US-Health Care Reform - Essay Example

Health Care Reform in the USA After decades of runaway costs and gaps in coverage dependent upon insurance, millions of Americans will finally haveaccess to high quality health care. In March, 2010, President Barack Obama enacted the Patient Protection and Affordable Care Act. The main goal of this legislation is to provide universal high quality health care for all. Something had to be done! Between 2007 and 2008, nearly one in three Americans under the age of 65 was uninsured for health care, with 80% of these people in working families. The cost in lost workplace productivity, greater risk of illness, and death was between $65 billion and $135 billion annually. More than half of all personal bankruptcies were partially the result of inability to pay for medical expenses previously incurred. The typical elderly couple was paying major portions of their limited incomes on health care expenses not covered by Medicare. Health care costs added significantly to the price of goods and services, making American products unaffordable, causing eventual decline competitively in the global marketplace. Those who had access to health care were dissatisfied at the quality of care. The national health care quality score was at around 65% out of a potential 100. Nearly 100,000 people were dying yearly as the result of medical errors; more than AIDS, breast cancer, or motor vehicle accidents. Despite the immense resources being spent on health care, the limited access and overall quality was disproportionately low. (Sheshami, 2010) Seniors, especially older women, had limited access to health care, especially preventive care at a time in their lives when they needed it the most. Yearly screenings were passed over with the result of chronic care actually costing more when debilitating conditions occur. Statistics show that senior and older women are nearly one third more likely to need comprehensive and long term health care services than men. Many either lacked or lost their employee sponsored coverage through loss of employment or loss of spousal coverage. They tend to be less able to afford health care and require more services; however, as a result of gaps in coverage and high out of pocket expenses, they are most likely to face financial ruin as a result of obtaining health care. Older women had less access to insurance coverage as a result of insurance premiums being higher for seniors, especially those with debilitating conditions. In many cases, a diagnosis of cancer or diabetes could cause the insurance company to do a review and cancel the policy. The denial rates of people 60-64 were nearly three times higher than for the younger population. Payment provider cuts had forced many physicians to reduce the number of Medicare patients they will treat. Rural areas had limited access to health care facilities and many seniors lacked transportation and initiative to seek out health care; many of the poor and uneducated women opted not to seek out health care and died early deaths as a result. (Executive Summary, 2010) With health care costs nearly one third higher than in 2001, American families continuously struggled while paying nearly ten percent of their incomes on health insurance; this excluded out of pocket co-pays and deductibles. This had caused many families to skip wellness care and preventive screenings, dental care, and prescriptive medication leading to chronic illness for children which resulted in more hospitalizations and death. Insurance co-pays and deductibles are up 44% on PPO plans from three years ago, forcing many employees to opt out of health care insurance, when possible. (Sebelius, 2010) The population most affected by lack of insurance coverage was the young adult population, with more than 30% of young adults ages 19-29 not being covered. These people fell between the cracks in that they were usually dropped from dependent coverage after their 19th birthday, worked part-time jobs, or worked for small businesses that offered no insurance plans. They are also more likely to change jobs frequently with gaps in coverage. Young women are particularly at risk during their reproductive years, as insurance companies charged much higher premium rates for young females; yet, this population has a lower income earning potential. They are also at higher risk for ER visits due to accidents and lack of care for chronic conditions. Two thirds of those without insurance also had no primary care physician. (Sheshamani, 2010) Insurance discrimination permitted people with pre-existing conditions to be denied health care coverage in 45 states throughout America. Many lost their coverage when they needed it most; such as after the diagnosis of a debilitating condition. Some insurance companies took the broad category approach in denying coverage for all conditions associated with an illness; for example, someone with hay fever may be denied coverage for any respiratory illness. Nine states could legally reject victims of domestic violence; stating it is a pre-existing condition. The practice of rescission, when an insurance company cancels the policy of a person found to have a debilitating condition, could even extend to family members. This practice, alone, saved three major insurance companies more than $300 million over the last five years. At least one company was found to have used rescission as a performance base evaluator for employees. (Sheshami, 2010) Americans currently make up approximately 18% of the GDP in purchasing health care; more than any other country in the world. Yet, our life expectancy is not the highest, nor is our overall health. We spend a lot of money on low-value, high-cost treatments, often bypassing lower cost, higher value treatments. There is a large variation in the quality of health care patients receive, with many procedures not being done in the most cost effective setting. The system we have is complex and administratively expensive, with preventable medical errors leading to costly outcomes. Most insurance systems are based on a fee-for-service encouraging providers to increase their volume of services, driving third party payor as well as health care costs up. There is also poorly communicated health information between providers; fragmentation leads to higher user costs, higher administrative costs, and lower health outcomes. When the uninsured do obtain care, usually at the ER, those who are insured must compensate providers through raised premiums. The average family pays nearly $1,000 in hidden tax costs per year which goes toward indigent care. (COE, June, 2009) On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, which was shortly thereafter amended to the Health Care and Education Reconciliation Act of 2010. This legislation began a system of overhaul on the currently malfunctioning system that would involve steps each year until 2018. Immediately, in 2010, the proposed changes would end rescission and lifetime coverage limits. Young adults would be covered as dependents until age 26. Uninsured persons having pre-existing conditions would have coverage through a temporary insurance until the new changes teak effect in 2014. Pre-existing conditions for children under 19 are no longer taken into consideration. There will be a temporary reinsurance for early retirees from 55 – 64, and beneficiaries of the Medicare Drug Plan will receive a $250 rebate to bridge the coverage gap with the gap closing entirely under the new law. Small business owners will receive a discount of 10% in order to provide insurance coverage plans to employees. A 10% tax will go into effect on July 1, 2010 for tanning salons that use ultraviolet light. All of these efforts are stopgap, preventive measures to halt the current decline in access to health care services as well as pave the way for a new system that maximizes health care quality while ensuring that high dollar values are met. (Wikipedia.org, 2010) The new law will mandate insurance coverage for all persons by 2014. It will be operated in a State run marketplace with a variety of insurance companies offering comparable services and pricing. The cost of the subsidies will be provided by the savings from reduced payments for indigent care. Needless deaths, due to lack of access to care will decrease, thereby raising the overall national health rating. Financially, bankruptcies will be fewer due to insurance coverage. Pharmaceutical and insurance companies will pay their fair market share in taxes. Health plans for all preventive services will be developed. Employers of more than 30 employees will be fined $2,000 per person uninsured. Insurance plans will be based on a sliding scale to allow affordability. It is estimated that overall, the new health care reform law will reduce the national deficit by $138 billion within the next ten years. (Wikipedia.org; 2010) The overall shift in focus will be from fee-for-service to quality of care, with more effective bundling of payments to encourage hospitals and providers to coordinate patient care. The full cost of wellness visits for both Medicare recipients and children, and personalized prevention plans will be covered by insurance. There will be a Medicare Graduate Medical Education program to regulate the number of physicians, with incentives for those willing to work in high need, low service areas. It will also work to balance income equality between all members of the medical profession. (Wikipedia.org; 2010) There is no perfect answer, however, we spend more than any other nation on health care; we should have a higher quality of care and more access to health care for our people. Change is definitely good! References Council of Economic Advisors. The Economic Case for Health Care Reform. Executive Office of the President. June 2009. Web. 6 Dec. 2010. Pp. 9-16. http://www.whitehouse.gov/assets/documents/CEA_Health_Care_Report.pdf Executive Summary. Strengthening the Health Insurance System: How Health Insurance Reform Will Help America’s Older and Senior Women. U.S. Department of Health and Human Services. 29 June 2010. Web. 6 Dec. 2010. http://www.healthreform.gov/reports/seniorwomen/index.html Health Care Reform in the United States. Wikipedia.org. Dec.2010. Web. 6 Dec.2010. http://en.wikipedia.org/wiki/Health_care_reform_in_the_United_States Sebelius, Kathleen. Protecting Families and Putting More Money in Your Pocket: How Health Insurance Reform Will Lower Costs and Increase Choices. Department of Health and Human Services. 29 June 2010. Web. 6 Dec. 2010. http://www.healthreform.gov/reports/families/index.html Seshamani, Meena. The Costs of Inaction: The Urgent Need for Health Reform. U.S. Department of Health and Human Services. 29 June 2010. Web. 6 Dec. 2010. http://www.healthreform.gov/reports/inaction/sources/index.html Young Americans and Health Insurance Reform: Giving young Americans the Security And Stability They Need. U.S. Department of Health and Human Services. 29 June 2010. Web. 6 Dec. 2010. http://www.healthreform.gov/reports/youngadults/Sources/index.html Coverage Denied: How the Current Health Insurance System Leaves Millions Behind. U.S. Department of Health and Human Services. 29 June 2010. Web. 6 Dec. 2010. http://www.healthreform.gov/reports/denied_coverage/Sources/index.html Read More