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Boston University *

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719

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Health Science

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Oct 30, 2023

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docx

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Uploaded by LieutenantBoulder12379

out of pocket payments, individual insurance, employer sponsored insurance, government-financed insurance. Include a sentence about which method is least effective, in your view, and why. Out of pocket payments: when patient pays money directly to the medical care (treatments) in the hospital or clinics (provider) without insurance. Individual insurance: this refers to people buying their own private health insurance plan, patient pays regular-based fee to the insurance provider, called premium. By paying your healthcare provider, your insurance company assists in covering some of the cost of your medical care. Employer sponsored: many employers offer healthcare coverage to their employees paying a premium for the insurance plan; so this is a part of benefit package comes from employer. Government-financed insurance: certain groups are covered in full by government-funded insurance programs, such as Medicaid for low-income people and Medicare for elderly, guaranteeing that care is available to vulnerable groups. Paying out of pocket is, in my opinion, the least successful approach since it puts a financial barrier in the way of people's access to healthcare. Cost concerns frequently cause people to postpone or forego critical medical treatment, which can ultimately result in worse health outcomes and higher healthcare expenses. The passage you've provided outlines some of the key changes that the Affordable Care Act (ACA) brought to the U.S. healthcare system: 1. Employer Mandate : Under the ACA, employers with 50 or more full-time employees are required to offer health insurance coverage to their employees. If they do not provide this coverage and at least one of their employees receives financial assistance for coverage through the health insurance exchanges, the employer is subject to a fee. This mandate was introduced to encourage employers to continue offering health insurance and ensure that employees have access to coverage. 2. Coverage for Young Adults : The ACA mandated that private health insurance plans must allow young adults to remain on their parents' policies up to the age of 26. This provision was intended to provide extended coverage for young adults, including college students, who might not have their own employer-based insurance yet. 3. Preexisting Condition Protections : The ACA prohibits insurance companies from denying coverage or charging higher premiums based on preexisting conditions. This change provides essential protection for individuals with existing health issues, ensuring they can access insurance coverage. 4. Premium Cost Restrictions : The ACA limited the variation in premium costs within insurance plans. Insurance companies are allowed to charge a maximum of three times the premium rate for the same benefit package, regardless of the individual's age. This change aimed to make insurance more affordable and equitable. These provisions of the ACA were implemented to increase access to healthcare, improve consumer protections, and enhance the overall functioning of the U.S. healthcare system.

The law aimed to make insurance more accessible and equitable for a broader range of individuals and families. Premium Cost Restrictions: The ACA limited the variation in premium costs within insurance plans. Insurance companies are allowed to charge a maximum of three times the premium rate for the same benefit package, regardless of the individual's age. This change aimed to make insurance more affordable and equitable. ChatGPT The passage describes a key provision of the Affordable Care Act (ACA): Premium Cost Restrictions : The ACA set limits on how much insurance companies can vary the cost of premiums for the same type of benefit package based on an individual's age. Specifically, insurance companies are allowed to charge a maximum of three times the premium rate for the same set of benefits, regardless of how old the individual is. This rule was implemented to achieve two main objectives: 1. Affordability : By capping the premium cost differences based on age, the ACA aimed to make health insurance more affordable for individuals of all age groups. Prior to this rule, older individuals often faced significantly higher premiums due to their age, which could make insurance unaffordable for some. 2. Equity : The goal was also to promote fairness and equity in health insurance pricing. By limiting the age-based premium variations, the ACA sought to ensure that younger and older individuals had more comparable premium costs for the same level of coverage. In summary, this provision was intended to create a more equitable and affordable health insurance system by narrowing the price gap for individuals of different ages while offering the same benefits. In 2012, Bud Carpenter was self-employed. To pay the $800 monthly premium for his individual health insurance policy, he had to work extra jobs on weekends, and the $5,000 deductible meant he would still have to pay quite a bit of his family’s medical costs out of pocket. Mr. Carpenter preferred to pay these costs rather than take the risk of spending the money saved for his children’s college education on a major illness. When he became ill with leukemia and the hospital bill reached $80,000, Mr. Carpenter appreciated the value of health insurance. Nonetheless he had to feel disgruntled when he read a newspaper story listing his insurance company among those that paid out on average less than 60 cents for health services for every dollar collected in premiums. ышьзду цщквы ChatGPT The scenario you've described illustrates some of the challenges and dilemmas that individuals can face when it comes to health insurance. Here are a few key points to note: 1. High Premiums and Deductibles : Bud Carpenter had to work extra jobs to pay for his individual health insurance policy, and he still had a substantial deductible to meet. This highlights the financial strain that many people experience due to the high cost of healthcare and insurance. 2. Financial Risk vs. Health Insurance : Bud Carpenter chose to pay for health insurance even with its high costs because he wanted to mitigate the financial risk associated with a major illness. This reflects a common dilemma individuals face – balancing the cost of insurance with the risk of medical expenses.

3. Healthcare Costs : The hospital bill of $80,000 for his leukemia treatment underscores the significant expenses associated with medical care, especially for serious conditions. Even with insurance, out-of-pocket costs can be substantial. 4. Insurance Payouts : The frustration expressed by Mr. Carpenter regarding his insurance company paying less than 60 cents for every dollar collected in premiums reflects concerns about the efficiency and transparency of the health insurance industry. This scenario highlights the need for a robust and accessible healthcare system that addresses the financial burden of healthcare for individuals and families. It also underscores the importance of understanding the terms and conditions of health insurance policies, including their coverage and cost-sharing aspects. n 2014, Bud Carpenter signed up for individual insurance for his family of four through Covered California, the state exchange set up under the Affordable Care Act. Because his family income was 200% of the federal poverty level, he received a subsidy of $1,373 per month, meaning that his premium would be only $252 per month for a silver plan with Kaiser Permanente. His deductible was $2,000. Insurance companies were no longer allowed to deny coverage for his preexisting leukemia. ChatGPT Bud Carpenter's experience in 2014 demonstrates some of the key provisions and benefits of the Affordable Care Act (ACA) in the United States: 1. Subsidies : Bud Carpenter received a significant subsidy through Covered California because his family income was at 200% of the federal poverty level. Subsidies under the ACA were designed to make health insurance more affordable for lower and middle-income individuals and families, reducing their monthly premium costs. 2. Preexisting Condition Protections : The ACA implemented regulations that prohibited insurance companies from denying coverage or charging higher premiums based on preexisting conditions. In Bud's case, he could obtain insurance coverage even with a preexisting condition like leukemia, which was a significant improvement in consumer protection. 3. Standardized Plans : Bud was able to purchase a silver plan from Kaiser Permanente with a $2,000 deductible. The ACA standardized insurance plans into metal tiers (bronze, silver, gold, and platinum), making it easier for consumers to understand and compare their coverage options. Overall, Bud Carpenter's experience reflects the ACA's efforts to expand access to healthcare, increase consumer protections, and provide financial assistance to those with lower incomes to make health insurance more affordable. These changes were significant steps in the U.S. healthcare system to improve coverage and reduce barriers to obtaining insurance. what is a deductible ChatGPT A deductible is a specific amount of money that an individual must pay out of their own pocket before their health insurance plan starts covering the costs of their medical expenses. In other words, it's the portion of healthcare expenses that you are responsible for before your insurance kicks in to share the costs.

For example, if you have a health insurance plan with a $1,000 deductible, and you incur $5,000 in covered medical expenses, you would need to pay the first $1,000, and your insurance would cover the remaining $4,000. Deductibles are designed to help control insurance costs and are often set as an annual amount. They can vary widely depending on the type of insurance plan and policy. Plans with lower premiums typically have higher deductibles, and plans with higher premiums tend to have lower deductibles. The choice of a plan with a higher or lower deductible depends on an individual's financial situation and healthcare needs. . The ACA established federal and state-based insurance exchanges to assist people seeking individual coverage to shop for insurance plans meeting the federal standards. Insurance companies are no longer able to deny coverage for medical conditions that existed prior to the purchase of the insurance. The benefit packages offered by plans in the exchanges vary depending on whether individuals purchase a low-premium bronze plan with high out-of-pocket costs, a high-premium platinum plan with lower out-of-pocket costs, or intermediate silver or gold plans (Kaiser Family Foundation, 2013) (Table 2–2). The contentious politics of the ACA are discussed in Chapter 15. ChatGPT The text you've provided describes some key provisions of the Affordable Care Act (ACA), also known as Obamacare, in the United States. Here are the main points: 1. Establishment of Insurance Exchanges : The ACA established both federal and state-based health insurance exchanges (Marketplaces) where individuals and families can shop for and purchase health insurance plans that meet federal standards. These exchanges were created to make it easier for people to compare and purchase health insurance, increasing transparency and accessibility in the insurance market. 2. Prohibition of Coverage Denials for Preexisting Conditions : One of the significant changes brought about by the ACA is that insurance companies are no longer allowed to deny coverage or charge higher premiums based on preexisting medical conditions. This is a crucial consumer protection, ensuring that people with existing health issues can still obtain insurance coverage. 3. Variety of Benefit Packages : Plans offered on the exchanges come in different metal tiers, including bronze, silver, gold, and platinum. These tiers represent the level of coverage and cost-sharing. For example, bronze plans typically have lower premiums but higher out-of-pocket costs, while platinum plans have higher premiums but lower out-of- pocket costs. Consumers can choose plans based on their budget and healthcare needs. 4. Controversies Surrounding the ACA : The text mentions that the politics of the ACA have been contentious. The ACA's passage and implementation sparked political debates, legal challenges, and policy discussions. Chapter 15 likely goes into more detail about the challenges and controversies surrounding the ACA. The ACA was a significant piece of healthcare reform legislation in the United States, aiming to expand access to healthcare, improve consumer protections, and make health insurance more affordable for a broader population. It had a substantial impact on the healthcare landscape in the country. With employment-based health insurance, employers pay a portion of the premium that purchases health insurance for their employees (Fig. 2–3). However, this flow of money is not as simple as it looks. The federal government views employer premium payments as a

tax-deductible business expense. The government does not treat the health insurance fringe benefit as taxable income to the employee, even though the payment of premiums could be interpreted as a form of employee income. Because each premium dollar of employer-sponsored health insurance results in a reduction in taxes collected, the government is in essence subsidizing employer-sponsored health insurance. This subsidy is enormous, estimated at $280 billion in 2018. ЫШЬЗДУ ChatGPT The passage you've provided highlights some key aspects of employment-based health insurance in the United States: 1. Employer Contributions : Many employers in the United States offer health insurance as part of their employee benefits package. In this system, employers typically pay a portion of the premium for their employees' health insurance plans. This contribution helps make health insurance more affordable for employees. 2. Tax Treatment : The federal government treats employer premium payments as a tax-deductible business expense. This means that employers can deduct the cost of providing health insurance for their employees from their taxable income. In other words, it reduces the amount of income subject to taxation for the employer. 3. Tax Benefits for Employees : Additionally, the government does not treat the value of the health insurance provided by the employer as taxable income to the employee. In essence, this means that employees do not have to pay income tax on the value of their employer-provided health insurance. This is known as a "tax-free fringe benefit." 4. Government Subsidy : The combination of tax benefits for employers and employees results in a substantial government subsidy for employer-sponsored health insurance. This subsidy is significant, amounting to billions of dollars annually. In 2018, it was estimated at $280 billion. This tax treatment and subsidy have been a fundamental aspect of the U.S. healthcare system, with the goal of encouraging employers to offer health insurance to their employees. It has also been a subject of debate and discussion in healthcare policy, with some advocating for changes to the system to make healthcare more equitable and cost- effective. Tax Treatment: The federal government treats employer premium payments as a tax- deductible business expense. This means that employers can deduct the cost of providing health insurance for their employees from their taxable income. In other words, it reduces the amount of income subject to taxation for the employer. Tax Benefits for Employees: Additionally, the government does not treat the value of the health insurance provided by the employer as taxable income to the employee. In essence, this means that employees do not have to pay income tax on the value of their employer-provided health insurance. This is known as a "tax-free fringe benefit." Government Subsidy: The combination of tax benefits for employers and employees results in a substantial government subsidy for employer-sponsored health insurance. This subsidy is significant, amounting to billions of dollars annually. In 2018, it was estimated at $280 billion. SIMPLE WORDS ChatGPT In simpler terms: 1. Tax Treatment for Employers : The government allows employers to subtract the money they spend on providing health insurance to their employees from their total income before calculating taxes. This means they pay fewer taxes because they're spending on health insurance for their employees.

2. Tax Benefits for Employees : The government doesn't consider the value of the health insurance provided by the employer as part of the employees' income. So, employees don't have to pay income taxes on the value of their employer-provided health insurance. It's like getting a tax break. 3. Government Help : Because both employers and employees get tax benefits for health insurance, the government ends up spending a lot of money to support this system. In 2018, this support was estimated to be a massive $280 billion. This tax system encourages employers to offer health insurance to their employees, but it also costs the government a lot of money. he new dynamic was called experience rating . (The following discussion of experience rating can be applied to individual as well as employment-based private insurance.) Healthy Insurance Company insures three groups of people—a young healthy group of bank managers, an older healthy group of truck drivers, and an older group of coal miners with a high rate of chronic illness. Under experience rating, Healthy sets its premiums according to the experience of each group in using health services. Because the bank managers rarely use health care, each pays a premium of $600 per month. Because the truck drivers are older, their risk of illness is higher, and their premium is $700 per month. The miners, who have high rates of black lung disease, are charged a premium of $800 per month. The average premium income to Healthy is $700 per member per month. Blue Cross insures the same three groups and needs the same $700 per member per month to cover health care plus administrative costs for these groups. Blue Cross sets its premiums by the principle of community rating. For a given health insurance policy, all subscribers in a community pay the same premium. The bank managers, truck drivers, and mine workers all pay $700 per month. Community rating achieves this redistribution in two ways: 1. Within each group (bank managers, truck drivers, and mine workers), people who become ill receive benefits in excess of the premiums they pay, while people who remain healthy pay premiums while receiving few or no health benefits. 2. Among the three groups, the bank managers, who use less health care than their premiums are worth, help pay for the miners, who use more health care than their premiums could buy.

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