Medicare and Medicaid: Differences and Challenges

America is well-known for its comprehensive healthcare service and a range of government-sponsored medical programs. Medicare and Medicaid can be considered two of the most significant and effective systems of the healthcare sector. It is fair to say that the development of these programs led to outstanding results; however, some issues related to their principles and goals still cause debates. In this paper, the programs will be compared in terms of their history and target populations. Medicaid state differences and the role of specialized nursing in both of the programs will also be analyzed.

There were certain reasons for establishing healthcare programs like Medicare and Medicaid. The history of Medicare started in 1965, when healthcare was made “a universal right” for people over 65 years old (What is the history of Medicare?, n.d., para. 1). The program was launched by Social Security Administration at a time when people were concerned about huge healthcare bills connected with their stay in the hospital. In the first years, more than 37% of the eligible population received benefits from the program (Stevens, 2017, p. 48). Over time, Medicare contributed to positively influencing the overall health condition and longevity of older Americans.

Medicaid program was created alongside Medicare; however, it was not originally a separate healthcare campaign. As Stevens (2017) explains, Medicare was first considered the “extension of medical payments” (p. 51). The situation of that time was characterized by poverty eradication tendencies. Therefore, the program was designed to help low-income families; however, more people started to receive these healthcare services over time (Stevens, 2017). Various campaigns and amendments focusing on specific healthcare issues and populations, such as programs of children’s insurance, have been created within Medicaid (Stevens, 2017). Nowadays, this program is another significant element of the U.S. healthcare sector.

Medicare and Medicaid differ according to the groups of the population they target. Medicare provides services for aged individuals, people with disabilities, and patients with end-stage renal disease (ESRD) (Beik, 2017). In general, patients need to be older than 65 years to be able to receive Medicare help; however, in certain cases (for example, ERSD) patients can be younger. In the case of Medicaid, services are provided to aged, blind, or disabled patients, children and pregnant women, and caretakers’ relatives (Beik, 2017). The program requires mandatory contributions from the recipients’ income; some of the patients, for example, aged or disabled people, are able to receive coverage from the government (Beik, 2017). As it is possible to see, Medicaid is a broader program in terms of population groups, while Medicare primarily focuses on aged or severely ill patients.

Another important difference between Medicare and Medicaid is connected with the type of administration. Medicare is administrated on the federal level, which means that its regulations and principles are common for all the American states (Beik, 2017). On the contrary, although the general objectives of Medicaid are common to all regions, different states are able to regulate specific aspects of their Medicaid plans. In Florida, for example, the Medicaid program is not expanded, which creates certain difficulties for the population of this region. About 900000 residents are not eligible for healthcare coverage, and therefore, are subject to various health conditions (Zhang, 2019, para. 4). However, in Miami, there are free clinics where uninsured patients can utilize medical services. These non-profit institutions are primarily focused on helping the indigent population of the state by providing shelter, food, and counseling, in addition to healthcare (Zhang, 2019). This example demonstrates that although Florida does not support Medicaid expansion, it maintains its healthcare level through donations and volunteering.

The reasons why many states decide not to implement the Affordable Care Act may vary, depending on their overall political, social, and economic situation. To begin with, the impact of Medicaid expansion is still “a considerable controversy,” and many states, therefore, hesitate to implement these measures (Barakat et al., 2017, para. 2). The demography also plays a crucial role, as regions with an especially dense or rapidly growing population or with a significant number of immigrants cannot provide extended health insurance coverage for their citizens. Moreover, the authorities of certain states doubt whether expanding healthcare insurance would have a positive effect on their budget and the quality of the healthcare services (Desmond et al., 2016). It is also important to mention that some of the states are able to provide healthcare for their residents independently, with the help of organizations working on the regional level.

In Medicare and Medicaid programs, all areas of nursing play their unique role in improving the overall health condition of American citizens. Medicare coverage policy deals with different types of medical needs and defines regulations for nurses specializing in particular fields. For example, in cardiac nursing practice, medical specialists conduct cardiovascular procedures, tests, and examinations for Medicare and Medicaid-eligible patients. As Merchant et al. (2018) emphasize, the recipients of these services, especially those with severe cardiac conditions, need to participate in the decision-making process together with their physicians. Specialists in this field of nursing also track the rehabilitation of the patients eligible to Medicare. Specialized organizations, for example, Million Hearts Cardiac Rehabilitation Collaborative, are created to comprehensively control the situation connected with heart disease treatment (Ritchey et al., 2019). Consequently, Medicare and Medicaid efficiency depends on the contribution of every particular nursing area.

To conclude, Medicaid and Medicare are two of the most well-known and significant healthcare programs in the U.S. They both contribute to the common goal of improving the health condition of American citizens. However, many issues, such as expanding Medicaid eligibility in certain states, still need to be solved. Therefore, further research of these programs and proper governmental regulation would allow to make them as accessible and effective as possible.

References

Barakat, M. T., Mithal, A., Huang, R. J., Mithal, A., Sehgal, A., Banerjee, S., & Singh, G. (2017). Affordable Care Act and healthcare delivery: A comparison of California and Florida hospitals and emergency departments. PLOS ONE, 12(8), 1-12. Web.

Beik, J. (2017). Health insurance today – E-Book: A practical approach (6th ed.). Elsevier Health Sciences.

Desmond, B.S., Laux, M.A., Levin, C.C., Huang, J., & Williams, B.C. (2016). Reasons why individuals remain uninsured under the Affordable Care Act: Experiences of patients at a student-run free clinic in Michigan, a Medicaid expansion state. Journal of Community Health, 41, 417–423. Web.

Merchant, F. M., Dickert, N. W., & Howard, D. H. (2018). Mandatory shared decision-making by the centers for Medicare & Medicaid services for cardiovascular procedures and other tests. JAMA, 320(7), 641-642. Web.

Ritchey, M.D., Maresh, S., McNeely, J., Shaffer, T., Jackson, S.L., Keteyian, S.J., Brawner, C.A., Whooley, C.A., Chang, T., Stolp, H., Schieb, L., & Wright, J. (2020). Tracking cardiac rehabilitation participation and completion among Medicare beneficiaries to inform the efforts of a national initiative. Circulation: Cardiovascular Quality and Outcomes, 13, 1-11.

Stevens, R.A. (2017). Welfare medicine in America: A case study of Medicaid. Routledge.

What is the history of Medicare? (n.d.). 2020. Web.

Zhang, M., Garcia, A., & Bretones, G. (2019). Demographics and clinical profiles of patients visiting a free clinic in Miami, Florida. Frontiers in Public Health, 7, 1-7. Web.

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