Health care is one of the sectors that have been ranked among the top priorities in the United States. To promote health care, the government came up with the Medicaid and Medicare programs to support people in accessing health care services. Medicare and Medicaid are governmental programs that were developed to aid provision of medical and health-related services to definite groups of individuals within the United States. Medicaid is a social welfare program, which is meant for certain people and families that have low incomes and few resources. It is structured by the federal government, but managed differently depending on the state. On the other hand, Medicare is a social insurance program, which is responsible for paying for hospital and medical care for the old people as well as the disabled people within the United States (Walker, 2003).
Challenges facing Medicaid
Access to care
It is argued that the number of people lacking health care insurance in the United States is much higher than those that have been covered. Therefore, there is need to for the government to put into place various policies that could increase the number of people that are covered by health insurance. For instance, through waivers and State Plan Amendments, the number of eligible for Medicaid increased by approximately 2.27 million by 2003 (Walker, 2003). Further milestones have been made, especially with the introduction of the Obama Care, which intends to ensure each and every American citizen has access to health insurance. However, there are still major challenges with regard to accessibility of Medicaid, considering the fact that at the moment only about 60% of the potential eligible population is covered by this program. To increase health care accessibility, factors or rather policies hindering the low income-earners from accessing Medicaid should be looked into and streamlined. Children, especially from the low income group form the largest group of the uncovered population, which further depicts the nature of accessibility facing the Medicaid program (Burke and Kevin, 2011).
One of the specific accessibility challenges facing Medicaid is the proposal to block grant this program. In this case, it has been proposed that the various states would be awarded a permanent and condensed amount of Medicaid funding from the federal government. With this proposal, it implies that entitlement services would be eliminated. Particularly, the block grant would disqualify a certain group of people who are eligible for Medicaid. The states would be forced to reduce eligibility as well as benefits, especially in the case of the disabled people. Furthermore, there exists a bias between home and community based services. Presently, about 58% of Medicaid funding is directed to institutional care. Certain waivers are available for only those who qualify for institutional level care, which implies that states can limit those eligible for the waiver, and put a limit of services given to certain geographic regions (Moffit and Senger, 2013).
Quality of care
The quality of care given through Medicaid is also faced with various challenges. One of such challenges is with regard to provider reimbursement rates. Currently, Medicaid reimbursement rates for dentists, specialists, and primary care physicians are very low. This is a major hindrance to accessibility of high quality medical care, especially among the people with disabilities. Although the recent past health care reforms increased the rates of Medicaid reimbursement for pediatricians and physicians, the same was not done with regard to the specialists. Perhaps, if the same could be extended to include the dentists and the specialists, the quality of care offered to the people could be improved (Moffit and Senger, 2013).
Cost of care
Perhaps, the cost of care is the major challenge facing Medicaid. The cost of Medicaid continues to increase every year, and this has become a major concern. In the 1990s, the cost of Medicaid was approximately $ 132 billion, and by 2004, it had increased up to about $304 billion. By 2012, this cost had increased significantly. Based on these statistics, it is evident that the cost of Medicaid almost triples within a span of about s10 years. It is argued that this increase is as a result of extended coverage and entitlement. However, most of this increase is as a result of the ever-rising long-term care costs (Moffit and Senger, 2013).
It is worth pointing out that Medicaid benefits three major groups: Children and women, people with disabilities, and the elderly. Children and women form the largest percentage those covered, with about 76%, but utilize a small percentage of about 25% of the funding of this program. The disabled and the elderly comprise of about 24%, but utilize a large percentage of the funding, about 75%. Considering Medicaid account for a large segment of state budgets, this program is also an area where states focus on when it comes to cutting down costs. Furthermore, states capitalize on the existing legal loop holes to reduce the beneficiaries of Medicaid as a way of creating revenue (Sharan, Genuario , and Mehta 2007).
Challenges facing Medicare
Access to care and quality of care
In the past, Medicare was seen as a program that would transform health care access for the elderly. However, it has contributed to accessibility problems, especially with regard to accessing a doctor of an individual’s choice. Particularly, beneficiaries of this program are finding it challenging in finding doctors that ready to take their government sponsored insurance. Lack of sizable reimbursement increase, together with the ever growing older population as well as medical costs, there is an exodus of physicians as well as other health care providers from the market. Besides, the existing legal framework limits the operations of the physicians in that they can agree to be “participating” or “non-participating.” This has significantly affected the accessibility of care through the Medicare program. Besides, it has hindered the quality of care received by the beneficiaries of the Medicare program (Raab and David, 2006).
Cost of care
Like in the case of Medicaid, the cost of Medicare is proving to be a major challenge. In 2002, the cost of Medicare was approximately $207 billion, and by 2012 it had increased up to about $408 billion. By 2030, it is projected that Medicare will cost up to about $3 trillion, and this indicates the seriousness of the problem of the increasing cost of Medicare. Demographic changes have been cited has the main cause of the increasing costs of Medicare. Due to improved health care services throughout the United States, the number of the elderly people has been increasing with time. Thus, pressure on Medicare funding keep on increasing from time to time. Besides, the number of working and pensionable people in relation to Medicare beneficiaries is reducing over time. All these indicate how the increasing cost of running the Medicare program has become over the years (Golden, et al, 2009).
Undoubtedly, the health care segment is a very vital element in any given country. In the United States, this sector has been growing over time. Particularly, the Medicaid and Medicare programs have evolved greatly since their creation. The two programs have been facing various challenges, especially with regard to accessibility of care, the quality of care, and the costs involved in running the programs. However, it is evident that managed care in each program would continue to grow, especially when taking into consideration the various policies that have been implemented since the formative stages of these programs. In fact, with time, policies are enacted to fine-tune how Medicaid and Medicare are run to suit the needs of the increasing and changing populations within the United States.
A good example of such policies include the most recent Obama Care policies, which are intended not only to reduce the costs of Medicaid and Medicare programs, but also increase the number of people covered, especially among the low-income earners. Finally, as Medicaid and Medicare programs continue to evolve, it is evident that challenges of the same will not only keep increasing, but also changing over time. Nevertheless, the cost of running these programs is likely to be the major challenge, especially considering the mode of financing the same remains a major issue. This is one area that the government should focus on implementing policies that would create a long-term solution, if at all health care growth will have meaning in the American society.
Burke, G and Kevin, P. (2011) Medicare and Medicaid Alignment: Challenges and opportunities for serving dual eligible. Issue Brief. Retrieved from http://www.nsclc.org/wp content/uploads/2011/08/Duals-Alignment-Issue-Brief.pdf
Golden, G. A.; Tewary, S; Dang, S; and Roos, B.A. (2009). Care Management’s challenges and opportunities to reduce rapid rehospitalization of frail community-dwelling older adults. Journal of Medicine, Vol. 50(4); 451-458
Moffit, E.R and Senger, A. (2013). Medicare’s demographic challenge- and the urgent need for reform. Health care. Retrieved from http://www.heritage.org/research/reports/2013/03/medicares-demographic-challenge-and the-urgent-need-for-reform
Raab, G and David, H.P (2006). From medical invention to clinical practice: the reimburse,ent challenge facing new device procedures and technology. Journal of American College of Radiology. Vol. 3, issue, 10; 772-777
Sharan AD, Genuario J, Mehta S, (2007) Current issues in health policy: A primer for the orthopaedic surgeon. J Am Acad Orthop;15:76-86
Walker, D.M. (2003). Medicare: Financial challenges and considerations for reform. Retrieved from http://www.gao.gov/new.items/d03577t.pdf