Risk Pooling in Health Care

There is a connection between socio-economics and health.79 Therefore, it’s expected when a states decided to expand Medicaid for more low-income residents, and then that population of people tend to be sicker than the rest of the population (Gershon & Sullivan, 2014). These reasons for expanding Medicaid will transfer those individual’s off the exchange policy into Medicaid, especially those within 100%-133% FPL range. Medicaid expansion could cause the exchange risk pools to become healthier, which means a healthier-risk pool that may be a financial boom for insurance companies that have participated in the exchange. Insurers that participate in the exchange are subject under law, to loss of medical ratio’s; which prevents them from retaining more than a certain level of profit (Gershon & Sullivan, 2014). In cost savings, with a healthier- risk pool possibly can be passed down for other consumer’s to use.

Financial burdens greatly limit the system’s accessibility; however, many in the U.S. are unable to fully utilize either option. Census estimates from 1999 indicate that 43 million Americans live without health insurance even though 75 percent of them have a full-time job or live in a household with at least one member working full-time (Mueller, , 5) In addition to the totally uninsured, census estimates also reveal that approximately 42 million other people in the U.S. are underinsured. This means that they have some insurance, but are still unable to afford all of their needed prescriptions, tests, visits to physicians, or hospital

In addition to those who are unemployed, you also have the Americans that are employed and still uninsured. These Americans either choose not to have health insurance or they are still unable to afford it. I have been there, I had to choose more money on my paycheck over having health insurance. For most, being uninsured is not a choice, insurance is simply unaffordable. In an article on The Economic Impact Of The Uninsured it states that “eighty percent of uninsured people are employed, or live in a home where a family member is employed. Their plight has nothing to do with a slow economy” (Knowledge@Emory). More young Americans look at insurance as a luxury not a necessity. However, when the unknown happens then these young people are faced with an enormous

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.

The Affordable Care Act has made many positive changes for uninsured and underinsured citizens. With the addition of a program called Health Insurance Marketplace, it is now possible for uninsured people in every state to purchase private insurance plans, those making under 400% or less of the Federal Poverty Level will be able to have tax credits making insurance more affordable (Lathrop & Hodnicki, 2014). Insurance companies are no longer allowed to cancel a policy or raise rates when a client gets sick. Insurance companies cannot refuse coverage to individuals with preexisting conditions such as cancer (“Quality Improvement,” 2015). Insurance companies now must cover preventive care and screenings allowing diseases like cancer to be caught early (“Quality Improvement,” 2015). Research has shown that through health screenings

A. To start off, currently, in the U.S., about 16 percent of our current population, which is about 44 million people, do not have any health insurance. To insurance companies, healthcare is not a right, like it is in countries like France, it is something that they just currently use as a profit. For them, customers are an asset, because unlike paying for a house or car, you never own insurance. Although the U.S. spends the most on insurance and healthcare, it still ranks as only 37th in the world for health care quality according to the World Health Report.

Some of the reasons some of the individuals may not want to buy health insurance the deductibles and premiums are very high and you pay way to much money for it. You also have to qualify for private health insurance.

T.R. Reid uses cost, quality, and choice to fully evaluate healthcare systems all around the world. As an American citizen, I have always thought our system was unfair. The poor suffer more than the rich for going to see a doctor for the same reason. In chapter one of The healing of America, T.R. Reid comments on how many Americans have also started to notice that the American healthcare system is not as great as we once thought. Not only is it unfair, but it is also expensive and unsuccessful (9). By looking at all the other countries’ healthcare systems, Reid would then be able to better pinpoint how America can better its health care system by taking portions of those health systems.

     Most of the people who are uninsured are the working poor, which the overall costs of medical care can hurt them. By the means of doing their best, these people just can’t afford the insurance. Health care has become increasingly unaffordable for businesses and individuals. (Reese) Premiums grow several

Someone without health coverage are less likely to receive preventative care and therefore more likely to become ill which increases medical costs, [1].

This worldwide phenomenon has been brought into focus by various health care reforms and other system-level developments (Farrar, Ryan, Ross, and Ludbrook, 2000). Meaning there are more claims on resources than there are resources available, some form of priority setting must occur. This making resources are scarce and there is a need, regardless of how many resources are available in total, to make choices about what to fund and what not to fund.

I. More than 43 million Americans reported being uninsured throughout 2002 and millions more lack coverage for shorter periods. The lack of insurance negatively affects not only the uninsured, but their families, the communities in which they live, and the country as a whole (The Institute of Medicine).

Current health plans are discriminatory in nature, premiums are based on age, sex, medical history, unhealthy habits, current health status, and what diagnoses, treatments, and prescriptions are covered expenses, limiting coverage to services that are medically necessary (Weber, 2013; Smaldone, & Cullen-Drill, 2010). Insurers base coverage decisions of like pools, thus “healthier” people are not required to subsidize the cost of care for those with riskier characteristics (Weber, 2013). Moreover, Judicial interpretations of the American Disabilities Act has permitted insurance plans to deny and place caps on care for certain health conditions if all policyholders

The healthcare system says that if one pays their insurance then they should get coverage. What the healthcare system forgets to tell people is that there are premiums to pay, even when one does not need healthcare at that moment. A premium is how much someone pays a month for their healthcare coverage. Since 2005 premiums has risen to the point that it takes almost takes all of an employer’s check (Clemmitt, Universal Coverage 2). If someone is unemployed or in school they just drop healthcare all together, because it’s

HR-101 proposes a cap on “Out of pocket” expenses. The cost of medical treatment can skyrocket quickly. Currently, even those with adequate insurance coverage can be left financially devastated if faced with a long-term critical illness. Private insurance companies often have a lifetime maximum payout amount. The consumer may then be left with a catastrophic amount of debt related to the treatment received and the unforeseen notion of the concept of a maximum lifetime payout figure.