Term Paper on "Health Policy Analysis: Nursing & Medicaid"

Term Paper 12 pages (3179 words) Sources: 20 Style: APA

[EXCERPT] . . . .

HEALTH POLICY ANALYSIS: NURSING & MEDICAID

Medicaid Policy Analysis

The Plight of the Poor and Medicaid Policy Framework

Visible and Vocal Advocate

Inherent Inequality in American Democracy

Eligibility, Physician Behavior and Low-Income Population Access to Care

Questions Addressed in this Study

Analysis & Evaluation

HEALTH POLICY ANALYSIS: NURSING & MEDICAID

The objective of the following work in writing is to examine Medicaid policy and to answer questions including those of: (1) What necessitated or facilitated the creation of the policy? (2) What was the policy attempting to accomplish? (3) Who had input into the development of the policy? (4) Was public comment solicited prior to the finalization of the policy? (5) for Whom Does the Policy Advocate? (6) What Purpose Does the Policy Serve in Its Health Care Arena? (7) How Is the Policy Operationalized? (8) What Are the Strengths of the Policy? (9) What Were the Limitations of the Policy? (10) What Impact Does the Policy Have on Social Justice? (11) What Is the Impact of the Policy on Vulnerable Populations? The eligibility requirements as set out in the Deficit Reduction Act of 1984 are examined in the following sections of this work in writing and examined as well is the soundness of eligibility requirements as the instrument by which alone to determine the eligibility of the poor for receiving Medicaid coverage.

I. Medicaid Policy Analysis

The work of Edward Allan Miller (2007) entitled: "Federal Administrative and Judicial Oversight of Medicaid: Policy Legacies and Tandem Institutions under the Boren Amendment" states "The role of the courts in shaping federal regulation of state policy decisions in the health sector is especially important for understanding the course of health policy in the United States. This is because, while federal statutes and regulations establish the broad parameters within which programs such as Medicaid operate, federal administrative review and judicial oversight ultimately determine whether particular policy actions fall within the scope of federal guidelines. But despite the importance of the courts, relatively few consider the relationship between the judiciary and federal regulation of state health policy decisions." (Miller, 2007)

Medicare and Medicaid were enacted in 1965 as Titles 18 and 19 and "reflected two distinct political philosophies and continue to do so. Medicare is a universalistic program: Its forty million beneficiaries constitute virtually all of the elderly who are automatically entitled to its benefits." (Brown and Sparer, 2003) There are approximately forty-million enrollees in Medicaid and this group is comprised of individuals who meet eligibility rules set by the states and shaped partially by federal mandates. Brown and Sparer states that those who advocate for U.S. national health insurance "tend to share an image that highlights universal standards of coverage, social insurance financing, and national administration -- in short, the basic features of Medicare." (2003)

While this approach is held to be equitable and efficient or to be "good policy and equally good politics" simultaneously Medicaid "is often taken to exemplify poor policy and poorer politics: means-tested eligibility, general revenue financing, and federal/state administration, which encourages inequities and disparities of care." (Brown and Sparer, 2003) Medicaid emerged "as a comprehensive health coverage for people who could not afford to buy care through private means. The program has contrived to stabilize its benefits and expand its number of beneficiaries with success that is surprising in a poor people's program." (Brown and Sparer, 2003) Medicaid however, "...lacking a universalistic mandate" resulted in the leaders of the Medicaid program giving consideration to "tightening eligibility when costs rose too fast or state revenues sank too low." (Brown and Sparer, 2003)

The federal government has expanded and alternatively reduced eligibility and then passed these mandates on to the states which often failed to adopt these new eligibility standards. For example the federal government required expanded Medicaid coverage, "...demanding that states give eligibility to poor women and children at more inclusive income and age limits. States duly protested these mandates, but Washington turned a deaf ear." (Brown and Sparer, 2003) Medicaid relies on general revenues and this in itself "should make it a political football, and 'soaring' rates of Medicaid spending have indeed generated considerable heat." (Brown and Sparer, 2003)

The reliance on Medicaid on general revenues (both state and federal) is stated by Brown and Sparer to have "encouraged strategic improvisations to which trust funding has been less conducive. States spending as little as twenty-three cents and no more than fifty cents of their own funds in each Medicaid dollar find that it pays to be creative in the search for disproportionate-share hospital (DSH) payments, federal waivers, upper payments limits, and other pots of gold." (Brown and Sparer, 2003)

II. The Plight of the Poor and Medicaid Policy Framework

Brown and Sparer (2003) state that Medicaid presently is affected by a challenge "its creators could not have foreseen in 1965: While the U.S. medical world has shifted massively to managed care arrangements, Medicare remains centered on a fee-for-service, third party payment model that was mainstream, indeed near ubiquitous thirty-five years ago." (2003) Medicaid is a joint federal-state endeavor which "combines a framework of federal rules and guidance with fifty varieties of state-plan relations." (Brown and Sparer, 2003)

Brown and Sparer state that the needs of Medicaid have "steadily expanded and now stretch beyond the impoverished women and children with whom the program is popularly identified. Roughly two-thirds of Medicaid spending serves the aged, blind, and disabled, who are about one-quarter of its beneficiaries. The equation of poor people's programs with poor programs failed to capture how heterogeneous and capacious the categories of entitlement would become as the politics of social policy played on." (Brown and Sparer, 2003)

III. The Nurses: Visible and Vocal Advocate

The work of Lundy, Lundy and Janes (2009) entitled: "Community Health Nursing: Caring for the Public's Health" states that public opinion is "expressed through special interest groups" and is "very influential in the development of public policy." (Lundy, Lundy and Janes, 2009) Many special interest groups including the American Hospital Association, the American Medical Association, and the American Insurance Association "spend huge amounts of time and money providing legislators with information on which to base health care decisions." (Lundy, Lundy and Janes, 2009) it does not help that many legislators are lacking in an in-depth understanding of health care issues" because the result is that the "information provided by special-interest groups often serves as a basis for health care decisions. When that happens decisions may fail to reflect the best interests of the majority." (Lundy, Lundy and Janes, 2009)

Lundy, Lundy and Janes states that nurses "...as the largest health care provider groups" need to be "both visible and vocal advocates for quality health care." (2009) Meeting that goal has been the focus of the American Nurses Association (ANA) which has "worked tirelessly over the years to develop an effective special-interest group infrastructure." (Lundy, Lundy and Janes, 2009) in 2007 the ANA "formulated a position paper stating that the U.S. health care systems needs restructuring, wellness promotion must become our emphasis, and universal access to health care services must be developed." (Lundy, Lundy and Janes, 2009) the ANA has further been active politically in several areas which include the area of health care rationing.

IV. Inherent Inequality in American Democracy

It is reported in the work of Jacobs and Skocpol (2007) entitled: "Inequality and American Democracy: What We Know and What We Need to Learn" that a recent and unpublished analysis of policy changes and public opinion which investigates the "possibility of unequal responsiveness to the policy preferences of rich and poor citizens." Reports a study which used data from 755 survey questions between the years of 1992 and 1999 "in which national samples of the public were asked about proposed changes in U.S. national policy." (Jacobs and Skocpol, 2007) This two-step procedure estimated the relationship between income and policy preferences for each of these 755 questions, the related the preferences of survey respondents at various income levels separately to actual changes in corresponding public policy." (Jacobs and Skocpol, 2007) f

Findings in the study indicate that a 10 percentage point increase in support for policy change among citizens at the ninetieth percentile of the income distribution was associated with a 4.8 percentage point increase in the likelihood of a corresponding policy shift." (Jacobs and Skocpol, 2007) it is stated that for the 300 policy question in which the imputed preferences of rich and poor citizens differed by 10 percentage points or more the disparities in apparent influence were even more stark, with a 10 percentage point shift in opinion among the poor associated with only a 9.5 percentage point difference in the likelihood of policy change. The analysis of national opinion and policy "suggests that the American political system is a great deal more responsive to the preferences of the rich than to the preferences of the poor." Jacobs and Skocpol, 2007)

It is stated that research demonstrates that there are "large differences in the nature, timing and effectiveness of state regulation efforts."… READ MORE

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