Applied Strategy
– Current Event – Health Affairs
Health
Insurance is a topic that has been the conversation of many individuals like me
for many years. Most of these
individuals are self-employed like realtors, loan officers, or simply small
business companies. All of these
individuals are affected by one thing: health insurance. It is obvious that no one can really have a tranquil
day knowing that he/she is not covered. What will happen if he/she gets sick
all of a sudden? Who is to cover the medical costs associated with such a sickness?
Some medical costs might be low while others might be high. No one really knows the true situation until
it happens to one of us.
I,
for one, do not have health insurance because I do not work for a company that
can provide it to me or my family. I have to purchase it from independent
distributors off the internet and it is not very cheap. I know many other
people in the same situation as myself. The one difference between them and me
is that I did purchase a health insurance policy five years ago and am still
paying for it. It is said that I am grandfathered into the policy. It is a very
expensive policy for my husband and I. I have no choice but to pay it. The sad
part is that I rarely use it. The difficult part is that I have thought to
cancel on many occasions to save the money but then I think that is wrong. What
will I do if I or my husband truly gets sick?
The bottom line is that I have no solution and I simply have to tough it
out.
Then,
President Obama gets elected. He talks about Health Reform Act, The Affordable
Care Act, and other account based plans. I get really excited because I think
the time is coming where I might be able to reduce my monthly payment. I called
my carrier which is Blue Cross Blue Shield and I was told that the Health
Reform Act would cost me more money because it covered more items than my
current plan. That was a big disappointment. So now what? Then the Affordable
Care Act of 2010 comes along. According to the article by Jon R Gabel “More
Than Half of Individual Health Plans Offer Coverage That Falls Short of What
Can Be Sold Through Exchanges As Of 2014”, it states that:
“Starting in 2014 exchanges will allow individuals
and employers of fewer than a hundred employees (or fewer than fifty employees
if states choose a lower limit) to purchase coverage in Internet-based
marketplaces. The exchanges will provide a choice of many plans and detailed
information about them. The Affordable Care Act prohibits the use of
Preexisting conditions to deny health insurance to people and forbid insurers
to set premiums based on a person’s health status and medical history. People
who buy coverage through exchanges and have household incomes of 133-400
percent of the federal poverty level will receive subsidies from the federal
government.”
From
the article, it can be seen that people like myself will still have to pay for
insurance coverage. Other individuals who cannot afford will receive benefits
from the government to cover their costs and get the same benefits as myself. Another
article by Karen R McLeese states “it is probably safe that at least certain
account-based plans will have a role in the health care’s new world order.
While the viability of certain plans such as stand-alone HRA’s may be in
jeopardy, plans that encourage consumer
responsibility and that can be coordinated with plans providing the benefits
contemplated by health care reform will continue to have a seat at the table.”
Said in different words, this means that not all HAS and other account plans
will survive the new health reform act. There are many strategies that need to
still be analyzed and studied. Health reform has many open issues that have yet
to be decided. Genevieve M Kennely quotes “The pending Supreme Court decision
on the Affordable Care Act and the fall presidential election raise concerns
about what would happen if the insurance expansion promised by the landmark
health reform law were to be curtailed.”
No
one really knows what the outcome of this will really be. We will just have to
wait and see. For practicing managers, this will be a very difficult situation
to prepare for. Everything changes constantly. Managers will have to stay
current with the news and how things are changing constantly. One word could
change a thousand things.
http://
content.healthaffairs.org/content/31/61339.full.html
Genevieve M Kenney and Stacey McMorrow and Stephen
Zuckerman and Dana E Goin, “A Decade of
HealthCare Access Declines For Adults Holds Implications For Changes In The
Affordable Care Act “. Health Affairs; May
2012, Vol. 3 No. 5 899-908
Karen R. McLeese, “Flexible Spending Accounts,
Health Reimbursement Arrangements, and Other Account-Based Plans: What Does
Health Care Reform Mean in 2012 and Beyond?” Benefits Law Journal; Summer 2012,
Vol 25, No. 2
With all the talk about health insurance, I am being cautiously optimistic about the whole change. I currently have employer based health insurance and have had it for quite some time now, but I have been in the position before where I didn't have coverage at all and couldn't afford to pay a premium. Sometimes small easy to cure illnesses can cost several hundred dollars once you pay the doctors fee and then pay for labs. I certainly understand how expensive it is to pay for doctors visits and its worse if you have to follow up with the physician and pay for another visit. I am very hopeful that the new Healthcare Reform will make it easier for people to cover themselves and their families. It is indeed an important matter to be addressed. Sometimes people that are sick can affect other people that arent sick. In that case a person that does have health care coverage still isn't really protected. The only difference is one can go to the doctor and the other can't, but in effect you still have two sick people. I think that there should definately be a way for everyone to be able to seek care when they are sick as well as have access to preventive care. I think that if this had been developed many years ago it would have worked out a lot better before the rising costs of healthcare took effect. Also years ago many people that did have healthcare coverage abused the coverage filing unnecessary claims. Basically running to the doctor for small issues that they could treat at home. This clogged up clinic schedules and helped drive up costs. In effect we are paying the price for all of the misuse and fraud that was out there concerning healthcare.
ReplyDeleteI hope that whatever develops as far as Healthcare Reform that it will help make or keep us all in better health. I hope that it can be made more understandable also because at this point the media has relayed so many conflicting stories for and against the Reform that many people are very confused as for whether or not it will help up or hurt us.
I find this very interesting. I have fortunately been covered under my mother's policy for a long time now. I am very fortunate to have had coverage many times recently. Had I not, I don't know what I would have done. My fiancee has not been as lucky to have ever had any health insurance. He had considered taking out a private policy as well. We did research and with the high premiums, higher deductibles and different exclusions we figured that since he was young and healthy we would be better off not having it and deal with whatever comes when it comes.
ReplyDeleteWell, about 18 months ago after fighting a day worth of stomach pain because he didn't have insurance coverage,he took his first trip to the emergency room and then to a specialist and eventually had to have a minor surgery. The expenses have not been pleasant, but we have recently looked back into the plan we considered about 3 years ago and if we had been enrolled, paying the premiums, paying the deductibles and utilizing the coverage the insurance expenses for the last 3 years would have still exceeded the cost of the entire incident. I am sure that we've just been lucky with this one incident and had it been something more serious the insurance would have been good to have.
I took a healthcare management class this summer and learned that our medical fees are based upon what medicaid/medicare is paying. These are also regulated by the government. If the government would cap what medicaid/medicare is allowed to pay it would lower everyone else's fees as well. This would save everyone, including the government, more money. It would just make doctors and hospitals less profitable. Which is more important?
Rebeca,
ReplyDeleteI can only imagine how much it costs you and your family for health insurance. I am lucky enough to work for a company that provides insurance and to my surprise it is still very expensive for my coworkers who have children. I was told by one of my colleagues that it costs them $300 a pay period to cover a family of 4 with our company covering the rest. With the new reform I can see why many people are getting upset. Those who are already struggling to have independent coverage will now have to expand the coverage and pay more to meet requirements. This is doing the exact opposite of what it is suppose to. Now, people are going to have to decide what is more affordable, paying out of pocket for healthcare insurance that you may or may not use or paying one time fine every year for not being covered.
Kimberly, I think most individuals especially the low income that do take advantage of the government will pay the one time fine. As Michelle states, it is simply cheaper to pay a one time fee than to be paying extremely high fees like myself. I only struggle to pay these fees because i would not want to be the unfortunate one that does need it one day and I wont have the money to pay the hospital or doctors. I have discovered, however that there are many charitable organizations that will cover hospital costs only in emergency situations. But to tell you the truth to both you and Michelle, I dont really know what is best right now. I just am thankful that I graduate in one week and hope to get a job with group benefits for the whole family. $300 for a family of four weekly is too high. Monthly would be ok with me.
ReplyDeleteI was fortunate at one time to be covered under my dad's policy. Now I have a policy that I purchased through BlueCross BlueShield as well. It is very expensive and when I got sick and had to go to the hospital it was still outragious what I had to pay. I hope they can make some changes with health care, but I am very scared to see what is going to happen. I am very excited to graduate this semester and am looking forward to getting a job that has health care benefits for my son and I.
ReplyDelete