Healthcare Reform: Medicaid, Medicare, Obamacare

Introduction

Governments should implement powerful policies, regulations, and systems to deliver high-quality and sustainable health services to their citizens. These objectives are usually implemented using the concept of health care reform. This rubric is widely used by professionals in health care and politicians to discuss significant policy changes or improvements that can maximize patient support. When a given nation develops a powerful healthcare system, it becomes easier for different practitioners and physicians to meet the medical needs of more citizens. This paper evaluates the issue of health care reform in the United States from a critical perspective.

Summary of the Issue

Health care reform is a concept that has been used in many regions, countries, and communities. Basically, the term “health care reform” is a notion that refers to high-quality and desirable care for every citizen (Marshall, 2017). Reforms are usually suggested and implemented as policies or laws. The role of the government is very crucial if a given nation is to reform and improve its health care system. In the United States, health care reform is implemented as a government policy aimed at influencing the quality and safety of health care services available in a given community or region (Walsh-Childers, 2016). Different stakeholders are involved throughout the process in an attempt to ensure that more citizens have access to quality health services.

Although health care reform is an issue that has a long history in the United States, the fact is that many propositions and suggestions have yet to be implemented. Some of the major reforms that have transformed the country’s healthcare sector include Medicare and Medicaid (McDonough, 2015). These policies were implemented in 1965. Some of the outstanding reforms that have been implemented in the recent past include the Health Care and Education Reconciliation Act and the Patient Protection and Affordable Care Act (also known as the Affordable Care Act or Obamacare) of 2010. Many experts argue that the Affordable Care Act (ACA) is the most remarkable healthcare law or legislation enacted in the country since the year 1965 (Marshall, 2017).

The ACA is a crucial piece of legislation that has managed to improve the quality, affordability, and accessibility of health care services in the nation. Since health care reform is an ongoing process or agenda, experts and stakeholders in the sector have proposed various laws that have the potential to meet patients’ needs (Marshall, 2017). It is undeniable that new policies and reforms will be outlined in the future in an attempt to transform the country’s health sector.

Analysis of Health Care Reform

Critique and Explanation

The above summary describes the current status of America’s health care reform. Past programs and policies such as Medicaid, Medicare, and Obamacare have been combined to form a unique system that supports the changing health needs of many citizens. It is also notable that Medicaid is one of the unique attributes of health care reform in the country. The program also supports the needs of low-income citizens and their respective families. This goal is achieved by covering medical costs related to custodial care (McDonough, 2015). The program is also known to support outpatient and inpatient hospital care. This means that Medicaid’s benefits are similar to the ones supported by the Medicare program. Nonetheless, Medicaid has continued to pose numerous disadvantages in the country. For instance, individuals who do not qualify have to cater to their own health needs or expenses.

Researchers and analysts have gone further to indicate that Medicare costs have been increasing significantly. Similarly, some claim that Medicaid has numerous drawbacks. For example, many recipients in different clinics or nursing homes tend to be discriminated against (McDonough, 2015). For example, Medicaid beneficiaries from minority groups might not receive timely or high-quality health services from such clinics. Some experts have acknowledged that the program does not support the health needs of poorer states. Patients and their doctors are also left without an option whenever there is coverage refusal.

Due to the complexities and gaps associated with these two programs, the country’s politicians presented numerous proposals that led to the implementation of the Affordable Care Act in 2010. Research studies have revealed that the legislation has addressed most of the challenges that had affected the country’s health care system for several decades. For instance, the law supported the needs of uninsured Americans. By 2015, the number of uninsured citizens had reduced by around 43 percent (Obama, 2016). More people have access to timely and quality medical services than ever before. The legislation has managed to transform the manner in which payment systems for health care in the United States work. McDonough (2015) indicates that around 30 percent of Medicare payments have now been made through different models such as Accountable Care Organizations (ACOs) or bundled payments.

On the other hand, the program has catalyzed various disadvantages that continue to affect the effectiveness of the country’s health care system. For example, around 5 million citizens have lost their employer-based insurances (Amedeo, 2018). Since the law required specific services that may be inappropriate for many citizens, some companies have decided to cancel their insurance plans. A good example of such services is maternity care (Walsh-Childers, 2016). The model has also been associated with increased short-term health care costs. The law has resulted in increased drug costs (Amedeo, 2018). This is the case because pharmaceutical companies have been forced to change their prices in order to meet the law’s provisions or requirements.

The ACA stipulates that illegal immigrants in the country should not receive funds from the government to cater to their insurance needs. On the other hand, the law does not require any person in the country to prove his or her citizenship. Additionally, there is no form of enforcement to ensure that illegal immigrants are denied health insurance. These issues show conclusively that health reform is something that will not end any time soon in the country (Walsh-Childers, 2016). This is true because there are significant issues that should be addressed in the sector.

Rationale

There are numerous opportunities for reforming the United States’ health care system. For instance, costs for health services have skyrocketed within the past five years. Several reasons can be presented to explain why this is the case. The first one is that the current system supports healthcare procedures that focus on the final days of a patient’s life. This malpractice has led to ineffective and unsustainable care delivery procedures. Secondly, failure to implement powerful preventative measures has created a situation whereby more citizens seek emergency treatment as the only option (Amedeo, 2018). Innovative procedures have not been implemented effectively in the country. Additionally, malpractice lawsuits have increased significantly. Consequently, many doctors and service providers have decided to increase the cost of their medical services (Walsh-Childers, 2016). The absence of stiff competition in the sector has resulted in a scenario whereby consumers cannot bargain for health services.

From this critical analysis, it is evident that there is a need for reforms in order to support the health needs of more citizens. Although the United States is one of the world’s most developed nations, it still grapples with an ineffective health care system (Amedeo, 2018). The current gap can only be crossed if adequate policies and laws are presented to reform the country’s health sector.

Different stakeholders have proposed a number of reforms to transform and improve the American health care system. For instance, the single-payer system is a proposal that can ensure that more people have access to quality medical care. Another notable proposal is to restructure the fee-for-service program (Walsh-Childers, 2016). Many experts also support the Center for Medicare and Medication Innovation (CMMI). The purpose of this agency is to come up with timely reform concepts and ideas. This is something that can be achieved through the use of pilot projects. The country is also facing potential reforms since President Donald Trump promised to repeal Obamacare. His administration is keen to implement the American Health Care Act (AHCA) as part of its reform agenda.

Importance of Health Care Reform

The above critique reveals that the current status of health care in the United States has been supported by every reform undertaken or implemented in the past. Statistics indicate that the ACA had made it possible for around 600,000 young people in the country to get health insurance within its first year (Marshall, 2017). This was the case because the law indicated that children below 26 years of age would be covered by their parents’ insurance plans. This fact is a clear indication that new reforms in health care can support the needs of more people and make it easier for them to pursue their economic goals.

Many professionals in this sector believe strongly that health care reform is a powerful strategy that can be used to improve the quality of medical services available to the people. In the United States, chronic conditions such as cancer, diabetes, and cardiovascular diseases continue to cause around 70 percent of all deaths (Marshall, 2017). Such conditions have also been observed to affect around 45 percent of the country’s population (Amedeo, 2018). Researchers have indicated that the prevalence and incidence of some of these diseases might grow rapidly in the near future (Amedeo, 2018). This challenge can only be mitigated using appropriate health reforms that can support the changing needs of the targeted people.

The health costs incurred when treating conditions such as cancer and diabetes have increased by over 50 percent within the past three years (Amedeo, 2018). Similar statistics are also projected for heart disease by the year 2023 (Amedeo, 2018). More people will be affected by conditions such as lung disease, hypertension, and stroke (Marshall, 2017). The health costs incurred by the government have continued to rise. That being the case, it would be appropriate to implement powerful wellness and disease prevention programs. Health care reform is, therefore, the best option for proposing and implementing such programs.

Health care reform has remained an interesting aspect of the medical sector that dictates the quality of patient services available in a given country. In the United States, the concept remains relevant since it is the only option for improving the quality of health services available to different citizens (Amedeo, 2018). Additionally, the concept has been pursued in the country because many people lack appropriate health insurance coverage. Statistics indicate that around 101,000 Americans die annually due to a lack of proper insurance coverage (Obama, 2016). The affected citizens find it hard to get adequate and timely health services.

The gains recorded in the country because of different reforms in the health care sector show conclusively that the process is meaningful. It is clear that past reforms have made it easier for more people to get health insurance. Similarly, the country’s economy has continued to grow steadily because its citizens are healthy. Additionally, the quality of health services in the country has improved significantly (Walsh-Childers, 2016). The future will, therefore, be brighter if the country pursues new laws and policies that can transform the health sector.

Recommendations

Since health care costs and expenditures have been increasing steadily, appropriate policies will ensure that more people receive superior health services (Walsh-Childers, 2016). This is the reason why several recommendations are needed to support the country’s future health care reform agenda. To begin with, it can be appropriate for the government to increase the level of health insurance coverage (Obama, 2016). The next thing is to implement powerful disease prevention programs in different communities. These efforts will reduce the medical costs incurred by many patients in the nation.

The ACA can also be supported using powerful implementation initiatives. The move will ensure that public initiatives or options are available to more citizens. The cost of every prescription drug should also be reduced. When such drugs are available to more people, it will be easier to advance the country’s health care status and improve its economic performance (Amedeo, 2018). These measures will ensure that better policies capable of meeting the health needs of more people are implemented.

Another powerful recommendation is for different stakeholders to be pragmatic in legislation, decision-making, and implementation (Obama, 2016). This approach will ensure that the issues associated with different political actors do not affect the country’s health sector. The ultimate goal of legislation should be to develop superior models and care delivery programs. Finally, Congress should focus on evidence-based reform concepts and ideas that have the potential to improve the sector (Obama, 2016). The current administration should be willing to support such concepts in an attempt to meet the health demands of underserved populations in the nation.

Conclusion

Several elements in the above discussion explain why reform is a critical aspect of health care. Most of the laws implemented within the past eight decades in the United States have led to numerous improvements in the country’s health care sector. Some laws such as the ACA have resulted in improved medical services. Although there are numerous gaps and challenge including the problem of terminal conditions, increased healthcare costs, and inadequate insurance cover, future reforms will be expected to transform the situation and support the greatest number of citizens. Finally, the involvement of different stakeholders and the concept of pragmatism will ensure that every reform results in an effective health care sector.

References

Amedeo, K. (2018). Why reform health care. The Balance.Web.

Marshall, L. H. (2017). Blogging about the Affordable Care Act: A rhetorical analysis of weblogs kept by the Democratic and Republican parties and the White House. Public Relations Inquiry, 6(1), 23-45. Web.

McDonough, J. E. (2015). The United States health system in transition. Health Systems & Reform, 1(1), 39-51. Web.

Obama, B. (2016). United States health care reform progress to date and next steps. Journal of the American Medical Association, 316(5), 525-532. Web.

Walsh-Childers, K. (2016). Mass media and health: Examining media impact on individuals and the health environment. New York, NY: Routledge.