Tag Archives: Health Care

Health Care: Prompt One

One of the most important aspects of the ACA is the 10 essential health care benefits. This added specific criteria of what insurance must cover in their policies.What are the 10-essential benefits insurance must cover? Healthcare.gov (2017) lists them as:

  1. Ambulatory patient services (outpatient care you get without being admitted to a hospital
  2. Emergency services
  3. Hospitalization
  4. Pregnancy, maternity, and newborn care
  5. Mental health and substance use disorder services
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits)

I feel like a lot of people don’t really understand how health insurance works (or why companies would not want to cover these 10 things); I had no idea before I took an introduction to public health policy. To sum up private health insurance (very basically): all eligible individuals are placed into a risk pool and each one pays a monthly premium to spread the risk/cost around. These monthly payments pay will cover the costs for health services for sick or injured individuals in the pool.

For example: If you have a risk pool of 100 people and each person pays $100 per month, insurance has $10,000-dollar revenue. But let’s say 10 people in the pool get sick and their care ends up being $15,000 that month, the insurance then is at a loss of $5,000. Insurance is a business and therefore the goal is to make a profit. The company makes more money when their risk pools are comprised of healthy individuals.  This is why insurers used to deny coverage or charge more to individuals with pre-existing conditions.

A preexisting condition is “a health problem you had before the date that new coverage starts” (HHS, 2017). Things like cancer, HIV, pregnancy, Alzheimer’s, acne, mental illness, domestic violence and rape victims, etc. fall into this category. When I found out that people could be denied coverage (and the things which counted as a pre-existing condition) I was stunned. It seemed so wrong and unethical. How could we as a nation leave so many people exposed to huge finical and health risks? People who were already incredibly vulnerable.

The 10 essential health care benefits also require maternity care coverage. Prior to the ACA very few women had maternity coverage. An uncomplicated birth could cost already insured women $10,000 and uninsured women $30,000 (THA 2013). Some Republican politicians do not think men should have to pay for prenatal care, as ‘a man has never delivered a baby’ (Woodall, 2017). I learned in my policy class that every dollar spent in family planning has a 400% return. How is it not in our best interest (morally and economically) to provide this coverage?

Women’s health care protections are especially in danger; just this Friday some protections on birth control coverage were removed from health insurance policies. This allows a company or non-profit to remove contraceptives from their coverage due to religious or moral objections (Kodjak, 2017).

There is an ongoing debate about healthcare in the US. The current administration wants to ‘replace and repeal’ the ACA. The 10 essential health care benefits are in danger, all the proposed replacements have severely weakened or removed them. The US is one of the only developed countries who does not have universal health coverage. These policies largely stem from the belief that healthcare is a privilege, not a right.


Works Cited

Kodjak, A., (2017). Trump Guts Requirement that Employer Health Plans Pay for Birth Control. Retrieved from http://www.npr.org/sections/health-shots/2017/10/06/555970210/trump-ends-requirement-that-employer-health-plans-pay-for-birth-control

Healthcare.gov. (2017). What Marketplace health insurance plans cover. Retrieved from https://www.healthcare.gov/coverage/what-marketplace-plans-cover/

Health and Human Services. (2017). Pre-existing conditions. Retrieved from https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html

Woodall, C., (2017) GOP Congressman asks why men should pay for prenatal care. Retrieved from http://www.pennlive.com/news/2017/03/gop_congressman_asks_why_men_s.html

Truven Health Analytics. (2013). The Cost of Having a Baby in the United States. Retrieved from http://transform.childbirthconnection.org/wp-content/uploads/2013/01/Cost-of-Having-a-Baby1.pdf


Healthcare Post

Before I looked into this article, to be honest, I had no idea what CBO was. And I’m glad that I know what it is and that i’ll be able to look into it more deeply if I want to know more information about it. What I learned from reading this is that many people wouldn’t know is that insurance will change and that many people will be affected by this new Better Care Reconciliation. In addition, about 15 millions people will be uninsured just in the near year, 2018. To think about this, it is very close, it is next year. It is kind of scary how everything might change in the near future. According to the article, about 22 million people will not have insurance by the year of 2026. Because under this new legislation, penalty for not having insurance will be eliminated so that’s why many people will be uninsured.

Now, I want to know if this new legislation is worth it. I mean, what I am seeing is that a lot of people will be uninsured. That’s a negative thing. It looks like this new legislation is not making things easier for low income families. Many low income families will suffer because of this. That is what it looks like so far from what I read. It would be more negative than positive. Well, I might find out more about it if I search Better Care Reconciliation of 2017 since there are a lot of information online whether it is through federal websites or just news.