Healthcare Medicaid and Medicare

Healthcare Proposal

Abstract

Socioeconomic status and high prices of healthcare insurance premiums are some of the critical factors that define the way US citizens are covered. However, a large subgroup of the population remains uninsured, particularly those who live in remote or rural areas or do not fall under the age categories of Medicare or Medicaid programs. This paper aims to put forth a new legislation proposal with changes in the terms that cater to addressing the disparities in health coverage, insurance paying alterations, cost-control tactics of the physicians, and vast integration of telehealth mechanisms for maximizing healthcare access. These reforms are expected to reduce discrimination against social class and area of living with greater network adequacy standards and fill gaps for upgraded economic growth.

Keywords: Healthcare insurance coverage, premiums, Medicaid, Medicare, social class, remote access, telehealth, cost-control by physicians, legislation proposal, network adequacy standards

Healthcare Proposal

Good healthcare needs to be free of discrimination or healthcare disparities in access, facilities, and availability of medical experts to maximize reach. A strong economy’s first depiction is its good healthcare system since economic growth and life expectancy are improved with this core element (Scott, 2021). Assured health expenditure for improving life expectancy has certainly shown positive results for the GDP growth of an economy whose country has prioritized this area. This paper aims to present a healthcare proposal based on the current legislation within the United States and how it could be changed for better access and provision of healthcare to certain population segments.

Current Healthcare System

The current US healthcare system does not offer universal health coverage and lacks a uniform health mechanism. It means it seems privileging only the higher income bracket people and low-income people face health disparities in various regions within the country (Chemweno, 2021). Although the US has been advancing in medical technological superiority and biomedical research it has conducted regularly for the past few centuries; it still lags in preventing medical errors. Poor management of mortality rates for certain chronic diseases still has a long way to go before fully incorporating the healthcare system for everyone equally. The lack of transparency is a clear medical issue that has not eliminated disparities throughout the country.

A majority of US people still find difficulty dining qualified doctors and nurses for the problems they face health-wise since they demand high rates. The costly healthcare system has caused trouble for access for most Americans, particularly for middle and low-income families across the country (Chemweno, 2021). The social and economic inequity has led to poor health conditions of citizens belonging to these two classes that need serious policy changes for better reach and optimal healthcare quality for all.

Another problem that is increasingly and rapidly becoming conspicuous with each day is healthcare costs. Almost 16% of the US population, fifty million people roughly, are not covered by healthcare insurance (Chemweno, 2021). The medical expenditures that one has to pay for a doctor, buying medicines, and getting expensive treatments are going out-of-pocket for middle and low-class people. They remain severely marginalized in terms of unaffordability that is growing at a fast pace ever than expected.

Future of Healthcare If Left as It Is

If the situation in US healthcare is left as it is, it will burden the country’s economy with a huge financial burden. Uninsured people would fall victim to serious illnesses and would not be able to contribute to the country’s growth (Shmerling, 2021). On the contrary, the government would have to expand its expenditure figures to cater to the treatments required for these people. Moreover, if the treatment costs are high, higher mortality rates would not be a good indication for any country’s GDP.

Since the healthcare industry has been technologically advanced, if technological access to medical facilities is not made reachable to the underserved population segments, the disparity rates would go beyond the existing ones. The technology could be used for various purposes, such as educating people on how to self-manage their chronic illnesses, checking out the signs when to visit their nearby doctors, etc. Moreover, the weekly or monthly contact through telehealth techniques with community nurses would create magnified change for the uninsured people as well as positive health outcomes. However, under-emphasis on this aspect of healthcare has not been addressed, and poor coordination has contributed to fragmented care and higher costs (Shmerling, 2021).

Legislative Proposals

According to the Affordable Care Act (ACA), launched in March 2010, affordable medical care should be available to as many people as possible (Healthcare.gov, n.a.). Maximum access is the solution to the existing problems so that future expenditures from the government could also be reduced, and the economy should be strengthened for future generations. Middle and lower-class people who are below the poverty level should be covered. For this matter, Medicare and Medicaid should include people younger than 65 so that insurance coverage could be reasonable for their pockets, too (Allen et al., 2021).

Health promotion could be regularly conducted in areas that are underprivileged or not accessed easily, such as rural areas that are more poverty-stricken. This would enable even those individuals who are not covered by insurance packages and are suffering from chronic illnesses (Strasser, 2016). There are transportation and communication difficulties in such areas that could be alleviated with telehealth, also for educational purposes.

Making insurance coverage a financial solution for all Americans, explicitly through subsidizing Medicaid and Medicare insurance premiums affordable, is another proposal for the legislation changes. One of the most uninsured segments of the population was young adults, as suggested by the national health data till 2016 (Wisk & Sharma, 2019). However, with changes in ACA, some positive alterations were made for the age group 19 to 25 years. Still, there are gaps in availability and actual benefits gained by low-economic young adult groups for the Medicaid ACA-activated expansion. The post-reform gains should be ensured with constant appraisal every six months so that inequalities in vulnerable groups could be identified promptly and the extent of reach could be renewed.

Making health insurance coverage portable for all Americans would be an extra value for those employees who change or lose their jobs as they would not have to worry about unemployment for coverage of medical costs, even if someone’s child or spouse falls ill, for instance. It is a family burden in itself when employment is absent. During that tenure, medical coverage in portability would be a fresh initiative and relief for the low-income class. The renewal of the insurance coverage could be generated through Health Insurance Portability and Accountability Act (HIPAA) for students, non-patient employees mainly from middle or low-income groups, billing companies, and individuals whose data records are in an electronic database (Edemekong et al., 2022).

Allowing access to healthcare for chronic illnesses even if they are not uninsured should be made possible with telehealth. Telehealth initiatives should be made mandatory for all areas of the country, rural or urban, so self-management and self-adherence can be promoted. These two tactics would release the economic burden to a great extent from the government’s shoulders since knowledge would be provided to those who cannot go to healthcare facilities on time, facilities that are not present within their vicinities, or qualified doctors who cannot be afforded. However, private insurance might be needed to regulate the induction of remote healthcare delivery through telehealth as support of software service providers to remote areas. That, too, would be necessary for all age groups (Shachar et al., 2020). Education to use technological devices and apps, such as smartphones and health monitoring apps, would also be a challenge. Hiring nurses to reach remote areas to educate the targeted individuals would also need investments (Abelsen et al., 2020). These investments could be gathered from tax legislation, such as tax costs’ equal distribution across all citizens.

The proposed legislation must also include the systematic control of costs by the medical professionals who provide services against the number of Americans who receive them and how they receive them. For example, a low-income American receiving medical help through telehealth should be re-considered compared to a low-income American visiting the hospital on his own to receive the same treatment. However, the general attitudes of physicians in controlling these costs are complex to interpret. They resist bundled payments and remove fee-for-service reimbursements (Tilburt et al., 2013). They think the entire blame should be put upon poor enhancement of continuity of care and management of chronic illness handling departments. The inconsistency reflected in their role as a medical professionals is hard to discern since it is their responsibility to control the costs under American Medical Association’s Council clauses on Ethical and Judicial Affairs (Tilburt et al., 2013). Resource and funds allocation from the government as a backing would restore their confidence within the system and might be surer that they would be compensated for their efforts, no matter at what higher level of the profession they are. The tensions between the professional roles hinder them from accepting lower reimbursements for service fees that result in cost-conscious practice. The willingness needs to be broadened, which is possible with legislation changes. The private and public medical coverages need to support the costs that physicians are struggling to adjust.