Social Policy BP 7: Medicaid and Medicare

Describe Medicaid & Medicare, including how they are administered, who they cover, eligibility, and efforts to cut costs in each program.

Can we talk for a moment about how grad students don’t get a Spring Break? Because we don’t. I went to Colorado for a few days with my son, and I had serious guilt about it. I knew everyone else in the cohort was slaving away on their little laptops, writing papers and other things for all the classes and everything that is due (and STILL managed to all be due at the same time).

That has nothing to do with Medicaid and Medicare. I just needed a moment to vent. Venting done.

I made this little chart that quickly touches on Medicaid and Medicare. One thing I found terribly interesting in the reading is that the Affordable Care Act (Obamacare) was created in part as a stop-gap to keep Medicare from going belly-up! It does appear that, unless the Boomers start actively dying, it will go belly-up sooner than later. And, now that it seems ACA has been chopped with no effective replacement (yet), we can say bye-bye to Medicare very, very soon. But let’s not think about that. Let’s look a my handy-dandy chart instead!

Medicaid

 

Medicare

 

Description

 

Largest public assistance program in the US. Medical coverage and who is covered is determined by the state under broad federal guidelines. Covers: inpatient and outpatient hospital services, prenatal and 60 days postpartum care, vaccines for kids, doctor services, nursing facilities for 21 and over, family planning, rural clinic services, and many other services. 2nd largest social insurance program in the US behind Social Security. Largest public payer of healthcare. Designed to help the elderly with prepaid hospital and optional medical insurance. Part A: Hospital Insurance. Part B: Supplemental Medical Insurance. Part C: Medicare Advantage Program. Part D: Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
How is it administered?

 

Administered through the state. Eligibility varies state-by-state. Administered by the US government. Premiums for Part A are derived from payroll taxes.
Who is covered?

 

Limited and low-income families with children who meet certain requirements. Supplemental Security Income recipients. Infants born to Medicaid-eligible women and through the first year of life. Poor children under 19. Foster and adoption assisted families and children. Other “needy” groups as determined by the state. Part A is provided free for persons 65 or older who are eligible for SS or Railroad Retirement benefits. Other parts of Medicare are available for a premium.
Eligibility

 

Each state has its own guidelines regarding who is eligible. This can cause wide variety among states. A person might be eligible in one state but not in another state, depending on that state’s guidelines. Must be 65 or over and eligible for SS or RR benefits. Part B available to US citizens and approved legal aliens.
Cost cutting measures

 

Many states require that patients on Medicaid also enroll in state-contracted HMOs. Medicare doesn’t cover everything, and there is a 3rd-party “Medigap” insurance available at a premium for things that Medicare doesn’t cover. The Affordable Care Act was also a cost-cutting measure that was projected to keep the Part A trust from going bankrupt until 2029.

Yay! You made it to the bottom of the chart. You are rewarded with a picture of one of my red tulips.

Jill

Generalist Practice PB7: Greenville-Spartanburg, SC

As evidenced in the text, what are three ways that the leadership of Greenville-Spartanburg, SC “re-invent[ed] their future” through global partnership?

Global partnership is a tricky subject. I don’t know many people who wouldn’t push for a strong local economy but NOT at the expense of the local product. However, if Greenville had pushed for this it could have spelled certain death for this community. Globalization was imminent, so Greenville embraced it and have had this aura of inclusion and globalization since the 50s. Here is what the leadership did:

  1. Milliken and Tukey, local business leaders, both worked to transform the Upstate South Carolina area to make it appealing to foreign business investors. They did this by exploiting the pro-business attitude of the area and pushing its well-known worker training programs.
  2. They went overseas to encourage foreign investors to come to Greenville-Spartanburg and put down roots, thus making a personal investment in the area and bringing their businesses with them.
  3. They pushed for business incentives and legal amendments to further encourage foreign businesses to plant themselves in the market in Upstate.

Thinking of a community with which you are familiar (feel free to use OKC or Pittsburgh from the text), how did that community diversify and restructure their future? Give 2 concrete examples.

  1. This process began over 60 years ago for this community, and it took the insight of two skilled businesspeople to clear the way for the globalization that has happened in Upstate. Now the area is filled with international restaurants, stores, multicultural events, and schools.
  2. Because of the push for business incentives and amendments as well as the strong worker training programs, international businesses are still flocking to the area. The workforce is skilled and flexible, the geographic location is ideal, and the area has spent 60 years cultivating an inclusive and culturally sensitive environment in which these businesses and people thrive.

Although I did not grow up in the OKC metro area, I can still see the results of global inclusivity that has happened in the area. I do recall visiting OKC as a teen and seeing how little there was here. Now the area is booming with shops, restaurants, night life, businesses, and cultural centers like the Civic Center. OKC has a strong sense of historic preservation as well, as there are memorials and museums all up and down the I-35 corridor and into the small communities. I am amazed at the volume of festivals scattered throughout the state and the amount of participants that are drawn to them each year. Oklahoma City’s globalization and preservation efforts have benefitted, not only OKC metro, but I believe the state as a whole.

Morse, S. (2014). Smart communities: How citizens and local leaders can use strategic thinking to build a brighter future (2nd edition). San Francisco: Jossey-Bass.