This document discusses implications for the Medicare program given demographic trends in the aging US population. It outlines 10 issues arising from an increasing senior population and the implications for Medicare delivery and costs. It also discusses potential solutions to issues providing healthcare for seniors, including maintaining the political and fiscal viability of Medicare in the future.

1. Implications for The Medicare Program Discussion
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DiscussionInstructions and assigned reading is attached below. If you have any questions
please feel free to ask.Implications for The Medicare Program
Discussionattachment_1attachment_2Unformatted Attachment PreviewInstructions: This
assignment must be done in APA format. It is broken down into 2 questions. A minimum of
1600 words (references is not included) for the overall assignment is required. The
minimum reference count is 4 (including in-text citations) for the overall assignment. Also,
even though this assignment is done in APA, it must keep the question, answer, and
reference format. Please see example below. Format: Question: XYZ Answer: XYZ Reference:
XYZ Articles for questions: http://www.nber.org/programs/ag/
http://www.ajan.com.au/Vol26/26-3_Johnstone.pdf
http://unpan1.un.org/intradoc/groups/public/documents/IPMAHR/UNPAN025894.pdf
https://hsric.nlm.nih.gov/hsric_public/display_links/705 1. The population of the US is
aging, with the fastest growing population segment being eighty plus. Coupled with this
factor are the slowing birth rates. These factors may lead to a decreased tax base to support
the federal programs for the aged. In an outline format list at least 10 issues arising in
healthcare delivery with ever increasing senior population. Your discussion should include
the implications for the Medicare program. 2. Outline a potentially viable and politically
acceptable solution to the issues related to providing healthcare for the aged Part Two: This
part of the assignment is simple. The minimum word count for this assignment is 250 words
(per response); with one reference each. Note: Write as if you’re actually talking to the
person. 1. The adoption of Medicare was geared towards providing the elderly with health
coverage as these individuals could no longer work, and this was considered the ‘right thing
to do’. The “1965 legislation declared that the Federal Government would provide the
financing (through social security via taxes and premiums) but not interfere in clinical
medicine” (DeWalt, Oberlander, Carey & Roper, 2005, para. 1). Initially, the goal of Medicare
was geared for acute care expenses requiring a physician or hospital services rather than
comprehensive care. For the most part, Medicare works because it serves the elderly as it
initially was set out to do. However, Medicare has evolved over the years expanding their
eligibility, benefits, and federal government involvement in the delivery of healthcare
services. After the implementation of Medicare, the reimbursement system was not
efficient. Hospitals were paid for all services provided whether or not they were actually

2. necessary. This brought profits to the hospitals but increased expenditures for the
government. Implications for The Medicare Program DiscussionTo control Medicare
spending, Congress passed the Professional Standard Review Organizations (PSRO’s) which
were audits to ensure Medicare was paying for approved Medicare services only (Morone,
Litman & Robins, 2009). This was not effective because there was no control of the actual
costs, quantity, or appropriateness of the Medicare-approved services. “In 1972, Congress
expanded coverage to include individuals under the age of 65 with long-term disabilities
and individuals with end-stage renal disease” (Anderson, 2019, para. 8). This helped by
covering individuals that fell in the gaps of no coverage. However, this contributed to the
increased costs and expenditures of the Medicare program. By expanding eligibility, this
was contrary to what Congress passed (original Medicare goals). As a result, diagnostic-
related groups (DRG) were introduced. DRG’s are payments that are based on the diagnosis.
This was more effective as it helped prevent overuse or inappropriateness of services. The
payment was directly tied to a certain amount based on the diagnosis. This meant that
hospitals needed to treat and discharge in an appropriate time or they would lose money.
This would inevitably lower costs on the Medicare side while causing hospitals to shift some
of the higher costs to private insurance companies which then implemented managed care
as a means to control costs (Bethel University, n.d). As costs increased, employers also
shifted some of these costs to their employers. This cost shifting did not work. “Thomson-
Reuters estimated that the healthcare system wastes between $505 and $850 billion
annually” (Adkinson & Chung, 2014, para. 10). Components of the ACA addressed fraud to
help reduce wastes evident with initiatives to prevent fraud by assessing providers and
ensuring their validity while increasing penalties and convictions. Additionally, the
“Medicare and CHIP Reauthorization Act (MACRA) of 2015 pushed for Medicare to pay
more for value and quality rather than how many services” (Anderson, 2019, para. 13).
These initiatives appear to be the most efficient at this time. Medicare Advantage plans
caused a “decrease in FFS Medicare spending growth, ($154 annually per 10-percentage-
point increase in Medicare Advantage)” (Johnson, et al. , 2016, para. 1). Currently, Medicare
Advantage plans provide “comprehensive competitive health care markets focused on
transparency, accountability, and payment connected to outcomes which matter to patients
and payers” (Moffit, Numerof & Buseman, 2018, para.16). Medicare Advantage plans offer
customers a choice, additional benefits such as dental, and coordinated care compared to
traditional Medicare. By offering preventive and comprehensive care through coordination
of care, Medicare Advantage plans are set out to control costs with these measures while
ensuring their payments are based on quality. Medicare Advantage plans such as BlueCare
Plus does an excellent job collaborating and coordinating care for both their Medicaid and
Medicare via BlueCare. Medicare has been successful in that elderly, disabled, and persons
with ESRD have health benefits. However, there have been necessary changes made to the
program since inception due to increased costs. Implications for The Medicare Program
DiscussionThe most recent efforts to push for quality of care will most likely be the most
efficient measure to assist with controlling costs and quality. However, Medicare has left
gaps of care in which leads people to either purchase a supplemental plan or a Medicare
Advantage plan. Fraud will always remain an issue and needs to continue to be a

3. performance improvement measure for all healthcare organizations. Moving forward, much
concentration will be focused on monitoring and comparing data so that changes can be
made along the way to ensure the Medicare program runs efficiently as possible. 2.
Medicare is coverage managed by the federal government. It contains two parts, A/B. Most
people have both but not all. Part A covers inpatient hospital stays, care in a skilled nursing
facility, hospice care, and some home health care(Hohmann,Hastings & Westrick,2018). Part
B covers certain doctors’ services, outpatient care, medical supplies, and preventive
services. Since its inception in 1965 Medicare continues to provide the majority of seniors
with affordable health insurance. In the last 50 years there have been many additional
benefits added. At its inception patients paid $3 per month for health coverage, currently
the Part B coverage has grown to over $100. The deduction from social security payments
still continues(Bjorklund,2018). If you don’t sign up for Medicare when you turn 65 your
premium will go up unless you have employer sponsored health insurance. Tax rates were
.35 percent of their earnings into the Medicare system back in 1966, now high income
workers are taxed an additional 0.9 percent on earned income exceeding $200,000 for
individuals and $250,000 for couples(Bjorklund,2018). The original Medicare program did
not cover prescription drugs. In 2006 a Part D prescription plan was made available. Signed
in 2010, the ACA added free preventative care services to Medicare, such things as
mammograms and colonoscopies and free yearly visits to the Doctor for a well visit. Some
downfalls are the costs to administrate, in 2016 Medicare spending totaled $588 billion
which is 15% of the federal budget and only expected to rise. Hospital stays are costly, older
enrollees see a skyrocket in premiums, and Medicare costs taxpayers a huge amount. Yes
Medicare works. It provides health care benefits for people 65 or older, people younger
than 65 who have certain disabilities, and people of any age who have certain disabilities. It
gives basic protection against health care costs, although it doesn’t cover all expenses, it
generally covers 80%(Hargadon, Tran & Homler,2017). California is an excellent state for
Medicare resources that are actually free. California also has the most Medicare
beneficiaries. The California Medicare savings organization pays for premiums and some
prescription costs. There is also SHIP (California state health insurance & assistance
program) which is a federal grant that provides funding to the state to offer one-on-one
counseling for Medicare beneficiaries and provides agencies the ability to go around and
help implement Medicare into clinics and hospitals(Fulton,Pegany & Scheffler,2015). 3. The
purpose of Medicare from its inception in 1965 has been to provide basic health insurance
for those who were age 65 and older. At the time of its inception, only about 56% of
Americans who were over the age of 65 were utilizing health insurance (Sheingold,
Zuckerman, DeLew, Maddox, & Epstein, 2018). One of the hopes for the policy makers was
to ensure that seniors did not see Medicare as a charity program but instead an outlet to
receive the needed care when they had retired and did not have health insurance from their
employer anymore. In 1972, the policy was amended to allow for those who have severe
disabilities to have the access to the healthcare they need. One of the problems with
Medicare is the high premiums and co-pays that are associated with certain procedures.
“For many years, the cost of treating each individual Medicare beneficiary has been growing
faster than has our gross domestic product, or GDP” (Custer, 2019, p.42). One of the goals of

4. Medicare is to control the cost of healthcare costs. Implications for The Medicare Program
DiscussionStudies have shown that enrolees in Medicare have actually been spending less
than those who have private insurance. Traditional Medicare was designed around the
concept of fee for service. Initially, hospitals would be paid for procedures they preformed
no matter what the quality of service. It was not until the introduction of value based
programs that Medicare can pay a provider based on the quality of the services provided.
For hospitals that make 70% of their income off of Medicare, they now have incentives to
provide quality care. Chapter 8 Medicare: The Great Transformation Jonathan Oberlander H
I G G S , This chapter describes Medicare, the largest federal health care program. The
author explains how Medicare has passed through four historical S stages, and he points to
the great tension that has marked the program’s H conflicts, past and present: Medicare’s
original vision reflected liberal ideas A clash with the contemof solidarity (we are all in this
together), which porary conservative vision that emphasizesNindividualism, markets, and I
competition. C Q U poliMedicare is a major arena of conflict in American health tics. The
fault-line in Medicare politics, while not exclusively A disputes over program reform.
Medicare, then, figures to be a prominent issue in American politics for years to come. Time
will not ease this clash. As the baby boomers5age into Medicare, the stakes associated with
Medicare reform will T only grow. Between 2000 and 2030, the share of the American
population age 65 and over will increase from 12Sto 20% and Medicare enrollment will
nearly double, from 40 to 78 million beneficiaries. The fiscal pressures exerted on and by
Medicare will be substantial and undoubtedly will intensify This chapter explores the
dynamics of Medicare politics, identifying major themes and changes since the program’s
adoption in 1965. The chapter is organized around four eras in Medicare’s history.1 I begin
with the origins of Medicare and the fight over its enactment. Next, I describe the politics of
accommodation that governed Medicare’s first 15 years of operation. The third section
turns to the regulation revolution in Medicare policy that transformed the program’s ­p
ayment systems for hospitals and physicians during the 1980s. The fourth section explores
the rise of competition and markets as frameworks for Medicare policy during the 1990s, as
well as the 2003 enactment of the Medicare Prescription Drug, Improvement, and
Modernization Act (also partisan, often divides Democrats from Republicans, liberals from
conservatives, and advocates of government health insurance from proponents of private
coverage. It is a fight 1 that does not lend itself to easy compromises or final resolution 1
because Medicare reform ignites fundamental debates about the welfare state, markets, and
generational equity. 0 9781305172005, Health Politics and Policy, Fifth Edition,
Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without
express authorization. CHAPTER 8 • Medicare: The Great Transformation known as the
Medicare Modernization Act, or MMA). Finally, I conclude by examining the implications of
health care reform and the rise of debt and budget deficit politics for Medicare. The Politics
of Enactment Medicare’s story begins with the failed campaign for national health insurance
during the first half of the 20th century.2 Progressives introduced a model bill for
compulsory health Hinsurance to submit to state legislatures in 1915, but it failed I due to a
combination of political naiveté (advocates assumed “rational argument and statistical
persuasion” were suffiG cient to win legislative passage); mobilization of opposition forces

5. (including employers, the insurance industry, G labor leader Samuel Gompers and, after
reversing its initial supportS ive stand, the American Medical Association [AMA], which ,
represented US physicians); and bad timing and xenophobia (American entry into World
War I enabled opponents to denounce compulsory health insurance as a “German plot,” S
while the 1917 Russian revolution similarly led to charges that reform was “un-
American”).3 These same political forces H proved to be enduring barriers to establishing
national health A insurance throughout the 20th century. Implications for The Medicare
Program DiscussionN The 1935 Social Security bill originally contained a single line
authorizing study of health insurance, prompting vigorI ous protests from the AMA, which
believed government health C insurance threatened the organizational, financial, and
clinical autonomy of physicians. President Franklin D. -Roosevelt Q (FDR), fearing the
controversy would jeopardize -enactment of U his Social Security legislation, refrained from
pushing health ASeinsurance and ordered the line removed from the Social curity Act. His
successor, Harry Truman, became the first -American president to propose national health
insurance but 1 ran fared no better in winning its passage. Truman, like FDR, into the AMA’s
unrelenting opposition—it turned debate1over national health insurance into a Cold
War−era referendum on 0 of “socialized medicine”—as well as a conservative coalition
Southern Democrats and Republicans that formed a voting5majority in Congress and
blocked much of his domestic agenda. T -Proposals for universal insurance went nowhere in
Congress. S Advocates of national health insurance within the Truman administration
believed it was time for a new strategy. -Wilbur Cohen and I. S. Falk, advisers to Federal
Security Agency -administrator Oscar Ewing, developed a plan to provide federal 127 health
insurance to beneficiaries of Social Security payments for Old Age and Survivors Insurance
(OASI). In June 1951, Ewing publicly announced a proposal for 60 days of hospital insurance
a year for the 7 million elderly retirees receiving Social Security, saying “it is difficult for me
to see how anyone with a heart can oppose this.”4 The plan reflected a political calculus of
incrementalism. 5 By restricting eligibility to the elderly, narrowing benefits to hospital
care, and linking health coverage to Social Security, the architects of the Medicare strategy
hoped to achieve a goal that had eluded the Truman administration and previous reformers:
enactment of federal health insurance. In focusing on the elderly, Medicare’s architects
intended to take advantage of the political sympathy that seniors commanded as a
deserving population that was both sicker and more likely to be uninsured than working-
age Americans in the 1950s. By omitting benefits for physician services, reformers hoped to
tamp down the AMA’s opposition to a federal insurance program. And by proposing health
insurance through Social Security, which provided the model for Medicare’s eligibility rules,
financing, and administrative arrangements, they hoped to exploit political associations
with America’s most popular social program and curry favor with the public. Ultimately, of
course, the Medicare strategy worked—after a half-century of failure, Medicare’s enactment
in 1965 represented a singular triumph for reformers. But that success came only after a
contentious, decade-long debate and an electoral landslide that transformed American
politics. Indeed, the carefully calibrated Medicare proposal did not succeed in calming the
AMA’s opposition to federal health insurance; for organized medicine, 60 days of hospital
insurance for the -elderly still constituted socialized medicine and set a dangerous

6. precedent for government intervention in the health care system. The AMA saw Medicare as
a slippery slope to national health insurance. It consequently campaigned just as hard
against Medicare as it had against the Truman plan. Meanwhile, though Medicare attracted
substantially more support in Congress than prior national health insurance proposals
had—Medicare sponsors came within one vote of winning a majority on the crucial House
Ways and Means committee in 1964—it still fell short of garnering enough votes to pass
Congress. The 1964 elections—Democrat Lyndon Johnson won the presidency in a
landslide and Democrats gained wide majorities in both the House and Senate, thereby
breaking the power of the conservative coalition—ended the impasse over Medicare,
leading to its enactment in 1965. 9781305172005, Health Politics and Policy, Fifth Edition,
Morone/Ehlke – © Cengage Learning. All rights reserved. No distribution allowed without
express authorization. 128 PART III • The Major Programs 1965 Legacies Several key
features of Medicare as it was enacted are worth highlighting because they created
enduring political legacies and policy dilemmas. First, Medicare provided a limited benefits
package focused on protecting the elderly against the acute costs of medical care rather
than providing comprehensive insurance for all medical costs or covering care for chronic
illness. The Medicare legislation enacted in 1965 was significantly broader than the original
Medicare proposal. House Ways and Means chair Wilbur Mills engineered a compromise,
with the approval of Lyndon Johnson,6 that H added insurance for physicians’ services and
the Medicaid program I for low-income Americans to the bill. But it still omitted coverage of
critical services such as outpatient prescription Gdrugs, long-term nursing home care,
hearing aids, and dental care. G Moreover, Medicare required significant beneficiary cost
sharing without any cap on catastrophic expenses or S limit on how much enrollees could
pay in a given year. These, limited benefits led directly to the growth in Medigap and
employersponsored supplemental health insurance policies that many Medicare
beneficiaries carry to fill in the program’sSsizable holes and set the stage for subsequent
fights over expanding H Medicare benefits. Second, Medicare at the start was divided into A
two programs ..Implications for The Medicare Program Discussion