The Ideal U. S. Health Care Insurance Policy
Today, in a country with a population that has grown six fold and where private and public-sector forms of health insurance are required to access a highly sophisticated healthcare system, the number of persons who lack health insurance approaches 47 million. Lack of health insurance has been associated with limited or no access to comprehensive medical services, worse health outcomes, financial catastrophe for many families, and financial challenges for many service providers. The U.S. Census Bureau conducts an annual social and economic supplemental survey each March- the widely cited Current Population and economic survey (CPS) - that asks respondents about their insurance coverage over the past year. The 2006 CPS estimate of the number of uninsured was 47 million (Smith, 2008). For healthcare providers, the relevant measure of the number of uninsured is the number of patients who lack insurance when they need services. Hospitals classify patient accounts as either charity care (no payment is expected after the patients’ inability to pay is determined) or as a bad debt (efforts to secure payments prove unsuccessful). Determination of eligibility from some social programs based on demographic is quite clear. On key to insurance coverage is employer sponsorship. Although employer sponsored health benefits are still the norm, changes in the employment market and the cost of healthcare coverage have eroded this base. Although those in the lowest-income-level jobs are less likely to be insured, the group with the greatest recent increase in the number of uninsured persons is composed of the working middle class adults. Approximately half of uninsured working persons are employed by firms that do not offer coverage (Smith, 2008). In order to create an ideal U.S. health insurance systems we must examine our current system and the aspects that play a major role in the percentage of the uninsured. In America, working people are the most disenfranchised because most of them are not eligible for public benefits and they cannot afford premium cost sharing. The US government finances health benefits for certain special populations, including government employees, the elderly (age 65 and over), people with disabilities, some people with very low incomes, and children from low income families. The program for the elderly and certain disabled individuals is called Medicare. The program for the indigent, jointly administered by the federal government and state governments, is named Medicaid. The program for children from low-income families, another state and federal partnership, is called the State’s Children’s Health Insurance Program (SCHIP). We must first deal with the eligibility criteria for Medicaid and Medicare. Similar to Social Security, Medicare is an entitlement program. Because people have contributed to Medicare through taxes, they are “entitled” to the benefits regardless of the amount of income and assets they may have. The qualified individual (QI) program provide states with block grants to pay Medicare premiums for individuals with low incomes between 120 and 135 percent of the federal poverty level. Under the Qualified Disabled and Working Individual (QDWI) program, states are required to pay Part A premiums for certain low income people who qualified for Medicare because of disability but then returned to work and hence lost the entitlement. Certain categories of people are automatically eligible under federal guidelines: (1) Families with children receiving support under the Temporary Assistance for Needy Families (TANF) program. (2) People receiving Supplemental security Income (SSI), which includes many of the elderly, the blind, and the disabled with low incomes. (3) Children and pregnant women whose family income is at or below 133 percent of the Federal Poverty Level, which was $20,650 for a family of four in 2007. The poverty level needs to...
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