.
Friday, August 16, 2019
The importance of the meaning and measurement of “affordable†in the Affordable Care Act Essay
Affordable Care Act Introduction            The purpose of this paper is to research about the general health care condition of the United States citizens. The paper also argues about the advantages of individual payment of health insurance as opposed to compulsory insurance. Financial benefits of obamacare affordable care Act are also illustrated throughout the paper. The paper also illustrates about the rising costs of health care in United States where the US has the highest healthcare expenditure globally. The U.S healthcare system is also compared with other systems adopted by other developed countries to show the pros and cons of the United States system. The paper describes also about PPACA and how it solves many serious challenges which are faced by the small business owners such as lack of affordable coverage, rising health insurance costs, limited choice of health plans and escalating costs of health care.            Affordable care Act refers to the healthcare reform law in the United States. It is aimed at making health insurance and healthcare to be more available and more affordable to more American citizens. The act does this by new regulations, new rules and consumer protections the industry of healthcare, through establishing a marketplace purposed for insurance which is subsidized and also by expanding and reforming public programs on healthcare programs such as Medicaid and Medicare. Affordable care Act also incorporates measures which are aimed at reducing healthcare spending in United States. Many American citizens are unaware that since 2010 when the Affordable care Act became into law after being signed they have been enjoying from the protections, rights and benefits of obamacare (Faria, 2012). Before this Affordable care Act many small businesses and low and middle income earning American citizens found it challenging to afford healthcar e for their families and also for themselves (Burkhauser & Lyons, 2011). In the past the many sick people were denied health treatment or coverage with diminutive right for appealing. Insurance companies charged individuals more on basis of their health status where women were required to pay higher rates. Affordable care Act entails provisions which are aimed at solving all these challenges. Obamacare gives rise to clear financial benefits for all stakeholders: the government, the individual and the insurance companies. BODY Macroeconomic angle Non –return on high healthcare expenditure America’s high healthcare expenditure            United States expenditure on health care is very high becoming a great concern however it is the medical expenditure growth rate and not its level which determines the financial security of United States. United States expenditure exceeds one -sixth of the economy of the country and the percentage keep rising every year. Unfortunately, this system does not deliver value to match the annual health care expenditure totaling to approximately 2.7 trillion dollars. Experts claims that approximately 20% to 30% of that spending which totals to about 800 billion dollars annually is spent on care that is inefficient, redundant and wasteful (Miller, 2001). This rise in healthcare expenditure harms the country in many ways. For seniors and families, the increasing medical care cost means increased expenses making them to make hard choices regarding to rent, needed care and balanced food. For the local, state and federal governments, increasing health costs result to higher Medicaid and Medicare costs, and decreased funding on key priorities like education, public safety and infrastructure (Oberlander, 2012). For the fortune 500 employers and small businesses these costs makes it challenging for them to add new workers, maintain retiree coverage becomes a great challenge for them and they are unable to compete in world economy. The net outcomes of increasing health care costs are ominous and far –reaching: increased costs for health insurance, erosion of global competitiveness, fraying of nation’s safety net and fiscal insolvency which is long-standing. Although health reform law has made important steps in spreading out coverage, more efforts should also be directed to reducing the increasing healthcare cost (Sade, 2012). Comparison with other developed nations            U.S health care expenditure is the highest compared to other nations yet the American citizens experiences more illnesses and die sooner compared to citizens from other developed countries. United States is ranked 37th position out of 191 nations according to the world health organization (WHO) health care systems rankings. This means that despite the fact that the united states citizens spends a lot of money on healthcare and the cost is still increasing however they are offered product which is ranked 37th position in quality. When comparing United States with other nations which are developed, it is evident that America performs poorly on infant mortality and life expectancy. Also United States tops list of deaths which are perceived to be preventable when diagnosed early and adequate early care is administered. Typical American citizen has very few doctor appointments annually compared to citizens from other nations but yet spends more for this privilege. When U.S citizen is admitted one day in a hospital, it would 5.6 times more when compared to what it would cost a Japan citizen. Also United States top all other developed nations in healthcare cost where it spends 8,233 dollars more per individual annually than other developed nations, although 47 million of those U.S citizens are still uninsured ( Hodge, Arias and Ordell, 2011).            The figure $8,233 per citizen annually spent by united states is over two and a half times more compared to what other developed countries spend per citizen annually globally including Europeans nations which are relatively rich such as united kingdom, Sweden and France. On an advanced global scale, it is clear that health care costs of United States represents 17.6% of the nation’s GDP.            According to reports from OECD (organization for Economic Co-operation and Development) which is an international economic group which consists of 34 member countries, American citizens are not getting what they expect.            United States has fewer physicians per individual compared to most other OECD nations. For example United States had 2.4 physicians per 1000 citizens in 2010 which is below 3.1 which is OECD average. In 2009, the hospital beds number in United States was 2.6 per 1,000 individuals which is lower than 3.4 beds which is OECD average.            Between 1960 and 2010, Life expectancy in the U.S increased by approximately nine years however those years were few compared to Japan where there was an increase of 15 years and also it was below 11 years which the average in OECD nations. Also, in 2010 the average U.S citizen lived 78.7 years which is below 79.8 years which is the average.            However, United States tops globally in the cancer treatment and health care research, for example. The breast cancer survival rate is very high in United States compared to other OECD nations and also U.S is among the best in survival from colorectal cancer. The poor general health condition of American citizens            United States citizens spend a lot of money on healthcare and the cost is still increasing however they are offered product which is ranked 37th position in quality. This means that Americans are offered poor general health care. U.S healthcare system does not deliver value to match the annual health care expenditure totaling to approximately 2.7 trillion dollars. Experts claims that approximately 20% to 30% of that spending which totals to about 800 billion dollars annually is spent on care that is inefficient, redundant and wasteful. Also United States tops list of deaths which are perceived to be preventable when diagnosed early and adequate early care is properly administered.            The leading cause of disability and death in United States is the chronic diseases. They lead to 7 out of 10 deaths annually. Stroke, cancer and heart disease leads to more than 50% of all deaths annually.            Out of 107 million American citizens approximately 1 out of every 2 adults aged 18 or much older had at least 1 of 6 reported chronic ailments which includes asthma, arthritis, diabetes, cancer, cardiovascular disease and chronic obstructive pulmonary disease. Typical American citizen has very few doctor appointments annually compared to citizens from other nations but yet spends more for this privilege. When U.S citizen is admitted one day in a hospital, it would 5.6 times more when compared to what it would cost a citizen from other nations. When comparing United States with other nations which are developed, it is evident that America performs poorly on infant mortality and life expectancy. United States has fewer physicians per individual compared to most other OECD nations. In 2009, the hospital beds number in United States was 2.6 per 1,000 individuals which is lower than 3.4 beds which is OECD average. These facts from various resea rches shows that American citizens experiences poor general health condition despite the fact that they spend the highest amount on healthcare but they end up getting poor quality compared to other developed countries. Therefore, it is evident that despite the fact that although America is among wealthiest countries globally however, it is far from becoming the healthiest nation (Sage, 2011). The nine health domains studied by Committee on Population, and Board on Population Health and Public Health Practice. When United States is compare with peer nations which are average America is ranked poorly in the following nine health domains. Adverse birth results: For many years America has experience huge infant mortality rate of high income nations and also ranked poorly on other birth results, like low birth weight. Kids in America are unlikely to live to age 5 compared to kids in other nations with high incomes. Injuries and homicides: Violence, deaths emanating from motor vehicle accidents and injuries which are not related to transportation occur at much more commonly in U.S than in other nations and are a primary cause of deaths in kids, young adults and adolescents. Since 1950s, Young adults and adolescents in United States have died at an alarming rate from homicide and traffic accidents than in other nations. Sexually transmitted infections and Adolescent pregnancy: since 1990’s , among all the developed nations the united states adolescents have had high chances of acquiring infections which are sexually transmitted and also have the highest number of pregnancies. HIV and AIDS: America is the second leading nation among 17 peer nations with high pervasiveness of HIV infection. Drug-related mortality: united states lose more life years to alcohol and also other drugs compared to individuals from peer nations, even after excluding deaths emanating from drunk driving. Diabetes and Obesity: For many years America has experienced the highest rates of obesity among the developed nations. High occurrence rates for obesity are experienced in United States kids and also in every age group subsequently. From 20 years onward the adults in America have among the highest occurrence rates of diabetes among peer nations. Heart disease: Death rate in America emanating from ischemic heart disease is second leading among the 17 peer nations. Citizens from united states attain age 50 with less favorable cardiovascular risk profile compared with their peers in Europe and also adults aged over 50 years have higher chances of developing and dying from cardiovascular disease compared to older adults in developed nations. Chronic lung disease: Lung disease are more common and linked with high mortality rates in America compared to UK and other European nations. Disability: older adults in United States depicts higher occurrence of activity limitations and arthritis compared to their counterparts in Japan, UK and other European nations (Sade, 2012). Comparison with other developed nations            For many years, Violence, deaths emanating from motor vehicle accidents and injuries which are not related to transportation occur at much more commonly in U.S than in other nations and are a primary cause of deaths in kids, young adults and adolescents. Since 1950s, Young adults and adolescents in United States have died at an alarming rate from homicide and traffic accidents than in other nations.            America has experience huge infant mortality rate of high income nations and also ranked poorly on other birth results, like low birth weight. Kids in America are unlikely to live to age 5 compared to kids in other nations with high incomes (Majette, 2011).            since 1990’s , among all the developed nations the united states adolescents have had high chances of acquiring infections which are sexually transmitted and also have the highest number of pregnancies.            America is the second leading nation among 17 peer nations with high pervasiveness of HIV infection. united states lose more life years to alcohol and also other drugs compared to individuals from peer nations, even after excluding deaths emanating from drunk driving.            For many years America has experienced the highest rates of obesity among the developed nations. High occurrence rates for obesity are experienced in United States kids and also in every age group subsequently. From 20 years onward the adults in America have among the highest occurrence rates of diabetes among peer nations.            Death rate in America emanating from ischemic heart disease is second leading among the 17 peer nations. Citizens from united states attain age 50 with less favorable cardiovascular risk profile compared with their peers in Europe and also adults aged over 50 years have higher chances of developing and dying from cardiovascular disease compared to older adults in developed nations.            Lung disease is more common and linked with high mortality rates in America compared to UK and other European nations.            Older adults in United States depicts higher occurrence of activity limitations and arthritis compared to their counterparts in Japan, UK and other European nations (Sade, 2012). Financial justification for system overhaul            United States healthcare system in not universal, where some people benefits more from the system compared to others. This system does not deliver value to match the annual health care expenditure totaling to approximately 2.7 trillion dollars. The Experts claims that approximately 20% to 30% of that spending which totals to about 800 billion dollars annually is spent on care that is inefficient, redundant and wasteful. United States top all other developed nations in healthcare cost where it spends 8,233 dollars more per individual annually than other developed nations, although 47 million of those U.S citizens are still uninsured. This necessitates an overhaul of the entire healthcare system which is both complex and gigantic. When comparing America healthcare system to Dutch system there are many improvements that are required in order for the US system to be successful. Some of these improvements should be trying to make it transparent and simpler for consumers to purchase health insurance easily through aggressive regulation of the insurance marketplace in such a manner that the products are universal.            Obamacare has four types of fundamental insurance packages which includes platinum, gold, silver and bronze. Dutch system has just one type of package for fundamental insurance. The system should not discriminate some applicants by charging them higher premiums depending on their age, health status, gender and just like Dutch system they should charge all the applicants the same price. Under the obamacare system the older applicants are supposed to pay three times as much in terms of premiums than the young ones. This means in obamacare system an applicant is supposed to input and then verify their age in order for their charge to be determined.            The system in US should be modified to be transparent where consumers should be allowed to compare prices and buy insurance through private sector portal websites instead of government run website. This will led to an aggressive way of restructuring and regulating the private sector industry as consumers will be able to compare the prices and decide which insurance to buy thus reducing consumer exploitation and increasing transparency. In this way the government will be able to reduce the rising healthcare costs and the number of the insured citizens will increase (Pipe, 2013). Microeconomic angle: Opposing views and rebuttals The individual’s point of view The individual mandate: compulsory insurance Opposing view: compulsory insurance places financial burden on citizens            Universal healthcare system where compulsory insurance is introduced to everyone would do more harm to the citizens due to the financial burden it would implicate to the citizens. This would give the insurance companies a chance to increase the premiums since government will not be able to cover everyone where some people will be coerced to purchase insurance from the private sector insurance companies since it is a compulsory insurance. The poor and low income earners would be required to dig deep into their pockets and purchase the insurance despite the fact that insurance premiums are rising. During presidential campaign in 2008, president Barrack obama who was then a Democrat senator assured American citizens to improve the health care where he claimed that 47 million American citizens were not in a financial position to afford health insurance. He instead advocated for creation of government run, federally administered health care sys tem where people would pay individually for their health care and insurance instead of compulsory insurance which overburdened the poor. He also explained that people could be offered subsidized government coverage making insurance affordable to many. Requiring for citizens to buy mandatory health care insurance from private companies at any price they decide to charge will be directly overburdening the citizens while promoting the insurance industry. This is because insurance premiums rise faster than income thus reducing the disposable income of the citizens.            For the poor and those who earn low incomes they will be forced to choose low premium plans which have high deductibles and co-payments. This is because they cannot afford the best plans due to high premiums. Therefore many poor citizens will be left with healthcare insurance which is unaffordable to use but they are mandated to purchase such insurance anyway    Compulsory insurance is extremely regressive and in some cases the mandated insurance plus the co-payments can add up to almost a third of the income which is a great financial burden to the citizensRebuttal 1: The ‘health promotion’ theory of insurance            Health promotion refers to the approach of allowing people to increase power over the health determinants thus improving their health. It is the most sustainable, efficient, effective and ethical approach to attaining good health.            PPACA invests in research to identify relative value of healthcare procedures.            PPACA solves many serious challenges which are faced by the small business owners such as lack of affordable coverage, rising health insurance costs, limited choice of health plans and escalating costs of health care. PPACA is highly popular as the most fundamental health care legislation since establishment of Medicaid and Medicare about 10 years ago. The act was enacted in 2010 and it was aimed at taking effect in phases in a period of 8 years and incorporates reforms like expansion of Medicaid eligibility, subsidizing of insurance premiums, providing businesses with incentives to offer health care benefits and prohibiting the insurers from denying some applicants coverage for the pre-existing conditions. It persuades states to introduce exchanges of health care where small businesses and adults who are uninsured can purchase insurance from a variety of the private insurers. One element of PPACA is promoting comparative effectiveness res earch. This is aimed at comparing treatment options which are available. The core benefit of PPACA is to reduce the number of the uninsured individuals and providing them with high value healthcare (Gray & Sullivan, 2011). It uses a mixture of subsidies, tax credits and mandates in encouraging people and corporations on buying coverage and also it protects applicants who are hard to insure including those who possess conditions which are pre-existing. Other elements of legislation will be aimed at encouraging evidence based decision making and improving healthcare practices. United States tops globally in the cancer treatment and health care research by PPACA, for example. The breast cancer survival rate is very high in United States compared to other OECD nations and also U.S is among the best in survival from colorectal cancer thus ensuring high value healthcare. The comparative effectiveness research (CER) involves a board which lowers overall expenditure through determining whic h procedures, treatments and medicines which are most perfect, their price tags and identifying those who ignore justifying identifying the evidence based health benefits. Through PPACA as the acknowledgement Medicare has been successful in rewarding certain health coverage providers and punishes some providers on basis of value of care. Through PPACA Medicare is required to measure performance and change payments of providers on basis of scoring system in its current value based purchasing program (Skocpol, & Williamson, 2011). PPACA promotes consumption of ‘high value’ healthcare.            The core benefit of PPACA is to reduce the number of the uninsured individuals and providing them with high value healthcare. It uses a mixture of subsidies, tax credits and mandates in encouraging people and corporations on buying coverage and also it protects applicants who are hard to insure including those who possess conditions which are pre-existing. Other elements of legislation will be aimed at encouraging evidence based decision making and improving healthcare practices. Through PPACA as the acknowledgement Medicare has been successful in rewarding certain healthcare providers and punishes some providers on basis of value of care. PPACA solves many serious challenges which are faced by the small business owners such as lack of affordable coverage, rising health insurance costs, limited choice of health plans and escalating costs of health care. Through PPACA Medicare is required to measure performance and change payments of provid ers on basis of scoring system in its current value based purchasing program. PPACA is highly popular as the most fundamental health care legislation since establishment of Medicaid and Medicare about 10 years ago. The act was enacted in 2010 and it was aimed at taking effect in phases in a period of 8 years and incorporates reforms like expansion of Medicaid eligibility, subsidizing of insurance premiums, providing businesses with incentives to offer health care benefits and prohibiting the insurers from denying some applicants coverage for the pre-existing conditions. It persuades states to introduce exchanges of health care where small businesses and adults who are uninsured can purchase insurance from a variety of the private insurers. One element of PPACA is promoting comparative effectiveness research. This is aimed at comparing treatment options which are available. The comparative effectiveness research (CER) involves a board which lowers overall expenditure through determin ing which procedures, treatments and medicines which are most ideal, their price tags and identifying those who ignore justifying identifying the evidence based health benefits. United States tops globally in the cancer treatment and health care research by PPACA, for example. The breast cancer survival rate is very high in United States compared to other OECD nations and also U.S is among the best in survival from colorectal cancer thus ensuring high value healthcare (Kotlikoff, 2007). Rebuttal 2: The ‘financial security’ model of health insurance            Individual’s financial risk due to unforeseen illness            Insurance companies play a great role in managing the risk of individuals. These companies enable individuals to share their liability through pooling the personal risk and assist them through reducing chances of facing financial desolation. Due to many risks that individuals faces on a daily basis, these insurance companies have advanced over the years to meet the needs of the average human beings and have come up with different products and policies which covers almost entire risks. These companies normally provide financial coverage of loss that a certain person is expected to suffer as a result of unforeseen events thus reducing the effects of a certain event. They compensate the financial damage and people whose peril can be pooled. An individual who want to be insured is expected to pay a premium which is dependent on the probability of the event occurring where high probabilities will lead to high premiums. In a case of health insur ance the insurance is able to insure individuals through pooling the risk of illness. The health care cost is easily balanced in the pool since some individuals go through life devoid of catching a cold whereas others have to spend many dollars for treatment. The act of pooling the peril with other individuals is a prudent decision since no individual is able to predict what their health will be, and also how much they will have to pay in order to be treated. It is therefore advisable for individuals to pay for their individual health insurance to avoid financial challenges that may face them in case of unforeseen illness (Woolf & Aron, 2013)            The escalating costs of health insurance prior to PPACA.            PPACA solves many serious challenges which are faced by the small business owners such as lack of affordable coverage, rising health insurance costs, limited choice of health plans and escalating costs of health care. The core benefit of PPACA is to reduce the number of the uninsured individuals and providing them with high value healthcare. It uses a mixture of subsidies, tax credits and mandates in encouraging people and corporations on buying coverage and also it protects applicants who are hard to insure including those who possess conditions which are pre-existing. Other elements of legislation will be aimed at encouraging evidence based decision making and improving healthcare practices. Before PPACA the health insurance costs were very high and still escalating year after year. This was as a result of requiring citizens to buy mandatory health care insurance from private companies at any price they decide to charge which directly ov erburdening the citizens while promoting the insurance industry. This made insurance premiums to rise faster than income thus reducing the disposable income of the citizens. The number of uninsured Americans was very high where 47 million American citizens were not in a financial position to afford health insurance. President obama was against this and he launched PPACA aimed at reducing the escalating health insurance costs. He also advocated for creation of government run, federally administered health care system where people would pay individually for their health care and insurance instead of compulsory insurance which overburdened the poor. He offered subsidized government coverage making insurance affordable to many. PPACA reduced the rising costs of health insurance which resulted to increased number of people who were insured (Hofer, Abraham, & Moscovice, 2011). Cost-sharing requirements under older health insurance regime.            There was a universal insurance regime where every person was supposed to be responsible for his or her health insurance. This regime required citizens to buy mandatory health care insurance from private companies at any price they decide to charge which directly overburdening the citizens while promoting the insurance industry. This made insurance premiums to rise faster than income thus reducing the disposable income of the citizens. The number of uninsured Americans was very high where 47 million American citizens were not in a financial position to afford health insurance. The insurance market place was not controlled by government which gave the insurance companies a chance to raise the premiums. Every individual was required to be covered where those who did not have a cover were faced by financial fines. Non-insurance or under-insurance as result of the above            This healthcare coverage approach made many people who were unable to pay the good plans to opt for the buying covers that were not helpful to them just because they wanted to fulfill the requirement. Many other people were unable to purchase any cover as a result of increased premiums as a result of uncontrolled insurance marketplaces. Also, most of the people were under insured due to financial constraints. This made many people in reality to be non -insured since the covers they purchased could not be used to compensate them during an event of illness. Also those who were under insured were not able to get fully compensation in an event of illness. Therefore, this led to poor general healthcare situation for many citizens (Hoffman, 2011).            PPACA places reasonable limits on financial insecurity due to health hazards            PPACA is aimed at reducing the number of the uninsured individuals and providing them with high value healthcare. It uses a mixture of subsidies, tax credits and mandates in encouraging people and corporations on buying coverage and also it protects applicants who are hard to insure including those who possess conditions which are pre-existing. Other elements of legislation will be aimed at encouraging evidence based decision making and improving healthcare practices. Through PPACA as the acknowledgement Medicare has been successful in rewarding certain healthcare providers and punishes some providers on basis of value of care. PPACA solves many serious challenges which are faced by the small business owners such as lack of affordable coverage, rising health insurance costs, limited choice of health plans and escalating costs of health care. Through PPACA Medicare is required to measure performance and change payments of providers on basis of scoring system in its current value based purchasing program. PPACA is highly popular as the most fundamental health care legislation since establishment of Medicaid and Medicare about 10 years ago. The act was enacted in 2010 and it was aimed at taking effect in phases in a period of 8 years and incorporates reforms like expansion of Medicaid eligibility, subsidizing of insurance premiums, providing businesses with incentives to offer health care benefits and prohibiting the insurers from denying some applicants coverage for the pre-existing conditions. It persuades states to introduce exchanges of health care where small businesses and adults who are uninsured can purchase insurance from a variety of the private insurers (Hoffman, 2011).            The comparative effectiveness research (CER) involves a board which lowers overall expenditure through determining which procedures, treatments and medicines which are most ideal, their price tags and identifying those who ignore justifying identifying the evidence based health benefits. United States tops globally in the cancer treatment and health care research by PPACA, for example. The breast cancer survival rate is very high in United States compared to other OECD nations and also U.S is among the best in survival from colorectal cancer thus ensuring high value healthcare. One element of PPACA is promoting comparative effectiveness research. This is aimed at comparing treatment options which are available (Sade, 2012). Financial relief to the individual            Insurance companies enable individuals to share their liability through pooling the personal risk and assist them through reducing chances of facing financial desolation. They play a great role in managing the risk of individuals and providing financial relief to individuals who are faced by a calamity which they had insured. These Due to many risks that individuals faces on a daily basis, these insurance companies have advanced over the years to meet the needs of the average human beings and have come up with different products and policies which covers almost entire risks. These companies normally provide financial coverage of loss that a certain person is expected to suffer as a result of unforeseen events thus reducing the effects of a certain event. They compensate the financial damage and people whose peril can be pooled. An individual who want to be insured is expected to pay a premium which is dependent on the probability of the ev ent occurring where high probabilities will lead to high premiums. In a case of health insurance the insurance is able to insure individuals through pooling the risk of illness. The health care cost is easily balanced in the pool since some individuals go through life devoid of catching a cold whereas others have to spend many dollars for treatment. The act of pooling the peril with other individuals is a prudent decision since no individual is able to predict what their health will be, and also how much they will have to pay in order to be treated. It is therefore advisable for individuals to pay for their individual coverage to avoid financial challenges that may face them in case of unforeseen event. Rebuttal 3: The ‘brute luck’ theory of health insurance            Underwriting; Insurers’ discrimination on the basis of unavoidable risk factors, resulting in high insurance costs            The insurance companies look at many determinants when determining the premiums to be paid by the applicant for them to be covered for a certain risk. Some applicants are supposed to pay higher premiums due to their health status, gender, race, religion, national origin, age among other factor. For instance, older adults are asked to pay higher premiums by health insurance providers than the premiums expected for young adults and kids. In this regard the insurers charge different premiums depending with groups on basis of their risk. These health coverage providers categorize their insureds into different risk pools on basis of their differences in their risk probabilities (Hoffman, 2011). PPACA prohibits above-mentioned discrimination            PPACA is against these discriminatory laws and requires the coverage providers to stop this discrimination and charge the applicants fairly without considering their pre-conditions. It protects applicants who are hard to insure including those who possess conditions which are pre-existing from this discrimination. This is aimed at ensuring that no one is penalized for their propensities and genetics or for factors and events which are beyond their control (Hoffman, 2011). Financial relief to the ‘unlucky’ individual            Insurance companies play a great role in managing the risk of individuals and providing financial relief to unlucky individuals who are faced by a calamity which they had insured. This is because they enable individuals to share their liability through pooling the personal risk and assist them through reducing chances of facing financial desolation. As a result of many risks that individuals faces on a daily basis, these insurance companies have advanced over the years to meet the needs of the average human beings and have come up with different products and policies which covers almost entire risks. These companies normally provide financial coverage of loss that a certain person is expected to suffer as a result of unforeseen events thus reducing the effects of a certain event. They compensate the financial damage and people whose peril can be pooled. An individual who want to be insured is expected to pay a premium which is dependent on the probability of the event occurring where high probabilities will lead to high premiums. In a case of health insurance the insurance is able to insure individuals through pooling the risk of illness. The health care cost is easily balanced in the pool since some individuals go through life devoid of catching a cold whereas others have to spend many dollars for treatment. The act of pooling the peril with other individuals is a prudent decision since no individual is able to predict what their health will be, and also how much they will have to pay in order to be treated. It is therefore advisable for individuals to pay for their individual coverage to avoid financial challenges that may face them in case of unforeseen event. This is because if they are unlucky they will be provided with financial relief by their health insurance providers (Hoffman, 2011).. The insurers’ point of view Opposing views & rebuttals Objection 1 & rebuttal Objection: Insurance companies’ bottom lines hurt through limitations on deductibles, co-insurance and co-payments, and prohibition on underwriting.            Employee expenses on cost sharing include coinsurance, deductibles and co-payments. Insurers companies are experiencing unfavorable impact due to the limitations on co-payments, coinsurance, deductable and prohibition on underwriting as they increases the risks therefore increasing the amounts paid as compensation thus reducing their returns. Rebuttal 1: Insurers’ losses from reduced profit margins mitigated through broadened customer base            Insurers’ losses from reduced margins can be reduced by increasing their customer base. This is because insurance use the pooling of risks approach where broadened customer base will result to high returns. This is because more customers will lead to more funds in funding pool of risks while the amount paid out to the unlucky individuals as compensation will be low than the premiums paid therefore leading to increased profit margins. Also, increased broadened customer base also serves as a way of diversifying the risks. Rebuttal 2: View disproved by financial statements and stock market movements            Such a view which is refuted by stock market movement and financial statements should not be used and should be regarded as void. Stock movements are un predictable and an insurance company should not be forced to compensate an unlucky individual who loses unless such a claim is validated. Objection 2 & rebuttal Objection: Compulsory acceptance of foreseeable risks unfair burden on insurers            PPAC protects the applicants from the insurer’s discrimination where the insurance companies are forced to accept foreseeable risks thus reducing the profit margins. This mandatory acceptance of these foreseeable risks will lead to increased expenses which are paid to the unlucky individuals as compensation which eventually leads to reduced returns. This act is unfair to the insurers since they should be given an opportunity to consider whether to accept or reject insuring individuals with foreseeable risks. This is because increase in amounts paid for these foreseeable risks as compensations will reduce the profits margins to an extent of making losses which may lead to such companies deciding to exit the industry due to constant loss making.            Rebuttal: Insurers allowed to underwrite avoidable risks and discriminate on the basis of lifestyle choices            Insurers should be allowed to discriminate based on lifestyle choices and underwrite avoidable risks. This is because the individual to be covered should be responsible. The fear that individuals may have that they may not be compensated if the risk was avoidable would prevent them from making choices which are reckless thus protecting the insurance companies from paying unfair amounts as compensation. Also individuals should be responsible and they should put necessary measures or efforts to ensure that the risk doesn’t occur, so as not to overburden the insurance provider with expenses which are avoidable. In this regard individuals should be ready to bear the responsibilities for the consequences of their freely made decisions. Summing up & Conclusion            Affordable care Act also incorporates measures which are aimed at reducing healthcare spending in United States. Many American citizens are unaware that since 2010 when the Affordable care Act became into law after being signed they have been enjoying from the protections, rights and benefits of obamacare. Before this Affordable care Act many small businesses and low and middle income earning American citizens found it challenging to afford healthcare for their families and also for themselves. In the past the many sick people were denied health treatment or coverage with diminutive right for appealing. Insurance companies charged individuals more on basis of their health status where women were required to pay higher rates. Affordable care Act entails provisions which are aimed at solving all these challenges.            The cost of health care in United States keeps rising year after year at an alarming rate. This rise in healthcare expenditure harms the country in many ways. For seniors and families, the increasing medical care cost means increased expenses making them to make hard choices regarding to rent, needed care and balanced food. For the local, state and federal governments, increasing health costs result to higher Medicaid and Medicare costs, and decreased funding on key priorities like education, public safety and infrastructure.            For many years America has experienced the highest rates of obesity among the developed nations. High occurrence rates for obesity are experienced in United States kids and also in every age group subsequently. From 20 years onward the adults in America have among the highest occurrence rates of diabetes among peer nations. However, United States tops globally in the cancer treatment and health care research, for example. The breast cancer survival rate is very high in United States compared to other OECD nations and also U.S is among the best in survival from colorectal cancer thus ensuring high value healthcare.            In conclusion, although obama care has been faced by many challenges however it has resulted to many benefits than costs. Before this Affordable care Act many small businesses and low and middle income earning American citizens found it challenging to afford healthcare for their families and also for themselves. In the past the many sick people were denied health treatment or coverage with diminutive right for appealing. Insurance companies charged individuals more on basis of their health status where women were required to pay higher rates. Affordable care Act entails provisions which are aimed at solving all these challenges. Although it have been faced by many challenges obamacare remains a good system which should not be done away with since it gives rise to clear financial benefits for all stakeholders: the government, the individual and the insurance companies. References Burkhauser, R. V., & Lyons, S. (2011). The importance of the meaning and measurement of â€Å"affordable†in the Affordable Care Act. Cambridge, Mass.: National Bureau of Economic Research. Faria, M.A. (2012). ObamaCare: Another step toward corporate socialized medicine in the US. Surgical Neurology International, Jan. 2012, 386+. Gray, B. J., & Sullivan, K. C. (2011). Provisions in the Patient Protection and Affordable Care Act (PPACA). New York: Nova Science Publisher’s, Inc. Hodge JG., Arias J., and Ordell, R. (2011). Nationalizing Health Care Reform in a Federalist System. Arizona State Law Journal, 42(4), 1245-1275. Hofer, A.N., Abraham, J.M & Moscovice, I. (2011). Expansion of Coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization. The Milbank Quarterly, 89(1), 69–89. Hoffman, A.K. (2011). Three models of health insurance: The conceptual pluralism of the Patient Protection and Affordable Care Act. University of Pennsylvania Law Review, 159(6), 1873-1954. Kotlikoff, L. J. (2007). The healthcare fix: universal insurance for all Americans. Cambridge, Mass.: MIT Press. Majette, G.R. (2011). PPACA and public health: Creating a framework to focus on prevention and wellness and improve the public’s health. Journal of Law, Medicine & Ethics, 39(3), 366-379. Miller, E. A. (2001). The Affordable Care Act: advancing long-term care policy in the United States. Norwood, NJ: New Age International. Oberlander, J. (2012). The future of obamacare. The New England Journal of Medicine, 367(23), 2165-7. Pipes, S. (2013). The cure for Obamacare. New York: Encounter Books. Sade, R.M. (2012). Introduction: The health care reform law (PPACA): Controversies in ethics and policy. Journal of Law, Medicine & Ethics, 40(3), 523-525. Sage, W.M. (2011). Brand new law! The need to market health care reform. University of Pennsylvania Law Review, 159(6), 2121-2146. Skocpol, T. & Williamson, V. (2011). Obama and the transformation of U.S. public policy: The struggle to reform health care. Arizona State Law Journal, 42(4), 1203-1232. Woolf, S.H., & Aron, L.Y. (Eds.) (2013). U.S. health in international perspective: shorter lives, poorer health. Retrieved from http://www.nap.edu/catalog.php?record_id=13497. Source document
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment