Pros And Cons Of Healthcare Caps

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

The National Federation of Independent Business (NFIB) agrees that the cost of health insurance is a high ranking concern for business owners. Every year, they conduct a study to see what the top general concerns facing small business owners. From the beginning of the fiscal year of 1986 to the present, every year has concluded that the cost of health insurance is the top burden facing small business owners in America. (Wade, Holly Pg 24, table 5). Another important factor to consider are lost capacity due to employee illnesses or unemployment. Brad Plumer of the Washington post recently did an interesting study to determine the amount of money lost due to inactivity at the workplace. Including businesses in both the public and private sectors, Plumer estimates that over $1.8 trillion dollars per year in lost productivity at the workplace. While the Post acknowledged the idea of lost productivity is not a clear science and can be overvalued this is nonetheless a huge amount of money wasted each year.

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

As the new healthcare law takes effect insurance premiums are expected to rise. On average for the last six years insurances premiums have gone up six percent per year. The average annual cost that employers pay to cover their employees is around $10,000 for each employee. Usually employees are responsible for 20 percent that total or $2000. At this time the new law has done

Employers are continuing to face rising health benefit costs and are constantly looking for alternatives to control these escalating costs. Health benefit premiums continue to increase at a double digit pace for employers and employees (Poor, Ross & Tollen, 2004). This escalation is putting environmental pressures on all impacted stakeholders. Companies and insurance providers are squeezing this industry to get a handle on cost while still providing an appropriate level of care. This cycle puts the patient front and center as the ultimate stakeholder who incurs changes in health benefits. This mandate of cost control, efficient operations and market share has facilitated a constant analysis of the dynamic health

Finally, in a February 2012 proposed regulation, CMS proposed that state Medicaid agencies reimburse pharmacies for retail drugs based on actual acquisition cost. CMS recognized, however, that states may not be able to determine the actual price paid by a pharmacy for a drug billed to Medicaid, so it suggested that states survey pharmacies or rely on other data to calculate an average acquisition cost for drugs purchased and billed by retail community pharmacies. The article reviewed the association between benefit caps, prescription drug use, and the costs associated. It also detailed drug cost sharing, additional medical costs, and specific health outcomes. Using observational data, the studies analyzed the changes and did a cost comparison of outcomes at two points of time, before and after the pharmaceutical benefits changed. The article detailed the impact of pharmaceutical drugs was often difficult to analyze because some data analyzed utilization while others analyzed actual pharmaceutical spending. The data surrounding utilization compared as many as five factors such proportion

were already providing health insurance because we’re in a competitive market and that helps us to retain and recruit good employees,” the Sacramento-based small business owner said, . One benefit for small businesses are tax credits“For us it was just good business. But pretty quickly we saw that our firm could benefit from the law. What appealed to us about the ACA were the tax credits and other financial incentives” (Taylor, 3), “A tax credit is an amount of money a taxpayer is able to subtract from taxes owed to the government” (investopedia.com , 1). this is good because businesses that barely make any money don't have to pay much taxes and they can maybe get more popularity due to the money they are saving. This is one example of how the ACA helps Small Businesses since …“ObamaCare creates the Small Business Health Options Program or SHOP, a part of each State’s Health Insurance Marketplace, where small businesses with 50 full-time equivalent employees or fewer can shop for group health plans. Starting on November 15th, 2015 those with 100 full-timers or less can use the SHOP” (www.obamacarefacts.com ,2 ). Small businesses are not required to provide health insurance to their employees if they wish because “... the answer is no. Under the Affordable Care Act, businesses with fewer than 50 full-time equivalent employees are not required to provide health insurance to their employees, and those employers will not face tax penalties if they decide not to offer their employees health insurance” (resources.ehealthinsurance.com, 1).This is good that very small businesses have the freedom not to get insurance because some businesses need to save money because of the expensive previous health care. Despite it being affordable, ObamaCare has given the freedom for small businesses to not give healthcare to employees. “Since health insurance for small business isn’t mandatory under the ACA, small

In a world of budget cut and layoffs, medical corporations face new and different challenges in addition to helping and healing patients. I used to work as a medical biller in a physician’s office for five years and I experienced how difficult for the health care providers to get reimbursed. The government and the insurance companies have been limiting the budget towards the health care services. This action also affects the hospitals greatly because Centers for Medicare & Medicaid Services (CMS) and some policymakers have requested the hospitals to reduce the

Third, the ACA regulates health care coverage in the United States. According to Lussier et al. (2016), the act mandates that all employers with more than 50 employees provide their full-time employees with health care coverage or face penalties for failing to do so” (p. 494). This act specifies that if organizations choose not to provide employees with benefits, they will be forced to pay a penalty for each eligible employee. However, organizations that do offer employee health and retirement plans must meet minimum requirements and comply with ERISA (Lussier et al, 2016). Employers and employees

The Affordable Care Act requires that health insurance does not put a lifetime limit on a persons’ coverage. This requirement is for all health insurers even those that offer school- sponsored plans for college students. Before the Affordable Care Act, these school- sponsored plans “commonly limit[ed] benefits on a per condition per lifetime basis." (Burnsed, 2010) This change is important to many people because no one can plan when or if a costly illness falls on them and by getting rid of lifetime caps, the people who do fall victim to server medical conditions will not have worry about coming up with the money to pay for their

The penalties companies will face are intended to motivate them to offer suitable health insurance to their employees, Bob Mcdevitt, union President of Local 54 of UNITE-HERE said, “The average cost of health insurance for my members is $6,000 per year. If the company pulled out that cost would be reduced to $2,000 and that’s supposed to be a penalty? A basic economic principle is if you can walk away from those kinds of legacy costs, it’s very enticing for any employer” (Miller, “Businesses Fearful”). I asked a

While part of this supposition is incorrect, there is some truth behind the notion. Larger companies can negotiate better rates for their employees because of the volume of coverage, compared to small or medium businesses (Urbel, 2013). Insurance companies are more apt to give a large company lower premiums because of the volume that is needed to cover their employees, as well as the lower actuarial risk of containing costs for serious illnesses (Ubel, 2013). A University of Michigan study found that between 2000-2011, small and medium businesses have been decreasing employer-based health insurance coverage, while larger companies (over one hundred employees) have consistently provided coverage (Ubel, 2013). This trend started before the passage of the ACA and supports that small and medium businesses were having difficulty in providing this benefit to their employees consistently.

Another 129 million with known pre-existing medical conditions will no longer have to worry about being denied health insurance or higher premiums due to their health. In addition, health insurance companies have to spend at a minimum of 80% of your premium on actual health care. If an insurance company cannot accommodate the 80%, then they have to issue rebates to their consumers. The ACA has aided millions with financial assistance to lower their monthly insurance premiums. Since the enactment of the ACA, this is the slowest health care rates have risen in over five

Most health care analyst believes that health benefits provided by employers are provided as part of the overall compensation paid to workers. Because of the rising cost of the health care benefits, employers’ shares of

There is a spacious room for lemon in insurance field. The price for health insurance is not fixed, it varies based on the level of the need an applicant may require for the insurance. As in the case of elderly people over the age 65, it is well known that it is very difficult for them to get health insurance because of its high price as they certainly will need it more than other applicants. On the other hand, employees working in companies are offered health insurance as a part of the companies’ policies and regulations. This actually create more room for lemon in the insurance field and less chance for old people who need it more. This ended up with adverse selection by the insurance companies. (A.Akerlof, Aug