicare strong and solvent – today and tomorrow.”

- President Barack Obama, June 8, 2010

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Projected Reform PromisesAffordable Care Act Update: Implementing Medicare Cost Savings

Billion in Savings

Extend the Medicare Hospital Insurance Trust Fund to 2029.

Strengthen Care Beneficiaries Receive

Guarantees Benefits for Beneficiaries

Provides New Benefits & Services

Provisions Improve: Quality of Care

Promote New Models of Care Delivery

Price Services

Modernize Health System

Fight Waste

Fight Fraud and

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Saving Billions…

“Administration’s ongoing efforts—will save nearly $8 billion within the next two years and approximately $418 billion by 2019.”

“Taken together, the Medicare savings will lower beneficiaries’ Part B premiums by nearly $200 for each beneficiary annually by 2018.”

(CMS Office of the Actuary, 2010, p. 2).

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CMS Office of the Actuary, 2010

CMS Office of the Actuary, 2010

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Special Interest Groups Effectiveness

Three Centers of Power:White House Capitol Hill House of Representatives & the SenateSupreme Court-Interpret LegislationThe numbers:

435 Congressmen & women100 Senators14,000 registered lobbyist

The math:14,000/535=26 lobbyist for each government official.

Special Interest Groups Power is Equal to its:

Memberships BaseFinancial Base-e.g.$144 spent by the Chamber of Commerce representing 3 million members.Grassroots mobilization.

Walking a Tightrope toBridges the Gap of Fringe Groups

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Memorandum:Transparency and Open Government

The 2004 Drug Bill was written by pharmaceutical lobbyist; in the middle of the night escorted in by Chairman Billy Tauzin with legislation containing a provisions which bans the US government from negotiating bulk discounts with the drug companies.

Approximately 20 people who worked for the federal government left to become lobbyist for the pharmaceutical companies; making hundreds of thousands in annual salaries.

Today, Billy Tauzin is the President and CEO of PhRMA, earning $2 million a year as a lobbyist. Tauzin salary per year to represent taxpayers was $154,100.00.

(Megahy, 2009)

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Opting Out of the Medicare ProgramPolicy Desired versus Actual Outcomes

Today, many health care providers are opting out of the Medicare program by excluding Medicare patients from their medical practices.

Many patients are taking on the responsibility for their own care; opening up the doors for home health care professionals.

EMR is an irreplaceable tool for patients who must monitor their own treatment.

An older adult taking her own blood pressure reading, results are forwarded to her EMR.

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Policy Desired Versus Actual Outcome

Home health care providers are picking up where the patient’s doctors leave off.

Telemedicine is another growing field of medicine to help those unable to travel to a formal medical facility.

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Dialysis Patient At Home With His Home Health Care Worker.

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Home Health Care AlternativesAccording to Medicare

Examples of skilled home health services include:

Wound care for pressure sores or a surgical wound

Physical and occupational therapy

Speech Therapy

Patient and caregiver education

Intravenous or nutrition therapy

Injections

Monitoring serious illness and unstable health status

Daily needs of the patient who is homebound.

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Home Health Professional assisting an older adult.

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Conclusion Policy Reforms

• Health Reforms—Legislation lowers health care insurance premiums to beneficiaries.

• Reform Bill— better Information to beneficiaries, patient protections, innovation in research, and coordinating better beneficiary care.

• Health Care Exchanges—Foster competition and offer choice, ensures minimum levels of coverage.

(Coy, 2011).

Obama

Care

Ryan’s

Medicare Reform

Bill

Health Care

Exchanges

Ranzino-Renda, 2012

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References

Centers for Medicare and Medicaid Services, (2012). Federal Advisory Committee Act (FACA). Retrieved from

http://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/index.html

Corning, P.A., (1969). The evolution of Medicare…from idea to law. History of Medicare. Retrieved from

http://www.socialsecurity.gov/history/corning.html

Coy, P. (June 2, 2011). Health exchanges: Common ground for Medicare reform? Bloomberg Business Week.

Retrieved from http://www.businessweek.com/magazine/content/11_24/b4232033430757.htm

Google Images, (2012). Billy Tauzin. Retrieved form http://www.american-buddha.com/moore.sicko90.htm

Google Images, (2012). Johnson signing the Medicare bill, 1965. Retrieved from

http://en.wikipedia.org/wiki/File:LyndonJohnsonSigningMedicareBill.gif

Google Images, (2012). Medicare Spending. Retrieved from Google images/search/Medicare/spending

Google Images, (2012). White Stone Shaping: Gems from a journey. Retrieved from

http://www.whitestoneshaping.com/2009/12/29/how-to-save-rather-than-spend-871b-on-healthcare

Holahan, J. & McMorrow, S., (2012). Medicare, Medicaid and the deficit debate: Timely analysis of immediate health

policy issues. Retrieved from http://www.urban.org/UploadedPDF/412544-Medicare-Medicaid-and-the-

Deficit-Debate.pdf

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References

(May 3, 2012). Medicare and Medicaid spending: Enrollment growth a driver for spending increases. The

Piper Report. Retrieved from http://www.piperreport.com/blog/2012/05/023/medicare-medicaid-

spending-enrollment-

Megahy, F. (2009). The best government money can buy? Documentaries-political Documentaries. Viewed on

Netflix.

The Wall Street Journal. (January 8, 2010). Medicare and the Mayo Clinic. Retrieved

from http://online.wsj.com/article/SB10001424052748703436504574640711655886136.html

The White House, (2012). Affordable Care Act of 2009. The Administration: Health Reform in Action.

Retrieved from http://www.whitehouse.gov/healthreform/healthcare-overview

Yahoo Images, (2012). Home health care. Retrieved fem. http://www.instantcard.net/home-health-care/

lMTQ4cG

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References

Yahoo Images, (2012). Medicare logo.

Yahoo Images, (2012) Medicare patients. Retrieved from

http://images.search.yahoo.com/images/view;_ylt=A2KJkexhz8tP3EgAaBSJzbkF;_ylu=X3oDMTB

Yahoo Images, (2012). Sick people. Retrieved from http://images.search.yahoo.com/images/view;

_ylt=A2KJkIWp9MxPJCQA48KJzbkF;_ylu=X3oDMTBlMTQ4cGxyBHNlYwNzcgRzbGs