Medicare Vs Medicaid

In 1945, President Truman attempted to convince Congress that the United States needed to establish a national health insurance coverage plan because of his believes that there should be “health security for all, regardless of residence, station, or race everywhere in the United States’. Unfortunately Truman’s attempts to establish a national health insurance plan were initially unsuccessful, which is why nearly twenty years later on July 30th, 1965 President Johnson had Truman join him at Truman’s Presidential Library in Missouri. This was because on this day, title 18 and title 19 were added to the Social Security Act, thus establishing Medicare and Medicaid as national health insurance plans. Over the course of the next 51 years since
the health based acts were signed, Medicare and Medicaid did end up improving the lives of an endless amount of Americans by providing them with much needed health insurance. Therefore within this piece, I would like to discuss the main target group of Medicare and Medicaid when they first begun, the expansion in eligibility for both programs, as well a few of the acts that influenced the development of both programs and the services they offered.
Even though the groups Medicare and Medicaid have not drastically changed much since they were established in 1965, they have changed a little bit over time. In fact, in the beginning when the acts were created, just over 50 years ago, Medicare was only intended to cover the medical expenses of the elderly, who were at least sixty-five years old, no matter what their financial or health situation was. This was partially the result of individuals sixty-five years old or older being three times more likely to get injured or needing to visit a hospital compared to someone younger than their age. In addition, individuals in this age range also are typically retired, meaning their incomes may have drastically dropped, thus preventing them from being to cover the additional health care expenses that come along with aging like getting sick more frequently or getting injured easier.3 Then, Medicaid was developed as a program intended to help provide health insurance for “low income children, caretaker relatives, the elderly, and individuals with disabilities”4 , Despite Medicaid’s positive intentions of helping lower income family’s, who can’t afford proper medical care, most states didn’t pick the program at first. Initially only 12 out of the 50 states adopted the program immediately, yet three major states, including New York received a majority, nearly 90% of the program’s federal funding. Yet, over the course of time, funding for the programs in each state did begin to ration out more proportionately until all the states had finally adopted to the program, which ended with Arizona in 1982 being the final, 50th state to adopt Medicaid.
Then within the first few years following the passing of the Medicare and Medicaid acts, both programs begun to experience a change in the eligibility of people that they covered.
Unlike Medicaid, Medicare only saw one expansion in its’ eligibility in 1972, whereas Medicaid actually experienced several eligibility based changes over the course of several years. Starting in 1972, Medicare went from only covering elderly individuals over the age of 65 to also covering “people under the age of 65 who (received) social security disability payments for at least 24 months”5 as well as people with “end-stage renal disease who require maintenance dialysis or a kidney transplant. 4 Then as I mentioned earlier, Medicaid does experience several changed in eligibility from the time it is established in 1965 until present day. A few of these changes included acts such as the addition like The Deficit Reduction Act of 1984, which allowed for the coverage of first time pregnant women as well as pregnant women, who lived in a home where both parents were unemployed under Medicaid. In addition to other acts like the Consolidated Omnibus Budget Reconciliation Act of 1985 being created, which expanded the coverage of pregnant women again to cover all remaining medical expenses of pregnant women, who were AFDC Eligible. Then even though these program were enacted at various different times they were still able to help achieve both program’s initial goals of improving lives of low income
Americans by providing them with insurance they would not have been able to cover by themselves.
In addition, as time progressed several different plans were added to the Medicare and Medicaid program to help further benefit the health and safety of the individuals that the program covered. For example, one program that helped expand coverage in Medicare was the Affordable Care Act, which was signed into law in 2010. This act allowed for the expansion of Medicare to cover the preventative care for qualifying seniors under the part b plan regarding a variety of screenings and services like abdominal aortic aneurysm screenings, depression screenings, and obesity screenings. In addition, ten years prior in 2000, Medicaid begun to cover breast and cervical cancers and treatments, which is also happens to be covered under Medicare, with the addition of the Breast and Cervical Cancer Treatment and Protection Act being passed. Then despite it taking nearly forty, forty-five years of Medicare and Medicaid being around for these acts to be added to the bills, both still served as ways of accomplishing the initial goal of both programs by providing health insurance coverage to lower income individuals, who may have had to go treatment if they programs had not existed.
Eventually government spending on both of the programs, nearly does get in the way of their successful attempts in providing health insurance to lower income family, elderly individuals, and any other person, who may qualify for Medicare and/ore Medicaid. Therefore, off and on over the course of the past fifty-one years, there have been several bills and acts passed in attempt to make sure both Medicare and Medicaid stay up and running. An example of an unsuccessful attempt at lowering the government’s cost of Medicare would definitely be the Medicare Catastrophic Act, which was passed in 1988. This act ended up in increasing the amount of out-of-the pocket money Medicare beneficiaries had to pay to cover new benefits of Medicare like added prescription drug benefits. This news upset many, many elderly individuals at this time to the point where they decided that they would protest the new act outside of government buildings because of how unfair they believed the extra spending the act placed upon them was. Fortunately for all the protestors and individuals upset with this act, the horrid Medicare Catastrophic Act did end up being repealed in 1989, partially due to it’s widely negative response.
Then unlike the Medicare Catastrophic Act, there were actually several different acts that were passed in response to attempt to decrease the amount of money the government spent on both programs, which were more successful. One act that definitely fit this description was the Medicare Prospective Payment Act, which established a fixed rates for hospitals and doctor offices that accepted Medicare and Medicaid. This was because prior to the development of this act, doctor’s who “practiced privately” where “at first (charging) their normal fees” like several critics had feared when Medicare and Medicaid was first developed. 5 An example of doctors charging more than the programs they intended too, goes back to several offices in Manhattan, who decided to they would charge their normal fees, or even higher fees at times to individuals under these programs. Therefore the passing of this act allowed for a standardization in the amount Medicare and Medicaid eligible individuals would pay during their doctor and hospital visits based upon the plan they were eligible. This was because in the times prior to the development of this acts, individuals in these programs were paying a variety of different rates depending upon what doctor office they went to, what hospital they had to visit, even what part of the United States they lived in. Therefore with addition of these plans, individuals could select hospital or doctor offices that met the plan’s requirements and fit their financial situation better.
Overall both Medicare and Medicaid have had their variety of ups and downs over the course of nearly the past 51 years that they have been around.
Despite the Medicare Catastrophic Act in 1988 and the critics, who did not support “Secretary of the Department of Health, Education, and welfare experimenting with alternative methods” of reimbursing physicians for Medicare and Medicaid visits, the programs have remained fairly successful. 6 Both programs were able to service intentionally positive changes based on the widening of the range of people who are eligible for their program, new acts that helped increase preventive care, and the addition of different acts like the Medicare Prospective Payment act that helped stabilize the amount of money these individuals paid depending on their plans, yet despite it all, they still supported the work Truman attempted to start twenty years
prior