Health Insurance and the Need for Reform Essay

I would also suggest to include vision screening, hearing screening, and the male/female sterilization services. The cost for these services is relatively low and they are standard services which should be include in any insurance plan. Eliminating these standard services would deter employees from getting involved with the insurance plan as a whole so the company would suffer. Custodial coverage should be another service included with the plan. This additional service is not high cost and the amount of utilization is relatively low. Deciding on this plan while including vision and hearing screenings, male/female sterilization, and custodial care; and removing obesity treatment services, would result in the premium costing approximately $3,943. The total number is just slightly under the budget of $4,000. The use of this plan will make Castor Hall up to $3.94 million from Constructit. This would be a very profitable choice for Castor Hall.

Health insurance comes as second nature to many of us. We grab that blue and white card and put it in our wallet and forget about it until we are sick or injured. When this happens, there it is, cushioning our fall like the extra padding it provided to cushion our wallets. This is not the case with everyone, however. Many Americans have no cushion to fall back on, no blue and white card to show the emergency room when they have an unexpected health concern. No HMO with a convenient co-pay amount when their son or daughter develops an ear infection.

A powerful force for change can be created by embracing transparency. According to the Department of Health and Human Services, “transparency is a broad-scale initiative enabling consumers to compare quality and the price of health care services so they can make their own informative choices among doctors and hospitals. This initiative is laying the foundation for pooling and analyzing information about procedures, hospitals and physicians services. In order to create value driven health care, there are four steps to turn raw data into

The Affordable Care Act was into law March 2010. The law has planned to make wide-range of changes to healthcare in the United States. The Affordable Care Act efforts to offer universal right to use to healthcare for Americans, control the rising costs of healthcare, adjust the private insurance industry complete things like state-based private exchanges and online marketplace that brings together state-approved insurance plans from multiple companies so consumers can shop for individual insurance plans, improve the quality of healthcare and make healthcare choices more consumer friendly and easier to understand (Medical Mutual,2017). Healthcare reform involves nearly all Americans from old or young,

This exercise point out some very important factors with regard to health care cost.  nursing homes and other health care delivery systems are faced with significant shortfalls in reimbursement for various reasons.  Medicare reimbursement often does not cover the full extent of treatment of individuals.  McPike (2008) notes that, “The insurance and hospital industries released a study today showing that underpayment by Medicare and Medicaid costs consumers and employers $88 billion more a year for health care as providers attempt to make up the difference.” Today with continue cutbacks in medicare reimbursement this number is significantly higher.  In an attempt to reclaim these losses, both self pay and privately insured patients are charge

“We will pass reform that lowers cost, promotes choice, and provides coverage that every American can count on. And we will do it this year.” The preceding is a powerful statement from the newly elected President Barak Obama. One of the main aspects of both political campaigns was health care reform. The above quote shows passion and encouragement, but the quotes about health care do not end there. Georgian republican gubernatorial candidate and health care policy maker John Oxendine expressed: “Their proposal would virtually devastate the private healthcare sector in this country along with competition and patient choice, by replacing it with bureaucratic planning and government control. The result of this plan and its one trillion

Health care reform is not a new concept in fact it has a long history in this country and has been on many political platforms. In 1948 Harry Truman had national health insurance on his campaign platform as part of the new deal but it never came to fruition due to democratic opposition and socialist fears (Christiansen, 2012). In 1965 president Johnson did have some success with signing Medicare and Medicaid into the social security act as well as President Nixon with the Health Maintenance Organization Act (Christiansen, 2012). In the years following many other presidents have tried with little success to fill the gaps in health care coverage. Under President Reagan’s administration the Medicare Catastrophic Coverage Act attempted to help with prescription drug coverage only to be repealed in 1989. President Clinton also tried for insurance reforms but he could not gain enough support for his plans. In 2003 President Bush was finally able to sign in the Medicare Prescription Drug, Improvement, and Modernization Act so that after 38 years seniors on the Medicare program would finally have prescription benefits (Thomas, Lee, & Lipton, 2004). Moving forward again to 2009 a bill was introduced and then signed by President Obama in 2010 is what is now known as the Affordable Health Care Act. It has been met with both praise and criticism.

During the 2013/2014 plan year, the health plan total cost ended almost 25% below the expected budget. Net paid claims were down -7.4% or $447,827 over the budget. On a PEPY basis, Lakeside had budgeted a $14,995 net cost per employee. The plan year ended at an $11,301 PEPY cost or $676,350 below the expected total cost. This was largely due to a large claimant with $250,000 exposure in the form of a laser coming off the plan with only $46k in claims. Stop loss reimbursements dropped 35%, which helped to secure a 3% total renewal. Lakeside also heavily invested in the plan, implementing both Healics’ coaching, increased

In the United States, there are three basic systems in which healthcare are financed: private insurance, public insurance, and uninsured. Within private and public insurance, there are several different types of plans that assist in financing health care. Private health insurance utilizes various healthcare providers to provide cost-sharing in receiving healthcare services through benefits provided by employers or for premiums (Shi & Singh, 2015). Some examples of healthcare providers are commercial insurance companies, self-insured businesses, and managed care organizations (Shi & Singh, 2015). Each healthcare provider outlines the coverage benefits, individual out-of-pocket requirements, and limitations through an insurance contract or plan

Cost sharing can be defined as shares of costs that are covered by insurance companies that the patient has to pay out of their own pocket. These can include deductibles, copayments, and coinsurance (Cost Sharing, n.d.). Within the past ten years, health insurance cost sharing has increased due to the changes in health care which has led to the need for increased deductibles, copayments, and insurance prices in general. The actuarial value is the expected percentage of health care costs that will be enough to cover the average population. The actuarial number for an employer-based plan is 83%, and 59% for an individual plan (Gable et al., 2016). According to the Kaiser Family Foundation (2016), employees are covered by their employer’s

The imminent advantages of the system have seen an increase in the number of patients covered under the socialized medicine system. The resultant increase in number of patients under the scheme is advantageous in that it provides options in terms of bulk buying of medication and medical equipment. The United States is the highest spender on health annually among developed nations worldwide. Therefore, the purchase of medical supplies in bulk for as many groups of items as possible lowers the cost considerably, as compared to repeated singular purchases. Socialized medicine provides the right to basic emergency care to individuals from all spaces and places regardless of their ability to pay for services rendered. Basic life-saving procedures and obstetric emergency care are examples of such services. Such laws do not bind single payer patient schemes in the private sector. Therefore, patients benefit from this provision greatly, especially if this is the last resort due to financial limitations. Another advantage of the provisions of socialized medicine is that it safeguards medical insurance in the event of termination of employment. A significant proportion of American citizenry are under medical insurance provided by their employers, as mandated by law for large organizations. This means that when their contract expires or they achieve retirement age, their medical insurance cover also ends. The elderly and retrenched are also in need of medical care and in certain cases, they need healthcare even more than the working class. Socialized medicine rights, under schemes like Medicare, ensure that the aged and disabled are eligible to receive medical care as needed. Insurance in socialized medicine is structured individually to allow policyholders to maintain their allotted insurance cover despite moving from one

This sort of protection pays for immoderate senior watch over individuals with interminable sicknesses, inabilities, or different conditions that need day by day consideration over quite a while outline. While medical coverage covers doctor's facility and specialist bills, it doesn't spread things, for example, nursing homes, helped living, grown-up day care administrations, and home consideration, which are all exceptionally expensive and might be required.

Social insurance is a form of compensation under government control for elderly, disable, or unemployed people. The program is only for people who meet certain requirement, they typically include a chain of work from doctors and hospitals that is under the service of health care. (see Business dictionary.) These providers are selected by the government to work with and do the service. Medicaid, Medicare, and unemployment compensation are all includes in the social insurance programs. The development of insurance companies operating a voluntary insurance pension insurance, absorb idle funds to enhance economic strength, to prepare for the aging population. (see Williamson. Pg. 101.) Some life insurance companies in the United States, in addition to operating life insurance, property insurance, death insurance, but also

Health insurance is a fundamental aspect of the United States’ society and the economy at large. The country 's economy relies on the health of its workforce as well as the wellbeing of the elderly members of the society. Medicare is one such program that provides health insurance to elderly Americans aged 65 years and above. The Medicare program is administered by the American federal government through private organizations. The program is thus funded through Payroll Tax as well as premiums from the revenues of the beneficiaries of the program. Younger Americans below the age of 65 years can also benefit from the program if they are disabled. The total beneficiaries of the program are estimated at around 55 million people, with a huge proportion being elderly beneficiaries. It is worth noting that the program does not cover all medical charges but rather about half of the total charges. The rest is covered by the beneficiaries themselves.

Insurance firms provide network services that incur far less expenses compared to out-of-network hospitals and physicians promoting more affordable healthcare for policyholders (Sommers et al., 2015). Preventive services are also offered which beneficial particularly for vaccines, screenings, and checkups, and the deductibles do not have to be met to receive the services at no cost. Cost support is accessible to assist in reducing the monthly costs of health insurance. It could be referred as a tax subsidy or tax credit whereby federal money assists individuals that incur accrue between 100 percent and 400 percent of the Federal Poverty Level (Nikpay et al., 2016). Hence, it helps the vulnerable populations which include lower income earners and people who are at risk of suffering from diseases that require long-term care such as chronic conditions.