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Health Care

Health Care. Alex Dulin Alex Beecham Nadim Wahab. What is Medicare?. Medicare is an insurance program that pays for hospital and medical care for elderly and certain disabled Americans. Federal based The program costs about $432 billion, or 3.2% of GDP, in 2007. Who is eligible?.

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Health Care

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  1. Health Care Alex Dulin Alex Beecham NadimWahab

  2. What is Medicare? • Medicare is an insurance program that pays for hospital and medical care for elderly and certain disabled Americans. • Federal based • The program costs about $432 billion, or 3.2% of GDP, in 2007.

  3. Who is eligible? • Must be at least 65 years old • Or, under 65 and disabled, or any age with End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant.) • Must be a U.S. citizen • Or permanent legal resident for 5 continuous years and is eligible for Social Security benefits with at least ten years of payments contributed into the system.

  4. How does it get paid for? • Payroll taxes collected through FICA (Federal Insurance Contributions Act) and the Self-Employment Contributions Act mainly fund Medicare. • The tax is 2.9% of wages • Half paid by the employee//Half paid by the employer. • Money is placed in a trust fund.

  5. Medicare Divided Part A • Hospital Insurance, Home health care • No monthly premium Part B • Supplementary Medical Insurance • a monthly premium ($96.40 per month in 2009) Part C • More client specific plans • Private insurance companies provide some of the coverage Part D • A prescription drug plan • Requires payment of a premium and a deductible

  6. What is Medicaid? • It is a means-tested health and medical services program • State based • Costs about $330 billion, or 2.4% of GDP, in 2007. • States: • Establish their own eligibility standards • Determine the type, amount, duration, and scope of services • Sets the rate of payment for services, and • Administer their own Medicaid program.

  7. Who is eligible? • Each state sets its own Medicaid eligibility guidelines • States must provide Medicaid services for individuals who fall under certain categories of need in order for the state to receive federal matching funds

  8. How does it get paid for? • Each State is then reimbursed for a share of their Medicaid expenditures from the Federal Government. • This Federal Medical Assistance Percentage (FMAP) is determined each year and depends on the State's average per capita income level. • Richer states receive a smaller share than poorer states • By law the FMAP must be between 50% and 83%.

  9. The Uninsured

  10. Source:

  11. Basic Numbers • Medicaid is a social welfare (or social protection) program that serves about 40 million people (as of 2007) • Costs about $330 billion, or 2.4% of GDP, in 2007. • Medicare is a social insurance program that serves more than 44 million enrollees (as of 2008). • The program costs about $432 billion, or 3.2% of GDP, in 2007. • Together, Medicare and Medicaid represent 21% of the FY 2007 U.S. federal government.

  12. Private Health Care

  13. Why is Healthcare so Expensive? • Medical Malpractice • Approval Takes Years • Private Companies Want Profit

  14. Private Health Insurance • What is it? • Who Offers It? • How does it work? • How Much Does It Cost?

  15. Pros • Better Access • Works If You Can Pay • Will Cover More Expenses • Protection From Bankruptcy • Better Chance of Living

  16. Cons • Expensive • Companies Want Profit • Eligibility • Dropped Coverage

  17. OBAMA-CARE

  18. The Healthcare Reform: Obama’s Plan • Obama has changed the current Healthcare plan in America. • This plan has prospects of being better for everyone and working out for the better in the long run. • He expanded and strengthened some aspects. • He also put an end to other current policies.

  19. Expanding and Strengthening • Children with pre-existing conditions can no longer be denied health insurance coverage. • Health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday. • This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool. • In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.

  20. Curbing and Banning • Insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. • Restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need. • New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.

  21. Healthcare in Florida

  22. Reform and Florida • 1 in 6 on Medicare • We spend $$$ on Prescriptions • 1 in 4 Retires are in “Doughnut Hole”

  23. Cover Florida HealthCare Plan • Healthcare plan created without tax dollars. • For recently unemployed Floridians or people without insurance for at least six months. • plans can be purchased for as low as $23.70 per month. • Blue Cross Blue shield of Florida and United Health care are available to all 67 Florida counties. • Wide set of benefits • Floridians have the opportunity to choose primary and preventive care instead of costly visits to emergency rooms.

  24. Miami-Dade Health Department Goals • Eliminate vaccine preventable diseases for residents and visitors. • Provide immunizations and education for infants, children, and adults. • Educate parents and guardians on importance of vaccines for adults and children. • To provide ongoing surveillance of Vaccine preventable diseases. • Provide consultative screening of immunization records.

  25. Healthcare Fraud • The U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending, or 68 billion dollars is lost to fraud each year. • Miami is one of the biggest targets for healthcare Fraud. • Over 75% percent of US healthcare fraud is in South Florida. • The Obama administration is asking congress for 1.7 billion dollars to fight healthcare fraud. • Governor Rick Scott was said to be part of a Healthcare scam when he was CEO of Columbia/HCA, a healthcare company.

  26. Ways of healthcare fraud • Unneeded care: Doctors may say you need treatment for something when you really don’t. • Bogus insurers: Insurance agents sell you low cost health coverage from fake insurance companies, then take your money. • Identity theft: People steal your medical ID number, then use it to bill health programs thousands of dollars for expensive treatments you never received.

  27. 2010: arrests by type of healthcare fraud

  28. The Good and The Bad

  29. The Good • Great doctors • Good, Proven Treatments • No Limit to Care Recieved

  30. The Bad • It’s Expensive • Lower Life Expectancy • Bankruptcy • It’s Expensive

  31. Works Cited • "Immunizations." Miami-Dade County Health Department. Web. 03 Nov. 2010. <http://www.dadehealth.org/immuniz/IMMUNIZintro.asp>. • Cover Florida Health Care. Web. 03 Nov. 2010. <http://www.coverfloridahealthcare.com/>. • Health Care Fraud Blog :: Published by Miami and Fort Lauderdale, Florida, Healthcare Attorney & Medicaid, Medicare, and Insurance Fraud Defense Lawyer, Robert David Malove. Web. 4 Nov. 2010. <http://www.healthcarefraudblog.com/>. • "Insurance Fraud | Medicare Fraud | False Insurance Claims | MiamiLawyer.com." Miami Criminal Lawyer | Federal Defense Attorney | White Collar Crime. Web. 11 Nov. 2010. <http://www.miamilawyer.com/healthcare-fraud>. • Coalition against Insurance Fraud. "Scam Alerts." Http://www.insurancefraud.org/health_scams.htm. Web. 4 Nov. 2010. •  Coalition against Insurance Fraud. "Fraud Data." Http://www.insurancefraud.org/stats.htm. Web. 4 Nov. 2010.

  32. Works Cited (cont) • Cinergy Health Info. "Lack of Insurance." Cinergy Health Info. Web. 3 Nov. 2010. <http://cinergyhealthinfo.com/health-care-issues/lack-of-insurance>. • Medical News Today. "What is Medicare?" Medical News Today. Google, Web. 3 Nov. 2010. <http://www.medicalnewstoday.com/info/medicare-medicaid/>. • Gruber, Jonathan. "Worst Case Scenario: With and Without Healthcare Reform." MoveOn.org. Political Action, Web. 3 Nov. 2010. • Department of Labor. "Where Does the Money Go?" Finance My Money. Web. 3 Nov. 2010. <http://financemymoney.com/wp-content/uploads/2010/05/ wheredidthemoneygo.jpg>. • Phillips, Macon. "What is in the Health Care Bill." The White House. Web. 4 Nov. 2010. <http://www.whitehouse.gov/blog/2010/03/23/whats-health-care-bill>.

  33. Works Cited (cont) • "Average Life Expectancy." QwickStep. QwickStep Answers Search Engine, 2010.      Web. 12 Nov. 2010. <http://qwickstep.com/search/      what-is-the-average-life-expectancy-in-the-us.html>. • Francis, Jason. "The Financial Impact of Health Care Reform." SolarShock. WordPress, 2 Sept. 2010. Web. 12 Nov. 2010. <http://www.solarshock.net/      ?p=137>. • Harris, Ed. "Ohio Anthem Insurance Rates." Ohio Health Insurance. WordPress, 21      Nov. 2008. Web. 12 Nov. 2010.      <http://ohiohealthinsuranceplans.wordpress.com/>. • "That's Not Reality. That's A False Assumption That The Free Market Always Is      More Efficient." Democratic Underground. Democratic Underground, LLC, 7      Nov. 2009. Web. 12 Nov. 2010. <http://www.democraticunderground.com/      discuss/duboard.php?az=view_all&address=102x4136260>.

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