Medicare Reform 2003 Research Paper Sample
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Factors like mission, vision, and values form the foundation for strategy development and implementation in healthcare industry. Evidently, well developed policy can create organizational value and serve customers better way. In addition, an effective strategy provides the organization with a winning formula for its purpose, goals, and standards. Therefore, it can be claimed that major intention of strategy development and implementation is to support the organization’s mission, to achieve the vision, and to promote the values. The US healthcare sector has been spending millions of dollars traditionally to improve its care quality and patient outcomes. Despite the increased investments in the health care delivery, health care still remains unaffordable to a notable percent of the US population. In the early 2000s, the US health regulators observed that many senior citizens were struggling to afford the growing costs of prescription drugs. The Medicare Modernization Act 2003 or MMA was introduced in an attempt to increase the affordability of Medicare services. This paper will evaluate various aspects of President Bush’s 2003 Medicare reform bill and the various factors led to its formation.
Scope of the Proposal
While analyzing the history of the Medicare Prescription Drug, Improvement, and Modernization Act, it is clear that the mounting health care costs forced the US Congress to pass this controversial act in 2003. The role of prescription drugs in patient care had been growing significantly since the establishment of the Medicare in 1965. At the time of the proposal of this health care reform, Medicare was really unaffordable to senior citizens due to the introduction of new and expensive drugs. Hence, the US regulators strongly believed that a comprehensive reform of the Medicare was inevitable to keep this service affordable to patients, particularly senior citizens who are the actual beneficiaries of this facility.
It is obvious that this reform intended to address a community problem, and it suggested extensive restructuring of the Medicare to achieve the desired change. As Oliver, Lee, and Lipton purport in their article “A Political History of Medicare and Prescription Drug Coverage”, in order to extend affordable services to the senior citizens, this Medicare Modernization Act or MMA introduced federal entitlement benefits for prescription drugs through implementing improved tax rates and subsidies. In addition, large employers were paid a subsidy under the MMA so as to persuade them to provide retired workers with private prescription coverage. Another notable feature of this proposal is that it discouraged the Federal government’s attempts to negotiate with drug companies for discounts. This proposal also prevents the US government from establishing a formulary. The advocates of this policy change demanded the state to offer rural hospitals an additional $25 billion. The reform proposal also included provisions for receiving higher fees from wealthier clients in order to avoid huge financial burden on the Federal government. In addition, a pretax health savings account was offered to the working people. Hence, it is clear that the controversial Medicare Modernization Act was introduced to increase the efficiency of the Medicare and to improve the affordability of services offered by this facility. The Republican Party might have expected to gain some political advantages over the Democrats by implementing the Medicare reform 2003. However, the major intention of the proposal was to enhance the care experience of Medicare clients.
Nature and Direction of the Policy
In the wake of escalating medical issues related to the senior citizen of the country, President Bush’s new reform approach focused on the assistance of over forty million beneficiaries in the country. In this regard, Bush was quoted as saying that the new reform would benefit the seniors of the country by providing them opportunity and control over the choice of medicines (“Bush signs landmark Medicare bill ..”). Even though the government claimed the imminent assurance of equity and efficiency in the medical treatment there is a widespread opinion that most of the cases were showing the other way. In many cases the new system failed to equate with the social expectations about satisfaction due to inaccurate treatment by the physicians and ill-equipped clinical system. Fiscella in her article “Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions” points out that despite the promises the Reform brought to the beneficiaries such as easy access to the system, improvement in primary care, health care information tools and bias watch, the authorities faced the potential challenges of disproportionate alignment between patient needs and health care resources as well as the revival of the unmerited patients. In granting security of access to the medical claims of the patients, the MMA made amendments in the provisions of the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS), a unit of the Department of Health and Human Services (HHS). However, the MMA’s Part D provision was driving towards conflicting opinions among the members of the Congress for their lack of faith in the prospective technical advancement of the administrative system. Golding in “Medicare Part D: Rights Without Remedies, Bars to Relief,and Miles of Red Tape” criticizes that the fund allocation proposed by the MMA reform was subject to controversies as the premiums were deducted from the SSA benefits of the economically backward classes and in some cases, they had to pay the bills themselves in order to avoid the loss of the MMA coverage. In an expansive way, the MMA provides for the quality of medical care for improving the efficiency of the system. According to a record prepared by Long, section 1013 of the MMA directs the Agency for Healthcare Research and Quality (AHRQ) to take necessary measures to improve the efficiency of the healthcare provided under the supervisor of various agencies including the SCHIP. The collective supervision of various agencies under the guidelines of the Supreme Court would bring a positive effect in the administration of the programs under the MMA reform.
Political Players in the Process
President Bush had the key role in incorporating the ideas associated with the reforms in bringing together all the proposed measures for the insurance of healthcare of the senior citizens. The Bill that aimed at relieving the financial burden of the disadvantaged class got the immediate approval by Bill Frist, who was the Senate Majority Leader. The Bill however, was not an all appeasing one for a majority of the beneficiaries who treated it as the Presidents defiance tactic against the conservatives of the Republican Party. The 2003 reform was a conglomeration of the models of the healthcare development system proposed by the previous leaders like Nixon and Clinton. Another important political player in the process of the MMA reform’s legislature was Bill Thomas, the Chair of House Ways and Means Committee (Oliver et al). The incorporation of the HHS guidelines and the cooperation of the Senate Finance Committee by Bush saw the complete participation of the Republican senators. The President made a change in his initial proposal for allotting the coverage of Medicare to outpatient prescription medical care benefits. The finalization of the reform Bill was generally acceptable to the majority of the Congress members, particularly; the support of Democrat senator Kennedy was remarkable.
Role of Proponents and Opponents
In order to assess the implications of the activities initiated by the proponents and opponents of the reform in the process of its legislation, it is necessary to investigate the medical reform history of the country. American is the global economic leader with all scientific developments in medical and healthcare enterprises. Also it clears ground for healthcare industry giants to establish their impacting proportion of bargaining power over the government systems of medical and healthcare. Along with the healthcare systems stand the major corporate players in the insurance sector. In order to regulate the healthcare and Medicare benefit mechanism the proposal for a reform of became necessary. The proponents of the Reform Bill claimed the advantages of the scheme to the senior citizens of the country. The President strongly insisted on extending the coverage to the buyers of prescription drugs with the additional fund allocation. For claiming the coverage, the seniors had to join an HMO as an eligibility criterion. The supporters came in favor of the President even from the opposition party while nine ruling Republicans denied their support (“Bush signs..”). The process of voting saw a dramatic demonstration of changing attitudes of the senators. Major players like Istook and Nick Smith made a sudden shift and joined the proponent group to vote for the Bill. The major contributors of the conference committee headed by Bill Thomas who was supported by Senators John Breaux and Max Baucus played a leading role in the executive functioning of the MMA reforms.
However, the challengers of the Bill strongly stood against the legislation by claiming that the seniors would be requiring the intervention of the Congress in every event of the functional disparity of the reform Act with regards to the cost of the prescription medicines. According to Morone, Litman and Robins, even after the Bill was enacted, there was a controversy from the claim of the Medicare actuary that the program was going much above the budgeted cost projected in the Bill (322). One of the major opposition voices was from Tom Daschle, the Senate Minority Leader who argued that the Bill would only support the medical lobbyists. He also warned that the seniors would mobilize and fight for the recall of the Medicare Bill in its original form on knowing that the new system would fail in its processing (“Senate passes Medicare bill”). Senator Ted Kennedy showed high disregard for the bill and wowed that he would oppose it at the grassroots’ level. Senator Barbara Mikulski also expressed her concerns about the bill and told that it was a demolitionist approach that would destroy the opportunities to help the seniors of the country. The non-participation of John Kerry and Joe Lieberman in the voting was significant news for the opponent groups’ favor; however, Kerry later ignored his earlier declaration to fight all the way to eliminate the proposal for the bill. Thus the MMA reform was an interesting subject for the critics and journalists because of the changing stands of the leaders and the bipartisan agreement of some of the senators from both the Democratic and the Republican parties.
Although the proposal was nearly rejected many times during the policymaking process, a few Congressmen and Senators switched their position on the bill each time to keep the proposal alive. The bill had been a hot topic of debate in Congress for almost six months. It had been also negotiated strongly before it became law amid unusual circumstances. When 214 yeas and 218 nays were counted after the initial electronic vote, three Republican representatives changed their position on the bill and consequently the bill passed by one vote (Roebuck, 216-215). Then the Senate passed the bill and it subsequently came back to the House for approval. After 45 minutes of voting, the count stood at 219-216. Speaker Dennis Hastert and the Majority Leader Tom DeLay managed to convince Ernest James Istook to change his position on the bill, leading to a 218-216 vote tally. As the House leadership was in need of two more votes, they kept the voting process open for hours. Later, the leadership succeeded in their attempt to convince Otter and Trent Franks to change their votes and finally the bill passed 220-215 (Roebuck, 127). Although the Democrats alleged that the voting process was foul, they could not prove their argument. Hence, the passing of the Medicare Modernization Act involved a series of dramatic events. Later it was identified that the MMA failed to accomplish all the stated objectives and hence the Bush Administration is still criticized for its controversial moves to pass the bill.
Rising health care expenses is an ever existing problem in the US healthcare industry as this issue significantly affects the quality of the care delivery and the percentage of the population covered. Despite a series of health care initiatives taken by the Federal government, growing health care expenses are still found to be a serious issue troubling US policymakers. From the above discussion, it is clear that the Medicare Modernization Act or MMA is a controversial Medicare reform implemented by the Bush Administration in 2003. Evidences suggest that the Medicare reform 2003 failed to meet social expectations in many areas due to inaccurate treatment by the physicians and ill-equipped clinical system. While analyzing the political history of this health care reform, it seems that the President Bush and his Republican party played a key role in making this bill into law. During the voting process, the House leadership influenced the representatives many times to switch their position on the bill so as to pass the bill.
“Bush signs landmark Medicare bill into law”. CNN, December 8, 2003. Web. 22 April 2015.
Fiscella, Kevin. “Health Care Reform and Equity: Promise, Pitfalls, and Prescriptions.” Annals of Family Medicine 9.1 (2011): 78–84. PMC. Web. 22 April 2015.
Golding, Elliot. Medicare Part D: Rights Without Remedies, Bars to Relief, and Miles of Red Tape. The George Washington Law Review, 77. 4 (2009): 1044-1062. Web. 22 April 2015.
Long, Lucinda E. Wyeth Research Topics. 2004. Web. http://www.fda.gov/ohrms/dockets/dailys/04/july04/070704/04S-0170-emc00019-01.pdf 22 April 2015.
Morone, James., Litman, Theodor and Robins, Leonard. Health Politics and Policy. Cengage Learning, 2008. Print.
Oliver, Thomas R, Philip R Lee, and Helene L Lipton. “A Political History of Medicare and Prescription Drug Coverage.” The Milbank Quarterly 82.2 (2004): 283–354. PMC. Web. 22 April 2015.
Roebuck, Kevin. HIPAA - Health Insurance Portability and Accountability Act: High-impact Strategies - What You Need to Know: Definitions, Adoptions, Impact, Benefits, Maturity, Vendors. Emereo Publishing, 2012. Print.
“Senate passes Medicare bill”. CNN. November 26, 2003. Web. http://edition.cnn.com/2003/ALLPOLITICS/11/25/elec04.medicare/index.html 22 April 2015.
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