Medicare Modernization

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Introduction

On December 8, 2003, President Bush signed into existence the Medicare Prescription Drug, Improvement, and Modernization Act (CMS, 2003). This Act over the years is intended to provide prescription drug benefits to seniors. It will also provide subsidies to insurance companies, health maintenance organizations, and would allow private plans to compete with Medicare (CMS, 2003).

Why were changes to Medicare deemed necessary?

The changes to Medicare where deemed necessary, because many seniors and elderly began to find that prescription medication necessary for their well being was out of reach due to costs (CMS, 2003). An overhaul of Medicare would reverse this; create affordable prescription medication, better and more affordable healthcare plans. Another reason for Medicare modernization was to reduce the overall expense of Medicare, because at the rate it was going, it was estimated that Medicare would run out of funds around 2026 .

This bill would not only ensure that prescription medication was more affordable for seniors, but it would create competition, create choices for seniors, and would make Medicare more effective (CMS, 2003). This health policy aimed at providing $400 billion, which would help over 40 million seniors obtain prescription medication at an affordable price (Medicare, 2008). The prescription part of the bill, Medicare part D, began in 2006, and Medicare recipients pay a minimum of $35 per month, with a $250 deductible for prescriptions. The plan will pay 75 percent of costs up to $2,250 . Its intention is to modernize Medicare and provide 21st century care for our seniors (National Institute of Health Policy, 2002).

What are the main provisions of the new legislation? Do you think they accomplish the desired goals?

The main provisions of the new legislation are to provide affordable prescription medication to seniors; make Medicare more competitive; allow for private insurance companies to provide coverage as well as Medicare; and allow for the importation of drugs from Canada, if approved by the Food and Drug Administration (Medicare, 2008). In a nutshell it is to update Medicare for care in the 21st century.

Another provision of the new legislation that will begin in 2010 is to provide subsidies to private insurers, allowing them to compete with traditional Medicare. This will give seniors the opportunity to have lower cost insurance by joining managed-care plans, which would restrict patient access to specialists ((Medicare, 2008).

The desired goals of the legislation have been met. However, the initial cost of $400 billion was understated and it is expected that the bill will eventually cost as much as one trillion dollars (CMS, 2003).

Who was involved in setting the agenda for this policy change?

Those involved in setting the agenda for this policy change included the beneficiaries, who are the recipients of this bill. Local communities, including medical personnel, drug companies, who will directly or indirectly be providing a service to Medicare beneficiaries. The taxpayers, who inadvertently have to foot the bill for Medical services, the political decision-makers, who made the bill a reality; lobbyists and advocates for seniors and those with disabilities (National Institute of Health Policy, 2002). The government and President Bush also played an important role and helped keep this bill alive even though it took six years to finally become legislation.

Discuss the roles and interests of specific agenda setters and their influence on the development of the legislation.

There were various groups and agenda setters that had influence on the development of the legislation. They included patient groups such as the ALS Association, the Alliance for Lung Cancer Advocacy, Support and Education, Alzheimer Aid Society of Northern California, Council for Affordable Health Insurance, CapCURE and Center for Patient Advocacy to name a few...
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