HN 300 Unit 6 Seminar Financing Human Services Madelyn Harvey, PhD.

HN 300 Unit 6 SeminarFinancing Human Services

Madelyn Harvey, PhD

Slides developed by David H. Johnson

Millersville University of Pennsylvania

Pearson Education 2011

© 2011 Pearson Education, Inc.All Rights Reserved

Social Welfare: Politics and Public Policy, 7eJohnson and DiNitto

Access to healthcare is no guarantee of good health

Other factors in good health: Lifestyle choices (smoking, drinking, etc.) Obesity Exercise Genetics



Age-related disparities Race-related disparities Racial and ethnic disparities in infant

mortality and life expectancy



Social Security Amendments of 1965 Covers virtually all Americans over age

65 Also covers disabled persons receiving

SSDI 2008 Federal spending about $468

billion



Hospital Insurance (HI) Pays for hospital care, skilled nursing

care following hospitalization, some home healthcare, and hospice care

Funded by portion of Social Security Payroll Tax (2.9 percent split between employer and employee)



Beneficiary pays deductible ($1,068 in 2009) Medicare pays for remainder of first 60 days

in hospital Medicare pays a portion of days 61 to 150 Medicare pays first 20 days of skilled nursing

home care in each benefit period. Beneficiary pays $133.50 per day for days 21

through 100 No benefits for nursing home care beyond

day 100



Voluntary component which covers physician services and outpatient hospital services, and certain home healthcare services

Covers durable medical equipment Part A beneficiaries who wish to have

Part B must pay premiums



Gaps in Medicare coverage include prescription drugs, long-term custodial care, catastrophic illness beyond 150 days hospitalization, and co-pays and deductibles

Plans and benefit levels for medigap policies are standardized



Optional alternative to original Medicare

Health Maintenance Organizations, which also cover some medigaps, for Medicare beneficiaries

Intended to contain healthcare costs, but costs are actually higher than traditional Medicare



Medicare Modernization Act of 2003 permits Medicare participants to join a private drug plan

Beneficiaries are required to pay monthly premiums, co-payments, and deductibles

Doughnut hole, a large gap in coverage under the original bill, will be eliminated under 2010 healthcare reform law



Three levels of nursing home care: Skilled (only type reimbursed by Medicare) Intermediate Custodial

Home healthcare alternatives Medicaid is primary government

funding source for LTC



Medicaid is an entitlement program passed along with Medicare in 1965

Costs are shared between federal and state governments, with each state administering its own program and setting its own rules

Covers about 50 million people



Any applicant who qualifies must be served

Federal government has over 50 groups that qualify, including aged or disabled poor, children and their parents, children under SCHIP, the medically indigent, and some legal immigrants



Covers 59 percent of Americans Premiums are deductible to employer Premiums are not taxable to employee Multiple types of plans



Covers about 9 percent of Americans Applicants subject to stringent

underwriting Usually higher premiums, deductibles,

and co-pays than group plans Pre-existing conditions may be

specifically excluded



Average of about 46 million Americans About 15 percent of the population More than half are “working poor” Race plays a factor Ten percent of children under 18



More than $2.2 trillion in 2007 Third-party financing and a rapidly

aging population both increase demand Advances in medical technology,

expansion of medical facilities, and litigation all increase costs



FDR backed off universal health care in Social Security Act of 1935

Private Blue Cross/Blue Shield plans formed in Great Depression

Wages frozen in World War II Organized labor pushed for fringe

benefits in lieu of pay raises Tax-favored status of employer plans



First Lady co-chaired the President’s Task Force on National Health Care Reform

Clinton unveiled Health Security Act in late 1993, which called for regional insurance exchanges

Plan failed to gain passage in late 1994



Healthcare choice Pre-existing conditions Healthcare as a privilege or a right Rationing of scarce healthcare

resources



Obama took office January 20, 2009 Congress wrestled with various plans for

most of 2009 House version passed its bill on

November 7, 2009 Senate passed its bill on December 24,

2009 Senate filibuster actually gave

negotiating power to Blue Dog Democrats



Can all Americans be insured? How does policy influence healthcare? How do we as a society decide who

gets healthcare?

HN 300 Unit 6 Seminar Financing Human Services Madelyn Harvey, PhD.

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Transcript of HN 300 Unit 6 Seminar Financing Human Services Madelyn Harvey, PhD.