Medicaid Case Study
Medicaid can be thought of as an insurance program for persons unable to afford health care with their current income and resources. The basis of program was initiated in 1965 and has helped countless individuals get quality health care. A body of research was instituted to track the progress of the program. Development assessment is based on the generosity of the program to patients and the interaction of the patients with the health care physicians. This paper seeks to evaluate the expansion of this system in various states, the collaboration among different stakeholders in the process, the anticipated economic impact, and how strategic decision making has been affected by historical institutionalism.
Expansion disparity
Following the passage of the affordable care act (ACA) in 2010, various states have taken different measures to expand their Medicare programs. The varying adoption of the program can be primarily linked to political control (Rigby & Haselswerdt, 2013). In addition, three other reasons are found to play a role in the adoption process. These are the influence of the states, previous policy trajectories, and the administrative capacity. The interaction of these factors causes the visible adoption differences in the adoption process.
In order to understand the political atmosphere around the affordable health care act, one must recollect the events surrounding its passing. The ACA was passed in a controversial vote where even though all the members of the Republican Party voted against it, the Democrats voted for it overwhelmingly. This contentious act, therefore, split the government into two; those for the bill and those against it. A prolonged legal battle ensued, challenging the constitutionality of the law (Hertel-Fernandez, Skocpol, & Lynch, 2016). The rivalry spilled over to the 2012 elections. Jacobs and Callaghan designed a study to investigate the impact of this division on the implementation process of the program in various states. The authors note that “States with greater democratic power are moving fastest and farthest in implementing Medicaid, whereas Republican control corresponds with relative inaction or slower progress on the reform (Jacobs & Callaghan, 2013, p.1032).” The examples that were given to prove their case are New York, California, Maryland, and Washington and included unified democratic fronts such as the progressive Medicaid program. In contrast, Republican controlled states were focused on opposing the implementation process at every stage. These states include Kansas, Oklahoma, South Carolina, and Texas (Jacobs & Callaghan, 2013). Previous studies on the issue by other researchers have all pointed to the same findings, thus, clearly showing the role played by political parties in the expansion of the Medicare program.
The economic condition of individual states leans towards the adoption of Medicaid’s new program. The calculation is that the federal government covers all the cost of the expansion for a third of the four-year period. Later on, Washington is supposed to continue picking up at the expense of the process while enjoying substantial administrative benefits (Jacobs & Callaghan, 2013). Moreover, the federal government is expected to top on these subsidies by covering the cost of the uninsured population which fell on the shoulders of the states. Federal funding may be helpful to states with strained financial conditions as they need the money more. The funding is structured that less affluent states get more funding than the more stable ones. Earlier research on the issue indicate that the economically stressed states are more likely to push for the Medicare expansion process as opposed to well-off states.
An investigation done by Jacobs and Callaghan has contradicting results. The research involved creating a measure of state economic situation using per capita income from the Bureau of Economic Analysis averaged for the four quarters in 2010. The earlier assumption that state affluence is inversely correlated with Medicare adoption is nullified by the findings (Jacobs & Callaghan, 2013). High per capita income states like New York, Connecticut, and Massachusetts are actively moving forward with the program. On the other hand, less prosperous states like Mississippi and Idaho seem to be lagging behind in the process. Healthcare lobbyists abundantly make it clear to decision makers the benefits of the adoption of the generous federal funding in the sector (Jacobs & Callaghan, 2013). Despite these efforts, only a few states with stringent budgets are moving forward with the program.
Government decision makers understand their options on policies depending on an established trajectory. This conclusion has been confirmed by a diverse body of research. Prior policy legacies have been linked as a factor in state decision making (Jacobs & Callaghan, 2013). Federal government systems influence social policy; shifting the control, preferences, and strategies of social groups and generating new institutional actors. Moreover, Kim and Jennings (2012) state that similar experiments and policy development produce learning about Medicare programs heavily influencing the extensiveness of their adoption. Research on this issue suggests that the adoption of ACA programs in various states was heavily influenced by previous policies towards low-income individuals and the insured. This bias has been particularly predominant in policies toward eligibility and benefits that existed prior ACA enactment (Jacobs & Callaghan, 2013). Therefore, state decisions with ACA’s adoption are moderately correlated to the previous policy decisions on the matter.
The administrative capacity given to individual states is also a contributing factor to the disparity in the adoption of the Medicaid program. Research suggests that policies that create administrative capacity have the capacity for fostering durability and expanding on development along the same path (Frean, Gruber & Sommers, 2016). Administrative capacity has proved to affect the level of confidence of authoritative policy makers (Frean, Gruber & Sommers, 2016). Also, it aids the government through the provision of tools to design, adopt and implement effective programs. States with higher administrative capacity like Oregon have been found to have more efficient procedures and resources to enroll Medicaid recipients. This observation points to the relationship between administrative capacity to determine eligibility, process enrollment and assure payments and efficiently monitor the quality of care (Jacobs & Callaghan, 2013). Further research by Jacobs and Callaghan has found that states with visibly stronger administrative structures are further in the implementation process. Thus, administrative capacity affects states decision making on Medicaid programs.
Stakeholder Collaboration
The effectiveness of the entire process is highly dependent on the collaborative efforts between various stakeholders. These stakeholders are the federal government, the state governments, the public, hospitals, and the physicians. They all have different but integral roles to play in the success of Medicaid’s expansion.
The federal government’s primary role is in funding the program. The development of the program and grant funding increases help improve community health center capacity. This conclusion is as a result of intensive research in the health care industry by Han, Luo, and Ku (2017). Their research showed that and active collaboration effort from the federal government through funding was directly proportional to the number of benefiting individuals. Therefore, the number of patients per center was seen to increase by over 1000 patients (Han et al., 2017). The Bureau of Primary Health Care has given out various types of grants to expand the number of community health centers. The money is aimed at improving the site’s infrastructures as well as its health information technology for better patient data management. Furthermore, the grant is aimed at improved care delivery for mental patients as well as dental care. The effectiveness of federal funding has also attracted some players in the private sector to chip in. The increased funding has resulted in increased revenue in the healthcare industry (Han et al., 2017). Therefore, the federal government is adequately doing its part in the expansion process.
As earlier mentioned, there is a variation in the level of state government cooperation in the implementation of the program. This difference is dependent on the issues affecting this program as noted earlier. States moving forward with the program are reported to enjoying fiscal and health care related benefits. Those that lag behind in the program are experiencing the preexisting challenges in the respective sectors. Thus, individual states as stakeholders are influencing the efficiency of the program differently.
Moreover, the public performs a central role in the cooperation of the various stakeholders. As such, a section of the public, that is, the uninsured, stand to benefit directly from the program (Young, 2012). There is a good reception from the general public in the place of the ACA enactment. However, a significant portion of the population in the country is opposed to the process. This portion remains a challenge due to their public opinion. Public opinion has a strong hold on influencing government policies. As a result, areas with huge numbers that are against program have seen a slow implantation process (Young, 2012). The vice versa is true; regions with populations that support the Medicare program have seen fast-paced expansion wince the public is cooperative while few still hamper the process.
Hospital and physicians are the other integral part of the stakeholder collaborative effort. A large number of hospitals are receptive to the program (Young, 2012). Centers that work in association with the Medicaid program have been found to treat more patients effectively. This observation can be attributed to the broadened handling capacity in these centers due to increased funding. There is visibly little resistance to treating uninsured patients among physicians. According to Young (2012), these doctors now feel more empowered to help uninsured patients that they could not earlier as result of the red tape. Embracing the new program, however, is not all good news for doctors. Studies in centers that offer Medicare has seen doctors working longer hours and having more workload. These effects may upset the cooperation on the long term if measures are not put in place to counter them. Hospitals and physicians are therefore effectively cooperating in the implementation process.
Anticipated Economic Impact
Expansion of the Medicaid program is bound to have different economic effects in the long run. First, the massive investment in economically strained states will elicit some positive impacts. Better treatment of the uninsured will result in a healthy population with a lower mortality rate. This healthy community can translate to a working one which can significantly improve the economy (Jacobs, Hill & Abdus, 2016). Also, increased funding in states from the federal government would result in the state diverting the available resources to other areas of urgency like education. Thus, the Medicaid program will be helpful to economically disadvantaged states.
Expansion of the program is going to create jobs across the country. As a result of the shared spending, facilities will be expanded to accommodate more patients. The expanded amenities will, in turn, require addition personnel to work in various positions, thus creating employment in regions previously correlated with low employment rates. These jobs include both trained staff like physicians and untrained personnel like cleaners working on part time and full terms basis (Jacobs et al., 2016). Communities or individuals could start up agencies to supply hospitals and other healthcare facilities with the various needed equipment, services, and or labor force. Such efforts will see the creation of employment indirectly from the Medicare program. Thus, the expansion will impact the economy through job creation.
Increased health coverage may impact the national economy as well. Due to better health access, people are less likely to miss workdays as a result of a sick day. This healthy working population can be estimated to translate to a more productive national workforce. A study done in the 1970s attributed health improvements to an addition of approximately $3.2 trillion in national wealth in the United States (Miller & Wherry, 2017). In addition, research shows that increase insurance coverage can be correlated with healthier individuals. Thus, in a way increase coverage will see a growth in the country’s Growth Domestic Product; it will grow the economy.
Finally, uncompensated health care will significantly reduce. As uninsured people reduce, so does the uncompensated health care. The reduction will translate to a reduction in the money lost between the cracks to cater for the uninsured health care (Rosenbaum, 2016). Consequently, an expansion of the Medicare program will reduce money lost in the system boosting the economy.
Historical Institutionalism
Historical institutionalism influences the political behavior of policy makers. Here, policies that have been made before have a likelihood of affecting the adoption of new policies. In health care, there are a variety of theories offered by experts to explain this phenomenon. Previous proposals have always failed even before making it to Congress. The radical idea for a comprehensive restructuring of the health care system is not a new one. In fact, President Clinton made an attempt to reform health care in 1994 to accommodate the less affluent members of society (Fioretos, Falleti & Shiengate, 2016). Prior to President Obama’s regime, many leaders have made unsuccessful attempts at comprehensively insuring the population. Thus, there are evident deep roots between Medicaid and preexisting policies.
As established, there is an age-old institutional bias towards comprehensive healthcare. This bias is not as a result of poorly designed frameworks within the government. According to Fioretos, Falleti, and Shiengate (2016), historical bias in various institutions is as partly a result of a political structure purposefully built into the American politics by the founding fathers themselves to protect the minority make majority rule. This factor coupled with the number of congressional reforms enacted with the sole aim of reducing the power and importance of national parties have led to individuals acting in their self-interest. During party platforms, individuals are seen to downplay the stance of the party on various issues. This tendency is particularly the case with a section of southern and Midwestern politicians (Fioretos et al., 2016). Even though they are Republicans they tend to have rather very conservative views on various issues supported by the party; in this case Medicaid. Accordingly, this behavior has seen this section of leaders being branded ‘blue dog republicans.” The current institutional bias can, therefore, attributed to the two underlying causes.
Also, the conservative public approach to health reforms can be credited to the presence of biased media. Traditional media such as Fox New has played a significant role in the shaping of public opinion on the matter. These media outlets sell agitative programming as compelling viewing while claiming to embody the “majority’s opinion” (Fioretos et al., 2016). The network preys on people’s fear of change and provides the status quo as an alternative. However, the population of the American population that watches the news is significantly small. As such, the misshaped news influences only a small section of the population.
Policy implantation in the past will affect future decisions and processes in the same. This argument forms the basis for the logic that change will be difficult in any sector struggling with historical institutionalism. Thus, according to Fioreto et al. (2016), any institution is embedded within a larger web of institutions that help shape the policies from the beginning. With this in mind, he argues that is change is made in a particular system then the effects will be felt across a large number of other stakeholder institutions. Therefore if a change is made in a particular system, the wave of change will be counter-effective as it will provide resistance to the same change through the surrounding institutions. Due to the various systems that have sprung up around the health care system, change is proving to be problematic.
The health care system has produced systems around it that seek to maintain the fee for historical service policy in operation. Individuals that are heavily vested in the old regime include private physicians who earn jaw-dropping sums of money and pharmaceutical companies that charge undue amount of money on medication (Fioretos et al., 2016). Judging from the amount of money they make, one can see why they would naturally resist a comprehensive health reform. These groups of individuals have both the will and resources to maintain the status quo. The puzzling question here is, “how are the as result of historical institutionalism?” Earlier on, during the development of the current health system policy decisions were made that amounted to a heavy private sector involvement in health care (Fioretos et al., 2016). Therefore, the health care system during its development created around itself robust dependent systems that make it difficult to effectively adopt and expand the Medicaid program ubiquitously (Koller, Alexander & Birch, 2017).
Conclusion
In essence, Medicaid is a comprehensive health program that is being implemented by the government. In the applied regions the program has proved helpful in helping people who would not otherwise gain access to medical care. The expansion of this program in various states has been faced with some roadblocks despite its evident advantages. These drawbacks include the political polarization of the policy makers, states’ economic status, and established trajectories and the administrative capacity of the states in question. The ACA was enacted by members of one party resulting in a two-party divide across the country. It was speculated that vulnerable states would implement the policy better due to the financial benefits that accompany it. However, the inverse is true as more affluent states seem to be implementing the program better. Established trajectories in governance policies, on the other hand, have been reported to influence the decisions of various states the implementation process. Administrative capacity has been proven to empower policy makers in their decision in view of the expansion of the program. Collaborative efforts have proven rather effective on the various levels involved. However, some stakeholder levels are faced with difficulties in the collaborative efforts. These stakeholders are the state governments, a section of the public and hospitals and physicians. Economically, the expansion of the Medicare process will have some positive impacts. These benefits are improved population health, job creation, the growth of the GDP, and compensated healthcare for the uninsured individuals. Lastly, historical institutionalism affects policy making. This influence has seen multiple failures in the efficient implementation of a comprehensive healthcare system. The healthcare system has systematically created systems that guard it against health reforms. These systems are both politically and economically fueled. Politicians that guard their interest represent the political front while the private sector forms the economic front. Thus, effective expansion is going to be very challenging for all the stakeholders involved.
References
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