Sick Around America directed by Jon Palfreman - Essay Example

Sick Around America Several challenges face the employer provided healthcare and the consumer directed health plans.Though employee friendly, the employer provided health plans pose a horde of problems both to the employers and employees. The challenges that face employees are highlighted in a documentary Sick Around America directed by Jon Palfreman. Perhaps, the most conspicuous challenge is when the employee loses or leaves his/her job which results in health coverage loss. Under the federal COBRA law, employees under comprehensive group coverage can only continue with the coverage provided they pay the premiums in full which is rather expensive leading to many employees not taking the option. Therefore, this leads to ‘job lock’. According to Buchmueller and Valletta (1996), this term defines reduced worker mobility that arises from the perceived risk of losing health coverage. This compromises especially individuals who have a medical condition, who, if they change jobs, may be denied coverage either for the existing condition or altogether under their new employers through application of the ‘preexisting condition’ clause. Another challenge that is evident is that employees are forced into jobs contrary to their career choices, just to secure health coverage. To the employers, small businesses feel the heat of these plans. The documentary Sick Around America highlights the plights of a small business hit by a million dollar cost for the delivery of a premature baby by the employees that resulted in their insurers increasing the premiums by over 78%. Consumer Directed Health Plan (CDHP) is operated by insurance companies who are not obliged to cover anyone. Indeed, they take steps to avoid those who are already sick through a practice called medical underwriting. This practice enables the private insurers to avoid the sick and select the healthy. This is done through rigorous forms that require a person to fill all his health history. This is compounded by the fact that the insurers have access to all the medical records ever developed about any person. As a result, any person with a history of serious conditions, such as diabetes and heart problems gets rejected. This was also applied to people with even common ailments. Failure to disclose anything material is regarded as fraud and the insurers employ this opportunity to recede retrospectively coverage of persons after they have become sick. Insurers take the opportunity of this window to frame questions that are ambiguous and that will, in some way, lead the unsuspicious applicant forgetful of some minor past details to give incorrect information, which would, in turn, allow the insurer to recede the contract. This practice was being abused. Indeed, the documentary points to the fact that some insurers actually paid bonuses to their employees who were in charge of rescission based on how many rescissions the carried out in a given year. Medical underwriting has been countered in some states through the guaranteed issues. In such states, the law requires everyone who seeks insurance to be insured. However, such guaranteed issues predisposed the subscribers to extremely high premiums given that it allowed them a leeway to subscribe after they got sick. In states such as Massachusetts that had the guarantee issues, everybody was mandated to buy a policy or else be fined. This was hard to implement given that due to the soaring cost of the premiums, many residents could not afford it, and it was, therefore, impossible to enforce it. The health care reform has introduced some far reaching provisions with regard to the above problems. For instance, to cure the problem that arises from medical underwriting, there are introduced programs that care for those who have been rejected due to health conditions or disability. Such programs include the Pre-existing Condition Insurance Plan (PCIP), while young adults below 26 years qualify for coverage under their parent’s plan, under the Young Adults Program. Another program that will take effect in 2014 is the Consumer Run and Oriented Plan (CROP) that will enable small business to buy insurance from the new non-profit consumer-run health insurer. With regards to employers, the new regime gives employers tax credits and the new programs endeared towards making health care more affordable to employees, employers and early retirees. Further the Affordable Care Act extends the Medicaid to those who cannot afford insurance. Some of the provisions resulting from the reform have attracted debate among the legislators and the public. It is argued that it shall have negative impacts on employees who already had good coverage as it is expanded to the uninsured. Indeed, a report by the business consultancy McKinsey & Company predicts a steep move from employer-sponsored plans to the new health insurance exchanges and, therefore, will result in a negative impact on their health care plans. Nevertheless, studies by the office of the actuary for the Center for Medicare and Medicaid services suggest that there would be only a slight decline. The documentary suggests that most of these provisions are hotly debated because the health care system is full of vested interests by all the stakeholders and the lobbyists who are keen on safeguard. The role of the court with regards to this policy area has been serving as a neutral arbiter in lieu of the vested interests that all the stakeholders have. Over 26 states have filed suits in the Supreme Court challenging the Affordable Care Act requiring the court to rule on key issues among them whether the new requirements on state Medicaid programs and individual mandate are constitutional. Works Cited Behlmann, Emily. U.S. Supreme Court Considers Health Reform Law Next Week: A Guide. Wichita Business Journal. March 23, 2012. Web. 17 Apr 2012. Buchmueller, Thomas, and Robert Valletta. The Effects Of Employer-provided Health Insurance on Worker Mobility. Industrial and labor relations review. Vol. 49(3). Web. April 17, 2012. Department of Health and Human Services. Putting Things into Context: Healthcare Reform. Web. 17 Apr. 2012. “Key Features of the Law” (n. d.). Web. 17 Apr. 2012. . Palfreman, Jon. Sick Around America. Frontline, PBS. Web. 17 Apr. 2012. < http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/view/ >. Palfreman, Jon. Transcripts, Sick Around America. Frontline, PBS. Web. 17 Apr. 2012. . Read More