Medicare, Medicaid, and the Affordable Care Act as examples of Public Policy Implementation
Welcome back to Dignity Discussion. This week let’s talk about Medicare, Medicaid, and the Affordable Care Act (ACA) as examples of public policy implementation. In past weeks we acknowledged that Medicare, Medicaid, and the ACA were programs established to provide needed services to United States (US) citizens. Let’s recap:
- The Medicare and Medicaid Act (1965) provided health care to citizens over 65 years of age (advanced age); and poor families (Social Security, n.d.).
- In 2010, President Barack Obama signed the Affordable Care Act (2010) that included expansion of the Medicaid program with the goal of improving programs; and making healthcare affordable for low-income families (Medicaid.gov., n.d.).
- The ACA was responsible for expanding healthcare coverage for millions of Americans; and also lowered healthcare costs; ended preexisting exclusions for children; and provided preventive care at no cost (US Department of Health and Human Services, 2015).
This all sounds like pretty good stuff? Let’s take look how this all relates to Death with Dignity laws…
Medicare, Medicaid, the ACA…and Death with Dignity?
The ACA’s goals are to to provide quality healthcare to all Americans, regardless of social, economic, or environmental factors. There is only one section in the ACA that states no healthcare professional shall be discriminated against if he or she chooses not to supply items or care in the physician-assisted suicide process (e.g., ACA Section 1553) (Patients Rights Council, 2013).
Last week, it was mentioned that states with aid in dying laws received no federal money for these types of services; therefore, if Medicaid is the insurer only state funds can be utilized (Oregon Public Health Division, 2014). Currently, Medicare and Medicaid pays for hospice services (e.g., Medicare Part A); and under the ACA, patients under the age of 21 can seek curative treatments while still under a hospice program without jeopardizing being discharged or paying out-of-pocket for hospice services (Medicaid.gov, n.d.).
A provision of the ACA was the enactment of the Independent Payment Advisory Board (IPAB). This 15 member (non-political) board, chosen by President Barack Obama (and approved by members of the Senate and House of Representatives), is designed to cut Medicare healthcare costs (American Medical Association, 2015). This is the “death panel” I spoke about last week. Opposition to the IPAB suggests that cutting Medicare pay rates leads to limiting access to care. In simpler terms, if a person with a terminal illness wants to pursue aggressive treatments then it will not be paid for under the ACA.
Let’s look at a video from Fox News on The IPAB:
In states like Oregon, where aid in dying exists, people have reported wanted treatment for terminal illnesses and getting coverage denied, but received letters that lethal prescriptions will be paid for.
Final Thoughts on ACA policy and Death with Dignity
Death and dying is a hard topic to discuss. I believe if health care decisions are broached early on it may make one’s decision about treatment options easier for themselves and their loved ones. Although, is it fair to deny a person aggressive treatment options for a life threatening disease, especially is that person is of advanced age?
One thing is for sure, opponents to aid in dying in the state of Arizona will have more ammunition with the death panel case when it comes to passing future bills.
Let’s take a poll. What do you think?
American Medical Association (2015). Independent payment advisory board. Retrieved from http://www.ama-assn.org/ama/pub/advocacy/topics/independent-payment-advisory-board.page?
KVAL.com (2008, July 31). Health plan covers assisted suicide but not new cancer treatment. Retrieved from http://www.kval.com/news/26140519.html?tab=video&c=y
Media Matters for America (2014, December 4). Fox resurrects ACA “Death Panels” myth. Retrieved from http://mediamatters.org/video/2014/12/04/fox-resurrects-aca-death-panels-myth/201773
Medicaid.gov (n.d.). Hospice benefits. Retrieved from http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/hospice-benefits.html
Medicaid.gov (n.d.). Provisions. Retrieved from http://www.medicaid.gov/affordablecareact/provisions/provisions.html
Oregon Public Health Division (2014). FAQs about Death with Dignity Act. Retrieved from http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Documents/faqs.pdf
Patients Rights Council (2013). Health care reform. Retrieved from http://www.patientsrightscouncil.org/site/health-care-reform/
Social Security (n.d.). Chapter 4: The fourth round 1957 – 1965. Retrieved from http://www.ssa.gov/history/corningchap4.html
Social Security (n.d.). History of SSA and the Johnson administration 1963 – 1968. Retrieved from http://www.ssa.gov/history/ssa/lbjmedicare1.html