The United States is one of the global nations that have focused on critical health policies that have defined the current and contemporary world.

Policy-making in the federal system

The United States is one of the global nations that have focused on critical health policies that have defined the current and contemporary world. In fact, it is a country whose citizens greatly focus on health as one of the major concerns across all the states. The Medicare, Obamacare and Medicaid are among the policies that have formed in the united states that have played a significant role over the years. This essay focuses on stating the importance of contribution of all stakeholders to the success of this program. The paper aims at its adoption, regulation, enforcement and evaluation of the program.
Adopted in 1965 from the rising of the social security Act, Medicaid is a healthcare care program that have been initiated by the federal government and funded by both the state and the federal initiatives. It is the largest funded program for individuals with limited income in the United States. The states provide up to half funding while other stakeholders contribute funds depending on the policies of the states (Kemp, 2007). With such support from both the federal and the state government, the United States demonstrates its commitment to the Health assurance for its people. The program major focus has been the poor. However, poverty is not the only qualifier for the program. Special consideration has been made for people who have various disabilities, women and elderly. Nursing homes is one of the programs that have experiences exponential growth (Smith, 2008). This projected growth has been the major concern for the federal and state governments for anticipated increase in budget for the program.
Like any other federal policy program, Medicaid is regulated by the Centre and Medicaid services (CMS) issues guidance in the form of letters to State Medicare Directors, information bulletin, letters to the state officials (mainly regarding to Medicaid financial issues), and communication of the frequently asked questions (Dudley, 2002). Center for Medicaid and Medicare services provide regulations and guidelines in regard to the statutory provisions of the social security Act. Regulations come in several forms which include the following:
The Notice of Proposal Rule Making (NPRM) that provides that policy making process to implementing provisions of the statute and solicits public comment on the proposals. The final rule interim with the comment going into effect after being published, but will be open for public comment for a specific period of time and them potentially revised and issue as the final rule. The comment made on the final rule and formally codifying the policies proposed in the NPRM and IFC (Brennan, 1981).
The state Medicaid directors letters are used to provide states with rules, clarification and guidance on current information or any statutory changes that may affect Medicaid policy and financing. The center for Medicaid and CHIP services (CMCS) information bulletins has played a significant role in communicating with states and other stakeholders interested in Medicaid and CHIP. These communications are formed to highlight the recently released policy guidance and regulations as well as sharing essential technical operations that are related to Medicaid and CHIP.
Enforcement of Medicaid program and its effectiveness is a multiplayer contributory implementation. The diversity of the program to reach to all the United States Citizens needs a both technical and financial assistance from multiple stakeholders. However, its legality from the Federal and States authorities has made it easy to pave its way it its position today. Therefore, the state citizens have been able to contribute in regard to the Affordable Care Act (Brennan, 1981). Therefore, collaboration of all stakeholders has enabled understanding of the program by all citizens. This has been a major driving force for the program and hence its position today.
Evaluation of Medicaid program has always taken an economic perspective. However, as demonstrated by the Affordable Care Act, the evaluation of the program has to include access to inpatient services under the Medicaid program, average lengths of the inpatient stays and ER visits, discharge planning by participating hospitals, the effect of the demonstration on cost of the full range of the mental health services as well as the percentage of consumers with Medicaid coverage who are admitted to inpatient facilities as a result of the demonstration as could be compared to the percentage admitted to the same facilities (Dudley, 2002). The report provided in June 2012 focused on the economic performance of the program. The program has been able to successfully meet essential factors under the Affordable Care Act. Under ACA, Medicaid eligibility is expanded to adults from 19-65 with financially incapacitated families. Further, the program has been able to demonstrate new enrollees together with estimated per capita Healthcare administration and expenditure costs to determine the aggregate federal and state costs of the Medicaid expansion from 2014-2020.
While the program’s run over the years has seemed to be effective, it has faced various criticism. The shortcomings have been provided based on its increase in budget leading to the increase of revenue to citizens. Therefore, states have always insisted on running this program which has rose controversies across the states and federal government. In essence, the complexity of the program demonstrates that the states may not be able to run the program (Kemp, 2007). This majorly rises from the fact that its administration differs from that of the state. Some States venture to subcontract it to private health insurance companies while others directly pay to providers without the need to use the program which essentially differs from the whole process of the program. Hence it will be unrealistic to let some states government to cover completely healthcare, as it will lead to the program bankruptcy for major healthcare costs, leading to inequality and lowering the access for the poor to healthcare (Dudley, 2002).
In conclusion, it should be noted that the program has been able to meet its objectives as indicated by the ACA. However, its success has highly lied on the fact that the United States citizens have been able to understand the program, it policies and taken focused role to ensure its success. Despite the challenges, its focus to expand by 2020 will enable help to the low income earners as well as the elderly and disabled people a better live to meet the general goal of the whole nation.

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Brennan, K. (1981). Medicaid. Washington, D.C.: Intergovernmental Health Policy Project.
Dudley, W. (2002). Religion in America: Opposing viewpoints. San Diego, CA: Greenhaven Press.
Kemp, D. (2007). Mental health in America a reference handbook. Santa Barbara, Calif.: ABC-CLIO.
Smith, R. (2008). Code of medical ethics of the American Medical Association: Current opinions
with annotations (2008-2009 ed.). Chicago: AMA Press

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