Medicare, Medicaid, AND HIPAA

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Medicare, Medicaid, AND HIPAA

The Health Insurance Portability Act (1996) was signed into law by President Bill Clinton to provide patients with privacy regarding their medical records as well as other health information given to healthcare service providers (Nowicki, 2018). As such, patients are protected from unscrupulous insurance companies that may want to use the information for personal gain with permission from the patients. As such, patients are guaranteed of having their health date safe from people who might use it negatively (Nowicki, 2018). For organizations, HIPPA has played a significant role in the healthcare industry by facilitating the shift from manual to electronic record keeping. It has also facilitated the harmonization of administrative healthcare functions and improved healthcare efficiency.

Medicaid is the primary public insurance over for low-income earners in the United States with at least one in every five people using it. As such, it finances almost 20% of all personal health care spending in the nation. It has some mandatory and optional benefits. Some of the mandatory benefits include inpatient, outpatient, nursing facility, lab, pediatric, and transportation services (Rowland, 2003). Conversely, some of the optional benefits Medicaid covers include clinic services, prosthetics, and dental services. However, Medicaid faces payment risk challenges which include duplicate state payment, payments to non-compliant MCOs, improper state capitation payments, and inaccurate state capitation rates. These risks affect service delivery.

Medicare is a federal insurance program that caters for particular young people with disabilities, senior citizens, and people with end-stage renal disease (ESRD). Individuals have the option of choosing Medicare Part A, B, C or D (Nowicki, 2018). The plans allow individuals to subscribe to one to suits their immediate or long-term needs. The C option is the most popular as it covers A, B, and D. However, Medicare faces several challenges. One such challenge is that there are fewer workers against retirees making funding difficult (Blumenthal et al., 2015). Additionally, the influx of baby boomers into the program makes puts financial strain on the program.


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Engl J Med372(5), 479-486.

Nowicki, M. (2018). Introduction to the financial management of healthcare

Organizations. Chicago, IL: Health Administration Press.

Rowland, D., Garfield, R., & Elias, R. (2003). Accomplishments and challenges in Medicaid

mental health. Health Affairs22(5), 73-83.

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