Health Insurance and Medicare Essay Example for Free

Health Insurance and Medicare Essay I. Introduction The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010 by President Barack Obama. Along with the Health Care and Education Reconciliation Act (HCERA), it represents the momentous transformation of the U.S. health care system. Its main goal is to decrease the amount of uninsured citizens as well as to reduce the overall costs of health care. It is a vastly complex reform that will affect many people in aspects of their health care, costs, and the country. There are many opinions about how this reform will affect the nation, some saying it will make us better off, others saying we will be worse off, and those who do not think it will make a difference. But regardless of these opinions, what the majority does agree on is that these laws may be difficult to understand and that many are not even aware of these changes. There are many problems that the health care industry is facing. The cost of health care may arguably be the most important factor that people are concerned about. Many think that health care policies and premiums are too expensive. Coupled with the fact that our population is aging, meaning that there will be more elder people with more health problems, health care costs are rapidly growing and take up a huge chunk of the federal budget. There are also many loopholes within the current health care system. Individuals who are looking to buy insurance can be denied based on their pre-existing conditions. Some insurance policies even have a lifetime limit on benefits. What all these examples basically sum up is that the people who are in need of health care the most are those who are also the most unlikely to be insured, or are under insured. In an attempt to address these issues, the PPACA and Reconciliation Act were established. The Health Care and Education Reconciliation Act was enacted to amend the PPACA. It is divided into two titles, one addressing the health reform and the other addressing student loan reform. It makes changes to some parts of the PPACA. That is why many people commonly refer to the overall health reform as just the PPACA. The most noted change this brings  is that it requires almost all citizens to have health care insurance, or to pay a penalty. Some examples and cases regarding this issue will be discussed later on. The PPACA also considerably expands public insurance as well as funds private insurance coverage. It will close loopholes such as setting life time limits as well as making it illegal to reject coverage for those with pre-existing conditions. In terms of affordability, the PPACA will expand Medicaid to cover low-income families and individuals across the nation. It also aims to cut down and reconstruct Medicare spending, which will be the main focus of this paper. II. The Impacts of the PPACA and HCERA on Medicare and Health Physicians The PPACA is made up of 10 titles. I will be discussing selected provisions in Titles II, III, IV, and V regarding Medicare. These include program modifications and payment to Medicare’s fee-for-service program, the Medicare Advantage, prescription drug programs, Medicare’s payment process, changes to address, waste, fraud, and abuse, and other miscellaneous Medicare changes. As for the HCERA, the first title has provisions detailing health care and revenues. Subtitle B of Title I involves provisions that change provisions PPACA relevant to those listed above (Medicare Advantage, fee-for-service, and prescription drug programs). Subtitle D has provisions regarding decreasing fraud, abuse, and waste in Medicare. Subtitle E discuses revenue related provisions such as a provision that changes Medicare tax provision in PPACA. A. Impacts on Medicare According to the Congressional Budget Office (CBO), the provisions in PPACA as amended by the HCERA will reduce direct spending by an estimated $390 billion (CRS, 2010). The provisions that are predicted to produce the largest savings include the following: (1) developing an Independent Payment Advisory Board to create changes in Medicare payment rates is presumed to save about $16 billion (2) decreasing Medicare payments to hospitals that aid a vast number of low-income patients, is expected to reduce expenditures by an estimated $22 billion (3) permanent deductions to Medicare’s fee-for-service payment rates (4) changing the high-income adjustment for Part B premiums, and (5) making maximum payment rates in Medicare Advantage closer to spending in fee-for-service Medicare. However, it is critical to  note that these are just estimates. Medicare is made up of four parts that are each accountable for paying for various benefits, dependent on different eligibility criteria. Under traditional Medicare, Part A and Part B services are usually paid by a fee-for-service basis (services supplied to a patient is reimbursed through a separate payment). Part A supplies coverage for skilled nursing facility (SNF) services, inpatient hospital services, hospice care, and home health care, which are subject to some limitations. Provisions that reduce Part A spending make up a large part of the savings related to this legislation through either payment changes or constraining payment updates. PPACA will alter Medicare’s payment updates to Part A hospitals to account for cost savings, which will significantly reduce Medicare spending in the next 10 years. Under PPACA (Title III Subtitle A Section 3001), beginning for discharges on October 1, 2012 hospitals will acquire value-based incentive payments from Medicare. The first year of the value based purchasing (VBP) program will aim at collecting data and assessing performance. Starting in 2013, adjustments to hospital payments will be made based on performance by the VBP program. There will also be VBP standards established (i.e. levels of improvement and accomplishments), as well as a method for assessing how hospitals perform. Hospitals with the highest score will obtain the biggest VBP payments. Those that meet or go beyond the standards are able to receive an increased DRG payment for each discharge within the year. However, to provide for these VBP incentive payments the DRG payments will be reduced by a certain percentage: 1.0% in 2013; 1.25% in 2014; 1.5% in 2015; 1.75% in 2016; and 2.0% in 2017. An alternate choice to receive covered benefits would be Medicare Advantage (MA). Private health plans are paid a per person amount to supply all Medicare-covered benefits to those who enroll in the plan under MA. The payments made to MA plans are decided by comparing the maximum amount Medicare will pay for benefits with a plan’s cost of providing those required benefits. If the plan’s cost is below the maximum, then it is paid  the cost plus a rebate equal to 75% of the difference to the maximum. But if the plan’s cost is above the maximum, then it is paid and must also charge the enrollee the difference between the cost and the maximum. PPACA modifies how the maximum payment is decided. Beginning in 2012, it will implement benchmarks (maximum amount Medicare will pay for benefits) calculated as a percentage of per capita FFS Medicare spending. It will also increase benchmarks depending on the quality of the plan. Those with a high quality rating will get an increase in their benchmark while new plans or those with lesser enrollments may also qualify to get an increase. PPACA will also vary the plan rebates based on quality with new rebates set from 50% to 70%. In regards to changes affecting Medicare’s prescription drug benefits, the health reform makes a few changes to the Medicare Part D program. PPACA increases the premiums held by higher income enrollees. The income standards are set to be at the same manner and level as that in Part B. Beginning in 2011, those enrolled in Part D will have a 50% discount for drugs during the coverage gap. In extension, HCERA will supply a rebate of $250 to those who enter the gap in 2010. Hopefully this phases out the â€Å"donut hole† (coverage gap) by slowly lessening the cost-sharing and coverage gap for generic and brand name drugs. Medicare’s finances are operated through two trust funds, the Hospital Insurance (HI) and the Supplementary Medical Insurance (SMI) trust fund. The main provider of income to the HI fund, which pays for Medicare Part A, is the payroll taxes paid by employers and employees. Medicare Part B and D are funded by general revenues and monthly premiums. In addition to all the previous provisions addressing Medicare’s financial issues, there is another precautionary step being taken. The PPACA has a provision to establish an Independent Payment Advisory Board with the goal of decreasing Medicare spending. B. Impacts on Physicians The PPACA and HCERA make various changes to the Medicare program, which in turn affects physicians and how they practice. Some of these provisions have clear consequences, such as immediately changing physician reimbursement, while others have indirect influences on how physicians may practice in the  future by modifying the incentives to improve the delivery and quality of care. PPACA broadens the Medicare Physician Quality and Reporting Initiative (PQRI) incentive payments though 2014 and administers a penalty for those who fail to report quality measures starting in 2015. It also supplies for a further bonus to physicians who meet the requirements of an assessment program, such as the Maintenance of Certification Program, while penalizes the physicians who fail to meet those standards in the future. Under Section 3002 of Title III, Medicare claims data will be used to provide reports to physicians that measure resources used to provide care for Medicare beneficiaries. Under Section 3007 of Title III, the Secretary of HHS is obliged to create and administer a separate payment modifier to the Medicare physician fee schedule. This payment should be based on the relative cost and quality of the care provided by physicians. The quality of care should be assessed based on risk-adjusted measure of quality determined by the Secretary. Costs are also assessed based on measures determined by the Secretary. Risk factors such as ethnicity, demographic, socioeconomic characteristics, and health status should be taken into account. By January 1, 2012 these explicit measures of cost and quality, along with implementation dates of the adjusted payments should be published. III. Regulations Implementation With such significant changes and provisions being made, there should be a way to keep track of how each is being regulated and implemented. I will discuss the regulations, time limits, and effective dates on how each are being done so by year. The first changes of 2010 start with Medicare provider rates. This includes reductions in the annual market basket updates for hospital services. Currently, there have been productivity adjustments added to market basket update in 2012. The Centers for Medicare and Medicaid Services (CMS) have issued these updates for varying provider types starting in August 2010. The  implementation of the Medicare Beneficiary drug rebate, which supplies a $250 rebate to those in the Part D coverage gap, started January 1, 2010. In May 2010, the CMS published a brochure containing information about the coverage gap in Medicare Part D. As of March 22, 2011, about 3.8 million people have received the $250 rebate (HHS, 2011). As for closing the Medicare drug coverage gap, on December 17, 2010 CMS sent a letter to pharmaceutical companies addressing guidelines to the Medicare Coverage Gap Discount Program. This program became effective on January 1, 2011. Moving onto provisions implemented in 2011, Medicare payments for primary care will provide a 10% bonus payment for services. It will also provide the same bonus to general surgeons working in areas with a shortage of health professionals. This is being implemented starting in January 1, 2011 through December 2015. As for the MA payment changes, they will restructure payment to private plans and prohibit higher cost-sharing requirements. This has been in effect since January 1, 2011. The CMS issued a notice to MA plans in April 2010 addressing the freeze in 2011 payment rates at 2010 levels. A Medicare Independent Payment Advisory Board made up of 15 individuals to arrange proposals and recommendations to decrease the per capita rate of growth in spending if it exceeds targeted rates was planned to be established. On October 1, 2011, funding was made available and the first proposals are due January 15, 2014. In 2012, the second part of the MA plan payments, which reduce rebates paid and provide bonuses to high quality plans, went into effect on January 1, 2012. On February 28, 2012 the CMS sent out a letter to MA plans addressing the payment rates for 2012. Fraud and abuse prevention was also implemented on January 1, 2012. It establishes procedures for screening and reporting those who participate in Medicare. On March 23, 2011 CMS issued a notice addressing the fee that providers would have to pay to fund the screenings. Later on in the year, on October 1, 2012 Medicare value based purchasing was put into effect. This creates a program to pay hospitals based on their quality of performance. This coming year in 2013, there will be a few provisions to come into effect  starting off the new year. On January 1, 2013 the Medicare tax increase (increases the Medicare Part A tax rate on wages by 0.9% on incomes of $200,000), Medicare bundle payment pilot program (program to create and assess payments for certain services), and the latter part of the prescription drug coverage gap (reducing coinsurance) will be put into effect. As for 2014, the last of the Medicare provisions will be implemented. The Medicare Advantage plan loss ratios are mandated to be no less than 85%; this will begin at the start of the year on January 1, 2014. The second implementation for that year will be Medicare payments for hospital-acquired infections; it will decrease payments to those hospitals for their hospital-aquired conditions by 1% and this process will continue onto 2015. IV. Cases Challenging PPACA When the PPACA and HCERA were signed into law, many people opposed and sued claiming that the reform was unconstitutional for a number of reasons. The most controversial was the mandate that require most citizens to obtain health insurance coverage, and if failing to do so would have to pay a penalty in the form of an individual tax. Another debated provision was the expansion of the Medicaid program to cover even more individuals, such as those with low income. All of these separate cases were then merged into a single case, The National Federation of Independent Business v. Sebelius, 567 U.S. (2012). When ruled, it was a momentous Supreme Court decision in which the Court maintained Congress’s authority to enact the provisions of the Affordable Care Act and the Reconciliation Act. In December 2011, it was announced that there would be a 6 hour oral argumentation heard by the Court over a time span of three days beginning on March 26, 2012 and ending on March 28, 2012 discussing varying debatable topics of these provisions. By a vote of 5 to 4, the Court maintained the Individual Mandate aspect of the PPACA as a binding exercise of Congress’s authority to lay and collect taxes. The critical characterization of this financial penalty as a tax is what passed the mandate as constitutional. Preceding this landmark case there were many previous hearings held, all  having similar conflicting opinions. The Eleventh Circuit was also dealing with arguments in relative cases challenging PPACA. While it was assumed that the Fourth Circuit, which had heard oral arguments before the Eleventh Circuit, would issue a decision on PPACA first, the Eleventh Circuit was actually the second to issue its opinion, on August 12, 2011. In Florida ex rel. Bondi v. U.S. Department of Health Human Services (2011) the plaintiffs of the case were two private individuals, the National Federation of Independent Business, and 26 individual states. The Eleventh Circuit then published a 300-plus page opinion finding by a 2:1 majority that the Individual Mandate (requiring health insurance coverage) is unconstitutional, and thus created a split of authority between the two Circuits. The Eleventh Circuit heard this appeal from the United States District Court for the Northern District of Florida, which saw the Individual Mandate to be an unconstitutional exercise of Congress’s authority. The district court also found that the Individual Mandate was not applicable to the rest of the PPACA, meaning that the whole act was invalid. The plaintiffs in the district court case also debated that the PPACA’s expansion of Medicaid was unconstitutional, but the district court granted the government judgment on that issue and the Eleventh Circuit agreed to that court’s decision. These two cases show how divided opinions can be and how difficult it was and is to pass a health reform law. Opinions are still divided, concerning many aspects such as the Medicaid expansion, the Commerce Clause, and the Necessary and Proper Clause. On the issue of Medicaid expansion, no one, single opinion had the support of the majority of the Justices. Also, on the issue of if the Individual Mandate was within the authority of Congress under the Commerce Clause and the Necessary and Proper Clause, again there was no single opinion that was supported by the majority of the Court. Despite all these controversies, and even though the act has passed, there are still those who are continuing to pursue litigation in order to repeal and defeat the PPACA. V. Conclusion Medicare spending has been increasing much more rapidly compared to the general economy, and this definitely raises concerns about Medicare’s  long-term sustainability. The provisions in the Affordable Care Act and the Reconciliation Act were established to decrease Medicare program costs by about $390 billion over the following 10 years through modifications in payments to various providers, by leveling payment rates between fee-for-service Medicare and Medicare Advantage, and by boosting efficiencies of how health services are delivered and paid for. Overall, the PPACA and HCERA are momentous pieces of legislation that will restructure the future of the U.S. health care system. It is still unclear of how well these provisions have been implemented, with some still having yet to be so. The main concern is probably how well costs will be contained or reduced. With all of these new taxes, hopefully the reform will actually reduce the federal deficit over the next ten years that these provisions are being implemented. There is still much work to be done within the next few years, to see how this reform works out. Many people are glad that it has passed and support this reform as well as encourage it to be expanded, while others oppose the reform arguing that it creates too much government involvement in the issue. But since it has passed and is enacted in the present, people should make use of what is being provided. Some are not even aware of the changes in the health care industry and are oblivious to how they are being affected. That is why it is important to stay informed and make decisions, after all this is what directly affects your future. References CRS Analysis of CBO (March 20, 2010). Estimates of the effects of PPACA and the Reconciliation Act combined. Congressional Budget Office. Retrieved October 31, 2012 from: http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf Barrett, Paul M. (June 28, 2012). Supreme Court Supports Obamacare, Bolsters Obama. Bloomberg Businessweek. Retrieved November 3, 2012 from: http://www.businessweek.com/articles/2012-06-28/supreme-court-supports-obamacare-and-bolsters-obama Congressional Budget Office (March 2009). An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act. Letter to the Honorable Evan Bayh. Congressional Budget Office, Washington, DC. Retrieved November 3, 2012 from: http://www.cbo.gov/doc.cfm?index=10781. Kaizer, J. (2010). Implementation Timeline. Health Reform Source. Retrieved November 5, 2012 from: http://healthreform.kff.org/timeline.aspx Hilgers, David W. (February 2012) Physicians post-PPACA: not going bust at the healthcare buffet. The Health Lawyer, Vol. 24. Retrieved November 4, 2012 from: http://www.americanbar.org/content/dam/aba/publishing/health_lawyer/health_mo_premium_hl_healthlawyer_v24_2403 Pozgar, George D. (2009). Legal essentials of health care administration. Missisauga, Ontario: Jones and Bartlett Publishers, Michael Brown. National Federation of Independent Business v. Sebelius, Secretary of Health Human Services 567 U.S. (2012) No. 11-393 Argued March 26-28, 2012 – Decided June 28, 2012 Florida ex rel. Bondi v. U.S. Department of Health a Human Services, 780 F.Supp. 2d. 1256 (N.D. Fla. 2011), order clarified by 780 F.Supp. 2d. 1307. (N.D. Fla. 2011).

Analysis of Edmund Wallers Poem On a Girdle Essay -- Edmund Waller Gi

Analysis of Edmund Waller's Poem "On a Girdle" At first glance, Edmund Waller’s poem â€Å"On a Girdle† seems to suggest nothing more than praise of one woman’s fair beauty and the speaker’s love for her. After diving deeper into the text, however, it becomes apparent that the speaker does a much better job of praising himself than the woman. His love is more a lust for control and possession than a true declaration of sentiment. Waller uses extreme imagery and exaggeration to seemingly praise this woman. More importantly, however, he subtlety belittles her through tropes and diction. Waller evokes this image of her girdle to express his own desire to restrict this beautiful woman. It cannot be denied that Waller professes love for this woman. He praises her tremendously. He refers to her girdle as â€Å"my heaven’s extremest sphere†. Through this statement he is claiming that for him her girdle was the most expansive point of his universe. This is undoubtedly an extreme statement. He also declares, â€Å"My joy, my grief, my hope, my love / Did all within this circle move!† Waller is profoundly affected by this woman. She instills in him joy, grief, hope and love, all emotions someone enamored with a woman might experience. He loves her so much that if he can have her then, â€Å"Take all the rest the sun goes round!†. In essence Waller is saying he loves this woman more than anything else on earth. Unarguably, Waller holds this woman in extremely high regard. He has placed her on a pedestal. The more interesting idea to consider, however, is why he places her upon this pedestal. This woman is placed upon the pedestal because of her physical beauty. She is described as having a â€Å"slender waist†, a â€Å"na... ... is an object which can be given and then the word â€Å"me† suggests the speaker’s desire for ownership of this object. By using diction that suggests possession and control Waller reveals his true intent for this woman that the loves. This entire poem conjures up an image, that of a man with his arms encircling a woman as her girdle once did. After reflecting upon this image it can be seen as a very controlling one. The man has his arms around the woman but she has no part of the embrace. She is trapped. She is merely the object he has his arms around. She may be beautiful, he may love her, but she plays no role in the relationship. She simply remains in his embrace much like the deer in its pen she was compared to earlier. This is what Waller desires from this woman. He never asks for her love in return. He longs only for possession of her body.

The Difference Between Working in Air Asia and Malaysian

The difference between working for Air Asia and Malaysian Airlines ( MAS ) Are you looking for a job in airline company, but do not know which one to choose? Your query will surely be answered as we move along in this composition. Working in the airline industry is a truly wonderful choice as it’s exciting, fun-filled yet lucrative. In fact, they are merely two prestigious airlines in Malaysia, namely Air Asia and Malaysian Airlines ( MAS ). So which one will be a better choice to work for? To be a better choice, it must excel in several aspects, which are salary and benefits, potential for personal development as well as administrative system. Firstly, salary and benefits, which usually are the main attractions in job searching. Air Asia offers their employees relatively high wage, which is approximately 20% higher than their main contender – MAS. Moreover, benefits provided by Air Asia are too good to be true! Benefits include a 5-day work week, life insurance, annual free flight, employee discounts, compassionate leave, etc. On the other hand, MAS offers a lower salary as compared with Air Asia. Furthermore, employees of MAS do not enjoy attractive benefits like what Air Asia has to offer. Evidently, Air Asia has won this aspect hands down. Secondly, personal development is a key element in our lives, that is to say, life can be rather stagnant and meaningless without personal development. Air Asia caters to their employees need in this aspect by creating an environment that is conducive to personal development and having a series of stratagems that could out-think its opponents. One of the stratagems is that any employee, regardless of background, can request to have a â€Å"job-switch† and promotion at any time. With that in mind, you can start working as a ground crew and years later you become a captain! Whereas Air Asia’s arch-rival, MAS, is unconcerned about the employee’s personal development as a key element of life, thus initiatives have yet to be implemented. Air Asia wins another point by executing such scrupulous plan. Lastly, the administrative system implemented in the airline is also crucial to provide a better working experience. The CEO of Air Asia, Tony Fernandes believes that open communication with all the employees lead the airline to success. He has implemented open-door policy since the establishment, thus being accessible by anyone working in the airline. This policy has helped reduce bureaucracy and hierarchy, and the employees appreciate it a lot as it gives them the right to speak up and give new ideas. Whereas MAS, which has a bureaucratic administration, is less favorable to its employees. Under this circumstance, to lodge a complaint or make a request, employees need to go through endless red tape. This results in less productivity in the airline and a dull working experience for the employees. Again, the open-door policy by Air Asia creates a better working atmosphere for the employees, and hence stands the airline in good stead. In a nutshell, Air Asia has outshone its adversary – MAS in several ways, namely, offering better salary and benefits, creating higher potential for personal development as well as having more preferable administrative system. As shown above, Air Asia is a better airline to work for.

Literary Devices In Letter From Birmingham Jail - Free Essay Example

Sample details Pages: 3 Words: 834 Downloads: 6 Date added: 2019/05/28 Category History Essay Level High school Tags: Letter From Birmingham Jail Essay Did you like this example? On April 16, 1963, Martin Luther King Jr. wrote, the now infamous, Letter from Birmingham Jail, which was a response to the eight clergymen who wrote a letter to Martin Luther King Jr. stating that there was racial segregation to be handled, but that it was a job for the courts and law to handle, and not everyday people. Don’t waste time! Our writers will create an original "Literary Devices In Letter From Birmingham Jail" essay for you Create order In his letter, King supported the idea that injustice was everywhere, and not just in court rooms. He supported his claims by applying anaphora, diction, parallelism, and rhetoric appeals. King uses his words to build trust and reassurance, feeling of emotions and logistics and credibility in his response letter to effectively get his messages across. King most effectively applies these devices by giving an incredible insight as to what African Americans are faced with daily, and the make-up of just and unjust laws in Alabama. King uses pathos by giving examples of how poorly Negros were frequently treated while the law watched it happen and did nothing about it. He implies how mothers and fathers were lynched and brothers and sisters are drowned because white men felt like doing it. He states that when you have seen vicious mobs lynch your mothers and fathers at will and drown your sisters and brothers at whim which causes the reader to feel and experience the brutality that the negro population suffered through (King 4). He uses pathos a second time by referencing a little girl who sees an advertisement for an amusement park that is opening. She begins to cry when shers told that she, along with other African Americans, are not allowed to go because the park wont allow colored people to enter (King 4). His descriptions highlight the extent of racism in Montgomery, at the time. His use of pathos in the letter evokes the true emotions that King had for the movement and how much the rebellions meant to him. King wants his child to go to an amusement park without being ridiculed by the white populous. He wishes for his fellow African American families to live without violence. He portrays his message using pathos throughout the letter. King incorporates diction when he discusses the differences between just and unjust laws. He says that, Any law that uplifts human personality is just. Any law that degrades human personality is unjust. All segregation statues are unjust because segregation distorts the soul and damages the personality (King 4). Kingrs use of the words degrades, damages, and distort bring an emphasis of negativity that also demonstrates the feelings that King has for the laws in Montgomery. Also, the word statues demonstrate that segregation can never be changed by itself. He is saying that segregation laws will be changed when people step in and make the change happen. His choice of words is important because it gives more description and emotional weight supporting his, and the Negro communityrs, hatred for the unjust laws and enforcement of those laws. It also brings the reader a sense of understanding as to why MLK is protesting and justifies his reasoning for instigating the protests. King implies parallelism to instill a sense of understanding to the reader as to why segregation is a big problem in Birmingham. King expresses that, Hence segregation is not only politically, economically, and sociologically unsound, it is morally wrong and sinful (King 5). The parallelism, used in the sentences, allows the reader to easily comprehend Kingrs argument against segregation. He also applies many adjectives that bring a unique flow to the paragraph. He also mentions sinful in reference to the segregation. This word choice is also effective because it shows that King is a former bishop. Plus, it is directed to the clergymen who wanted to stop him and his protests, in the first place. King finally uses anaphora to express his disappointment with the white populous and how their harsh treatment led the Negro population to start a rebellion. He reasons that, It is unfortunate that protests are taking place in Birmingham, but it is even more unfortunate that the cityrs white power structure left the Negro community with no alternative (King 1). The beginning of both sentences begins with the same word, unfortunate. This is important because it outlines Kingrs overwhelming disappointment with the circumstances surrounding the protesting, but it also gives the reader a realization that the Negro population has a valid reason to continue to rebel. Plus, the reader will have a feeling of guilt and disappointment in not only the law, but in themselves because they know it is shameful to treat people horribly, especially because they have a different color of skin. In conclusion, Martin Luther King Jr.rs response to the eight clergymen made Kingrs points very clear. It had many uses of literary devices, including those of the rhetoric type. His letter has had a profound impact on history, as well as the civil rights movement. If King didnt write this letter with such passion and energy, then it would have severely hindered the movement entirely.