Paper Example on Medicare and the Vulnerable Populations

Introduction

Despite the United States goals and efforts to eliminate or reduce disparities in healthcare over the years, significant discrepancies among them mortality, morbidity, access to healthcare and risk factors continue in most vulnerable population. The vulnerable populations continue to face many challenges not only in their social life but regarding health as most of them usually need constant medical attention. Vulnerable populations include the individuals with chronic health conditions, human immunodeficiency virus (HIV), severe mental illness, the homeless, the elderly, low-income children, uninsured individuals, ethnic and racial minorities, and the economically disadvantaged among others (Waisel, 2013). Nevertheless, the government both at the national and state level have over the years developed various policies or programs aimed at catering for the vulnerable populations concerning health. One such policy is Medicare. This paper will discuss this policy giving its brief history on how it was created, describing how it impacts nursing practice and the vulnerable population, analyze if there are some changes needed and the role of nurses in this policy.

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Brief Description of Medicare

Medicare is a sole-player federal health insurance program that offers health insurance to individuals of age 65 and above together with those people living with disabilities, and individuals with amyotrophic lateral sclerosis and end-stage renal disease also referred as permanent kidney failure that is always in need of dialysis (Newhouse & McGuire, 2014). The United States federal government regulates Medicare programs through the administration of Centers for Medicare and Medicaid Services.

For individuals to qualify for this services, they must have worked and paid into the Medicare systems via the tax payroll. Medicare is by various stakeholders and sectors such as general revenue, beneficiaries' surtaxes and premiums, and payroll tax. Medicare provided over 55 million people including children and older adults of 65 years and above with health insurance in 2015 showing that impact and influence of the policy (Colla et al., 2016). Those enrolled in Medicare, half of their healthcare charges are usually catered for meaning that vulnerable individuals have a chance to access health services through this program.

Impact of Medicare on Nursing Practice and the Vulnerable Population

Medicare has been of benefit through the provision of insurance to the elderly, people living with disability and to people of low income. That indicated the program had been set to make people get quality healthcare especially if they cannot afford it. The program has had a significant effect on the vulnerable population through the elimination of the measurable health benefits thus reducing for the people the risk of high expenditures on medical care.

Before the introduction of Medicare, the elderly mostly faced that risk of high medical expenditure. Medicare is thus associated with a significant reduction of out-of-pocket spending on medical care especial for the vulnerable population (Shortell, Casalino & Fisher, 2010). Also, the program has impacted on the provision of better health care thus reducing their mortality rate.

Over the past years, some of the older adults could not afford proper medical care although they cod access hospital. However, those with legal access to the hospitals and are suffering from life-threatening diseases and lacked medical insurance were given a chance to access the health care facilities for medical care. According to analytical statistics, the health status of the vulnerable population has improved as well as reduced mortalities caused by cardiac diseases as the program has d to the adoption of advanced cardiac technologies (Brody et al., 2016).

Through the Medicaid health program, the working condition for nurses has improved since the communication channel between the extended-care facility nurses and the hospital nurses and between the medical society and the health department of the state has been opened. Medicaid has also recapped the nurses from the kitchen and made them active in their hospital services, nursing homes, and other health agencies. The nurses have also had a chance to add on refresher courses through the Medicaid program to make them achieve a graduate licensed status for practical nurses.

History of Medicare

Health insurance in the US started in the 1920s where private health facilities started offering pre-paid services to their patients where the Blue Cross Organization began in the 1930s. Later in 1929, the teachers created the first hospitalization plan that is employer-sponsored. Then, in the year 1965, on July 30th the by the president of the US Lyndon B. Johnson signed law legislation which led to the establishment of Medicaid and Medicare programs (Oliver, Pennington, Revelle & Rantz, 2014).

The policy of people being registered into the program has been there for fifty years now with the aim of protecting the well-being and health of the American families, improving the security of the nation and saving the lives of the American citizens. During the establishment of the policy, the benefit aims targeted the Americans citizens of all ages.

The Medicare and Medicaid in the USA were established to help the elderly over the age of 65 and persons living with a disability. The Medicare program was programmed and designed to bring expansion in the access of the healthcare mainstream for the low-income earners especially those who do not receive the payments from public assistance. In the years 1997 and 1999 the Congress changed the law of Medicaid to allow the state to go on with the Medicaid benefits for the workers who are not eligible for SSI and those with disabilities (Unroe et al., 2015). Although since the Medicaid policy was enacted there has been several reforms and modification especially in areas servicing children for low income.

Changes to the Medicare Policy

Changes need to be made on Medicaid to make it more applicable to today's nurses, since 1965, there was a mandate from the Balanced Budget Act of 1997 that is BBA on the most significant decrease of payment for those covered by Medicare and are home nursing residents (Mahmoudi, Kotsis & Chung, 2015). There was a change in the payment of the skilled nursing facilities by the BBA for the residents that were covered by the Medicare. However, since 1998 the Prospective Payment System a new system, changed the payment mode by paying the nursing homes on a possible basis rather than using the reflective cost-based system.

Today there is a fixed amount for the nursing homes, but they do not offer any additional payment for extra services provided. Therefore, there should be a change in the payment system of Medicaid to the nurses and nursing home to improve the quality of care (Mahmoudi, Kotsis & Chung, 2015). The nurses will be motivated to provide quality care at the nursing home residents. Also, then there should be an expansion of Medicaid so that there will be the creation of more jobs for healthcare workers thus improving the quality of care provided.

Role of Nurses in Medicare

The nursing organization in the US have raised their voices to debate over the changes that were made to Medicaid. The nurses can help in improving the changes in Medicaid through increasing their efficiency in all the health care facilities. That would assist in the improvement of healthcare quality and advance in their studies that will help them in delivering the best services to their patients (Foote, Virnig, Town & Hartman, 2008). That also improves the healthcare outcomes that the nurses provide to the nursing home residents.

The nurses can also contribute to the changes being made in Medicaid by adding to the decision making as urged by the American Nursing Association to the lawmakers. The nurses are required to take part in the testing and developing measures instead of waiting for the results of what will be imposed by the policymakers and the payers. Nurses can also give their feedback on how the policy is working in nursing homes and other health facilities. That will help in the proper working of the Medicaid policy.

References

Brody, A. A., Gibson, B., TresnerKirsch, D., Kramer, H., Thraen, I., Coarr, M. E., & Rupper, R. (2016). High prevalence of medication discrepancies between home health referrals and Centers for Medicare and Medicaid Services home health certification and plan of care and their potential to affect the safety of vulnerable elderly adults. Journal of the American Geriatrics Society, 64(11), e166-e170.

Colla, C. H., Lewis, V. A., Kao, L. S., O'Malley, A. J., Chang, C. H., & Fisher, E. S. (2016). Association between Medicare accountable care organization implementation and spending among clinically vulnerable beneficiaries. JAMA internal medicine, 176(8), 1167-1175.

Foote, S. B., Virnig, B. A., Town, R. J., & Hartman, L. (2008). The impact of Medicare coverage policies on health care utilization. Health services research, 43(4), 1285-1301.

Mahmoudi, E., Kotsis, S. V., & Chung, K. C. (2015). A review of the use of Medicare claims data in plastic surgery outcomes research. Plastic and Reconstructive Surgery Global Open, 3(10).

Newhouse, J. P., & McGuire, T. G. (2014). How successful is Medicare advantage?. The Milbank Quarterly, 92(2), 351-394.

Oliver, G. M., Pennington, L., Revelle, S., & Rantz, M. (2014). Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nursing Outlook, 62(6), 440-447.

Shortell, S. M., Casalino, L. P., & Fisher, E. S. (2010). How the Center for Medicare and Medicaid Innovation should test accountable care organizations. Health Affairs, 29(7), 1293-1298.

Unroe, K. T., Nazir, A., Holtz, L. R., Maurer, H., Miller, E., Hickman, S. E., ... & Sachs, G. A. (2015). The optimizing patient transfers, impacting medical quality and improving symptoms: transforming institutional care approach: preliminary data from the implementation of centers for Medicare and Medicaid services nursing facility demonstration project. Journal of the American Geriatrics Society, 63(1), 165-169.

Waisel, D. B. (2013). Vulnerable populations in healthcare. Current Opinion in Anesthesiology, 26(2), 186-192.