Assignment: Skilled Nursing Facility

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Assignment: Skilled Nursing Facility

Assignment: Skilled Nursing Facility

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The federal healthcare reform legislation that was signed into law by President Obama in March 2010 was made up of two specific laws: the Patient Protection and Affordable Care Act (signed into law on March 23) and the Health Care and Education Reconciliation Act of 2010 (HCERA, signed into law on March 30), collectively referred to as the healthcare reform laws and the Affordable Care Act (ACA). President Obama subsequently signed into law the Medicare Access and CHIPS Reauthorization Act of 2015 (MACRA) designed to substantially alter Part B reimbursement.

elIgIbIlIty Medicare, or Title XVIII of the Social Security Amendments of 1965, is a federally funded program that provides health insurance to Americans at age 65. Medicare was expanded in 1972 to include coverage for people younger than 65 with disabilities who qualify for Social Security disability benefits and those with end-stage renal disease. Within the context of balancing the federal budget, considerable discussion has taken place regarding increasing

the eligibility age of Medicare in a fashion similar to Social Security (people born in 1960 or later cannot collect full Social Security benefits until they reach age 67).2

benefIts In 1966, Medicare covered seven basic services, including inpatient hospital services, out- patient diagnostic services, physician and other medical services, and outpatient therapeutic services. Since 1966, a large number of services have been added, including some preventive services, hospice coverage, and skilled nursing facility coverage (see exhibit 6.1 for details).

fInAncIng Medicare was initially financed by assessments on employers for Part A (0.35 percent of payroll up to $6,500), by a coinsurance of $3 per month paid by beneficiaries for Part B, and by general revenue allocations to Part B (Harris 1975). Initial Medicare expenditures had been grossly underprojected, however. President Johnson reportedly believed that Medi- care spending would run about $500 million a year (Peterson 1996). Yet actual Medicare expenditures were $4.2 billion in 1967, the first full year of the program (Helbing 1993). The growth of Medicare expenditures was also grossly underprojected. Even critics of the program underestimated—they guessed that Medicare would cost $1 billion by the end of the twentieth century; in fact, it cost $205 billion per year by 2000. In 2014, Medicare spending was $618.7 billion, and it is expected to surpass $1 trillion by 2022 (Keehan et al. 2016).

In 2015, Medicare was financed from three primary sources—general revenues (41 percent), payroll tax contributions (38 percent), and beneficiary premiums (13 percent)— with other sources accounting for 8 percent. The parts are funded as follows (Kaiser Family Foundation 2016):

◆ Part A is financed through a 2.9 percent tax on earnings. This tax is split evenly between the employer and the employee; it accounts for 87 percent of all Part A revenue. The ACA increased the payroll tax contributions to 3.8 percent starting in 2013 for individuals earning more than $200,000 and couples earning more than $250,000.

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