Mandatory Insurance Coverage

Mandatory Insurance Coverage

Mandatory Insurance Coverage

According to Winston Churchill (as cited in Citizens for Health, 2015), “Healthy citizens are the greatest asset any country can have.” In this paper the author examines the world’s healthcare systems, the U.S. healthcare crisis, the urgency of national healthcare reforms, what transformations the American healthcare system has undergone under the Affordable Care Act (ACA), what Americans gained and what they lost by implementing the new law, and what a mandatory health coverage means for them.

Introduction

There are about 200 countries on our planet and each country has its own healthcare system in order to treat the sick and keep people healthy. According to Reid (as cited in Frontline, 2008), all health care systems have general patterns that can be divided into four basic systems. First is the Beveridge model where health care is provided and financed by the government through tax payments (Great Britain, Spain, New Zealand, Hong Kong, Cuba and most of Scandinavia). Second is the Bismarck model where an insurance system used. The insurers are called "sickness funds" usually financed jointly by employers and employees through payroll deductions. Unlike the U.S. insurance industry, Bismarck-type health insurance plans have to cover everybody, they do not make a profit, and they have tight governmental regulation (Germany, France, Belgium, Japan, Switzerland, and some Latin American countries). Third is the system that has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run non-profit insurance program. These universal insurance programs tend to be cheaper and much simpler than American-style for-profit insurance (Canada, Taiwan, and South Korea). Fourth is the out-of-pocket model. Only the developed, industrialized countries have established health care systems. Most of the nations on the planet are too poor to afford systemic health care. In such countries the rich get medical care and the poor stay sick or die.

Problem Definition

Americans have elements of all of the above models in their fragmented national health care. When it comes to treating veterans or disabled, we are like Britain or Cuba. For Americans over the age of 65 on Medicare, we are like Canada. For working Americans who get insurance on the job, we are like Germany. For the uninsured, the United States is like Cambodia, Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket or if you're sick enough to be admitted to the emergency room at the public hospital. The United States, unlike every other country, has a very fragmented, socially segregated for-profit healthcare system. All the other developed countries have settled on one model for everybody. This is fairer, simpler and cheaper than the U.S. system.

According Kaiser Family Foundation (KFF), in 2013 the uninsured rate among nonelderly individuals was 16.7 percent. Many of those had been uninsured for more than five years (2015). Most of the uninsured fell into the coverage gap because they did not have access to coverage through their jobs (self-employed or unable to afford employer-sponsored coverage) and they were not eligible for Medicare (KFF, 2015). Historically, Medicaid was only available to low-income children, parents, pregnant women, people with disabilities, and the elderly. Without eligibility for cheaper preventive care, this population often ends up seeking expensive medical treatments for a critical illness and, as a result, faces unaffordable medical bills. These unpaid bills raise the healthcare costs, insurance premiums and state and federal taxes. The United States spent $8,508 per person on health care in 2011, over 2.5 times the average spent by member countries of the OECD (ProCon.org, 2015). This vicious cycle went on and on.

Previously, insurance companies could deny coverage or charge more because of a pre-existing condition. They could impose lifetime dollar limits on essential health benefits. They could drop your coverage when you got sick due to a mistake you made on your application. No one was able to control how they spent our premium money. They could use your money for advertisements and bonuses for executives. They could charge you for preventive and screening services.

How This is Addressed by the ACA

On March 23, 2010, President Obama signed the Affordable Care Act (ACA) into law putting in place comprehensive reforms that improved access to affordable health coverage for everyone and protects consumers from abusive insurance company practices (The White House, 2015). After the enactment of the ACA, the United States Supreme Court agreed to consider several issues related to the constitutionality of this law. It included two major provisions of the ACA: the individual mandate (the minimal essential coverage) and the Medicaid expansion (KFF.org, 2012). A majority of the Court upheld the individual mandate and decided to make the Medicaid expansion optional for states. Under the ACA, Americans gained better access to healthcare. Now consumers and their doctors, not insurance companies, are in charge. Millions of Americans who do not get coverage at work are getting financial assistance to lower their monthly premiums. Under the law, most young adults who can’t get coverage through their jobs can stay on their parents’ plans until age 26 (The White House, 2015). The Health Insurance Marketplace is a one-stop shop where consumers can choose a private health insurance plan that fits their health needs. Nearly 50 million older Americans and Americans with disabilities rely on Medicare each year and the new health care law makes Medicare stronger by adding new benefits, fighting fraud, and improving care for patients. The projected life of the Medicare Trust Fund has been extended by 13 years to 2030 as a result of reducing waste, fraud, and abuse, and slowing cost growth in Medicare (The White House, 2015). More than 105 million Americans no longer have lifetime limits (The White House, 2015). According to the ACA, insurance companies need to spend at least 80 percent of your premium dollar on medical care and quality improvements. If not, they will have to provide you a rebate.

Pros and Cons

The ACA ignited long term debates among American politicians and polarized American society. History shows that laws successfully