Expansion of the United States' Healthcare coverage has been a topic of debate for several years since the introduction of Medicare and Medicaid in 1965 (Greer & Mendez, 2015). The 2000 presidential campaigns marked a significant point of this debate. Notably, there was contradicting healthcare policies as proposed by each of the two top presidential candidates. Both candidates, George W. Bush and Al Gore, strongly criticized each other's health policy proposals. Though faced with numerous opposing views, healthcare expansion remains a commendable reform that would improve healthcare quality, accessibility, and, affordability of primary medical services. This paper presents an evaluation of the health insurance policy expansion program with respect to the policy debate, the complexities governing health insurance value, and the cost associated with the coverage expansion.
The Health Coverage Policy Debate
According to Sun, Ahn, Lievens, and Zeng (2017), there has been a significant deterioration in the US healthcare system. Evidently, there has been a noticeable decrease in accessibility, cost increase, quality decline, and poor performance in the healthcare system. Therefore, a great urge has emerged to expand and transform the healthcare system in order to curb the worrying trends. However, the expansion and reform proposals have generated contrasting opinions among the politicians, health stakeholders, the business community, and American. Precisely, the healthcare reform issue has taken center stage on the US national agenda. There has been substantial recognition that the existing system is ineffective and hence the rise of a need to structurally reform and expand the healthcare insurance policy.
In an attempt to counter the expansion and reform proposals, Sun, Ahn, Lievens, and Zeng (2017) argue that such reforms are wasteful as the uninsured can still access health care services through community health centers. Such centers included outpatient public clinics, non-profit community hospitals, and local health departments among others. Unfortunately, this belief is a mere misperception of existing fact about the healthcare system. Markedly, accessibility of healthcare services is a more complex process than it possibly appeared to such critics. It is so complicated that even the already insured still found difficulties while accessing healthcare services. For example, the cover was restricted to just a few needs leading to limited access to healthcare services. Additionally, community health centers had inadequate capacity to provide healthcare. For this reason, the uninsured visiting such centers could not satisfactorily get comprehensive healthcare services. Therefore, a need to have a comprehensively reformed and an expanded health policy remained a priority for many Americans (Smyrl, 2014).
The common notion that care rationing was not needed in the US was also used to fight against health cover expansion plans (Camargo Jr. & Grant, 2015). They asserted that the existing insurance markets were to remain undisturbed. Such notion flourished because the public believed that rationing naturally existed in the US and any further attempt to ration the healthcare coverage was an outright denial of basic services. Nevertheless, this ideology was often an overlook of the existing healthcare system. Smyrl (2014) explains that market-based healthcare policies implicitly denied Americans services, especially those who could not pay for them. What typically missed within the public attitude was a societal perspective of the nature of services that were to be availed. There was a great mix up on the kind of services to provide for those who could afford without compromising the services of those who could not pay for health coverage. Clearly, there was a need to reform and expand the healthcare cover to eliminate such ambiguities.
Maruthappu, Ologunde, and Gunarajasingam (2013) pinpoint that some Americans believed that the free market had the potential to resolve all the healthcare problems. They claimed that the health insurance in the competitive market could successfully resolve all the healthcare delivery problems concerning costs, access, and quality. Therefore, they strongly opposed plans to expand and reform the healthcare coverage system. Unfortunately, the healthcare insurance market was not actually operated in a free competitive manner. Smyrl (2014) points out that healthcare market mechanisms yielded distributional advantages only for a particular group of individuals such as the insurers and providers. The uninsured remained sidelined within the healthcare market. Furthermore, the public interest was poorly presented in the private healthcare market. A good case example was that market-oriented healthcare insurer commonly used strategies that were basically designed to manage costs rather than care services. Thus, such beliefs on the free care market were not convincing enough to warrant the abolition of plans to expand healthcare coverage (Camargo & Grant, 2015). Instead, a rapid response to reform the existing healthcare system would be the best move to manage situations in the insurance market.
Another point in the debate was that there was a widespread misleading view that the US healthcare system was the best in the world. As Smyrl (2014) notes, this was a major obstacle to the implementation of the healthcare reforms and coverage expansion plans. Holders of this view believed that the US healthcare coverage system was on the right track and attempts to expand and reform was wasteful and would not have any significant impact. They strongly questioned whether previous attempts to reform and expand the healthcare coverage system had actually resulted in any demonstrable health effects. However, consistent world health reports indicated that the US was comparatively performing poorly in various health aspects (Sun et al., 2017). Such reports were clear indications that the US healthcare system was far from the best and serious measures were needed to be put in place. Expansion of health insurance coverage for every American would be an appropriate move.
Criticisms over proposals to restructure the US National Health Insurance (NHI) rendered efforts to expand the healthcare cover unfeasible. NHI reform critics argued that over-intrusive government roles in the proposed policy would politicize the whole plan and hence compromise the quality of health coverage. Additionally, such critics believed that government participation would lead to poor political acceptance of the policy among the Americans and limitedly serve the public interest. However, trials to implement the proposed NHI reforms in some states such as California provided factual evidence (Maruthappu, Ologunde, & Gunarajasingam, 2013). The trials included tax credits for individuals and employers, public program expansion, and single payer models. These trials revealed overwhelming health benefits among the covered. This, therefore, served as a good indication that many Americans desperately needed the implantation of the proposed health cover expansion.
Though faced with strong criticism, health insurance expansion and reform program remains a primary need among many Americans. The opposing views do not provide substantial grounds to ignore the need to develop a comprehensive and an expanded health insurance system. However, views from the critics should be taken into account while developing and implementing such reforms. This will ensure that the new health policy plan will serve best the interest of both the proponents and the opponents.
Complexities Governing Individual Health Insurance Value
Determination of the value of health insurance coverage for an individual is a complex process. Xu et al (2017) explain that cost-sharing factors play a prime role in the overall value of a healthcare cover and hence contribute to this complexity. Such factors include out-of-pocket spending limit, deductibles, coinsurance, and copayments. Out-of-pocket expenses are costs that individuals incur, out of their personal cash reserves, in order to receive a medical service. the insurance company does not always cover a portion of an insured medical bill. This necessitates the insured individuals to meet this cost by themselves in the form of out-of-pocket expense. Deductibles, copayments, and coinsurance form part of the out-of-pocket expense. A higher out-of-pocket spending limit results into higher cover value for individuals
A deductible on a health insurance plan is the amount an individual pays before the insurance company begins making a contribution towards any cost concerning health care services. The aim of the deductibles is to reduce the total cost incurred while an insurance company is compensating for medical expenses. Unfortunately, deductible sometimes gets complicated because some insurers treat prescription costs differently from the health coverage plan (Xu et al, 2017). In such circumstances, prescription costs are split into a special category of deductible and policyholders are made to meet the related costs. A higher deductible results in a higher cover value though with lower premiums. It is, however, important to note that both the government sets both the minimum and maximum values of deductibles. These values are however subject to amendments.
Coinsurance is the practice of sharing healthcare service costs between a consumer and his or her health insurance company. It is usually a percentage of the total cost of a health service covered. This means that when a medical risk occurs, the insured pays a percentage of the total cost associated with the risk while the insurance company pays the rest. Different medical services have different coinsurance percentages. Additionally, a coinsurance amount varies from one insurance organization to another. Markedly, a high coinsurance percentage results in a higher insurance value. Coinsurance, therefore, plays a great role in determining the value of individual health insurance.
A co-payment is a flat fee paid by a policy-holder for a medical service in an attempt to share the cost of a healthcare service with the insurance company. The amount of the fees paid depends on the plan and the medical service covered. Co-payments for most health plans can always be paid either before or after the deductibles. However, co-payments that apply before deductibles are always preferred because they allow insurance companies to make earlier payments for medical services. Therefore, co-payments have a direct impact on the value of a health insurance plan. A higher co-payment results in a high insurance value.
Costs Associated with Providing Expanded Coverage
Greer and Mendez (2015) assert that expanded health insurance coverage demands extra spending in order to meet the objectives of expansion. With the expansion being a comprehensive plan, several costs are incurred. Hospital care cost is one of the costs to be met in the coverage expansion. One of the expected effects of the expansion is an increase in the number of individuals seeking medical attention at the hospitals. The government must, therefore, allocate extra funds to cater for this increase in the hospital care services. Similarly, coverage will also lead to an increase in clinical and physician services hence the government must incur an extra cost to meet this increase in demand for such services. Furthermore, prescription drugs will have significant contributions to the overall cost of the coverage expansion. Expanded coverage translates into an increase in the number of patients seeking healthcare service and hence an increase in the number of prescribed drugs. Increased drug prescriptions must be met by a cost. Therefore, the governm...
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