Employer Healthcare Benefit Plans More Than Half Essay

Excerpt from Essay :

Employer Healthcare Benefit Plans

More than half of the American population is covered by a comprehensive health plan of one type or another. That's approximately 160 million people. The programs that come under the above mentioned coverage include the likes of employer sponsored plans and other government initiatives for instance Medicaid and Medicare, a small proportion of health insurance which is purchased on individual basis may also be included in this. If we proceed to explain employer sponsored health programs, government initiatives and individual healthcare benefits individually, then briefly we can say that the employer benefit plans mostly comprise of group plans and are called "the employee welfare benefit plans"

Table of Contents

Introduction

Literature Review

Discussion

The Estimated Effects of PPACA on Coverage

The Number of Uninsured Decreases by 53%

Four Million Children Will Gain Coverage

The Individual Mandate Contributes Most to Reducing the Number of Uninsured

Premiums in the Non-group Market Also Decline

5. Conclusion 8

6. Recommendations 9

7. References 10

Healthcare

Introduction

More than half of the American population, are covered by a comprehensive health plan of one type of the other, this makes approximately 160 million people. The programs that come under the above mentioned coverage include the likes of employer sponsored plans and other government initiatives for instance Medicaid and Medicare, a small proportion of health insurance which is purchased on individual basis may also be included in this. If we proceed to explain employer sponsored health programs, government initiatives and individual healthcare benefits individually, then briefly we can say that the employer benefit plans mostly comprise of group plans and are called "the employee welfare benefit plans." These plans are subject to federal rules which include disclosure, various fiduciary standards, claims collected throughout ones employment and grievances, once these are covered then a continuation of coverage is added to these benefits (Manning. 2000).

Employees are provided with healthcare benefits by their employers by either purchasing health insurance by a health insurance insurer or by utilizing self insured policy and providing benefits through that. However under the self insured health plans, the insurer holds the insurance risk and all the financial liabilities for the payments of claims are retained by him. The most common distinction between these two plans is very important. We can see that fully insured health plans are most of the times dependent on the various state regulations which utilize the plans put forward by health insurers and HMO's which to the products the issue, which include products like inclusion of various benefits which are state mandated, other approvals of insurance contact forms and the rates which apply to it. However, self-insured plans which cover more than 48 million people are covered by the federal law itself which is also known as Employee and Domestic Retirement Income Security Act (EDRISA).

The main purpose of this elaborative healthcare insurance process is that according to most observers this entire process seems to be very confusing and for common people who do not know what exactly and to what extent they are entitled to -- end up missing on their own benefits. For this reason the Patient Protection and Affordable Care Act was introduced in December 2009. This bill does not only cover people who already have healthcare benefits which includes employee, employer and domestic benefits, but also aims to provide people who do not have even the basic domestic healthcare protection available to them. This bill has been also dubbed as the "All American Healthcare Act" since it covers almost every American citizen irrespective of their race or creed (Manning. 1987).

Literature Review

Briefly the act suggests the following postulates to have come in action by 2010.

There will initially be an increase in demand of certain expected patients which will include outpatients, patients who require long-term care and other who require preventive care services. In the short-term which is during the calendar year of 2010, Medicare payments and the protection which comes with it, were to be extended to the rural hospitals as well, which will include services such as hospital outpatient services, lab services and those services which involve low volume of Medicare related patients.

In this bill the utilization of private hospitals and the physicians' offices are increasingly targeted through the cleaver task of steady implementation of "financial disincentives" and other regular changes over the promised eighty-year-old period of implementation. In this way congress is the authority which determines the payment scales for all physicians and their participation in any future Medicare initiatives throughout the summer of 2010.

The bill also suggests that from 2010 till 2016, on the primary care level the physicians will be able to receive bonuses up to 10%, which will calculates against their to be determined payment scales. This is only eligible if 60% of the physician's total Medicare charges include office, nursing home visits and other various home care visits.

All the general surgeons who will be performing any major surgeries which in the 10-19 days service period in a federal law regulated healthcare professional healthcare will also be eligible for 10% bonus for the payment for their services.

The new Medicare rules and regulation are focused towards the payment of the physicians by encouraging doctors to make their organizations a more "accountable care organizations" so that improvement in quality and efficiency can be achieved. This will assist in the facilitation of the development of a central mechanism which can control healthcare delivery.

The act also urges that Medicare create and physician payment program so that quality of care can be rewarded rather than the volume of services undertaken. Although the focus towards rewarding quality against quantity is a commendable step, it will however, discourage the hard working physicians who have their private practice who happen to now handle majority of patients or high volume of them. They are also responsible for treating the long queues of elderly patients who do not have proper insurance.

The act also calls for the creation of a Patient-Centered Outcomes Research Institute which will be responsible for contacting the private sector groups as well as the various federal agencies to conduct effective research on the comparative level. This is important because despite the current claims which lead to the contrary CER will be responsible for finding and also defining the ultimate boundaries including rules and regulation for sounds medical practices. This will in return ration all the health care to the elderly by weighing in the estimated cost which will be accounted for the care which will be given to the patient by comparing the patient's statistic of the years he might live.

Finally the act will treat the traditional U.S. healthcare institutions and the various practices as if they were the defacto federal property and hence will establish the projection which will lead to the ineluctably of the complete federalization of the healthcare system.

Discussion

We can base our discussion into three major sections. First will be the Acts status on the coverage. Second will be the various relative contributions of different options which will help in expanding the coverage of the overall results produced. Finally the decline in the premiums in the non-group market

The Estimated Effects of PPACA on Coverage

The Number of Uninsured Decreases by 53%

According to the PPACA the number of American citizens by 2019 will be reduced to 53% which is approximately 25 million. The increased and confirmed statistics when it comes to coverage comes from various factors which include comparison from status quo, the number of people who will enrolled in employer sponsored insurance (ESI) which is estimated to increase up to 6 million, also the number of people who are insured in the non-group market which obviously excludes exchanges, this is estimated to increase up to 10 million and finally the number of people covered by Medicaid is estimated to increase up to 12 million.

Four Million Children Will Gain Coverage

Under this act an estimated addition of about 4 million children will receive insurance coverage which will be compared against the status quo. This will is easy to predict because the increase in the number of children insured will come completely through the number of people enrolled in the ESI which is estimated to be 2.2 million by 2019. These increases reduce the number of children to 400,000 who are covered currently by the non-group market.

The Individual Mandate Contributes Most to Reducing the Number of Uninsured

when it comes to the point of individual mandate the act is quiet self sufficient as it promises to include and estimate each major converge provision as a separate entity which will include factors like individual employment penalties, employer individual penalties and Medicaid expansion. This indicates that the individual mandate by itself will have the largest impact of coverage, hence subsequently reducing the number of people who will be uninsured down to 31 million by 2019 (Pauly. 2000). This shows a reducing number of 21.5 million which is 41% if compared…

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