Health insurance is not the first thing on the minds of seemingly healthy individuals. Many people, that are nonelderly, generally consider buying health insurance if they have a hazardous job, choose to have children, or have a chronic illness. But, is this section of American life without its drawbacks? With the rise in people being diagnosis with long term or chronic illnesses, the criminal act of defrauding the health insurance industry is becoming more and more commonplace.
This paper will explore some of the history behind health insurance, the difference between public and private health insurance, and what the 2010 Health Care Reform Bill entails. Insurance options in America Changing Healthcare Options What is the definition of health insurance Individuals acquire health insurance for similar reasons they may acquire auto or homeowners insurance. Health insurance is a an agreement for the insurer to provide or reimburse medical care costs provided to the insured individual in the event of an illness or injury.
[ (Obringer, 2006) ] Insurance is provided to individuals on a high risks kind of platform. An insurance company, like BCBS or The Hartford, agrees to pay certain medical costs incurred by the insured during the year of coverage. A health insurance policy tells what the insurance company and the insured will pay for medical expenses. The policy may stipulate that a co-payment be paid by the insured and the remaining bill will be picked up by the insurer. [ (Obringer, 2006) ] Or, the insurer may not cover any expenses until a certain amount that is chosen by the insured individual is met first.
This is known as a deductible. [ (Obringer, 2006) ] Another type of policy coverage is known as coinsurance. Co-insurance is a policy provision under which you and the insurance company share the total cost of covered medical services after the deductible has been met set as fixed percentages. [ (Unknown) ] The United States spends more money per person on healthcare than any other country. [ (Institute, 2005) ] In 2007, the Census Bureau released the number of reported people without insurance or that were underinsured.
[ (Klein, 2009) ] Nearly 46 million Americans, to include nearly 10 million that are not citizens, are uninsured. [ (Klein, 2009) ] What is public health insurance Health insurance has been around since the 17th century in the United States. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] American colonists saw a need to control and prevent the spread of disease among the tightly pack colonies. What may be the very creation of the first public health service in the United States was founded in 1798.
[ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] The Act for the Relief of Sick and Disabled Seaman mandated a $. 20 tax per month on a seaman’s wages to provide for mariners’ health care, which led to the creation of the Marine Hospital Service. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] The time period surrounding the United States Civil War made the treatment and prevention of infectious disease even more apparent. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] By 1869, the creation and management of state boards of health began.
[ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] And, by 1875 six states and the District of Columbia had boards of health put into place. From 1794, with the appointment of a health officer in Baltimore, Maryland, to the establishment of a Children’s Bureau in 1912, to working on lengthening the adult life span after the 1950s, leaps and bounds have been made within the public health system. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] Many factors go into protecting and improving public health in the United States.
These factors include government agencies, volunteer health agencies, schools and religious systems, businesses, and a variety of others. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] But, functions that only the government can perform are assessments, policy development, and assurance as defined by the Institute of Medicine in The Future of Public Health. [ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] In the United States, a large portion of responsibility with public health lies within the U. S. Department of Agriculture (USDA) and the Environmental Protection Agency (EPA).
[ (Public Health from Encyclopedia of Health Care Management, Sage, 2004) ] The most significant player in public health, however, is the Department of Health and Human Services (DHHS). The Department of Health and Human Services (HHS) is the United States government’s principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. [ (HHS. gov) ] Public health insurance programs, like Medicare and Medicaid, are managed under the DHHS. One out of every four Americans has public health under Medicare, Medicaid, or a combination of both.
[ (HHS. gov) ] Medicare makes up the largest national public health insurer, taking in more than one billion claims per year. [ (HHS. gov) ] Public health insurance provides elderly, disabled, low income individuals, nonresident aliens, and children the resources they need to aid in prevention and treatment issues that may arise. Public health insurance helps millions that otherwise would be left defenseless against the mounting health conditions that have become a staple definition among low income or the elderly, like the expansion in diabetes and cancer.
But, public health insurance rarely covers people whom have the means to protect themselves. This is where another party comes into play, private health insurance. What is private health insurance Private health insurance is sought out by the individual to help cover their health care costs. Private health insurance made its way into the American public households during the time of the Great Depression. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] In 1929 one of the first hospitals to provide care at a per month premium of $.
50 for 21 day was Baylor Hospital. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Under the pioneer, Justin Kimball, these per month premium health care plans were quickly approved and marketed by the American Hospital Association and became known as Blue Cross. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Indemnity plans are the most common type of insurance plans. [ (Indemnity Plans, 2007) ] By 1934, these “fee for service” plans began gaining popularity and were soon approved by the American Medical Association.
[ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] These plans became known as Blue Shield. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] People choosing a Blue Shield plan had the expanded option of being covered under health insurance regardless of their choice of hospital or healthcare provider. Private health insurance plans became increasingly popular during World War II as a form of compensation paid to workers that was not subject to wartime wages and price controls.
[ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] The rapid growth of private health insurance has come about because people are willing to pay more money to cover them in the event of an emergency or unforeseen health issue. People tend to purchase health insurance when they know there is an apparent risk; when the risk is very large; or when their income may be lower. There is some economics involved with private insurance. The more income an individual has at their disposal, the greater their ability to pay for more expensive medical expenses.
This income-insurance relationship has allowed for the formation of a variety of health insurance plans. There are four major types of insurance typically offered by employers. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] The first plan is a conventional coverage option that allows the insured to chose the hospital and physicians of their liking throughout the country. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Conventional coverage subscribers usually face a deductible of $200 and pay a share of their hospital, physician, or pharmacist bills (often 20%).
[ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Health maintenance organizations, or HMOs, are second and offer comparable benefits to conventional coverage but provider care is limited to provider participation in the plan chosen by the insured individual. There is often a copay per doctor visit and the insured holds responsibility for the entirety of a doctor bill if they use a provider out of the network.
[ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Third would be preferred provider organizations, or PPOs, that offer coverage on an even smaller listing and have the same copayments as an HMO. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] The somewhat advantage of a PPO is if an in network provider is not available, the insured can use an out of network provider along with paying a larger portion of the bill. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] Finally, point-of-service plans, or POSs, are a combination of both HMOs and PPOs.
Like the PPOs, the insured may use covered providers that are outside of the network, but a primary care provider is required as with the HMOs. [ (Health Insurance from Encyclopedia of Health Care Management, Sage, 2004) ] As of 2007, 3% of workers with employer-sponsored coverage were in a conventional plan, 21% were in an HMO, 57% were in a PPO, and 13% signed up for a POS. [ (BuyerZone, 2011) ] With all of the confusion behind or unavailability of public and private health insurance plans to all individuals, a not so new idea of a national health care plan has been brought back to the table as of late.
2010 Health Care Reform Bill On March 23rd, 2010, current president Barack Obama placed his signature on a new bill that hopes to reform current health care legislation. A national health care plan is nothing new. Beginning with Theodore Roosevelt, a push for a nationwide health care plan has been in the making for quite some time. [ (Igel, 2008) ] In 1933, Franklin D. Roosevelt tried to draft new health care provisions to include publicly funded health care programs. [ (Igel, 2008) ] This, however, came quickly under fire from the AMA along with state and local affiliates, and ended up being removed from the bill in 1935.
[ (Igel, 2008) ] The next contender for national health car was Harry Truman. As a portion of his Fair Deal in 1949, the idea of national health care was met with more opposition and Truman found that portion of his plan washed out. [ (Geselbracht) ] Richard Nixon’s comprehensive health insurance plan found itself getting the thumbs down from Senator Ted Kennedy in 1974. [ (Hall, 2007) ] Followed by Carter, in 1982, proclaiming the same sentiment that Ted Kennedy’s disapproval of a national health care plan stopped this idea cold, William Clinton’s high hopes to implement a national plan in 1992 also fell apart.
[ (Igel, 2008) ] The 2010 Health Care Reform bill requires the majority of legal residents and U. S. citizens have health insurance. [ (Foundation, 2011) ] Individuals would be able to purchase coverage with premium and cost sharing credits available to individuals or families making $88,000 or less. [ (Foundation, 2011) ] Medicaid would be expanded to include people living up to 133% of the federal poverty level. [ (Foundation, 2011) ] Employers of 200 + employees must automatically enroll employees into a health insurance plan, which employees may deny coverage if they chose.
[ (Foundation, 2011) ] Assess employers with 50 or more full-time employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. [ (Foundation, 2011) ] There are many provisions that make up the new bill, like abortion coverage, offering prescription drugs in generic formulas, and stopping insurance companies from dropping individuals that actually fall ill or become injured.
[ (Foundation, 2011) ] These multitudes of requirements will be worked into phases for each subsequent year following 2010 and ending in 2019. [ (Foundation, 2011) ] Conclusion The United States has a pretty wide variety of options on the table currently. The ultimate goal is to help those that are uninsured become insured and hopefully improve the quality of life and healthcare of the people inhabiting the United States. Private health insurance options will still be a primary contender on the forefront of helping individuals and families with their healthcare needs.
But, for people that may not have bought into the idea of buying health insurance, they will now find themselves digging a little deeper to avoid the tough penalties tacked on to not being covered. Works Cited (n. d. ).
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