The thought process that is involved with choosing an insurance plan can range from simple to very complex. So many factors can affect how an individual or a family chooses what type of coverage they may need. Some of these factors can include present illnesses, present state of health, work or personal habits and environment, age of self or family members and types of activities that the individual or family members are involved in.
The reason health insurance exists is because of the unknown. The unknown about who will become injured or ill and at what time and to what extent this event will be. It is a given that there will be thousands of people across the U.S. every day that will need to seek out healthcare in some form or another and will need help from health insurance to pay for that care. This fact makes the choice involved with health insurance about risk.
According to Moriates, Arora, and Shah (2015), “At its most basic level, all insurance is designed to mitigate risk of financial catastrophe. Insurance ideally spreads this predictable population-level risk among the entire group so that the unlucky afflicted individuals can afford to have these vital therapies when they need it. The idea is that lifesaving therapy should not necessarily deplete one’s life savings. One of the great challenges in
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Approximately one half of all of the healthcare expenses in the United States are paid for through the states or the federal government in the form of Medicaid or Medicare (Mosser and Begun, 2014). According to Bodenheimer and Grumbach (2012), “Medicare is a social insurance program, requiring individuals or families to have made social security contributions to gain eligibility to the plan. Medicaid, in contrast, is a public assistance program that does not require recipients to make contributions but instead is financed from general tax
On a global scale, the United States is a relatively wealthy country of advanced industrialization. Unfortunately, the healthcare system is among the costliest, spending close to 18% of gross domestic product (GDP) towards funding healthcare (2011). No universal healthcare coverage is currently available. United States healthcare is currently funded through private, federal, state, and local sources. Coverage is provided privately and through the government and military. Nearly 85% of the U.S. population is covered to some extent, leaving a population of close to 48 million without any type of health insurance. Cost is the primary reason for lack of insurance and individuals foregoing medical care and use of prescription medications.
For decades, one of the many externalities that the government is trying to solve is the rising costs of healthcare. "Rising healthcare costs have hurt American competitiveness, forced too many families into bankruptcy to get their families the care they need, and driven up our nation's long-term deficit" ("Deficit-Reducing Healthcare Reform," 2014). The United States national government plays a major role in organizing, overseeing, financing, and more so than ever delivering health care (Jaffe, 2009). Though the government does not provide healthcare directly, it serves as a financing agent for publicly funded healthcare programs through the taxation of citizens. The total share of the national publicly funded health spending by various governments amounts to 4 percent of the nation's gross domestic product, GDP (Jaffe, 2009). By 2019, government spending on Medicare and Medicaid is expected to rise to 6 percent and 12 percent by 2050 (Jaffe, 2009). The percentages, documented from the Health Policy Brief (2009) by Jaffe, are from Medicare and Medicaid alone. The rapid rates are not due to increase of enrollment but growth in per capita costs for providing healthcare, especially via Medicare.
Medicare and Medicaid are one of important government programs. According to Medicaid.gov site, there are more than 4.6 million low-income seniors enrolled in Medicare and about 8.3 million people that are enrolled in both Medicare and Medicaid. Anyone that enrolled with Medicare and limited income and resources are eligible to get assistance paying for their premiums and out-of-pocket medical expenses from Medicaid. Not only does Medicaid cover additional services, but, services covered by both programs are first paid by Medicare with Medicaid in the difference up to the state’s payment limit (Medicaid.gov, 2015) .
To begin with, a number of researchers have in the past connected the high risk of deaths with lack of proper insurance. The same issue is critically argued by Wilper et al. some researchers have even gone to an extent of suggesting private health insurance, although costly, is more effective than public health insurance (Goodman). Note that, this is not the issue with Wilper et al study. In fact, Wilper et al compares health insurance and mortality rate, with their argument being that the lack of health insurance is the cause of 45,000 adult deaths that take place in America every year.
In 1965 President Johnson signed both Medicare and Medicaid programs into law (Nile, 2011). According to Medical news today, “Medicare is a social insurance program that serves more than 44 million enrollees as of 2008” (MediLexicon International Ltd, 2011, para2). It cost about $432 billion or 3.2% of GDP, as of 2007(par2).Medicare is broken down into parts, Part A is hospital Insurance Part B is medical Insurance, and Part D is Medicare prescription drug coverage (medicare.gov). Like we previously stated Medicare is a health insurance for people who are 65 and older, people under 65 with certain disabilities, and people of any age with End- Stage Renal Disease. Medicaid is a joint federal-state program of medical assistance for low income persons (Benefit.gov). It is administered by the Illinois Department of Human Services (DHS) and Illinois Department of Public Aid (IDPA). Medicaid serves about 40 million people as of 2007; it cost $330 billion, or 2.4% of GDP, in 2007.(par.2) “In Illinois you may be eligible for Medicaid if you are a child, pre...
Health insurance comes as second nature to many of us. We grab that blue and white card and put it in our wallet and forget about it until we are sick or injured. When this happens, there it is, cushioning our fall like the extra padding it provided to cushion our wallets. This is not the case with everyone, however. Many Americans have no cushion to fall back on, no blue and white card to show the emergency room when they have an unexpected health concern. No HMO with a convenient co-pay amount when their son or daughter develops an ear infection.
The United States government is considered to be a social welfare state. As discussed in class and mentioned in our notes a social welfare state is, “a society with a set of government programs that ensures a minimum standard of living for families and protects individuals from loss of income”. The United States in turn has several programs in its social welfare system. One of them is Medicare, which has seen a huge growth in recent years, and is funded by payroll taxes. Medicare
Medicare and Medicaid are two of the United States largest broken systems, which must sustain themselves in order to provide care to their beneficiaries. Both Medicare and Medicaid are funding by a joint effort between the federal government and the local state government. If and when these governments choose to cut funding or reduce spending, Medicare and Medicaid take the biggest hit. Most people see these two benefits as one in the same, two benefits the government takes out of their pay check to help fund health care. While the government does deduct a sum from paychecks everywhere, Medicare and Medicaid are very two very different programs.
What exactly is Medicaid? Medicaid is the largest health insurance in the United States, and it services many low-income families. This government health program is state regulated and varies among states due to having their own guidelines. Medicaid was signed into law on July the 30th, 1965. Medicaid’s guidelines come from the old Welfare law. “Medicaid has never matched that of food stamps, for which eligibility standards are linked to financial need alone. As Smith and Moore explains, the federal government, using its extraordinary demonstration powers under section 1115 of the Social Security Act, has allowed states to experiment with “decategorization” over the years, but Medicaid’s statutory bar against coverage of poor adults remains perhaps its most obvious failure” (Rosenbaum). Regardless of the many faults of this programs design, Medicaid helps close to 60 million low-income families in the United States. The people it helps would include: pregnant women, young children and their parents, the disabled, and the elderly, and other members of society that have low income. Medicaid is involved in many pregnancies and newborn care from a financial standpoint. It allows parents to have medical care for the child while in a low-income household. Medicaid has a huge impact on each states health systems and is used in a wide variety of ways.
Health reform and health policy has taken over in the United States in recent years. Medicaid is one of the top policies being implemented throughout our nation today. To understand how Medicaid and federalism cross paths with each other one must understand the basic definitions and concepts each one brings. Federalism is “system of government in which the same territory is controlled by two levels of government. Generally, an overarching national government governs issues that affect the entire country, and smaller subdivisions govern issues of local concern.” In short, federalism is a government system that has an overseeing central government over state government. While, “Medicaid is a health insurance program for low-income individuals and families who cannot afford health care costs. Medicaid serves low-income parents, children, seniors, and people with disabilities.” Medicaid is a test based welfare program for United States Citizens. Now the question is how does Medicaid intersect with federalism? These two intersect because Medicaid is a need-based program that is funded by the federal government and the state government and administered at the state level. The issue with Medicaid is that if it expands then a crowding-out effect may occur. Meaning, that the more the government spends on Medicaid then less they would be able to spend on other programs such as: education, transportation, or other state priorities. Medicaid is supposed to provide access to health insurance for approximately half of our nations uninsured citizens. Without Medicaid a vast amount of low-income citizens will go without having a healthcare insurance plan.
Medicare and Medicaid are programs that have been developed to assist Americans in attainment of quality health care. Both programs were established in 1965 and are federally supported to provide health care coverage to vulnerable populations such as the elderly, the disabled, and people with low incomes. Both Medicare and Medicaid are federally mandated and determine coverage under each program; both are run by the Centers for Medicare & Medicaid Services, a federal agency ("What is Medicare? What is Medicaid?” 2008).
One in six Americans and mostly all of the population 65 years and older, are covered by Medicare. In 2012, Medicare provided for 50.7 million people, 42.1 million aged and 8.5 million disabled, with a total cost of $574 billion. This is about 21% of national health spending and 3.6% of Gross Domestic Product (Davis, 2013). Medicare, being a social insurance program, is required to pay for covered services provided to enrollees so long as the specific criteria is met. On av...
Health insurance is available from several sources. Private health insurance is provided by private companies. Subscribers pay health insurance companies a monthly fee for health insurance. In return, the company agrees to pay the doctor and hospital costs if the subscriber gets sick. There are different levels of coverage that a subscriber can purchase, but the cost of a health insurance policy is also set by the amount of risk the subscriber is willing to take. The more expense the subscriber is willing to pay, as either deductible or co-payment, the less the insurance company will charge for the insurance. Some Americans purchase their own health insurance, but most employers pay for the health insurance of its workers. Often this insurance
Health insurance provides benefits for sickness, injury, surgery, and prescription medication. There are a variety of plans with different
Health insurance facilitates entry into the health care system. Uninsured people are less likely to receive medical care and more likely to have poor health. Many Americans are foregoing medical care because they cannot afford it, or are struggling to pay their medical bills. “Adults in the US are more likely to go without health care due to cost” (Schoen, Osborn, Squires, Doty, & Pierson, 2010) Many of the currently uninsured or underinsured are forced accept inferior plans with large out-of-pocket costs, or are not be able to afford coverage offered by private health insurers. This lack of adequate coverage makes it difficult for people to get the health care they need and can have a particularly serious impact on a person's health and stability.