Health Insurance Coverage

Medicaid is a social health care program that covers nearly 60 million Americans, including children, pregnant women, seniors, parents and individuals suffering with disabilities. Medicaid is the biggest source of funding for health related services and medical needs for the people with low income in the United States. This program is funded jointly by the state and federal level governments, but it is the state’s responsibility to manage this program. The Medicaid program is not a required program that states have to use, but all 50 states have implemented this program. With the introduction of the Affordable Care Act (ACA), and its passing in 2010, the ACA unveiled its plans to expand Medicaid eligibility to nearly all low-income adults as an addition to the other groups that fall into the Medicaid eligibility. The Medicaid program had “many gaps in coverage for adults” because it was only restricted to the low income individuals and other people with needs in their own specific category. In the past, the majority of the states who had adults that did not have children dependent on those parents were not eligible for Medicaid. These low income adults without dependent children would be without medical insurance assistance before the ACA was introduced. Medicaid is now available to all Americans under the age of 65 whose family income is at or below the federal poverty guideline of “133 percent or $14,484 for an individual and $29,726 for a family of four in 2011” (NSCL).

H. (04/2015). Comprehensive Health Insurance: Billing, Coding & Reimbursement, VitalSource for Allen School of Health Sciences, 1st Edition. [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781323131503/

Long time ago, there was no need for health insurance in America, as doctors had many clients because their services were not so expensive and in some cases in rural areas, people could pay by giving other items. Doctors were not as knowledgeable as they are nowadays to care for the sick, therefore this didn't have much effect then on the patients, as they were treated for the basic illnesses.

The judiciary, executive, legislature, at both state and federal levels, are the three branches of government primarily responsible for the formulation of healthcare policies in the United States. There are other non-governmental organizations such as professional and ethics bodies that provide rules and guidelines in some health care policies.

Unaffordable health insurance/coverage is a major issue in the United States (US). There is a lot of coverage in the news media about The Affordable Care Act (ACA) that was signed into law in 2010 by President Obama to aid in assist in health insurance for all residents of United States.the US. The purpose of this paper is to address some of the questions most frequently asked; 1. What is health care reform and specifically what is the ACA? 2. What benefits does one see for nursing? 3. What are Accountable Care Organizations and can this improve access to patient care?

Why do people remain uninsured? According to the Kaiser Family Foundation (KFF), “Even under the Affordable Care Act (ACA), many uninsured people cite the high cost of insurance as the main reason they lack coverage”(Key Facts) “In 2015, 46% of uninsured adults said that they tried to get coverage but did not because it was too expensive”(Key Facts). Many people do not have access to coverage through a job, and some people, particularly poor adults in states that did not expand Medicaid, remain ineligible for financial assistance for coverage. Some people who are eligible for financial assistance under the ACA may not know they can get help, and others may still find the cost of coverage too expensive.

Usually Medicaid beneficiaries have one or more additional sources of coverage. Medicaid is a federal and state medical assistance program; and coverage will vary from state to state. The program provides medical care for low-income families; with emphasis on children, pregnant women, elderly, disabled, and parents with dependent children who do not have any other way to pay for healthcare. Third Party Liability (TPL) is the legal obligation of certain individuals, entities, insurers, or programs to pay part or all of expenditures for medical assistance furnished under a Medicaid state plan. Therefore, by law, any and all other available third-party resources must meet their legal obligation to pay claims before Medicaid pays for the care

Through the years people in the Unites States have struggle with issues dealing with having health coverage. In March 2014 Obama care also known as Affordable Care Act was sign into law making it possible for the lower and middle class to be able to afford health insurance. The affordable care act was in congress from 2009 to 2010.With the act been pass it made it easier for the people to qualify and get help and pay so little with no extra cost. Even thought the insurance is not free it is now affordable for people so now people have a wider range of coverage options. With the affordable care act been pass they are hoping with the affordable screening and preventive services they can be more proactive with people’s healthcare and delay

With the development of public health in U.S., the health insurance coverage has benefited most American citizens. But there is a large ethnic minority group in the U.S. which is most likely to lack coverage, Hispanics. Concerning Latinos with health, there is a barrier for Latinos to get health care. Latinos who are not citizens or permanent residents do not have health insurance, even though PPACA legal non-citizen residents will be able to buy insurance. Without health insurance, Hispanics face health disparities that make them suffer with bad health outcomes and having a higher illness rates.

The issue of healthcare coverage under the federal health reform has been politically debated by many Americans, including the current Democratic presidential candidates Hillary Clinton and Bernie Sanders. The healthcare reform enacted in 2010 under President Obama’s regime intended to support the ongoing healthcare system as a building block to enhance more access to health insurance coverage for millions of uninsured Americans; yet the government’s tireless effort to ensure all individuals are covered remains a major issue across the country.

Michael Fraser is the executive vice president of the Pennsylvania Medical Society. Fraser states that some of the plans offered through the Affordable Care Act have an annual deductible of $6,350. Patients must pay this deductible before insurance covers any portion of their medical fees. Once met, these plans only cover 60 percent of the medical costs, leaving the patient responsible for the remaining 40 percent.

I too believe that healthcare should be a right for all citizens. Health is defined by the World Health Organization (WHO) as a state of complete physical, mental, and social well-being (Macionis, 2015, p. 267). Preventative and acute care is important to maintain health and is needed by everyone in the world. Since the creation of the Affordable Care Act many have argued the negative repercussions of the program often neglecting the positives. The fact is, most working adults (59.5%) are offered insurance for themselves and their families at a discounted rate through their employers (Robert Wood Johnson Foundation, 2013). Despite a 10% decline in employers that offer insurance compared to 2011, the option is still available for half of the working population (Robert Wood Johnson Foundation, 2013). Small business owners that employ fifty or more employees are eligible to provide subsidized health insurance for their employees (HealthCare.gov, 2016). In addition, 30.1% of American's utilize either Medicaid or Medicare, a government program that aids or supplements insurance cost ("Medicare and Medicaid, Age and Income - Random Samplings," 2013) . The Affordable Care Act asks that the other 8.4% of the population purchase health care through the "marketplace" where they are able to select and tailor their health care

One financial problem the healthcare industry is facing right now is healthcare collections. Healthcare collections have always been a financial problem to healthcare industries because of nonpayment from the uninsured and individuals who are uneducated about their health plans. Nonpayment to healthcare industries means a loss of revenue. A loss of revenue means that health care industries may run the risk of exhausting their financial resources and become unstable. This financial problem is very typical in the healthcare industry.

Currently, the issue of health insurance has been a bone of contention for the public regarding whether the United States government should provide this health plan or not. People often possess different perspectives and refer to pros and cons on both sides of the spectrum. While some believes a universal healthcare system will set a foundation for a lower quality of service, increasing governmental finance deficit, and higher taxes, others do not hold the same thought. A universal healthcare system brings enormous advantages rather than disadvantages, such as all-inclusive population coverage, convenient accessibility, low time cost, and affordable medical cost, all of which not only provide minimum insurance to the disadvantaged but also improve the efficiency of medical resources distribution.

It is a patchwork of loosely connected financing mechanisms varying in terms of sponsorship and provider type. It also reflects the age, health and economic status of the specific patient groups that are being served. Considering the growing number of Americans who are uninsured for health care and the low ranking of the United States among a variety of health indicators, one may say that it is a disappointing financing system. These observations provide a basis for supporting our position for a national health care system. Where possible, comparisons will be drawn between the United States and other countries. Special focus will be paid to similarities in the public and private financing components of the system, reimbursement of various provider categories and trends that we may expect to see in the future.