Healthcare Reform- Who, Where, How?
Who will purchase insurance?
The answer is simple- everyone! Everyone will be required to have insurance. The way coverage is expanded to everyone is by requiring everyone to have it, through whatever means they can. The bill mandates that most US citizens (and legal residents) purchase what is called "minimal essential coverage" for themselves and their dependents. (Good luck finding what they mean by "minimal essential coverage". I think this will be a future moving target.)
Where will they get it?
Through employers, primarily. If employers do not offer insurance, there will be established new "healthcare exchanges" which in essence are large purchasing organizations that offer insurance options to individuals at group-purchase rates. (Explaining these will be a future post). For those who choose not to carry insurance, there will be tax penalties (bringing in the IRS for policing practices). This penalty begins in 2014 and starts out small, but by 2016 is pretty substantial. The penalty will be whichever is greater: $695 for each family member (maximum $2085) or 2.5% of household income. Since the subsidies max out at $88,000 for a family of four, a household of 4 and income of $100,000 would pay $2500 in tax penalties.
Exceptions to the mandate for having health insurance includes American Indians, illegal immigrants, or prisoners.
How will it be paid for?
Employers, citizens, and the government...in other words, you and I will. Subsidies will be available for individuals making up to $44,000 per year ($88,000 for a family of four). Employers with 50 or more employees will be required to provide coverage or face stiff penalties. One of the requirements of the bill is that insurance carriers who sell to individuals and small groups will be required to put 80% of their premiums into medical services (large group insurers will be required to 85% of premiums on medical services). Companies (or organizations/exchanges) who don't meet these numbers will be required to refund those covered. (This starts January 2011).
My opinion- The reason for the requirement for everyone having insurance is simple...dilute the pool with relatively healthy people with minimal health issues who would otherwise choose to risk going without insurance or buy catastrophic policies. If those are required to purchase insurance, they offset the costs to insurance carriers (at least in theory). To me though, it seems like an indirect (or maybe direct) health tax. I know there are constitutional issues (like, the government can regulate commerce, but not require it).
I have some concerns about "minimal essential coverage". There is some talk around (I haven't found the final language yet) about requiring preventive services being covered. My gut tells me that a lot of the care we are accustomed to providing may not be covered. There is a push towards something called "evidence based medicine". This approach, while helpful in some cases, requires almost everything we do in a patient encounter conform to a set of guidelines or standards. Common sense, logic, and the nuances of the doctor-patient relationship have no role in prescribing, testing, or treating many common conditions. I can't tell you how many times I have found a cancer or coronary artery blockage based on my knowledge of the patient, their risk factors, and their lifestyle. These would have not met "evidence-based" criteria. This is a weekly, if not daily happening. I have concerns.
In keeping with my promise to provide mostly facts, I will not comment (at least for now) on the requirements and penalties on small businesses. That will be for another day.
The answer is simple- everyone! Everyone will be required to have insurance. The way coverage is expanded to everyone is by requiring everyone to have it, through whatever means they can. The bill mandates that most US citizens (and legal residents) purchase what is called "minimal essential coverage" for themselves and their dependents. (Good luck finding what they mean by "minimal essential coverage". I think this will be a future moving target.)
Where will they get it?
Through employers, primarily. If employers do not offer insurance, there will be established new "healthcare exchanges" which in essence are large purchasing organizations that offer insurance options to individuals at group-purchase rates. (Explaining these will be a future post). For those who choose not to carry insurance, there will be tax penalties (bringing in the IRS for policing practices). This penalty begins in 2014 and starts out small, but by 2016 is pretty substantial. The penalty will be whichever is greater: $695 for each family member (maximum $2085) or 2.5% of household income. Since the subsidies max out at $88,000 for a family of four, a household of 4 and income of $100,000 would pay $2500 in tax penalties.
Exceptions to the mandate for having health insurance includes American Indians, illegal immigrants, or prisoners.
How will it be paid for?
Employers, citizens, and the government...in other words, you and I will. Subsidies will be available for individuals making up to $44,000 per year ($88,000 for a family of four). Employers with 50 or more employees will be required to provide coverage or face stiff penalties. One of the requirements of the bill is that insurance carriers who sell to individuals and small groups will be required to put 80% of their premiums into medical services (large group insurers will be required to 85% of premiums on medical services). Companies (or organizations/exchanges) who don't meet these numbers will be required to refund those covered. (This starts January 2011).
My opinion- The reason for the requirement for everyone having insurance is simple...dilute the pool with relatively healthy people with minimal health issues who would otherwise choose to risk going without insurance or buy catastrophic policies. If those are required to purchase insurance, they offset the costs to insurance carriers (at least in theory). To me though, it seems like an indirect (or maybe direct) health tax. I know there are constitutional issues (like, the government can regulate commerce, but not require it).
I have some concerns about "minimal essential coverage". There is some talk around (I haven't found the final language yet) about requiring preventive services being covered. My gut tells me that a lot of the care we are accustomed to providing may not be covered. There is a push towards something called "evidence based medicine". This approach, while helpful in some cases, requires almost everything we do in a patient encounter conform to a set of guidelines or standards. Common sense, logic, and the nuances of the doctor-patient relationship have no role in prescribing, testing, or treating many common conditions. I can't tell you how many times I have found a cancer or coronary artery blockage based on my knowledge of the patient, their risk factors, and their lifestyle. These would have not met "evidence-based" criteria. This is a weekly, if not daily happening. I have concerns.
In keeping with my promise to provide mostly facts, I will not comment (at least for now) on the requirements and penalties on small businesses. That will be for another day.
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