Under the Patient Protection and Affordable Care Act, underwriting will effectively disappear. Enrollee demographics and medical history can no longer be used to calculate premiums. Two exceptions allow for rate variation based on age and smoking, although even in those cases the degree of variation is legally capped. Without the ability to use underwriting for risk selection or assigning premiums, insurers will have to find new ways to compete. Premiums will no longer reflect the underlying risks, and rate variation will cease to be a meaningful tool in competing for a healthy insured population.
Although medical underwriting can no longer be used for risk selection, the new law will provide some useful protections for insurance companies. One new program will establish reinsurance for high-risk populations. This reinsurance program will assess fees from insurers with low-risk populations, and provide reimbursements to insurers with high-risk populations. If the program operates as intended, health plans will no longer be as sensitive to the risk of their insured population. With this program balancing population health risk between different insurers, competition for healthy applicants will no longer provide a market advantage.
With the face of the competitive landscape changing, insurers who can effectively adapt will find new opportunities to stand out in the marketplace. Instead of matching premiums to risks or competing for the healthiest customers, insurers can compete on the quality and efficiency of their plans. Reforms such as the new insurance exchanges, public reporting requirements of quality metrics, and a new health plan rating system will help insurers use the merits of their products to attract new applicant...
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...ity to support the national strategy. This center will be responsible to develop, disseminate, and provide training in strategies for quality improvement. Part of this role will include identifying providers that consistently deliver high-quality, efficient care, and use best practices that are adaptable to other companies or circumstances. These providers will be used as a model for what can be achieved by other providers, and the new center will make recommendations for how other providers can implement some of the same practices. This program could provide a tremendous leadership opportunity for health plans that succeed in improving their quality and efficiency. Insurers who are dedicated to providing excellent quality and efficiency will receive public recognition of their efforts, and this leadership role could prove to be an important competitive advantage.
One of the most controversial topics in the United States in recent years has been the route which should be undertaken in overhauling the healthcare system for the millions of Americans who are currently uninsured. It is important to note that the goal of the Affordable Care Act is to make healthcare affordable; it provides low-cost, government-subsidized insurance options through the State Health Insurance Marketplace (Amadeo 1). Our current president, Barack Obama, made it one of his goals to bring healthcare to all Americans through the Patient Protection and Affordable Care Act of 2010. This plan, which has been termed “Obamacare”, has come under scrutiny from many Americans, but has also received a large amount of support in turn for a variety of reasons. Some of these reasons include a decrease in insurance discrimination on the basis of health or gender and affordable healthcare coverage for the millions of uninsured. The opposition to this act has cited increased costs and debt accumulation, a reduction in employer healthcare coverage options, as well as a penalization of those already using private healthcare insurance.
“Americans without insurance coverage will be able to choose the insurance coverage that works best for them in a new open, competitive insurance market – the same insurance market that every member of Congress will be required to use for their insurance. The insurance exchange will pool buying power and give Americans new affordable choices of private insurance plans that have to compete for their business based on cost and quality. Small business owners will not only be able to choose insurance coverage through this exchange, but will receive a new tax credit to help offset the cost of covering their employees.
The aim of affordable care act (ACA) was to extend health insurance coverage to around 15% of US population who lack it. These include people with no coverage from their employers and don’t have coverage by US health programs like Medicaid (Retrieved from, https://www.healthcare.gov/glossary/affordable-care-act/). To achieve this, the law required all Americans to have health insurance which is a reason of controversy because, it was inappropriate intrusion of government into the massive health care industry and insult to personal liberty. To make health care more affordable subsidies are offered and the cost of the insurance was supposed to be reduced by bringing younger, healthier people to the health insurance system. This could be controversial, if older, sicker people who need the coverage most enter the market but younger group decline to do so. The insurance pool will be unbalanced and the cost of coverage will rise correspondingly.
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
Healthcare has been a topic of discussion with the majority of the country. Issues with insurance coverage, rising costs, limited options to gain coverage, and the quality of healthcare have become concerns for law makers, healthcare providers and the general public. Some of those concerns were alleviated with the passing of the Affordable Care Act, but new concerns have developed with problems that have occurred in the implementation of the new law. The main concerns of the country are if the Affordable Care Act will be able to overcome the issues that plagued the old healthcare system, the cost of the program, and how will the new law affect the quality of the health delivery system.
Before Obamacare was passed, millions of Americans were uninsured, suffered and died prematurely each year since lack of health insurance. Insurance companies could deny any one for pre-existing illnesses or drop them when they get sick, or stop treating them when they touched annual or life-time perimeters. Over 60% of bankruptcies were associated to medical expenses, several of these people had insurance. Insurance companies had no limits on raising premiums. Preventative measures and wellness visits were not covered adequately (Mowrey, 2013).
The health of the American people lags behind those from other developed countries. Federal public health agencies have a wide range of responsibilities and functions which includes public health research, funding, and oversight of direct healthcare providers. It has been a long time since changes have been made to the way the federal government structures its health care roles and programs outside of Medicare and Medicaid (Trust, 2013). With healthcare reform on the horizon now is the time to invest time and money in prevention, not medicine, making it a top priority to improve health and prevent disease. Funding efforts at all levels of the public health continuum need to focus on developing programs aimed at such leading initiatives as tobacco cessation, improving nutrition, supplying safe workplaces, and increasing physical activity in all ages of the population. People should have equal access to quality preventative medicine and education.
Health insurance is currently an important issue in the United States. Everyday more and more Americans become uninsured due to job loss and an increase in premiums. These Americans add to the ever growing population of 45.7 million people who are currently uninsured (Bialik). Moreover only 27% of those uninsured are under the age of 65 (NCHC). This is staggering considering most of those who are uninsured have, or soon will, suffer from some sort of illness or injury. As a result they will not be able to afford proper treatment. Insurance premiums can range in cost from fifty dollars per month, to fifteen hundred dollars per month (Kreidler). An individual’s premium is determined by factors they choose as well as other factors looked at by their provider. The cost of health insurance in America varies depending on the controllable factors, like particular insurance policies, and uncontrollable factors, like age.
A mandate will be made through this health care reform plan that will make providers more involved in the care of their patients. Steps will be taken to help increase the number of physicians in areas experiencing shortages along with incentives for physicians to become family practitioners. Preventative care will be the focus therefore annual checkups and routine procedures will be covered by all insurances. A coordination track where doctors, nurses, and other providers work effectively and efficiently in teams, analyzing the outcomes and processes of care to rid the system of waste will be created (Cortese & Korsmo, 2009).
However, the reason a lot of these insurance companies are not popular among the general public is because they are new to the insurance game and are often unable to handle processing claims that have become second nature to the giants of the insurance industry. Opponents could also claim the ACA’s out of pocket maximum helps people not get drowned in debt. Sure, maybe the individuals themselves aren’t directly in debt and being spammed with outrageous hospital bills. However, the part of their bills that count toward their out of pocket maximum are sometimes unclear. “Even though things are a lot simpler now, depending on your plan not all services are going to be covered 100% and not all services are always going to count toward your out-of-pocket maximum. Double check that your health plan isn’t cutting any of the corners” (Out-of-Pocket) Opponents may also say that the ACA lowers premiums, but that 2008 statement has become increasingly known as a lie. Obama spent 2008 telling the American people throughout his campaign insurance would be reduced “up to”, “on average”, and “typically” $2,500 “per family, per year”. That turned out to be false and “by some estimates, the average rates in the individual market have increased nearly 25 percent compared to what they would have been without Obamacare, and have increased measurably in 45
Currently in the United States, acquisition of affordable health insurance plans through employers and private corporations is one of the main topics in the political landscape between liberals and conservatives. The traditional way of obtaining health insurance is either by subtracting a certain amount of payout from one’s salary/paycheck or pay out of pocket. However, many people do not have access to health care because of the high costs associated with poor insurance plans that require individuals to pay high premiums and deductibles, which may or may not contain good benefits such as free preventative care. In addition, due to the past economic recession in 2008, many employers could not afford to pay for health benefits and canceled numerous plans for many employees. This effectively increased the rate of uninsured Americans as well as the increasing health care costs.
A country’s health care system refers to all the institutions, programs, personnel, procedures, and the resources that are used to meet the health needs of its population. Health care systems vary from one country to another, depending on government policies and the health needs of the population. Besides, health care programs are flexible in the sense that they are tailored to meet health needs as they arise. Among the stakeholders in the formulation of a country’s health care system are governments, religious groups, non-governmental organizations, charity organizations, trade/labor unions, and interested individuals (Duckett, 2008). These entities formulate, implement, evaluate, and reform health services according to the needs of the sections of the population they target.
... is an abstract model that proposes an exploratory plan for health services and evaluating quality of health care. In accordance with the model, information about quality of care can be obtained from three categories: structure, process, and outcomes. In addition, not long ago The Joint Commission include outcomes in its accreditation valuations (Sultz, & Young, 2011, p. 378).