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Health Coverage for All – Who Wins and Who Loses

As the health care debate heats up it is important to take a step back and look at the facts as they exist right now. With several competing bills making their way through the House and the Senate, and with President Obama presenting his own ideas for reforming health care, it is a good idea to look at the proposals as they have been laid out. Understanding each proposal and how it will affect individuals employers and the country as a whole will help to put things in perspective. With so much shouting on both sides of the aisle the real facts are easily obscured, but it is up to every American to do his or her own homework and determine whether or not to support the health care reform proposals as they exist today.

Mandatory Health Insurance Coverage One of the hallmarks of the health coverage reform measures as they exist today is mandatory health insurance coverage. The proposals now under consideration mandate that every individual who can afford health insurance coverage purchase a policy to protect themselves. Under the bill making its way through the Senate finance committee individuals who refuse to purchase affordable health insurance coverage will face a fine ranging from $750 for individuals to over $3,000 for high income families. It can be a bit hard to determine the winners and losers under this scenario, but it may be safe to assume that young healthy workers who choose to forgo health insurance coverage may end up on the losing side of the equation – at least from their own point of view. Many young workers, even those who earn a good living, often choose to go without health insurance – essentially rolling the dice and assuming that nothing bad could happen to them. Of course when a health crisis does arise those young healthy workers may find themselves facing financial ruin – or passing the burden of their care on to the rest of the taxpayers.

A Public Option There has been a great deal of debate over the so-called public option in health care reform. The public option as envisioned by President Obama and the Democrats in Congress would consist of a government run program that competes with private health insurers. The idea behind the plan is that competition will help to drive prices down and prevent some of the most egregious abuses of the health care industry. The winners and losers in the public option can be a bit difficult to sort out as well, but many people feel that private insurers will lose out to the public plan because the government plan will not have to turn a profit. Many who are opposed to health care reform feel that the inclusion of a public option will eventually drive private health insurers out of business. On the other hand a public option can help to make health insurance more affordable for individuals, and those who are in favor of such a plan feel that the public option will help to keep health insurance costs under control. Coverage for Preexisting Conditions Many observers on both sides of the aisle feel that the exclusion of preexisting conditions places an unfair burden on individuals who need to purchase their own health insurance coverage. Many consumers find themselves unable to change jobs or strike to on their own because a preexisting health problem prevents them from buying health insurance coverage on the open market. Many people with health conditions like diabetes, heart disease and a history of cancer find themselves unable to buy health insurance at all, and even when insurance is available it is often prohibitively expensive. The plans under consideration would all prevent insurers from refusing coverage for those with preexisting conditions, and unlike many parts of the health care reform plan this change seems to have strong bipartisan support. With this proposal, the winners and losers are quite clear. Individuals with preexisting health conditions will be the winners under this scenario. And since they will no longer be permitted to refuse coverage or charge more for riskier individuals health insurance companies stand to lose – with lower profits and more risk.

Expanded Eligibility for Medicaid Another hallmark of the health insurance reform plans making their way through Congress is expanded eligibility for Medicaid. This government program currently provides health coverage for the poorest Americans, but under the new health insurance plans eligibility would be expanded to more people. The exact requirements vary from plan to plan, but expanded eligibility for Medicaid is a big part of the health reform measures under consideration. This expanded Medicaid eligibility will offer benefits to individuals who would otherwise be eligible for government subsides. By expanding eligibility requirements the government will provide assistance to more individuals, including those who currently make too much to be eligible but too little to afford health insurance coverage on their own. Expanded Medicaid eligibility will also be a boon to companies who provide coverage to Medicaid patients. Some of the largest health insurance companies compete in this area, and the proposed changes could offer expanded opportunities to the biggest players in this marketplace. Some health care providers, including medical clinics, hospitals and individual doctors, could end up losing if Medicaid eligibility is expanded, especially if reimbursement levels remain at their current levels or go down. The reimbursement levels for Medicaid are already quite low, and expanded coverage could place additional downward pressure on those reimbursement rates. No matter which side of the aisle you find yourself on, it is important to understand the proposed changes to our health care system. Listening to the pundits can provide an unrealistic idea of what is – and is not – included in the bills, so it is important for every American to do his or her own research to determine exactly what health care reform will mean if and when a bill is passed by Congress and signed by President Obama.

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