Medicare Reform 2003

In November 2003, the United States Congress passed a controversial health policy bill that President George W. Bush signed into law. The new legislation makes the most far-reaching changes to Medicare since the program was created in 1965. The changes to Medicare were necessary because the Medicare program currently is not at par with the improvements that the US healthcare system has incorporated. Such disparity between Medicare and the enhanced healthcare system resulted in a deficiency of choices and benefits that may be provided to Medicare enrollees.

It is known that Medicare provides healthcare assistance to millions of Americans nationwide and such disparity has tremendously affected a significant portion of its members. The 1965-born Medicare was determined not to offer any out-patient prescription drug benefit, which in turn obliges the senior-age enrollees not to take their much needed medicines. In addition, the old Medicare program does not give full coverage for essential preventive healthcare services, including cancer or diabetes monitoring hence the almost 50 year old health program is definitely unable to shield its enrollees from any uncontrollable costs of medical services.These costly measures often affect seniors because major medical services often exhaust all of the savings of the seniors. The main provisions of the new legislation included several tenets for Medicare reform (Kelly, 2007). Firstly, the new legislation describes that all senior citizens must have the opportunity to a fully-financed prescription drug benefit.

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Secondly, the modern Medicare program must offer a superior coverage programs for preventive care and any serious illness. In addition, members of the Medicare health program must be given the choice of maintaining the original health plan at no cost.Also, the reformed Medicare program should offer improved health insurance options, similar to the options that are provided to employees of the federal government. The new legislation also describes a financially stable and consolidated Medicare program. The reformation of the Medicare program also includes a reinforced management system that is able to augment healthcare of seniors. The reformation also describes that regulations and administrative operations are constantly updated and reorganized, including the control and abolishment of fraud and abuse of the benefits of the Medicare program.The new legislation also asserts a superior quality of health care provision for senior citizens. All these new features associated with the reformation of the Medicare program had costed the government $400 billion that will be spent for the improvement of the program for the next 10 years.

The direct result of such new legislation of the Medicare program is that senior citizens receive prescription drug coverage, which includes procurement of the medications that they need, without any imposition from the government as to which brand of drug they will purchase.The reform with also result in the availability of choices of an individual healthcare plan that the Medicare beneficiary may pick out, based on his personal decision, if he thinks that a particular healthcare plan is able to provide their specific needs (Schulke et al. , 2007). Such setting was only earlier available to Members of Congress and employees of the federal government. Beneficiaries of the new Medicare program will also be given the option to choose his own doctor, hospital and any other healthcare facility that they want to receive treatment and care for their health illnesses.The new Medicare program will also provide complete coverage for preventive services for a wide range of diseases such a cancer, osteoporosis, hypertension and diabetes. More importantly, members of the new Medicare program are safeguarded from costly out-of-pocket expresses that drain the finances of senior citizens. The new legislation also allows low-income senior citizens to collect additional financial support so that these individuals do not have to spend money in order to avail of better healthcare services.

The Medicare reform came about because for an extended duration of time, political pressures have kept the United States from bringing the benefits of modern health care to the Medicare program. President Bush, during the development of the reform program, setup a meeting with the different members of both political parties to collaborate with him to pass this new legislation in 2003. The President believes that the United States carries a moral obligation to fulfill Medicare’s promise of health care security for America’s seniors and people with disabilities.

To meet this obligation, the nation must act now to bring Medicare into the 21st Century by providing more choices and better benefits to every senior in America. Moreover, with health care costs on the rise and the Baby Boom generation nearing retirement, Medicare faces major financial obstacles. These include designing Medicare to maximize the use of today’s modern health care delivery methods to employ and appreciate the benefits for current and future participants while addressing the long-term sustainability of the program.

In addition to the prescription drug benefits, the measure provides billions of dollars in subsidies to insurance companies and health maintenance organizations, and takes the first step toward allowing private plans to compete with Medicare. It is the largest expansion of Medicare since the program was created in 1965, though most of its provisions won’t take effect for several years. The drug benefit, for example, does not take effect until 2006. Before that, seniors will be able to purchase a discount card that could provide a 10 to 25 percent off prescription drugs.In 2006, Medicare recipients pay $35 per month with a $250 deductible for prescriptions (Robst et al. , 2007). The plan indicates payment of 75 percent of costs up to $2,250. The prescription drug provision removed a proposed guideline the president had originally sought — requiring seniors to join an HMO to be eligible for the benefit.

The law also allows the importation of drugs from Canada, where many drugs are significantly cheaper, but only if the Food and Drug Administration has approved the drugs.It also provides subsidies to private insurers to compete with traditional Medicare, giving seniors the opportunity to join managed-care plans, which typically cut costs by restricting patient access to specialists. That provision does not take effect until 2010. Recently, the House passed the measure after Bush made late-night, last-minute phone calls asking members to support it.

An unusually long three-hour vote was ended by GOP leaders at 6 a. m. , after a 218 to 216 deficit flipped to a 220 to 215 victory.

The Senate’s 54-to-44 vote was not entirely along party lines — 10 Democrats voted in favor and nine Republicans voted no. Opponents of the legislation warned that seniors would demand that Congress revisit the issue once they realized what the bill does and does not do. High on the list of things not covered in the bill is a mechanism to stem rising prescription drug costs. The theory is that private sector competition will drive down the cost of drugs.This may happen, or it may not happen hence it is imperative that it is put under regular review and assessment. References Kelly GC (2007): Medicare margins.

Emerg. Med. Serv. 36(8):32. Robst J, Levy JM and Ingber MJ (2007): Diagnosis-based risk adjustment for medicare prescription drug plan payments. Health Care Financ.

Rev. 28(4):15-30. Schulke DG, Krantzberg E and Grant J (2007): Introduction: Medicare quality improvement organizations–activities and partnerships. J. Manag. Care Pharm.

13(6 Suppl B):S3-6.