Commercial Health Insurance Industry Analysis Paper

In 2010, the United States created The Affordable Care Act (ACA). The objective was to share the responsibility of costs between the government, individuals, and employers to provide affordable access to quality health insurance. “However, health coverage remains fragmented, with numerous private and public sources, as well as wide gaps in insured rates across the U.S. population.” (“United States: International Health Care System Profiles,” n.d.). Each individual state within the US, generally has control over private insurance.

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

Rising health insurance premiums have made healthcare unaffordable in the United States. Health insurance premiums in this country have undergone a steady rise over the past few years while incomes have remained the same. More than 50% of individuals with low incomes holding private insurance in the United States are unable to afford their healthcare costs (Collins, Gunja, Doty & Buetel, 2015). In addition, costs related to healthcare are equally unaffordable to 25% of working-age individuals who hold private health insurance policies (Collins et al., 2015). According to the Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) survey on employer health benefits, employer-sponsored health insurance plans have also had moderate rises in premiums in 2013 for both individuals and family coverage (Claxton et al., 2013). While

It has been six years since the Affordable Care Act has been implemented into the United States healthcare system. As the pieces and provisions of this monumental federal statute become understood and executed, it is transforming the demand for care. Prior to the ACA, a significant number of Americans were marginalized and unable to obtain coverage. This system was faced increasing healthcare costs, placing greater financial strain to everyday Americans, businesses, and public health insurance systems. The ACA did not only help ensure health coverage for all (almost

The complexity of health care could take the rates on a massive trajectory that does not favor the people covered. Therefore, the financial protection that the levels of health insurance covers, help to guard against the risks related to the unexpected costs of health care. The source of coverage could still have an impact by the insurance coverage and financing alternatives that one has access to; Conversely, private insurance, social insurance, and the national health services are the types of healthcare systems by funding and provision. As we look to health care coverage and the reform of Obamacare, I’ll analyze the impact of the uninsured in the industry and look for a resolution to improve the

The short term decision to start in a limited area and then only grow by one state in 2015 may have served the purpose of limiting risk during a time of uncertainty, however, in the long term, penetrating into new markets may be difficult because individuals currently enrolled are automatically re-enrolled at the end of the period. For Aetna, it may be harder to pull a member from a plan that they currently have. The largest healthcare insurance company UnitedHealth was more conservative than Aetna in the first two years, with participating starting in five states in year one then increasing to 24 in year two. With the addition of UnitedHealth in the same markets as Aetna and the unknown risks associated with new enrollees for the 2015 plan year, the short term could be crucial for Aetna. If Aetna is able to add to 2014’s positive results, and increase membership in markets that UnitedHealth entered, it will go a long way toward their long term goals of increasing membership in the individual and small group sector (Demko, 2014).

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

For those Americans not covered or find their work coverage too expensive, there is a new way for them to buy insurance on their own called Health Insurance Marketplaces. Some states have named these marketplaces something else. The Health Insurance Marketplace is like a virtual insurance megamall where private insurers compete for American’s business. Americans can pick out how much coverage they want, how much they want to pay for it, from cheaper high deductible plans to more expensive plans. Regardless what plan is chosen, all plans will cover a complete set of services like hospital visits, doctor visits,

As the implementation of The Affordable Care Act (ACA) nears, news media is featuring a large number of individuals whose health insurance coverage is being cancelled. The current administration claims that their objective is for everyone to have health insurance, but there is a gap between their new legislation and the results. American consumers are falling in the gap between private insurance plans that are too expensive, and the poorly developed government system. Despite claims from the Obama administration, the Affordable Care Act limits the American public’s choice of private health insurance plans.

Another issue for fee-for-service system is that the providers set the prices for services. Patients were free to seek any type of healthcare services that they thought they required, while providers set the costs for each service that was billed to indemnity insurance companies (Shi & Singh, 2015). Insurance companies had little control on the types of services that the patient received and prices billed for each service. The fee-for-service model encourages excessive and unwarranted procedures and offers no incentives to utilize economical services (Smith, 2010). While the patients enjoy the freedom of being able to seek out their own services, over-utilization of expensive services on unnecessary and highly technical services increased healthcare costs.

In 2010, the United States took the first tangible step toward universal health care coverage, with the legalization of the Patient Protection and Affordable Care Act of 2010. According to the U.S. Census Bureau’s most recent report the total population of the United States is nearly 309 million people (U.S. Census Bureau, 2010). In 2009, it was estimated 49 % of the population was covered under an employer sponsored insurance plan (Kaiser Family Foundation, 2009). The same 2009 data reported an additional 29 % of the population was covered under some form of government or public program (Kaiser Family Foundation, 2009). Leaving 17 % of the U.S. population vulnerable without any form of health insurance coverage (Kaiser

In the United States, there are many health insurance offered in the market for its citizens. Either through their employer or in the private market where coverage in not guaranteed and if you have a pre-existing condition, you will likely be denied. As private insurances soars, high premiums becoming unaffordable in the US, having the healthcare system failing to cover over 46 million Americans and leaving millions uninsured leading to bankruptcy (Palfreman, 2009). As most of the developed countries have removed the dependence of the health insurance

Health Choice Insurance Co. is a managed care organization which provides health plans beneficial for you, your family or your company. Although the company is based out of Arizona, it is affiliated to IASIS which has its presence in Utah, Texas, Nevada, Louisiana, Colorado, Florida, Arkansas and Arizona. Being a subsidiary of IASIS, Health Choice Insurance Co. provides Medicare as well as Medicaid services in Utah and Arizona area. Being relatively new in this industry, from 1998 Health Choice Insurance Co. have been successful in expanding their network to 19 acute care units and one behavioral hospital in 8 different states such as

As a leading insurance company, Aetna’s primary market broadens to reach those who work full time or part time based on hourly wages through its subsidiary company, Strategic Resource Company (SRC) which was bought by Aetna, Inc in 2005 (SRC: Our Mission, 2012). Aetna’s fourth subdivision target market, which is considered the biggest subdivision, is providing insurance to “employers, third-party administrators, commercial insurance companies and other health plans (Aetna Subsidiaries, 2012)”. These latter targets are aimed at through Aetna’s fourth subsidiary Cofinity which includes over 2.5 million members as of 2009 (About Cofinity, 2009). Besides targeting health insurance consumers, Aetna aimed at a target market that excludes health insurance seekers yet includes health care providers. Through a fifth subsidiary, Medicity, Aetna created another target market subdivision where it can provide health information technology in health care facilities such as hospitals and practices (About Medicity, 2012). Finally, Aetna aims at acquiring shareholders and therefore targeted a market of

The health sector is among the most important sectors in the United States economy. The government has enacted certain laws that affect the corporation’s activities and the insurance industry in general. The regulation affects competition among the health insurance companies, and the insurance industry in general.