Health Care Debate


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Presentation by Dona Koenigsman at Healthcare: Get in the Game, Forsyth Library, FHSU. Nov 3, 2009.

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Health Care Debate

  1. 1. HEALTHCARE 2009<br />
  2. 2. Did you know...<br />More than 17 percent of women are uninsured, and even more are underinsured.<br />Between 1999 and 2008, health insurance premiums increased 119 percent — 3.5 times more than wages during the same period.<br />3 in 5 women are unable to pay her medical bills.<br />Real median earnings declined for women and men in 2008, and the wage gap for women stands at 77 cents of every dollar that men earn.<br />With the increase in the number of uninsured Americans, more mothers will have to make the choice between medical care and putting food on the table. <br />More daughters will have to choose between filling their prescriptions and paying their rent. <br />
  3. 3. &quot;Cadillac&quot; Health PlansAlso known as &quot;gold-plated insurance,&quot; these plans are very expensive, very generous and require little or no out-of-pocket expenses for those who have them. Public employers and union employees in the manufacturing sector (like many of those who worked for the Detroit automakers) commonly have Cadillac plans.<br />Catastrophic Health Insurance Coverage with a very high deductible that is intended to protect against unforeseen illness or injury. While this insurance can protect against medical bankruptcy, it does not typically cover routine, preventive medical care.<br />Co-Insurance Insurance that covers a preset percentage of a patient&apos;s medical care. For example, a health-care plan that covers 80% of the charge for hospitalization, leaving the patient responsible for the remaining 20%.<br />Co-Pay The preset fixed amount a patient must pay at the time a medical service is rendered.<br />
  4. 4. Fee-for-Service Paying or billing for every individual medical procedure, test or device. This is the most common way payments are made in the U.S. health system.<br />Generic Drugs Prescription drugs with the same ingredients as name-brand drugs, but which are sold at a fraction of the cost. Once a pharmaceutical company develops a drug, the company&apos;s patent rights prevent that drug from being sold in generic form for a set period of time.<br />Health-Savings Account (HSA) A tax-deductible personal savings account, usually offered by employers along with high-deductible health-insurance plans, that can be used to pay for medical expenses.<br />Pre-Existing Condition A health-insurance plan that reimburses medical expenses at different rates, depending on whether a patient chooses to get care inside or outside a pre-determined group of providers.<br />Public Option A government-run health-insurance plan that could offer coverage at a cost below that of private insurance plans because of lower administrative costs and possibly lower reimbursements to doctors and hospitals.<br />
  5. 5. Employer-Based Insurance: Paying More, Getting Less<br />
  6. 6. Changes to 2010 health benefits, which reflect the first chance employers have had to restructure their plans since the economy started tanking in September 2008,<br />Surveys indicate that in 2010, 40% of employers will shift more premium costs onto employees and 39% will increase deductibles, co-payments, co-insurance or out-of-pocket maximums<br />More employers are steering workers toward catastrophic health policies with deductibles as high as $5,000 or $10,000<br />
  7. 7. The days of paying a $15 or $25 co-pay for a visit to a specialist are slowly being replaced by co-insurance: The patient pays 10%-20% of the actual cost of each doctor&apos;s visit, lab test, procedure or prescription.<br />Large employers offer so-called wellness programs, including efforts to get workers to lose weight or quit smoking.<br />Firms are conducting &quot;dependent audits,&quot; weeding out enrollees who don&apos;t actually qualify for coverage or charging employees more for dependents who are offered coverage elsewhere.<br />
  8. 8. Bringing more young adults into the health care system would balance out the costs for everyone else because the young use the least amount of care.<br />Should young people be forced to buy insurance? If so, how much should they pay for it? <br />critics argue that young people could end up paying disproportionately larger premiums, effectively subsidizing older Americans who tend to use more health-care dollars.<br />&quot;We&apos;re going to be the ones paying for it in this climate of deficit spending,&quot; said Alex Hansen, a senior at Marquette and chairman of the College Republicans.<br />
  9. 9. Young … and uninsured<br />Young people ages 19 to 24 have the highest uninsured rates of any other age group in the nation, according to the Kaiser Family Foundation. Experts cite a number of reasons for the disparity: They are less likely to work at companies that offer coverage, they make little money to buy it on their own, and they don&apos;t qualify for government programs that provide free or affordable coverage.<br />Many of them also say they don&apos;t need insurance - even if they can afford it - because they are young and healthy.<br />recent polls show that young Americans tend to be more supportive of health reform efforts than any other age group. Young people also tend to worry more than any other age group about losing their current coverage.<br />
  10. 10. Young adults represent the largest group of uninsured people while they also increasingly report mental health issues in college. The San Jose Mercury News reports: &quot;Young adults aged 19 to 29 are less well-protected by health insurance than any other age group in America: Almost one in three have no insurance - and many more are underinsured.<br />Young adults who have graduated from college and are employed do not necessarily have health insurance either since many first jobs don&apos;t offer affordable health plans<br />The gap is so critical and so costly that House Speaker Nancy Pelosi last week announced a new provision proposed for the health insurance reform bill: It would allow young people to remain covered under their parents&apos; insurance plan until their 27th birthday<br />
  11. 11. The Underinsured People with, for example, catastrophic health insurance (see definition) but who still face the threat of high medical bills and who are just as likely as the uninsured to forgo services like preventive care. The underinsured also include people who have relatively low caps for insurance, meaning their insurers will pay only a preset annual amount (any expenses beyond that will not be reimbursed). Research suggests that as many as 25 million Americans are underinsured. <br />The Uninsured An estimated 46 million Americans. Several groups make up a large portion of the uninsured: young adults who can&apos;t afford health insurance and don&apos;t feel they need it; people without employer-sponsored health insurance who have pre-existing conditions that make buying an independent policy cost-prohibitive; families and individuals who aren&apos;t poor enough to qualify for Medicaid but who are too poor to afford health insurance; employees of small businesses who choose not to or can&apos;t afford to offer insurance to employees; and illegal immigrants.<br />
  12. 12. Penalties for no coverage<br />With lawmakers still hammering out the details of their plans, every proposal would require that virtually all Americans - including young people - have health coverage. Those who opt to go without insurance could face fines of as much as $950 a year for higher income people, according to one proposal in the Senate.<br />This coverage mandate, backed by the insurance industry, is drawing criticism from those who worry about government intrusion in people&apos;s lives or question whether Congress can legally force Americans to buy insurance.<br />Supporters say health insurance should be treated like car insurance so that the uninsured don&apos;t drive up costs for everyone else. <br />