49 49 health care law chapter 11 public health care

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/Business-English-13th-Edition-9780357033784-278/
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Health Care LawChapter 11:Public Health Care Financing Programs:Medicare and MedicaidI.Introduction, p. 761- The ACA changed both programs, but altered Medicaid mostdramatically.Medicaid eligibility was expanded, & benefit requirements were changed.A.Federal and state programs that pay for or provide health care include Medicare,Medicaid, VA, CHAMPUS.B.Medicare is a social insurance program, & Medicaid is a welfare program-respectively spent about $554 ($401.3) billion and $403 ($310.6) billion in 2011(2006).II.Medicare, p. 765Bellevue Hospitalcase – US Court of Appeals upheld CMS use of MSAs for groupinghospitals, but held that the failure to update the payment formula (wage index) adequatelyfor occupational mix violated the statute and was arbitrary and capricious.A.Eligibility, p. 773 – Medicare is not a means-tested program - covered about 48.7million elderly (40.4) & disabled (8.3) beneficiaries in 2011. The 2003 MedicareModernization Act requires wealthier beneficiaries to pay more for Part B.Its Part Dprovisions include subsidies for lower-income beneficiaries for drugs.Medicare benefits elders, & their children who do not have to bear the cost of theirparents’ health care cost, and are more likely to receive an inheritance free of medicaldebts.Middle-aged parents are better able to pay for their children’s educationbecause their parents have Medicare.Beneficiaries paid taxes to cover the educationof those now paying Medicare payroll taxes.Obviously, the Medicare entitlement isa complex issue.Medicare, for various political reasons, has not grown into a social insurance programfor the general population like numerous central European nations.It has made theAmerican health care system more equitable.B.Benefits, p. 7741.Coveragea.Part A – hospital coverageb.Part B – physician, professional servicesc.Most beneficiaries purchase Medicare supplement policies5050
Health Care Law(to cover coinsurance and deductible amounts), Medicare Advantage plans(with better benefits), receive supplemental from former employers, or alsoreceive Medicaid (if poor enough).2.Prescription Drugs, p. 779 – Other than long-term care, this was the mostsignificant omission in Medicare coverage.The drug benefit is the only one where CMS has no control over what it pays. Thelaw (MMA of 2003, & the ACA) prohibits CMS from establishing prices. Thislimitation suggests the power of the drug companies. Pharmacies andpharmaceutical benefit management companies (PBMs) are also advantaged bythe legislation.Younger and healthier beneficiaries (drug expenses under $2,930 a year for 2013)and those with high cost chronic conditions (reach catastrophic coverage range)are favored by the law. Beneficiaries with expenses in the “doughnut hole” (totaldrug expenditures over $2,930) suffer because they lose coverage they hadthrough Medicare supplement or employee benefit plans. The ACA will, overtime, plug the doughnut hole.The dual eligible (Medicare and Medicaid) may dobetter or worse depending on the plan they are in, or the state where they reside.

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Term
Fall
Professor
Rennick
Tags
Sula, health care professionals, health care institutions
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Business English
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Chapter 4 / Exercise 45
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