This is an informative piece for anyone serious about the topic of health care reform.
http://www.cms.hhs.gov/MedicareProgramRatesStats/Downloads/MedicareMedicaidSummaries2008.pdf
Costs have been increasing.
"Health spending in the United States has grown rapidly over the past few decades. From $27.5 billion in 1960, it grew to $912.6 billion in 1993, increasing at an average rate of 11.2 percent annually. This strong growth boosted health care’s role in the overall economy, with health expenditures rising from 5.2 percent to 13.7 percent of the Gross Domestic Product (GDP) between 1960 and 1993."
"National health expenditures are projected to reach $4.3 trillion in 2017, up from $2.1 trillion in 2006. After increasing 6.7 percent in 2006, NHE growth is projected to remain steady at 6.7 percent in 2007 and 6.6 percent in 2008. From 2006 through 2017, health care spending is projected to grow at an average annual rate of 6.7 percent, roughly 1.9 percentage points faster than the expected rate of GDP growth. As a percentage of GDP, national health spending is expected to reach 19.5 percent by 2017, up from 16.0 percent in 2006."
When the term "rationing of care" is used - this is ONE of the meanings -> $0 benefit for skilled nursing facility after 100 days.
"For hospital care covered under Part A, a fee-for-service beneficiary’s payment share includes a one-time deductible amount at the beginning of each benefit period ($1,068 in 2009). This deductible covers the beneficiary’s part of the first 60 days of each spell of inpatient hospital care. If continued inpatient care is needed beyond the 60 days, additional coinsurance payments ($267 per day in 2009) are required through the 90th day of a benefit period. Each Part A beneficiary also has a “lifetime reserve” of 60 additional hospital days that may be used when the covered days within a benefit period have been exhausted. Lifetime reserve days may be used only once, and coinsurance payments ($534 per day in 2009) are required.
For skilled nursing care covered under Part A, Medicare fully covers the first 20 days in a benefit period. But for days 21-100, a copayment ($133.50 per day in 2009) is required from the beneficiary. After 100 days per benefit period, Medicare pays nothing for SNF care. Home health care has no deductible or coinsurance payment by the beneficiary. In any Part A service, the beneficiary is responsible for fees to cover the first 3 pints or units of non-replaced blood per calendar year. The beneficiary has the option of paying the fee or of having the blood replaced."
We often hear that people who most need coverage are not covered. However, there were 56 million people covered under Medicaid in 2007 and 51% (28.7 million) were children.
"As with all health insurance programs, most Medicaid beneficiaries incur relatively small average expenditures per person each year, and a relatively small proportion incurs very large costs. Moreover, the average cost varies substantially by type of beneficiary. National data for 2005, for example, indicate that Medicaid payments for services for 28.7 million children, who constituted 51 percent of all Medicaid beneficiaries, averaged about $1,667 per child. Similarly, for 13.7 million adults, who comprised 24 percent of beneficiaries, payments averaged about $2,475 per person. However, other groups had much larger per-person expenditures. Medicaid payments for services for 4.9 million aged, who constituted 9 percent of all Medicaid beneficiaries, averaged about $13,675 per person; for 9.1 million disabled, who comprised 16 percent of beneficiaries, payments averaged about $13,846 per person. When expenditures for these high- and lower-cost beneficiaries are combined, the 2005 payments to health care vendors for 56.3 million Medicaid beneficiaries averaged $4,859 per person.
Long-term care is an important provision of Medicaid that will be increasingly utilized as our nation’s population ages. The Medicaid program paid for over 41 percent of the total cost of care for persons using nursing facility or home health services in 2005. National data for 2005 show that Medicaid payments for nursing facility services (excluding ICFs/MR) totaled $44.7 billion for more than 1.7 million beneficiaries of these services—an average expenditure of $26,234 per nursing home beneficiary. The national data also show that Medicaid payments for home health services totaled $5.4 billion for 24
1.2 million beneficiaries—an average expenditure of $4,510 per home health care beneficiary. With the percentage of our population who are elderly or disabled increasing faster than that of the younger groups, the need for long-term care is expected to increase.
Another significant development in Medicaid is the growth in managed care as an alternative service delivery concept different from the traditional fee-for-service system. Under managed care systems, HMOs, prepaid health plans (PHPs), or comparable entities agree to provide a specific set of services to Medicaid enrollees, usually in return for a predetermined periodic payment per enrollee. Managed care programs seek to enhance access to quality care in a cost-effective manner. Waivers may provide the States with greater flexibility in the design and implementation of their Medicaid managed care programs. Waiver authority under sections 1915(b) and 1115 of the Social Security Act is an important part of the Medicaid program. Section 1915(b) waivers allow States to develop innovative health care delivery or reimbursement systems. Section 1115 waivers allow statewide health care reform experimental demonstrations to cover uninsured populations and to test new delivery systems without increasing costs. Finally, the BBA provided States a new option to use managed care without a waiver. The number of Medicaid beneficiaries enrolled in some form of managed care program is growing rapidly, from 48 percent of enrollees in 1997 to 64 percent in 2007.
More than 56 million persons received health care services through the Medicaid program in FY 2005 (the last year for which beneficiary data are available). In FY 2007, total expenditures for the Medicaid program (Federal and State) were $335.8 billion, including direct payment to providers of $232.6 billion, payments for various premiums (for HMOs, Medicare, etc.) of $67.0 billion, payments to disproportionate share hospitals of $16.1 billion, administrative costs of $17.3 billion, and $2.7 billion for the Vaccines for Children Program. Expenditures under the SCHIP program in FY 2007 were $8.8 billion. With no changes to the program, spending under Medicaid is projected to reach $523 billion by FY 2013. (SCHIP is currently authorized and funded only through March 2009.)"
Again, this is an informative piece and should be reviewed in it's entirety.
