Subsidized options for low-income individuals and families
Because health care financing is so interwoven with provider reimbursement and cost containment, national health insurance proposals usually also address those topics. The controversies that erupt over universal health care coverage become simpler to understand if one returns to the four basic modes of health care financing outlined in Chapter 2 : out-of-pocket payment, individual private insurance, employment-based private insurance, and government financing.
There is general agreement that out-of-pocket payment does not work as a sole financing method for costly contemporary health care. National health insurance involves the replacement of out-of-pocket payments by one, or a mixture, of the other three financing modes. Under government-financed national health insurance plans, funds are collected by a government or quasigovernmental fund, which in turn pays hospitals, physicians, health maintenance organizations HMOs , and other health care providers. Under private individual or employment-based national health insurance, funds are collected by private insurance companies, which then pay providers of care.
Historically, health care financing in the United States began with out-of-pocket payment and progressed through individual private insurance, then employment-based insurance, and finally government financing for Medicare and Medicaid see Chapter 2. In the history of US national health insurance, the chronologic sequence is reversed. Early attempts at national health insurance legislation proposed government programs; private employment-based national health insurance was not seriously entertained until , and individually purchased universal coverage was not suggested until the s Table 15—1.
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Following this historical progression, we shall first discuss government-financed national health insurance, followed by private employment-based and then individually purchased universal coverage. The most recent chapter of this history is the enactment under the administration of President Obama of the Patient Protection and Affordable Care Act of , a pluralistic approach Forgot Password?
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Enable Autosuggest. Previous Chapter. And some firms, as Hurst said, have started self-insuring and would not be captured in the DOI figures. But still, it looks like something is happening in the small business market.
Boros says he can't tell exactly where employees of small businesses go for insurance if the company ends coverage. Some of the numbers he's looking at don't add up. Private plans say they are covering about the same number of people, the state's uninsured rate was consistent last year at 3.
There's no question this mystery is putting enormous pressure on the state budget. The Baker administration reviewed eligibility and the number dropped to about 1. Many small businesses say they hope to be part of that conversation, but they're struggling. The idea that employers would take their share of responsibility for expanding coverage was premised on the pledge that health insurance would be affordable. For many small businesses it is not.
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Erb says he doesn't feel like he can drop health insurance and still attract good employees. Besides, he said, "I don't know what the options are, kick everyone out and throw them to the Connector? Skip to main content. Close close Donate.
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