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1.What is the role of Healthcare Policy in improving care for patients? Who are the key actors? What impact does Politics have on Policy making? Do you think Politicians are making progress in trying to improve healthcare through policy making? Indicate who or why not.Essay FormatTimes New Roman, 12 size – single spaceResponse should be no more than 2 pages per question. You are not required to complete 2 pages if you complete your answer in less that is fine.Please provide examples from your reading, policy briefing, discussions and research as appropriate. Please use APA formatting to reference your work.
policy_operations_and_modification__0419__2_.pptx

medicare_and_medicaid.pptx

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Policy implementation:
Operation & Modification
April, 2019
Modification of Policy
• Modification is necessary for proper rulemaking
and is part of the operations process of proper
rulemaking.
– Existing policies are modified most frequently through
changes in the rules or regulations used to guide their
implementation.
– For new Policies:
• Language is often vague
• This is often done on purpose to provide additional
information and examples by those responsible for
regulating the rules
Modification in Policy Operation
• The actual running of Operation the programs
embedded in public laws.
• The operational stage of a policy is primarily a
responsibility of the appointees and civil servants who
staff the government, particularly those who manage
the departments and agencies with policy
implementation responsibilities.
• Managers responsible for operating a public law have
significant opportunities to modify the policy—
– in terms of its impact on and consequences for those
affected by the law
– through the manner in which they manage its operation.
Modification of Policy




Often needed to correct a policy
Used to clarify a policy
Can be done in rule making process
Can be done post rule making process in
operationalizing a rule
• Feedback can take place on policy for
modification from the influencers and those to
be impacted by the policy
Modification of Policy
• The practice of using rulemaking to modify policies by
updating or changing features of their implementation
pervades policymaking.
• Rules promulgated by executive branch agencies and
departments to guide policy implementation possess
the force of law.
• The rules themselves are policies.
• As implementation occurs, rulemaking becomes a
means to modify policies and their implementation
over time. In the process, rulemaking creates new
policies.
• Changed rules are modified policies.
Modification of Policy
• Modification of policies through changes in
the way they are implemented is a routine
occurrence in the ongoing policymaking
process.
Modification of Policy Influencers
• Internal Influencers:
– Internally, the managers responsible for operating policies approach
the task in ways that are similar to the ways of managers in all
settings; that is, they seek to control the results of their operations.
– Standards or operating objectives (e.g., to serve so many clients per
day, to process so many reports in a quarter, to distribute benefits to
certain categories of beneficiaries, to assess compliance with certain
regulations by so many firms);
– Operations ensue; results are monitored; and changes are made in
operations, objectives, or both when results do not measure up to the
predetermined standards (Longest 2005).
– Routine operational modifications are part of the implementation
phase of any policy.
– Changes are part of the daily work that occurs within organizations
that implement policies.
Modification of Policy Influencers
• External Influencers:
– Useful information and expertise is appreciated and
saught.
– i.e. The leader of a health-related organization or interest
group, speaking from an authoritative position with
relevant information based on actual operational
experience with the implementation of a policy, can
influence the policy’s further implementation.
– If the information supports change, especially if it is
buttressed with similar information from others who are
experiencing the impact of a particular policy, reasonable
implementers may well be influenced to make needed
changes.
The Iron Triangle
• Relationships between:
1. Those who feel the consequences of policies,
usually operating through their interest groups,
and
2. Tose responsible for implementing policies
important to them are expanded to include
members of the
3. Legislative committees or subcommittees with
jurisdiction over the policies.
https://www.learnerator.com/blog/iron-triangle-ap-us-government-crash-course/
Participants May Include
• Special Interests Groups
– Associations
– Societies
– Unions




Agencies i.e VA
The Public – You!
Legislatures
Professional Lobbyists
Resources
• https://www.learnerator.com/blog/irontriangle-ap-us-government-crash-course/
• http://www.guwsmedical.info/healthpolicy/modification-in-the-policyimplementation-phase.html
• http://bipartisanpolicy.org/person/tomdaschle/

HEALTH POLICY FOR PATIENTS
MEDICARE AND MEDICAID PROGRAMS
April 2019
U.S. MEDICARE AND MEDICAID
PROGRAMS
• This presentation provides you with an overview of the 2 largest insurance
programs that exist for patients today the Medicare and Medicaid programs.
• Objectives:
• You will understand what the program are and how they were originated.
• Learn who and how the programs are administered.
• Understand how much US spends on health care and the Medicare and Medicaid
programs.
• Take a look at how Politics and Policy influence these programs.
SECRETARY OF HHS
• U.S. Secretary of Health and Human Services. (redirected from HHS Secretary) The
head of the Department of Health and Human Services. The secretary is responsible
for protecting the public hea lth . He/she has jurisdiction over drug inspections,
implementation of Medicare and Medicaid, health service for Native Americans, and
many similar operations.
• Alex Michael Azar II born June 17, 1967) is an American politician, lawyer,
pharmaceutical lobbyist and former drug company executive who is the current
United States Secretary of Health and Human Services.
• Azar was nominated by President Donald Trump on November 13, 2017 and
confirmed by the United States Senate on January 24, 2018. He was formerly the
United States Deputy Secretary of Health and Human Services under George W. Bush
from 2005 to 2007.
DR. SEEMA VERMA, ADMINISTERS THE
MEDICARE AND MEDICAID PROGRAMS
HOW MUCH DO WE SPEND ON
HEALTHCARE IN THE US?
• According to the most recent data available from the Centers for Medicare and
Medicaid Services (CMS), “the average American spent $9,596 on hea lthca re
• In 2017, U.S. health care costs were $3.5 trillion. That makes health care one of the
country’s largest industries.
• It equals 17.9 percent of gross domestic product. In comparison, health care cost
$27.2 billion in 1960, just 5 percent of GDP.
MEDICARE SPENDING
• Medicare spending was 15 percent of total federal spending in 2017, and is
projected to rise to 18 percent by 2028.
• Based on the latest projections in the 2018 Medicare Trustees report, the
Medicare Hospital Insurance (Part A) trust fund is projected to be depleted in
2026, three years earlier than the 2017 projection.
• In 2017, Medicare benefit payments totaled $702 billion, up from $425 billion
in 2007.
MEDICARE SPENDING CONT’D
• As a share of total Medicare benefit spending, payments to Medicare Advantage
plans for Part A and Part B benefits nearly doubled between 2007 and 2017, from
18 percent ($78 billion) to 30 percent ($210 billion), as enrollment in Medicare
Advantage plans increased over these years.
• Average annual growth in Medicare per capita spending was 1.5 percent between
2010 and 2017, down from 7.3 percent between 2000 and 2010, due in part to the
Affordable Care Act’s reductions in payments to providers and plans, and to an
influx of younger beneficiaries from the baby boom generation aging on to
Medicare, who have lower per capita health care costs.
• Medicare per capita spending is projected to grow at an average annual rate of 4.6
percent over the next 10 years, due to growing Medicare enrollment, increased use
of services and intensity of care, and rising health care prices.
U.S TOP 2 GOVERNMENT INSURANCE
PROGRAMS
• What is Medicare?
• What is Medicaid?
• Medicare is a national health insurance
program in the United States, begun in
1966 under the Social Security
Administration and now administered by
the Centers for Medicare and Medicaid
Services.
• Medicaid provides health coverage to
millions of Americans, including eligible
low-income adults, children, pregnant
women, elderly adults and people with
disabilities.
• Medicaid is administered by states,
according to federal requirements.
• The program is funded jointly by states
and the federal government.
MEDICARE A DEEPER DIVE
• Medicare provides coverage for:
• People who are 65 or older
• Certain younger people with disabilities
• People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a
transplant, sometimes called ESRD)
• The different parts of Medicare help cover specific services
MEDICARE COVERAGE

Medicare Part A (Hospital Insurance)


Medicare Part B (Medical Insurance)



Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
Medicare Part D (prescription drug coverage)

Part D adds prescription drug coverage to:

Original Medicare

Some Medicare Cost Plans

Some Medicare Private-Fee-for-Service Plans

Medicare Medical Savings Account Plans
These plans are offered by insurance companies and other private companies approved by Medicare. Medicare
Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare
Prescription Drug Plans.
MEDICARE ADVANTAGE (PART C)
• Medicare Advantage (also known as Part C) is an “all in one” alternative to
Original Medicare. These “bundled” plans include Part A, Part B, and usually
Part D.
MEDICARE ADVANTAGE
• A type of Medicare health plan offered by a private company that contracts with Medicare. Medicare
Advantage Plans provide all of your Part A and Part B benefits. Medicare Advantage Plans include:

Health Maintenance Organizations

Preferred Provider Organizations

Private Fee-for-Service Plans

Special Needs Plans

Medicare Medical Savings Account Plans

If you’re enrolled in a Medicare Advantage Plan:

Most Medicare services are covered through the plan

Medicare services aren’t paid for by Original Medicare

Most Medicare Advantage Plans offer prescription drug coverage.
MEDICAID A DEEPER DIVE
• The Center for Medicaid and CHIP Services (CMCS) serves as the focal point
for all national program policies and operations related to Medicaid, the
Children’s Health Insurance Program (CHIP), and the Basic Health Program
(BHP). These critical health coverage programs serve millions of families,
children, pregnant women, adults without children, and also seniors and people
living with disabilities.
MEDICAID A DEEPER DIVE
• Authorized by Title XIX of the Social Security Act, Medicaid was signed into
law in 1965 alongside Medicare. All states, the District of Columbia, and the
U.S. territories have Medicaid programs designed to provide health coverage
for low-income people. Although the Federal government establishes certain
parameters for all states to follow, each state administers their Medicaid
program differently, resulting in variations in Medicaid coverage across the
country.
• In 2015, Medicaid celebrated its 50th birthday by posting program highlights,
research findings and the voices of our beneficiaries in 50 days of postings.
C H I L D R E N ‘ S H E A LT H I N S U R A N C E
P ROGRA M
• The Children’s Health Insurance Program (CHIP) was signed into law in 1997
and provides federal matching funds to states to provide health coverage to
children in families with incomes too high to qualify for Medicaid, but who
can’t afford private coverage. All states have expanded children’s coverage
significantly through their CHIP programs, with nearly every state providing
coverage for children up to at least 200 percent of the Federal Poverty Level
(FPL).
• In the State of Ct it is referred to as the Husky Plan.
MEDICAID BASIC HEALTH PLAN
• The Basic Health Program was enacted by the Affordable Care Act and
provides states the option to establish health benefits cover programs for lowincome residents who would otherwise be eligible to purchase coverage
through the Health Insurance Marketplace, providing affordable coverage and
better continuity of care for people whose income fluctuates above and below
Medicaid and CHIP levels.
AFFORDABLE CARE ACT
• Beginning in 2014, the Affordable Care Act provides states the authority to
expand Medicaid eligibility to individuals under age 65 in families with incomes
below 133 percent of the Federal Poverty Level (FPL) and standardizes the
rules for determining eligibility and providing benefits through Medicaid, CHIP
and the health insurance Marketplace.
• Fills in current gaps in coverage for the poorest Americans by creating a
minimum Medicaid income eligibility level across the country.
• Beginning in 2014 coverage for the newly eligible adults will be fully funded by
the federal government for three years. It will phase down to 90% by 2020.
COST OF MEDICAID SPENDING

NHE grew 3.9% to $3.5 trillion in 2017, or $10,739 per person, and accounted for 17.9% of Gross Domestic
Product (GDP).

Medicare spending grew 4.2% to $705.9 billion in 2017, or 20 percent of total NHE.

Medicaid spending grew 2.9% to $581.9 billion in 2017, or 17 percent of total NHE.

Private health insurance spending grew 4.2% to $1,183.9 billion in 2017, or 34 percent of total NHE.

Out of pocket spending grew 2.6% to $365.5 billion in 2017, or 10 percent of total NHE.

Hospital expenditures grew 4.6% to $1,142.6 billion in 2017, slower than the 5.6% growth in 2016.

Physician and clinical services expenditures grew 4.2% to $694.3 billion in 2017, a slower growth than the
5.6% in 2016.

Prescription drug spending increased 0.4% to $333.4 billion in 2017, slower than the 2.3% growth in 2016.

The largest shares of total health spending were sponsored by the federal government (28.1 percent) and the
households (28.0 percent). The private business share of health spending accounted for 19.9 percent of
total health care spending, state and local governments accounted for 17.1 percent, and other private
revenues accounted for 6.8 percent.
PATIENT POLICY CONSIDERATIONS
• The Presidents latest budget – contain cuts to Medicare and Medicaid program
spending – How will this impact patients?
• Medicare for all – recent announcements made by Presidential candidates – Is
this good for the country or not? Who will pay for the program? How will the
program benefit patients?
TO LEARN MORE – RESOURCES
• Medicare – https://www.medicare.gov/sign-up-change-plans/types-of-medicarehealth-plans/medicare-advantage-plans
• Medicaid – https://www.medicaid.gov/about-us/program-history/index.html
• Medicare for All – http://www.medicareforall.org/pages/Home
• Kaiser family Foundation – https://www.kff.org/medicare/issue-brief/the-factson-medicare-spending-and-financing/
• Medicaid Costs – https://www.cms.gov/research-statistics-data-andsystems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-factsheet.html

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